Vascular Diseases of the Kidney Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Vascular Diseases of the Kidney. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Vascular Diseases of the Kidney Indian Medical PG Question 1: All are seen in Nephrotic syndrome except
- A. Atherosclerosis
- B. Thrombo-embolism
- C. Lipiduria
- D. Increased protein C levels (Correct Answer)
Vascular Diseases of the Kidney Explanation: ***Increased protein C levels***
- In **nephrotic syndrome**, there is an **increased urinary loss of anticoagulant proteins**, including **Protein C** and **Protein S**, leading to a state of **hypercoagulability**. [1]
- Therefore, **Protein C levels are decreased**, not increased, making this the exception.
*Atherosclerosis*
- **Hyperlipidemia**, a hallmark of nephrotic syndrome, contributes significantly to **accelerated atherosclerosis** due to dysregulation of lipid metabolism.
- The increased levels of **LDL cholesterol** and other lipoproteins promote plaque formation and arterial stiffening.
*Thrombo-embolism*
- Patients with nephrotic syndrome are at a significantly **increased risk of thromboembolic events**, such as deep vein thrombosis and pulmonary embolism, due to a **hypercoagulable state**.
- This state results from the **urinary loss of anticoagulant proteins** (e.g., antithrombin III, Protein C, Protein S) and increased levels of procoagulant factors (e.g., fibrinogen, factor V, factor VIII).
*Lipiduria*
- **Lipiduria**, the presence of lipids in the urine, is a characteristic feature of nephrotic syndrome, often manifested as **oval fat bodies** and **fatty casts**. [1]
- This occurs due to the increased glomerular permeability that allows lipoproteins to filter into the urine. [1]
Vascular Diseases of the Kidney Indian Medical PG Question 2: In the context of bilateral renal artery stenosis, which antihypertensive drug is considered contraindicated?
- A. Beta-blockers
- B. Calcium channel blockers
- C. ACE inhibitors (Correct Answer)
- D. Diuretics
Vascular Diseases of the Kidney Explanation: ***ACE inhibitors***
- In bilateral renal artery stenosis, ACE inhibitors can precipitate **acute kidney injury** by severely reducing **glomerular filtration pressure**, as both kidneys rely on **angiotensin II** for maintaining this pressure [1].
- They inhibit the production of **angiotensin II**, leading to **efferent arteriolar dilation** and a drop in glomerular hydrostatic pressure, which is critical for filtration in stenosed kidneys [2].
*Beta-blockers*
- Beta-blockers are generally considered safe and effective in treating hypertension associated with renal artery stenosis, as they do not directly interfere with **renal autoregulation** in the same critical way as ACE inhibitors.
- They lower blood pressure by reducing **cardiac output** and inhibiting renin release but do not acutely compromise **glomerular filtration** in the presence of stenosis.
*Calcium channel blockers*
- Calcium channel blockers are safe to use in bilateral renal artery stenosis and are often effective in controlling blood pressure.
- They dilate **afferent arterioles**, which can actually help maintain or improve **glomerular filtration rate** by increasing blood flow to the glomerulus.
*Diuretics*
- Diuretics can be used cautiously in renal artery stenosis to manage blood pressure and fluid overload.
- However, aggressive diuresis can lead to intravascular volume depletion, which might exacerbate **renal hypoperfusion** in already stenosed kidneys.
Vascular Diseases of the Kidney Indian Medical PG Question 3: What is the most likely diagnosis in a patient presenting with hypertension, proteinuria, and renal failure?
- A. Mycosis fungoides
- B. Wegener's granulomatosis (Correct Answer)
- C. Invasive aspergillosis
- D. Sarcoidosis
Vascular Diseases of the Kidney Explanation: ***Wegener's granulomatosis***
- This condition, now known as **Granulomatosis with Polyangiitis (GPA)**, classically presents as a triad of **upper respiratory tract disease**, **lower respiratory tract disease**, and **renal disease** [1].
- The renal involvement often manifests as **glomerulonephritis**, leading to **hypertension**, **proteinuria**, and potentially rapid progression to **renal failure** [2].
*Mycosis fungoides*
- This is a **cutaneous T-cell lymphoma** primarily affecting the skin, presenting with patches, plaques, and tumors.
- It typically does not involve the kidneys in a manner that would cause **hypertension**, **proteinuria**, and **renal failure**.
*Invasive aspergillosis*
- This is a serious **fungal infection** most commonly seen in **immunocompromised individuals**, affecting the lungs and other organs.
- While it can cause systemic illness, it does not typically present with the classic triad of **hypertension**, **proteinuria**, and **renal failure** as a primary finding.
*Sarcoidosis*
- This is a **multisystem inflammatory disease** characterized by the formation of **non-caseating granulomas** in various organs, most commonly the lungs and lymph nodes.
- While renal involvement can occur, it's less common and doesn't typically present with the acute, severe combination of **hypertension**, **proteinuria**, and **renal failure** seen in GPA.
Vascular Diseases of the Kidney Indian Medical PG Question 4: In shigella dysentery associated hemolytic uremic syndrome, the false statement is ?
- A. Hepatic failure (Correct Answer)
- B. Leucocytosis
- C. Thrombotic angiopathy
- D. Neurological abnormalities
Vascular Diseases of the Kidney Explanation: Detailed assessment of the complications of Hemolytic Uremic Syndrome (HUS) following Shigella infection shows that hepatic failure is not a characteristic component. ***Hepatic failure***
- **Hepatic failure** is not a typical hallmark or direct complication of **Shiga toxin-producing E. coli (STEC) HUS**, which primarily targets the kidneys.
- The primary organs affected in **HUS** are the **kidneys (acute kidney injury)**, brain (neurological symptoms), and hematopoietic system (thrombocytopenia, microangiopathic hemolytic anemia) [2].
*Leucocytosis*
- **Leucocytosis** (elevated white blood cell count) is a common finding in **Shigella dysentery**, reflecting the systemic inflammatory response to the infection.
- It can be a predictive marker for the severity of **HUS** development in patients with **STEC** infection.
*Thrombotic angiopathy*
- **Thrombotic angiopathy** is the underlying pathological process in **HUS**, characterized by **microvascular thrombosis** and **endothelial damage** [1].
- These microthrombi lead to **thrombocytopenia**, **microangiopathic hemolytic anemia**, and **ischemic organ damage**, particularly in the kidneys [1], [2].
*Neurological abnormalities*
- **Neurological abnormalities** such as seizures, altered mental status, and strokes can occur in a significant proportion of **HUS** patients.
- These complications are due to **cerebral microthrombosis** and **endothelial damage** in the brain, affecting blood flow and neuronal function.
Vascular Diseases of the Kidney Indian Medical PG Question 5: Hyperplastic arteriolitis with necrotizing arteriolitis is seen in ?
- A. Buerger's disease
- B. Benign hypertension
- C. Malignant hypertension (Correct Answer)
- D. Diabetes
Vascular Diseases of the Kidney Explanation: ***Malignant hypertension***
- Characterized by **hyperplastic arteriolitis** and **necrotizing arteriolitis** [1][2], is a severe form of hypertension that typically leads to end-organ damage.
- These vascular changes are associated with a markedly elevated blood pressure, often exceeding **180/120 mmHg**, and can result in acute renal failure or **hemorrhagic strokes**.
*Benign hypertension*
- Generally presents with **minimal vascular changes** and is not associated with the severe arteriolar alterations seen in malignant hypertension.
- It does not commonly lead to **acute target organ damage**, distinguishing it from malignant hypertension.
*Diabetes*
- While diabetes can lead to **microvascular complications** such as **diabetic nephropathy**, it does not specifically cause hyperplastic or necrotizing arteriolitis.
- Diabetic vascular changes are typically related to **hyaline arteriosclerosis**, not the severe changes seen in malignant hypertension.
*Buerger's disease*
- Mainly affects small and medium-sized arteries and veins, typically presenting with **thrombosis** and **vasculitis**, but not hyperplastic or necrotizing arteriolitis.
- Primarily associated with **smoking** and does not manifest with the severe renovascular complications like malignant hypertension.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 498-499.
Vascular Diseases of the Kidney Indian Medical PG Question 6: Most common cause of persistent hypertension in a child with intrinsic renal disease is -
- A. CGN (Correct Answer)
- B. Obstructive uropathy
- C. Renal tumor
- D. Chronic Pyelonephritis
Vascular Diseases of the Kidney Explanation: ***CGN***
- **Chronic glomerulonephritis (CGN)** is a leading cause of persistent hypertension in children with intrinsic renal disease due to widespread glomerular damage leading to **renin-angiotensin-aldosterone system** activation and fluid retention.
- The damaged kidneys are unable to filter waste and regulate blood pressure effectively, contributing to sustained hypertension.
*Chronic Pyelonephritis*
- While chronic pyelonephritis can cause hypertension, it is typically due to **scarring and inflammation** affecting renal function.
- However, it is not as common a cause of persistent hypertension as CGN in children with intrinsic renal disease.
*Obstructive uropathy*
- **Obstructive uropathy** is classified as a **post-renal (obstructive) disorder** rather than intrinsic renal disease, though it can lead to secondary renal parenchymal damage.
- It can cause hypertension through renal parenchymal damage and **renin release** due to increased pressure, but it is not a primary intrinsic renal disease.
*Renal tumor*
- **Renal tumors**, such as Wilms' tumor, can cause hypertension through **compression of renal arteries** or increased renin production.
- While a significant cause of hypertension, it is generally less common than CGN as a cause of persistent hypertension in children with *intrinsic renal disease* overall.
Vascular Diseases of the Kidney Indian Medical PG Question 7: Which of the following is TRUE about Nephrotic Syndrome?
- A. Is characterized by normal or increased GFR
- B. Presents with minimal or no hematuria
- C. Causes hyperlipidemia (Correct Answer)
- D. Is associated with decreased serum albumin levels
Vascular Diseases of the Kidney Explanation: ***Causes hyperlipidemia***
- **Hyperlipidemia** is a hallmark of nephrotic syndrome, occurring due to increased hepatic synthesis of lipoproteins in response to **hypoalbuminemia** and decreased catabolism of lipids [1].
- The liver attempts to compensate for oncotic pressure loss by increasing lipoprotein production, leading to elevated **cholesterol** and **triglyceride** levels.
*Is characterized by normal or increased GFR*
- While GFR can initially be normal, it often **decreases** in nephrotic syndrome as renal damage progresses or due to associated conditions like **acute kidney injury**.
- There is no characteristic increase in GFR; instead, sustained massive proteinuria is the defining feature.
*Presents with minimal or no hematuria*
- This statement is generally true for pure nephrotic syndrome, but it's not the most defining characteristic compared to hyperlipidemia. Nephrotic syndrome is primarily about **proteinuria**, not hematuria [2].
- Conditions with significant hematuria are more typical of **nephritic syndromes**, which have different underlying pathophysiologies [2].
*Is associated with decreased serum albumin levels*
- This statement is true, but it describes a **consequence** of the massive proteinuria in nephrotic syndrome, not the primary mechanism of disease [1].
- The defining feature of nephrotic syndrome is **massive proteinuria** (protein loss in urine), which *leads* to **hypoalbuminemia** (low serum albumin levels) [2].
Vascular Diseases of the Kidney Indian Medical PG Question 8: Thrombotic thrombocytopenic purpura is a syndrome characterized by which of the following?
- A. Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever (Correct Answer)
- B. Thrombocytopenia, anemia, neurological abnormalities, progressive hepatic failure and fever
- C. Thrombocytopenia, normal anemia, neurological abnormalities, progressive renal failure and fever
- D. Thrombocytopenia, anemia, no neurological abnormalities, progressive renal failure and fever
Vascular Diseases of the Kidney Explanation: ***Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever***
- Thrombotic thrombocytopenic purpura is characterized by **thrombocytopenia** and **microangiopathic hemolytic anemia**, along with neurological and renal complications [1][2].
- The presence of **fever** and other systemic symptoms is consistent with this **thrombotic microangiopathy** syndrome [1].
*Thrombocytosis, anemia, neurologic abnormalities, progressive renal failure and fever*
- This option incorrectly lists **thrombocytosis** rather than **thrombocytopenia**, which is a hallmark of thrombotic thrombocytopenic purpura (TTP) [1].
- While it includes anemia, the absence of thrombocytopenia makes it inconsistent with TTP's classic presentation [2].
*Thrombocytopenia, anemia, neurologic abnormalities, progressive hepatic failure and fever*
- Although it correctly states **thrombocytopenia** and **anemia**, it incorrectly identifies **progressive hepatic failure** instead of **renal failure**, which is a key feature of TTP [1].
- The presence of neurological abnormalities and fever does align with TTP; however, the hepatic failure aspect is misleading.
*Thrombocytosis, anemia neurologic abnormalities, progressive renal failure and fever*
- Again, this option incorrectly notes **thrombocytosis**, contradicting the characteristic finding of **thrombocytopenia** found in TTP [1].
- While other features align with TTP's clinical picture, the thrombocytosis excludes this option from being correct [2].
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 947-948.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 667-668.
Vascular Diseases of the Kidney Indian Medical PG Question 9: All the following are features of Polycystic disease of kidneys EXCEPT:
- A. Erythrocytosis (Correct Answer)
- B. Renal failure
- C. Haematuria
- D. Hypertension
Vascular Diseases of the Kidney Explanation: ***Erythrocytosis***
- While other renal conditions like **renal cell carcinoma** can cause erythrocytosis due to increased **erythropoietin** production, it is generally **not a typical feature** of Polycystic Kidney Disease (PKD).
- Patients with PKD usually have **normal or even low erythropoietin levels** despite compromised kidney function, and anemia is more common, particularly as **renal failure progresses**.
*Renal failure*
- **Progressive cyst growth** leads to replacement of normal kidney parenchyma, inevitably culminating in **end-stage renal disease** [1] in the majority of patients.
- This is a hallmark feature, often necessitating **dialysis or transplant** later in life for individuals with autosomal dominant polycystic kidney disease (ADPKD) [2].
*Haematuria*
- **Gross or microscopic hematuria** is a common symptom in PKD, often resulting from **cyst rupture** [1], bleeding into a cyst, or the passage of a calculus due to urinary stasis.
- It can be a presenting symptom and can cause significant pain and anxiety for patients.
*Hypertension*
- **Hypertension** is an early and frequent complication of PKD, often preceding any significant decline in glomerular filtration rate.
- It is primarily caused by activation of the **renin-angiotensin-aldosterone system (RAAS)** [3] due to arterial compression and ischemia from expanding cysts.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 951-955.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 544-545.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 520-521.
Vascular Diseases of the Kidney Indian Medical PG Question 10: IgA nephropathy is not associated with which of the following?
- A. Focal mesangial proliferation
- B. Gross hematuria concurrent with upper respiratory infection
- C. Immunofluorescence deposits contain IgA and IgG
- D. Decreased complement level (Correct Answer)
Vascular Diseases of the Kidney Explanation: ***Decreased complement level***
- IgA nephropathy is typically associated with **normal serum complement levels** (C3 and C4), which is an important distinguishing feature.
- Unlike post-streptococcal glomerulonephritis or lupus nephritis where complement levels are **low/decreased**, IgA nephropathy does not cause systemic complement consumption.
- While complement activation does occur locally in the glomerulus (via lectin and alternative pathways), it does not lead to a decrease in serum complement levels.
*Focal mesangial proliferation*
- This is a **common histological finding** in IgA nephropathy, reflecting the proliferative response to IgA deposition in the mesangium.
- The mesangial cells proliferate in an attempt to clear the immune deposits.
*Gross hematuria concurrent with upper respiratory infection*
- This is a **classic clinical presentation** of IgA nephropathy, often referred to as **synpharyngitic hematuria**.
- The episode of gross hematuria typically occurs **within 1-2 days** of the onset of an upper respiratory tract infection, distinguishing it from post-streptococcal glomerulonephritis where hematuria appears 1-3 weeks later.
*Immunofluorescence deposits contain IgA and IgG*
- The defining feature of IgA nephropathy on immunofluorescence is the **predominant deposition of IgA**, often accompanied by C3.
- While IgA is the primary immunoglobulin, **IgG and IgM can also be present** in variable amounts, but IgA must be the dominant or co-dominant immunoglobulin for the diagnosis.
More Vascular Diseases of the Kidney Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
