Acute Kidney Injury — MCQs

10 questions

Which of the following is the most effective treatment for severe acute hyperkalemia requiring definitive management?

The most appropriate investigation to diagnose and determine the extent of renal injury in a 15-year-old boy who presents with hematuria and left-sided abdominal pain 48 hours after sustaining a blunt abdominal injury, with a pulse rate of 96/minute, blood pressure of 110/70 mmHg, hemoglobin of 10.8 gm%, and packed cell volume of 31%, would be-

Renal trauma is best treated by -

Acute onset of anuria in elderly men is typically associated with which of the following conditions?

What is the treatment for most cases of blunt trauma to the kidney?

Interstitial nephritis is common with

Which of the following conditions is a direct indication for initiating dialysis?

Which of the following statements are correct regarding Weil's disease? I. It is caused by a virus named leptospira II. Acute kidney injury can lead to oliguria in this disease III. Microscopic agglutination is the investigation of choice IV. Ceftriaxone given parenterally is effective treatment Select the correct answer using the code given below :

Hemolytic uraemic syndrome is associated with

Q10

Which of the following is NOT a common cause of acute renal failure?

Acute Kidney Injury Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is the most effective treatment for severe acute hyperkalemia requiring definitive management?

A. Insulin and glucose
B. Dialysis (Correct Answer)
C. Resin therapy
D. Calcium gluconate

Explanation: ***Dialysis*** - **Hemodialysis** is the most effective and rapid method for definitively removing **potassium** from the body in cases of **severe acute hyperkalemia**, especially when other treatments are insufficient or renal function is compromised [2]. - It creates a **concentration gradient** that allows for efficient removal of excess potassium from the blood [2]. *Insulin and glucose* - This treatment promotes the **intracellular shift of potassium**, temporarily lowering serum potassium levels but does not remove potassium from the body. - While effective for acute management, it is not a definitive long-term solution as potassium can shift back out of cells. *Resin therapy* - **Potassium-binding resins** (e.g., sodium polystyrene sulfonate) exchange potassium for another ion (like sodium or calcium) primarily in the **gastrointestinal tract**, leading to potassium excretion. - These therapies work slowly and are generally not suitable for **severe acute hyperkalemia** requiring rapid definitive management. *Calcium gluconate* - **Calcium gluconate** is given to **stabilize the cardiac membrane** and reduce the risk of arrhythmias in hyperkalemia [1]. - It does not lower serum potassium levels but rather antagonizes its cardiac effects, making it an emergent symptomatic treatment, not a definitive potassium-lowering measure [1].

Question 2: The most appropriate investigation to diagnose and determine the extent of renal injury in a 15-year-old boy who presents with hematuria and left-sided abdominal pain 48 hours after sustaining a blunt abdominal injury, with a pulse rate of 96/minute, blood pressure of 110/70 mmHg, hemoglobin of 10.8 gm%, and packed cell volume of 31%, would be-

A. Sonographic evaluation of abdomen
B. Intravenous pyelography
C. Contrast enhanced computed tomography (Correct Answer)
D. MR urography

Explanation: ***Contrast enhanced computed tomography*** - **CT with intravenous contrast** is the gold standard for evaluating **renal trauma**, providing detailed anatomical information on the extent of injury, including lacerations, hematomas, and urinary extravasation, which might be missed by other modalities. - It rapidly assesses the **parenchyma**, **collecting system**, and surrounding structures, allowing for proper staging of the injury and guiding management decisions. *Sonographic evaluation of abdomen* - **Ultrasound** is useful for rapidly detecting **free fluid** (e.g., blood) in the abdomen and assessing major organ integrity, but its ability to characterize renal parenchymal injuries or urinary extravasation is limited. - It is **operator-dependent** and often insufficient for detailed staging of renal trauma compared to CT. *Intravenous pyelography* - **IVP** primarily evaluates the **collecting system** and ureteral patency but has limited sensitivity for assessing renal parenchymal injuries or perinephric hematomas. - It involves radiation exposure and a contrast load, and generally provides **less anatomical detail** than modern CT scans. *MR urography* - **MR urography** provides excellent soft tissue contrast without ionizing radiation, but it is typically **less readily available** in an emergency setting and takes longer to perform than CT. - Its role in acute trauma is usually reserved for cases where **iodinated contrast is contraindicated** (e.g., severe allergy, renal insufficiency) or when specific soft-tissue detail is crucial for follow-up.

Question 3: Renal trauma is best treated by -

A. Nephrostomy
B. Heminephrectomy
C. Early drainage of perirenal haematoma
D. Observation and supportive measures (Correct Answer)

Explanation: ***Observation and supportive measures*** - Most cases of **renal trauma**, especially blunt trauma, are managed **non-operatively** with observation, bed rest, fluid resuscitation, and pain control. - This approach minimizes unnecessary interventions and allows the kidney to heal spontaneously, preserving **renal parenchyma**. *Nephrostomy* - **Nephrostomy** is primarily indicated for **urinary diversion** in cases of unresolving urinoma or obstruction, not as the initial treatment for all renal trauma. - It is an invasive procedure and carries risks of infection and further injury, making it unsuitable for first-line management of stable renal trauma. *Heminephrectomy* - **Heminephrectomy** involves surgical removal of a portion of the kidney and is reserved for **severe renal injuries** with extensive damage to a segment or pole of the kidney that cannot be salvaged. - It is a highly invasive procedure with potential morbidity and is not indicated for the majority of renal trauma cases. *Early drainage of perirenal haematoma* - **Early drainage of a perirenal haematoma** is generally avoided unless the haematoma is expanding, infected, or causing significant compression, as it can disrupt the natural tamponade effect. - In most cases, perirenal haematomas resolve spontaneously with conservative management without requiring surgical intervention.

Question 4: Acute onset of anuria in elderly men is typically associated with which of the following conditions?

A. Bilateral infarction of kidneys
B. Obstructive urinary disease (Correct Answer)
C. Acute tubular necrosis
D. Acute cortical necrosis

Explanation: ***Obstructive urinary disease*** - In elderly men, **prostatic enlargement** (benign prostatic hyperplasia or prostate cancer) is a common cause of urinary obstruction, leading to **bilateral hydronephrosis** and anuria [1]. - Anuria in this context is typically acute because the obstruction causes a sudden inability for urine to pass from the kidneys [1]. *Bilateral infarction of kidneys* - This is a rare cause of anuria and usually results from **atheroembolic disease** or other vascular catastrophes. - While it can cause anuria, it is less common than obstructive causes in older men and often presents with more severe **systemic symptoms**. *Acute tubular necrosis* - This typically presents with **oligo-anuria** rather than complete anuria, and often follows an **ischemic or nephrotoxic insult** [2]. - While it can cause significant renal dysfunction, complete anuria for an extended period is less typical compared to obstruction [1]. *Acute cortical necrosis* - This is a rare and severe form of acute kidney injury, often associated with obstetric complications (e.g., **placental abruption**), severe sepsis, or disseminated intravascular coagulation (DIC). - While it causes anuria, it is not typically associated with elderly men as a primary cause compared to obstructive etiologies.

Question 5: What is the treatment for most cases of blunt trauma to the kidney?

A. Conservative (Correct Answer)
B. Nephrectomy
C. Nephrotomy
D. Nephroplexy

Explanation: ***Conservative*** - The majority of kidney injuries resulting from **blunt trauma** are low-grade (Grades I-III) and can be successfully managed with **conservative (non-operative) methods**. - This typically involves bed rest, careful monitoring of vital signs and urine output, hydration, and serial imaging to ensure stability and healing of the kidney. *Nephrectomy* - **Nephrectomy** (surgical removal of the kidney) is generally reserved for severe, high-grade kidney injuries (Grades IV-V) that are life-threatening or cannot be controlled by other means. - Indications include uncontrollable hemorrhage, extensive renal parenchymal destruction, or a non-viable kidney. *Nephrotomy* - **Nephrotomy** is an incision into the kidney, often performed for stone removal or to drain an abscess, but it is not a primary treatment for blunt traumatic kidney injury. - While surgical repair (nephrorrhaphy) may sometimes be indicated for high-grade injuries to preserve the kidney, a simple nephrotomy is not the standard approach. *Nephroplexy* - **Nephroplexy** is a surgical procedure to fix a prolapsed or "floating" kidney (nephroptosis), which is an entirely different condition from traumatic injury. - This procedure aims to secure the kidney in its normal anatomical position and is not indicated for kidney trauma.

Question 6: Interstitial nephritis is common with

A. Black water fever
B. Rhabdomyolysis
C. Tumor lysis syndrome
D. Nonsteroidal anti-inflammatory drugs (NSAIDs) (Correct Answer)

Explanation: ***Nonsteroidal anti-inflammatory drugs (NSAIDs)*** - **NSAIDs** are a known cause of **acute interstitial nephritis** (AIN), an inflammatory condition affecting the tubules and interstitium of the kidney [1]. - This adverse reaction often manifests as **fever**, **rash**, **eosinophilia**, and **acute kidney injury**, typically 7-10 days after drug exposure. *Black water fever* - **Blackwater fever** is a severe complication of **malaria**, characterized by massive hemolysis leading to **hemoglobinuria**, which darkens the urine. - It primarily causes **acute kidney injury** through **acute tubular necrosis** due to hemoglobin precipitation in the renal tubules, not interstitial nephritis. *Rhabdomyolysis* - **Rhabdomyolysis** involves the breakdown of muscle tissue, releasing myoglobin into the bloodstream, which is toxic to the kidneys. [1] - This condition leads to **acute kidney injury** predominantly through **acute tubular necrosis** due to myoglobin casts obstructing tubules and direct toxicity, not interstitial inflammation. *Tumor lysis syndrome* - **Tumor lysis syndrome** occurs when large numbers of cancer cells are rapidly destroyed, releasing intracellular contents like potassium, phosphate, and nucleic acids. - The high concentration of **uric acid** and **phosphate** in the renal tubules leads to crystal formation, causing **acute kidney injury** primarily through **acute uric acid nephropathy** and **phosphate nephropathy**, rather than interstitial nephritis [1].

Question 7: Which of the following conditions is a direct indication for initiating dialysis?

A. Severe metabolic acidosis
B. Fluid overload
C. Severe hyperkalemia (Correct Answer)
D. Acute kidney injury

Explanation: ### Severe hyperkalemia - **Severe hyperkalemia** (potassium levels typically >6.5 mEq/L or rapidly rising, especially with ECG changes) is an immediate life-threatening indication for dialysis when conservative measures fail or are insufficient [1]. - Dialysis effectively removes **excess potassium** from the blood, preventing fatal cardiac arrhythmias. *Severe metabolic acidosis* - While **severe metabolic acidosis** (pH <7.1-7.2) can be an indication, it is often managed first with bicarbonate administration and is typically not a stand-alone **direct** *emergency* indication for dialysis unless accompanied by other severe features or resistance to medical therapy. - The decision to dialyze for acidosis often depends on the underlying cause, degree of renal failure, and response to initial management [2]. *Fluid overload* - **Fluid overload** is a common complication of kidney failure, but it becomes a *direct* indication for dialysis when it is **refractory to diuretic therapy** and causes life-threatening symptoms such as **pulmonary edema** [2]. - Without such refractory state and immediate danger, fluid overload itself is not always an *immediate* trigger for dialysis compared to severe hyperkalemia. *Acute kidney injury* - **Acute kidney injury** (AKI) is the underlying *condition* that can lead to indications for dialysis, but AKI itself is not a *direct indication* for dialysis. - Dialysis is initiated for the *complications* of AKI, such as refractory hyperkalemia, severe metabolic acidosis, or fluid overload, rather than the diagnosis of AKI alone [2].

Question 8: Which of the following statements are correct regarding Weil's disease? I. It is caused by a virus named leptospira II. Acute kidney injury can lead to oliguria in this disease III. Microscopic agglutination is the investigation of choice IV. Ceftriaxone given parenterally is effective treatment Select the correct answer using the code given below :

A. I, II and III
B. II, III and IV (Correct Answer)
C. I, III and IV
D. I, II and IV

Explanation: ***II, III and IV*** - **Weil's disease**, a severe form of leptospirosis, frequently causes **acute kidney injury (AKI)**, which can manifest as **oliguria** due to renal tubular damage and interstitial nephritis [2]. - The **microscopic agglutination test (MAT)** is considered the gold standard for diagnosing leptospirosis due to its high specificity and sensitivity in detecting specific antibodies against *Leptospira* serovars [2]. - **Ceftriaxone** is an effective parenteral antibiotic for treating severe leptospirosis, including Weil's disease, particularly when oral antibiotics are insufficient or the patient is critically ill. *I, II and III* - Statement I is incorrect because Weil's disease is caused by a **spirochete bacterium**, *Leptospira interrogans*, not a virus [1]. - While statements II and III are correct regarding **AKI and oliguria** and the utility of **MAT**, the incorrectness of statement I makes this option wrong. *I, III and IV* - Statement I is incorrect as Weil's disease is caused by a **bacterium** (*Leptospira*), not a virus [1]. - While statements III and IV are correct, the presence of an incorrect statement (I) makes this composite option incorrect. *I, II and IV* - Statement I is factually incorrect; Weil's disease is caused by the **bacterium *Leptospira***, not a virus [1]. - Although statements II and IV are correct—**AKI with oliguria** is a feature and **ceftriaxone** is a treatment—the fundamental error in statement I invalidates this option.

Question 9: Hemolytic uraemic syndrome is associated with

A. Bartonella henselae
B. Malaria
C. E. coli 0157 (Correct Answer)
D. Parvovirus B19

Explanation: ***E. coli O157*** - **Hemolytic uremic syndrome (HUS)** is most commonly associated with infection by **Shiga toxin-producing E. coli (STEC)**, particularly serotype O157:H7 [2]. - The Shiga toxin damages the **endothelium** of blood vessels, leading to **thrombotic microangiopathy**, which manifests as **hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury** [1], [2]. *Bartonella henselae* - This bacterium is the causative agent of **cat scratch disease**, characterized by **lymphadenopathy** and sometimes systemic symptoms. - It is not typically associated with hemolytic uremic syndrome. *Malaria* - Malaria is a **parasitic infection** transmitted by mosquitoes, causing **fever**, **chills**, and **anemia** due to red blood cell lysis. - While it can cause anemia, it does not directly lead to the thrombotic microangiopathy of HUS. *Parvovirus B19* - **Parvovirus B19** causes **erythema infectiosum (fifth disease)** in children and can cause **aplastic crisis** in individuals with underlying hemolytic disorders. - It primarily targets erythroid precursors in the bone marrow but is not directly linked to HUS.

Question 10: Which of the following is NOT a common cause of acute renal failure?

A. Chronic kidney disease due to analgesic nephropathy (Correct Answer)
B. Acute pyelonephritis
C. Acute kidney injury from snakebite
D. Acute kidney injury due to rhabdomyolysis

Explanation: Chronic kidney disease due to analgesic nephropathy - This is a cause of chronic kidney disease, characterized by gradual, irreversible kidney damage over a long period due to prolonged use of certain analgesics. [1] - It does not present as an acute, sudden decline in kidney function, which is the hallmark of acute renal failure. [1] Acute pyelonephritis - Severe cases of acute pyelonephritis (kidney infection) can lead to acute kidney injury due to sepsis, inflammation, and potential obstruction. [1] - The systemic inflammatory response and direct tissue damage can impair kidney function rapidly. [1] Acute kidney injury from snakebite - Snake envenomation can cause acute kidney injury through various mechanisms, including hemolysis, rhabdomyolysis, direct nephrotoxicity, and systemic hypotension. - These effects can lead to rapid and severe kidney damage. Acute kidney injury due to rhabdomyolysis - Rhabdomyolysis involves the breakdown of skeletal muscle tissue, releasing large amounts of myoglobin into the bloodstream. [1] - Myoglobin is toxic to the renal tubules, leading to acute tubular necrosis and rapid onset of acute kidney injury. [1]

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