Kidney in Systemic Diseases — MCQs

10 questions

A hypertensive diabetic patient with microalbuminuria should receive:

Patient presenting with cutaneous vasculitis, glomerulonephritis, peripheral neuropathy, Which investigation is to be performed next that will help you diagnose the condition?

All of the following features may be used to distinguish PAN from microscopic polyangitis, except:

A young girl is admitted with joint pains and butterfly rash and positive urine proteinuria. The best test for her diagnosis is ?

Interstitial nephritis is common with

A 51-year-old person came with a complaint of hematuria. On examination, he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9mg%. Renal biopsy is as shown below. Which of the following investigations should be done to identify the etiology of the disease?

Loss of foot process is classical in case of?

A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath, with a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, with a maculopapular rash on her face, JVP of 4 cm, normal heart sounds, clear lungs, and pedal and periorbital edema. Her creatinine is very high, and a urinalysis reveals many RBCs and RBC casts. For this patient with glomerulonephritis, select the most likely diagnosis on renal biopsy.

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

Q10

At what glomerular filtration rate (GFR) is the term "end-stage renal disease (ESRD)" typically classified?

Kidney in Systemic Diseases Indian Medical PG Practice Questions and MCQs

Question 1: A hypertensive diabetic patient with microalbuminuria should receive:

A. Losartan (Correct Answer)
B. Clonidine
C. Metoprolol
D. Amlodipine

Explanation: ***Losartan*** - **Losartan** is an **Angiotensin Receptor Blocker (ARB)**, which is a preferred treatment for hypertension in diabetic patients with microalbuminuria due to its **renoprotective effects**. - ARBs work by blocking the effects of **angiotensin II**, leading to **vasodilation** and a reduction in **glomerular hypertension**, thereby slowing the progression of diabetic nephropathy [2]. *Clonidine* - **Clonidine** is a centrally acting alpha-2 agonist, which can be used for hypertension but is not a first-line agent, especially in diabetic patients with microalbuminuria. - It is associated with side effects such as **sedation** and **rebound hypertension** if discontinued abruptly, and lacks the specific renoprotective benefits of ARBs. *Metoprolol* - **Metoprolol** is a **beta-blocker** that can be used for hypertension but is generally not the first choice for diabetic patients with microalbuminuria due to lack of specific renoprotective effects seen with ARBs [1]. - Beta-blockers can **mask symptoms of hypoglycemia** in diabetic patients and may also worsen **insulin resistance** in some individuals. *Amlodipine* - **Amlodipine** is a **calcium channel blocker** that is effective in lowering blood pressure but does not offer the same **renoprotective benefits** as ARBs in diabetic patients with microalbuminuria. - While safe for use in diabetics, it does not specifically address the underlying **glomerular hyperfiltration** associated with early diabetic kidney disease.

Question 2: Patient presenting with cutaneous vasculitis, glomerulonephritis, peripheral neuropathy, Which investigation is to be performed next that will help you diagnose the condition?

A. ANCA (Correct Answer)
B. RA factor
C. Hbsag
D. MIF

Explanation: ### ANCA - The combination of **cutaneous vasculitis**, **glomerulonephritis**, and **peripheral neuropathy** points towards a small-vessel vasculitis, for which **ANCA (anti-neutrophil cytoplasmic antibodies)** testing is crucial [1]. - ANCA is highly specific for conditions like **Granulomatosis with Polyangiitis (GPA)** and **Microscopic Polyangiitis (MPA)** [1]. ### RA factor - **Rheumatoid factor (RF)** is primarily associated with **rheumatoid arthritis**, which typically presents with symmetrical polyarthritis, not the constellation of symptoms described. - While RF can be positive in some vasculitides, it is not the most specific initial test for the given clinical presentation. ### Hbsag - **Hepatitis B surface antigen (HbsAg)** typically screens for **Hepatitis B infection**, which can cause **polyarteritis nodosa (PAN)**, a medium-vessel vasculitis. - However, the patient's symptoms (cutaneous vasculitis, glomerulonephritis) are more characteristic of **small-vessel vasculitis**, making ANCA a more direct investigation [1]. ### MIF - **MIF (Macrophage Migration Inhibitory Factor)** is a cytokine involved in inflammation, but it is not a routine diagnostic marker for vasculitis. - It is not used as a primary investigation to diagnose specific autoimmune or inflammatory conditions like vasculitis.

Question 3: All of the following features may be used to distinguish PAN from microscopic polyangitis, except:

A. RBC cast in urine
B. ANCA positivity
C. HBV infection
D. Necrotizing vasculitis (Correct Answer)

Explanation: ***Necrotizing vasculitis*** - Both **polyarteritis nodosa (PAN)** and **microscopic polyangiitis (MPA)** are characterized by **necrotizing vasculitis**, making it a shared feature rather than a distinguishing one. [1] - This pathological finding describes the **inflammation** and **necrosis** of vessel walls, which is central to the pathogenesis of both conditions. [1] *RBC cast in urine* - **Red blood cell (RBC) casts** in the urine are indicative of **glomerulonephritis**, which is a prominent feature of **microscopic polyangiitis (MPA)** but typically absent in **polyarteritis nodosa (PAN)**. [1] - The presence of RBC casts points to **renal involvement**, particularly in the small vessels of the glomeruli, which distinguishes MPA's pattern of injury. [1] *ANCA positivity* - **Anti-neutrophil cytoplasmic antibodies (ANCAs)**, particularly **p-ANCA (MPO-ANCA)**, are frequently positive in **microscopic polyangiitis (MPA)** but usually negative in **polyarteritis nodosa (PAN)**. - ANCA positivity helps classify MPA as an **ANCA-associated vasculitis**, a distinction not typically applied to PAN. *HBV infection* - **Hepatitis B virus (HBV) infection** is strongly associated with a significant subset of **polyarteritis nodosa (PAN)** cases, whereas this association is rare in **microscopic polyangiitis (MPA)**. - Serological testing for HBV can therefore help differentiate between the two conditions, with a positive result favoring PAN.

Question 4: A young girl is admitted with joint pains and butterfly rash and positive urine proteinuria. The best test for her diagnosis is ?

A. Antibodies to RNP
B. Antibodies to tRNA synthetase
C. Anti ds-DNA antibody (Correct Answer)
D. Anti-centromere antibody

Explanation: ***Anti ds-DNA antibody*** - The presence of **joint pains**, a **butterfly rash** (malar rash), and **proteinuria** are classic clinical features highly suggestive of **Systemic Lupus Erythematosus (SLE)** [1]. - **Anti-dsDNA antibodies** are highly specific for SLE and correlate well with disease activity, especially **lupus nephritis**, which is indicated by proteinuria [4]. *Antibodies to RNP* - **Anti-RNP antibodies** are associated with **Mixed Connective Tissue Disease (MCTD)** and can be present in SLE, but they are not as specific for SLE or its renal involvement as anti-dsDNA [2]. - While MCTD can have overlapping features with SLE [3], the combination of a butterfly rash and significant proteinuria steers the diagnosis more directly towards SLE. *Antibodies to tRNA synthetase* - **Anti-tRNA synthetase antibodies** (e.g., anti-Jo-1) are characteristic of **inflammatory myopathies** such as polymyositis and dermatomyositis, not SLE. - These antibodies are typically associated with muscle weakness, interstitial lung disease, and "mechanic's hands," which are not described in the patient's presentation. *Anti-centromere antibody* - **Anti-centromere antibodies** are highly specific for **Limited Cutaneous Systemic Sclerosis (CREST syndrome)** [2]. - CREST syndrome presents with calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias, which are not mentioned in this patient's symptoms.

Question 5: 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 6: A 51-year-old person came with a complaint of hematuria. On examination, he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9mg%. Renal biopsy is as shown below. Which of the following investigations should be done to identify the etiology of the disease?

A. ANA
B. ANTI GBM antibodies (Correct Answer)
C. HIV RNA
D. Urine immunoelectrophoresis

Explanation: ***ANTI GBM antibodies*** - The presence of hematuria and renal failure suggests a possible **glomerulonephritis**, where **anti-GBM (Glomerular Basement Membrane) antibodies** would help confirm conditions like Goodpasture syndrome [2]. - This test specifically identifies **anti-GBM disease** [1,2], which is crucial in guiding management for this patient with suspected renal pathology [3]. *ANA* - **Antinuclear antibody (ANA)** testing is typically used for autoimmune diseases like **Systemic Lupus Erythematosus** but is less specific for glomerular diseases. - In this context, ANA would not specifically help in identifying the **etiology of renal failure** associated with hematuria. *Urine immunoelectrophoresis* - This test is primarily useful for detecting **light chains** in conditions like **multiple myeloma** and may not be relevant to general hematuria or renal failure. - It is not a direct test for **glomerular disease etiology** related to hematuria and edema. *HIV RNA* - While **HIV** can lead to renal complications, including **HIV-associated nephropathy**, this test is not the first line for etiological determination in this specific presentation. - Negative **HIV serology** doesn't rule out renal disease caused by other factors, making this test less relevant here. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 526-527. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 537-538. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 918-919.

Question 7: Loss of foot process is classical in case of?

A. Segmental glomerulosclerosis (Correct Answer)
B. Diabetic nephropathy (later stages)
C. Membranous nephropathy
D. IgA vasculitis

Explanation: ***Segmental glomerulosclerosis*** - Characterized by a **loss of foot processes**, leading to a "focal" or "segmental" pattern of sclerosis on histology [1][2]. - Often presents with **nephrotic syndrome**, including proteinuria and edema, due to damage to the glomeruli [1][3]. *Membranous glomerulitis* - Primarily involves **thickening of the glomerular capillary walls** without the loss of foot processes initially. - It is often associated with **membrane antibodies** and can lead to nephrotic syndrome, but not specifically linked to foot process loss [2]. *Diabetic nephropathy* - Characterized by **nodular glomerulosclerosis** and other microvascular changes, but the loss of foot processes is not a classic feature. - Typically presents with **diffuse glomerular basement membrane thickening** and eventual renal failure. *IgA nephropathy* - Characterized by the deposition of **IgA antibodies** in the mesangial area, leading to hematuria but not directly causing loss of foot processes. - Symptoms often include **recurrent episodes of hematuria** which can be triggered by infection, rather than nephrotic syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 530-532. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 913.

Question 8: A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath, with a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, with a maculopapular rash on her face, JVP of 4 cm, normal heart sounds, clear lungs, and pedal and periorbital edema. Her creatinine is very high, and a urinalysis reveals many RBCs and RBC casts. For this patient with glomerulonephritis, select the most likely diagnosis on renal biopsy.

A. diffuse proliferative GN (Correct Answer)
B. crescentic glomerulonephritis
C. focal segmental glomerulosclerosis
D. membranoproliferative glomerulonephritis

Explanation: ***diffuse proliferative GN*** - This patient's constellation of symptoms, including **facial rash, hair loss, arthralgias, thrombocytopenia**, and **renal involvement** (elevated creatinine, RBCs, and RBC casts), strongly points to **systemic lupus erythematosus (SLE)** [2], [4]. - **Diffuse proliferative glomerulonephritis (DPGN)** is the **most common and severe form of lupus nephritis** (WHO Class IV), characterized by widespread involvement of glomeruli with significant proliferation and inflammation [1]. - On renal biopsy, DPGN shows **subendothelial immune complex deposits** ("wire loop" lesions) and **proliferation of mesangial and endothelial cells** [1]. *crescentic glomerulonephritis* - While crescentic glomerulonephritis can cause a rapid decline in renal function and is associated with some autoimmune conditions, it is a **histological pattern** seen in various rapidly progressive glomerular diseases, not a specific underlying disease entity itself [3]. - The clinical picture here strongly suggests SLE, and while crescent formation can occur in severe lupus nephritis, **DPGN is the more specific and prevalent form** of nephritis for this presentation [1]. *focal segmental glomerulosclerosis* - **Focal segmental glomerulosclerosis (FSGS)** is a common cause of **nephrotic syndrome** and can lead to renal failure, but it is **not typically associated with the systemic symptoms** (rash, arthralgias, hair loss, thrombocytopenia) seen in this patient, which are characteristic of SLE. - While FSGS can rarely occur in lupus nephritis, it is less common than DPGN and lacks the widespread immune-mediated systemic features. *membranoproliferative glomerulonephritis* - **Membranoproliferative glomerulonephritis (MPGN)** can present with nephritic or nephrotic syndrome and may be associated with some autoimmune conditions like **cryoglobulinemia** or chronic infections (Hepatitis C). - However, the overall clinical context of **systemic inflammation, multi-organ involvement** (rash, arthralgias, thrombocytopenia), and the characteristic findings strongly favor **lupus nephritis**, for which **DPGN is the most characteristic finding** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 232. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 230-232. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 528-529. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 230.

Question 9: 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]

Question 10: At what glomerular filtration rate (GFR) is the term "end-stage renal disease (ESRD)" typically classified?

A. less than 15% of normal (Correct Answer)
B. 10%—25% of normal
C. 15%—25% of normal
D. 5%—10% of normal

Explanation: ***Less than 15% of normal*** - **End-stage renal disease (ESRD)** is defined by a **glomerular filtration rate (GFR)** that falls below **15 mL/min/1.73 m²**, which is approximately **less than 15% of normal function**. - At this stage, **renal replacement therapy** (dialysis or transplantation) is typically required to sustain life. *15%—25% of normal* - This GFR range (15-25 mL/min/1.73 m²) corresponds to **Stage 4 chronic kidney disease (CKD)**, which is severe but not yet formally "end-stage." - Patients in this stage require careful monitoring and management, but may not immediately need renal replacement therapy. *10%—25% of normal* - This range overlaps with both **severe CKD (Stage 4)** and the beginning of **ESRD (Stage 5)**, but it is not the precise definition for ESRD. - The critical threshold for ESRD is uniformly established as GFR below 15 mL/min/1.73 m². *5%—10% of normal* - While a GFR in this range certainly indicates **ESRD**, the official classification includes any GFR **below 15% of normal** (or below 15 mL/min/1.73 m²), making "less than 15%" the most accurate and inclusive answer. - This smaller range describes a more advanced state within ESRD, but not the general definition.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free