Nephrotic and Nephritic Syndromes — MCQs
An 8-year-old child presents with hematuria 5 days after a throat infection. What is the most likely diagnosis?
Basic abnormality in a case of nephrotic syndrome is:
Which of the following is not a complication of nephrotic syndrome?
Child with proteinuria, generalized edema, hypoproteinemia, and hyperlipidemia - most common cause is?
A child presents with brown colored urine and oliguria for last 3 days. He has mild facial and pedal edema. His blood pressure is 126/90. He has +3 proteinuria with 100 red cell and a few granular casts. His creatinine is 0.9, urea is 56. What is his diagnosis?
Most common cause of nephrotic syndrome in children?
All of the following are true about nephrotic syndrome except?
Post streptococcal glomerulonephritis causes -
In minimal change disease, which of the following is seen?
Which of these conditions is classified as a nephritic syndrome?
Nephrotic and Nephritic Syndromes Indian Medical PG Practice Questions and MCQs
Question 1: An 8-year-old child presents with hematuria 5 days after a throat infection. What is the most likely diagnosis?
- A. Nephrotic syndrome
- B. Ig A nephropathy (Correct Answer)
- C. Post streptococcal nephropathy
- D. Hereditary nephritis (Alport syndrome)
Explanation: ***Ig A nephropathy*** - This condition is characterized by **hematuria** that typically occurs within days (1-5 days) of an **upper respiratory tract infection**. - The rapid onset of symptoms after infection is a key differentiator from post-streptococcal glomerulonephritis. *Nephrotic syndrome* - This syndrome is defined by **massive proteinuria**, **hypoalbuminemia**, **edema**, and **hyperlipidemia**, not primarily by gross hematuria following an infection. - While some forms of nephrotic syndrome can cause hematuria, the prominent feature here is the timing after a throat infection and gross hematuria. *Post streptococcal nephropathy* - This condition typically presents with **hematuria** 7-21 days after a Streptococcus infection, a longer latency period than described here. - It often involves a decline in renal function, hypertension, and edema, which are not the primary focus of the vignette's timing. *Hereditary nephritis (Alport syndrome)* - This is a genetic disorder causing progressive renal failure, **sensorineural hearing loss**, and ocular abnormalities. - While it causes hematuria, it is typically chronic and not acutely triggered by a throat infection in a specific timeframe as described.
Question 2: Basic abnormality in a case of nephrotic syndrome is:
- A. Hyperlipidemia
- B. Pedal edema
- C. Hypertension
- D. Proteinuria (Correct Answer)
Explanation: Basic abnormality in a case of nephrotic syndrome is: ***Proteinuria*** - The fundamental abnormality in nephrotic syndrome is **massive proteinuria** (protein excretion > 3.5 g/day in adults), resulting from increased glomerular permeability [1]. - This **proteinuria** leads to hypoalbuminemia, which then triggers many of the other clinical manifestations of the syndrome. *Hyperlipidemia* - **Hyperlipidemia** is a common consequence of nephrotic syndrome, driven by increased hepatic lipoprotein synthesis in response to low plasma oncotic pressure and reduced lipoprotein catabolism. - While characteristic, it is a **secondary abnormality** arising from the primary protein loss rather than the basic underlying cause. *Pedal edema* - **Pedal edema** is a prominent clinical feature of nephrotic syndrome, resulting from the combination of reduced plasma oncotic pressure due to hypoalbuminemia and secondary sodium and water retention [1]. - Although highly visible, it is a **symptom** and a downstream effect, not the primary pathological process. [1] *Hypertension* - **Hypertension** can occur in some cases of nephrotic syndrome, particularly with more severe renal involvement or concurrent fluid overload. - However, it is **not a universal feature** and is generally considered a complication or an associated condition, rather than the core initiating abnormality.
Question 3: Which of the following is not a complication of nephrotic syndrome?
- A. Hypoalbuminemia (Correct Answer)
- B. Infection risk
- C. Hypertension
- D. Hypercoagulability
Explanation: ***Hypoalbuminemia*** - **Hypoalbuminemia** is a *defining feature* of nephrotic syndrome, not a complication. - It results from the **massive urinary protein loss** that is central to the diagnosis of nephrotic syndrome [1]. *Infection risk* - Patients with nephrotic syndrome are at increased risk of **infections** due to urinary loss of immunoglobulins and complement factors [1]. - This often manifests as **peritonitis**, cellulitis, or pneumonia. *Hypertension* - **Hypertension** is a common complication, often due to **fluid retention**, activation of the **renin-angiotensin-aldosterone system**, and underlying renal dysfunction [1]. - It contributes to the progression of kidney disease and cardiovascular morbidity. *Hypercoagulability* - **Hypercoagulability** is a significant complication caused by urinary loss of **antithrombin III** and other anticoagulant proteins, coupled with increased synthesis of prothrombotic factors [1]. - This increases the risk of **thromboembolic events**, such as deep vein thrombosis and pulmonary embolism.
Question 4: Child with proteinuria, generalized edema, hypoproteinemia, and hyperlipidemia - most common cause is?
- A. Mesangial glomerulonephritis
- B. FSGS
- C. IgA nephropathy
- D. Minimal change nephrotic syndrome (Correct Answer)
Explanation: **Minimal change nephrotic syndrome** - This is the most common cause of **nephrotic syndrome** in children, characterized by the classic tetrad of **proteinuria**, **hypoalbuminemia**, **edema**, and **hyperlipidemia**. - The disease involves **effacement of podocyte foot processes**, visible on electron microscopy, but the glomeruli appear normal on light microscopy. *Mesangial glomerulonephritis* - This condition involves immune complex deposition in the **mesangium**, often presenting with **hematuria** and proteinuria, but not typically the full nephrotic picture in children. - It's a form of **glomerulonephritis**, distinct from the podocytopathy seen in minimal change disease. *FSGN* - **Focal segmental glomerulosclerosis (FSGS)** is a common cause of nephrotic syndrome, but it's less common than minimal change disease as the initial presentation in young children. - It is characterized by **segmental scarring of glomeruli**, which can be seen on light microscopy. *IgA nephropathy* - This is a common cause of **glomerular hematuria**, often presenting after an upper respiratory infection. - While proteinuria can occur, it's typically not severe enough to cause the full-blown **nephrotic syndrome** with generalized edema, hypoproteinemia, and hyperlipidemia in children.
Question 5: A child presents with brown colored urine and oliguria for last 3 days. He has mild facial and pedal edema. His blood pressure is 126/90. He has +3 proteinuria with 100 red cell and a few granular casts. His creatinine is 0.9, urea is 56. What is his diagnosis?
- A. PSGN (Correct Answer)
- B. FSGS
- C. IgA Nephropathy
- D. Nephrolithiasis
Explanation: ***PSGN*** - The presentation with **brown urine**, **oliguria**, **edema**, **hypertension**, and **hematuria with red cell casts** is classic for an acute nephritic syndrome. - Given the patient is a child, and the constellation of symptoms including **sudden onset**, **significant hypertension**, and **granular casts**, **Post-Streptococcal Glomerulonephritis (PSGN)** is the most likely diagnosis. - PSGN typically follows streptococcal pharyngitis or skin infection by 1-3 weeks and presents with acute nephritic syndrome. *FSGS* - **Focal Segmental Glomerulosclerosis (FSGS)** typically presents with **nephrotic syndrome** (heavy proteinuria, hypoalbuminemia, severe edema), not primarily with nephritic features. - While it can cause proteinuria, the presence of **red cell casts** and significant hematuria with acute hypertension points to an inflammatory glomerulonephritis, not FSGS. *IgA Nephropathy* - **IgA Nephropathy (Berger's disease)** can also cause nephritic syndrome in children with hematuria and RBC casts. - However, it typically presents with **recurrent episodes of gross hematuria** occurring **during or immediately after** upper respiratory infections (synpharyngitic hematuria), rather than the delayed presentation seen here. - It usually has a more chronic course with less prominent edema and hypertension compared to PSGN. *Nephrolithiasis* - **Nephrolithiasis (kidney stones)** would typically present with **colicky flank pain** and hematuria. - It would not explain the prominent **edema**, **hypertension**, **significant proteinuria**, or presence of **red cell casts** seen in this patient.
Question 6: Most common cause of nephrotic syndrome in children?
- A. Membranous GN
- B. RPGN
- C. PSGN
- D. Minimal change disease (Correct Answer)
Explanation: ***Minimal change disease*** - This is the **most common cause of nephrotic syndrome in children**, accounting for about 80-90% of cases. - It is characterized by **normal glomeruli on light microscopy** but effacement of podocyte foot processes on electron microscopy. *Membranous GN* - While a common cause of nephrotic syndrome in adults, **membranous glomerulonephritis** typically is rare in children. - It is characterized by **thickening of the glomerular basement membrane** due to immune complex deposition. *RPGN* - **Rapidly progressive glomerulonephritis (RPGN)** is a severe and aggressive form of glomerulonephritis leading to rapid loss of renal function, not typically presenting as isolated nephrotic syndrome. - It is characterized by the presence of **crescents** in the glomeruli. *PSGN* - **Post-streptococcal glomerulonephritis (PSGN)** typically presents as **nephritic syndrome** (hematuria, hypertension, azotemia), rather than nephrotic syndrome. - PSGN usually follows a **streptococcal infection** and is characterized by subepithelial immune complex deposits.
Question 7: All of the following are true about nephrotic syndrome except?
- A. Hypoalbuminemia
- B. Proteinuria >3.5 g/day
- C. Increased risk of infection
- D. Decreased serum triglycerides (Correct Answer)
Explanation: ***Decreased serum triglycerides*** - Nephrotic syndrome is characterized by **hyperlipidemia**, including **elevated total cholesterol** and **triglycerides**, due to increased hepatic synthesis of lipoproteins and decreased catabolism [1]. - This is a direct consequence of the body's attempt to compensate for low oncotic pressure and is a major diagnostic feature. *Hypoalbuminemia* - This is a **hallmark characteristic** of nephrotic syndrome, resulting from the significant loss of albumin in the urine [1]. - A low serum albumin level (typically <3.0 g/dL) contributes to **edema** due to decreased plasma oncotic pressure [1]. *Proteinuria >3.5 g/day* - This is the **defining diagnostic criterion** for nephrotic syndrome, indicating massive protein excretion through damaged glomerular capillaries [1]. - The protein loss is specifically defined as >3.5 grams per 1.73 m² of body surface area per day. *Increased risk of infection* - Patients with nephrotic syndrome are prone to infections, particularly **bacterial infections** like spontaneous bacterial peritonitis [1]. - This increased risk is due to the urinary loss of **immunoglobulins** (especially IgG), complement factors, and impaired cellular immunity [1].
Question 8: Post streptococcal glomerulonephritis causes -
- A. Nephritic syndrome (Correct Answer)
- B. Primary Nephrotic syndrome
- C. Chronic renal failure
- D. Secondary Nephrotic syndrome
Explanation: ***Nephritic syndrome*** - **Post-streptococcal glomerulonephritis (PSGN)** is a classic cause of **nephritic syndrome** [2], characterized by **glomerular inflammation** [1]. - Key features of nephritic syndrome include **hematuria**, **oliguria**, **hypertension**, and mild proteinuria with edema [2]. *Primary Nephrotic syndrome* - **Nephrotic syndrome** is defined by massive **proteinuria** (>3.5g/day), **hypoalbuminemia**, **edema**, and **hyperlipidemia** [2]. - PSGN typically presents with **microscopic or gross hematuria** and only moderate proteinuria, not the heavy proteinuria characteristic of nephrotic syndrome [2]. *Chronic renal failure* - While severe or recurrent cases of PSGN can eventually lead to **chronic kidney disease (CKD)** [3], it is not the immediate or primary presentation. - PSGN typically presents as an **acute** glomerulonephritis [1]. *Secondary Nephrotic syndrome* - **Secondary nephrotic syndrome** refers to nephrotic syndrome caused by systemic diseases (e.g., diabetes, lupus). - PSGN is an inflammatory condition primarily affecting the glomeruli, leading to nephritic features rather than dominant nephrotic range proteinuria [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 914-915. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 915. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 916-917.
Question 9: In minimal change disease, which of the following is seen?
- A. No immunodeposits (Correct Answer)
- B. Immunodeposits in blood vessels
- C. Immunodeposits in mesangium
- D. Immunodeposits in glomerulus
Explanation: ***No immunodeposits*** - Minimal change disease (MCD) is characterized by the **absence of immune complex deposition** in the glomeruli [1]. - This lack of immunodeposits is a key diagnostic feature, distinguishing it from other types of glomerulonephritis [1]. *Immunodeposits in blood vessels* - Immunodeposits in blood vessels are typically associated with **vasculitic conditions**, such as ANCA-associated vasculitis or cryoglobulinemic vasculitis. - This finding is not characteristic of minimal change disease, which primarily affects the podocytes of the glomeruli. *Immunodeposits in mesangium* - Mesangial immunodeposits are characteristic of conditions like **IgA nephropathy** or **membranoproliferative glomerulonephritis** [1]. - These conditions involve immune complex deposition within the mesangial matrix, which is absent in minimal change disease [1]. *Immunodeposits in glomerulus* - While "glomerulus" is a broad term, the absence of **immune complex deposition** within the glomerulus (including capillary loops, mesangium, and subepithelial/subendothelial spaces) is precisely what defines minimal change disease [1]. - The primary abnormality in MCD is **podocyte foot process effacement**, not immune complex deposition [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928.
Question 10: Which of these conditions is classified as a nephritic syndrome?
- A. Minimal Change Disease
- B. Membranous Glomerulopathy
- C. Post Infectious Glomerulonephritis (Correct Answer)
- D. Focal Segmental Glomerulosclerosis
Explanation: ***Post infectious Glomerulonephritis*** - Characterized by **hematuria, hypertension, and edema**, typically following an infection, such as streptococcal pharyngitis [2]. - Immune-mediated response leads to **decreased GFR** and signs of nephritic syndrome [1][2]. *Focal segmental glomerulosclerosis* - Primarily causes **nephrotic syndrome**, characterized by proteinuria and edema rather than hematuria [2]. - Often associated with **secondary causes** like obesity or HIV, not typically post-infectious. *Membranous Glomerulopathy* - Results in significant **proteinuria** and is classified as a **nephrotic syndrome** rather than a nephritic one [2][3]. - It presents with **edema and hypoalbuminemia**, lacking the hallmark features of hematuria. *Minimal change disease* - Predominantly causes **nephrotic syndrome** with heavy proteinuria and little to no hematuria [2]. - Young children are commonly affected, and it responds well to **corticosteroid therapy** [1].
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