Nephrology Practice Questions

Q: Nephrotic syndrome is caused by all of the following systemic diseases EXCEPT?

Atherosclerosis. Atherosclerosis is a macrovascular disease characterized by the buildup of plaques in large and medium-sized arteries. While it can lead to **Renal Artery Stenosis (RAS)** and subsequent ischemic nephropathy or secondary hypertension, it does not cause **Nephrotic Syndrome** [1]. Nephrotic syndrome requires significant damage to the glomerular filtration barrier (podocytes and basement membrane), leading to massive proteinuria (>3.5g/day). Atherosclerosis primarily affects the arterial wall, not the glomerular capillary loops [1]. **2. Why the Other Options are Incorrect:** * **Diabetes Mellitus (DM):** The most common cause of secondary nephrotic syndrome worldwide. Hyperglycemia leads to non-enzymatic glycosylation, glomerular hyperfiltration, and Kimmelstiel-Wilson nodules, resulting in heavy proteinuria [3]. * **Systemic Lupus Erythematosus (SLE):** Lupus Nephritis (especially Class IV and V) involves immune complex deposition that disrupts the glomerular basement membrane, frequently presenting as nephrotic or nephritic-nephrotic syndrome. * **Amyloidosis:** Both primary (AL) and secondary (AA) amyloidosis involve the deposition of insoluble fibrillar proteins in the mesangium and capillary walls, making it a classic systemic cause of profound nephrotic syndrome [3]. **3. NEET-PG High-Yield Pearls:** * **Most common cause of Nephrotic Syndrome in adults:** Diabetes Mellitus (Secondary); Focal Segmental Glomerulosclerosis (Primary) [2]. * **Most common cause in children:** Minimal Change Disease [2]. * **Amyloidosis Clue:** Look for "Apple-green birefringence" under polarized light with Congo Red stain. * **SLE Clue:** "Wire-loop lesions" on light microscopy (Class IV). * **Atherosclerosis Clue:** Associated with "Hollenhorst plaques" in the retina or "Blue toe syndrome" after vascular procedures [1].

Q: Pulmonary-renal syndrome is seen in all, EXCEPT:

Membranoproliferative glomerulonephritis (MPGN). **Explanation:** **Pulmonary-renal syndrome (PRS)** is a clinical entity characterized by the combination of **diffuse alveolar hemorrhage (DAH)** and **rapidly progressive glomerulonephritis (RPGN)**. [1] **Why MPGN is the correct answer:** Membranoproliferative glomerulonephritis (MPGN) is primarily a pattern of glomerular injury caused by immune complex deposition or complement dysregulation. While it causes nephrotic or nephritic syndromes, it is **not** typically associated with pulmonary hemorrhage. Therefore, it does not fall under the classic definition of PRS. **Analysis of other options:** * **Goodpasture’s Syndrome:** The classic PRS [3]. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies that cross-react with the alveolar basement membrane (Type IV collagen) [2]. * **ANCA-associated Vasculitis:** Includes Granulomatosis with polyangiitis (GPA) and Microscopic polyangiitis (MPA) [3]. These are the most common causes of PRS, where small-vessel inflammation leads to both capillaritis in the lungs and crescentic GN in the kidneys [1]. * **SLE and Cryoglobulinemia:** Systemic Lupus Erythematosus (SLE) can cause PRS via immune-complex mediated small-vessel vasculitis. Cryoglobulinemia, though rarer, can also trigger systemic vasculitis involving both organs. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of PRS:** ANCA-associated vasculitis (specifically Microscopic Polyangiitis) [1]. * **Diagnostic Gold Standard:** Renal biopsy (shows crescents) and serology (Anti-GBM, ANCA, ANA) [2]. * **Iron Deficiency Anemia:** Often seen in PRS due to recurrent intrapulmonary bleeding (sequestration of iron in macrophages). * **Treatment:** High-dose corticosteroids and Cyclophosphamide (or Rituximab); Plasmapheresis is specifically indicated in Goodpasture’s to remove circulating antibodies.

Q: All of the following indicate Chronic Renal Failure (CRF) with respect to Acute Renal Failure (ARF), except-

Anemia. **Explanation:** The distinction between Acute Kidney Injury (AKI/ARF) and Chronic Kidney Disease (CKD/CRF) is a high-yield topic in NEET-PG [1]. The correct answer is **Anemia** because it is a common feature of **both** conditions, making it an unreliable differentiator [1]. 1. **Why Anemia is the correct answer:** While anemia is a hallmark of CKD (due to decreased Erythropoietin production), it is also frequently seen in ARF [1]. In acute settings, anemia can occur due to hemodilution, hemolysis (e.g., HUS), or acute blood loss. Therefore, its presence does not specifically point toward chronicity. 2. **Analysis of Incorrect Options:** * **Small Kidneys:** This is the most reliable sign of CRF. Chronic inflammation leads to fibrosis and parenchymal thinning (except in Diabetes, Amyloidosis, and Polycystic Kidney Disease). * **Creatinine > 7 mg%:** While high, the absolute value of creatinine does not differentiate ARF from CRF [1]. However, in the context of this specific question's logic, a very high, stable creatinine without acute symptoms often suggests the body has adapted to chronic failure. * **Constrictive Pericarditis:** This is a sequela of chronic uremic serositis. While acute uremic pericarditis can occur in ARF, "constrictive" changes imply a chronic, fibro-calcific process over time. **Clinical Pearls for NEET-PG:** * **Best indicator of CRF:** Bilateral small kidneys on Ultrasound (< 9 cm). * **Exceptions (Large kidneys in CRF):** "SHAPE" – **S**cleroderma, **H**IV nephropathy, **A**myloidosis, **P**olycystic kidney disease, **E**ndocrinopathy (Diabetes). * **Other signs of CRF:** Renal Osteodystrophy (secondary hyperparathyroidism) and Broad Waxy Casts on urinalysis.

Q: Which of the following is NOT true about Alport syndrome?

Autosomal dominant. **Explanation:** Alport Syndrome is a hereditary type IV collagen disease characterized by the triad of **progressive glomerulonephritis, sensorineural hearing loss, and ocular abnormalities.** [1] **Why "Autosomal Dominant" is the correct answer (the false statement):** The most common inheritance pattern of Alport Syndrome is **X-linked Dominant (approx. 85%)**, caused by mutations in the *COL4A5* gene. While an Autosomal Recessive form exists (due to *COL4A3* or *COL4A4* mutations), the **Autosomal Dominant form is extremely rare.** In the context of standard medical examinations like NEET-PG, Alport is classically taught and tested as an X-linked condition. **Analysis of other options:** * **X-linked:** This is the most common mode of inheritance (85% of cases), making it a true statement. [1] * **Nerve deafness:** Bilateral high-frequency sensorineural hearing loss is a hallmark feature, typically manifesting in late childhood or adolescence. * **Glomerulonephritis:** The disease is fundamentally a basement membrane disorder. It presents with persistent microscopic hematuria, progressing to proteinuria and eventually End-Stage Renal Disease (ESRD). [1] **High-Yield Clinical Pearls for NEET-PG:** * **Pathophysiology:** Defect in **Type IV Collagen** (the "Basket-weave" appearance on Electron Microscopy). [1] * **Ocular Sign:** **Anterior Lenticonus** (pathognomonic) – a conical protrusion of the lens surface. * **Dot-and-fleck retinopathy:** Yellowish-white granules in the perimacular region. * **Diagnosis:** Skin biopsy can sometimes be used for diagnosis because the α5(IV) chain is also expressed in the skin. * **Post-Transplant Complication:** Patients may develop **Anti-GBM disease** (Goodpasture-like syndrome) after a kidney transplant because the host immune system recognizes the "normal

Q: What is the most common cause of death in Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

Cardiovascular disease. **Explanation:** **1. Why Cardiovascular Disease is Correct:** While ADPKD is primarily a renal disorder, the most common cause of mortality is **Cardiovascular Disease (CVD)**, accounting for nearly 50% of deaths. The underlying mechanism is multifactorial: chronic hypertension (the most common complication of ADPKD), left ventricular hypertrophy (LVH), and accelerated atherosclerosis. Hypertension in ADPKD occurs early—often before any decline in GFR—due to intrarenal ischemia caused by expanding cysts, which triggers the **Renin-Angiotensin-Aldosterone System (RAAS)**. **2. Analysis of Incorrect Options:** * **Renal Failure (Option A):** Although ADPKD is a leading cause of End-Stage Renal Disease (ESRD), patients on dialysis or post-transplant are more likely to die from cardiovascular complications than from uremia itself. Mutations in the PKD1 gene account for 85% of cases and PKD2 for about 15%; ESRD occurs in approximately 50% of patients with PKD1 [1]. * **Ruptured Berry Aneurysm (Option B):** This is a high-yield association (occurring in ~10% of patients), but it is **not** the most common cause of death. It is a significant cause of sudden neurological death, but its overall incidence is much lower than CVD. * **Sepsis (Option C):** While cyst infections and urinary tract infections are common morbidities, they are rarely the primary cause of death in the modern antibiotic era. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common extra-renal manifestation:** Hepatic cysts (usually asymptomatic). * **Most common initial symptom:** Flank pain or hematuria [1]. * **Genetics:** PKD1 (Chromosome 16) is more common and severe; PKD2 (Chromosome 4) has a slower progression [1]. * **Treatment Tip:** **Tolvaptan** (V2 receptor antagonist) is used to slow cyst growth and disease progression. * **Screening:** Ultrasound is the initial screening modality of choice for family members.

Q: An 80-year-old person has developed a posterior circulation (PCA) territory stroke. On ambulatory Holter, he is found to be having atrial fibrillation. What calculation should be used to evaluate for renal insufficiency of the patient?

Cockcroft-Gault formula. ### Explanation **Correct Answer: D. Cockcroft-Gault formula** The patient has suffered an embolic stroke due to **Atrial Fibrillation (AF)**. In clinical practice, the management of AF requires anticoagulation (e.g., Warfarin or Direct Oral Anticoagulants like Dabigatran, Rivaroxaban). Most **Direct Oral Anticoagulants (DOACs)** require precise dose adjustments or are contraindicated based on renal function. The **Cockcroft-Gault formula** is the gold-standard method specifically used in clinical trials for DOACs to estimate **Creatinine Clearance (CrCl)** and determine appropriate dosing. **Analysis of Incorrect Options:** * **A. NIHSS score:** This is a tool used to quantify the neurological deficit and severity of an acute stroke. It does not assess renal function. * **B. ABCD2 score:** This is used to predict the risk of a stroke in the days following a Transient Ischemic Attack (TIA). * **C. CHA₂DS₂-VASc score:** This is a clinical prediction rule for estimating the **risk of stroke** in patients with non-valvular atrial fibrillation to determine if anticoagulation is necessary. It does not measure renal insufficiency. **Clinical Pearls for NEET-PG:** * **Cockcroft-Gault Formula:** $CrCl = \frac{(140 - \text{age}) \times \text{weight (kg)}}{72 \times \text{Serum Creatinine (mg/dL)}} \times (0.85 \text{ if female})$. * **High-Yield:** While MDRD and CKD-EPI are preferred for staging Chronic Kidney Disease (CKD), **Cockcroft-Gault** remains the standard for **drug dosing** (especially DOACs and Aminoglycosides) [1]. Serum creatinine is the most widely used compound for indirectly assessing GFR in clinical practice [1]. * **PCA Stroke Presentation:** Look for "The 3 Ds": Diplopia, Dizziness, and Dysarthria, or contralateral homonymous hemianopia with macular sparing.

Q: Which of the following is NOT used in the management of hypernatremia?

Nil by mouth. ### Explanation Hypernatremia is defined as a serum sodium concentration >145 mEq/L and always represents a **relative deficit of water** compared to sodium. The management goal is to replace the water deficit and address the underlying cause. **Why "Nil by mouth" is the correct answer:** "Nil by mouth" (NPO) is contraindicated in hypernatremia. In fact, the safest and most effective way to treat hypernatremia in a conscious patient is the **oral administration of plain water**. Restricting oral intake would exacerbate the water deficit and worsen the hypernatremic state. **Analysis of other options:** * **5% Dextrose in water (D5W):** This is the intravenous fluid of choice for correcting a pure water deficit [1]. Once the dextrose is metabolized, it provides "free water" to dilute the extracellular sodium [1]. * **0.9% Saline in 5% Dextrose:** While isotonic saline (0.9%) is usually avoided in hypernatremia, it is used in patients with **hypovolemic hypernatremia** who are hemodynamically unstable (shock) to restore circulatory volume before switching to hypotonic fluids. * **Indomethacin:** This is a specific treatment for **Nephrogenic Diabetes Insipidus (NDI)**. It inhibits prostaglandin synthesis; since prostaglandins antagonize the action of ADH, indomethacin enhances water reabsorption in the collecting ducts. **Clinical Pearls for NEET-PG:** * **Rate of Correction:** Do not exceed a reduction of **10–12 mEq/L in 24 hours** (or 0.5 mEq/L/hr) to prevent **Cerebral Edema**. * **Formula for Free Water Deficit:** $Water\ Deficit = Total\ Body\ Water \times \left(\frac{Current\ Na^+}{140} - 1 ight)$. * **Drug of Choice for Central DI:** Desmopressin (dDAVP). * **Drug of Choice for Lithium-induced NDI:** Amiloride (blocks lithium entry into ENaC channels).

Question 1

Nephrotic syndrome is caused by all of the following systemic diseases EXCEPT?

Accepted Answer

Atherosclerosis

Answer

Diabetes Mellitus (DM)

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Amyloidosis

Question 2

Pulmonary-renal syndrome is seen in all, EXCEPT:

Accepted Answer

Membranoproliferative glomerulonephritis (MPGN)

Answer

Goodpasture's syndrome

Answer

Antineutrophil cytoplasmic antibodies (ANCA)-associated small-vessel vasculitis

Answer

Lupus erythematosus, or cryoglobulinemia

Question 3

Gross hematuria, 3 days following an upper respiratory tract infection in a young female is likely due to?

Accepted Answer

IgA nephropathy

Answer

Post-streptococcal glomerulonephritis

Answer

Minimal change disease

Answer

Membranous glomerulonephritis

Question 4

All of the following indicate Chronic Renal Failure (CRF) with respect to Acute Renal Failure (ARF), except-

Accepted Answer

Anemia

Answer

Small kidneys

Answer

Creatinine > 7 mg%

Answer

Constrictive pericarditis

Question 5

Which of the following is NOT true about Alport syndrome?

Accepted Answer

Autosomal dominant

Answer

X-linked

Answer

Nerve deafness

Answer

Glomerulonephritis

Question 6

What is the most common cause of death in Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

Accepted Answer

Cardiovascular disease

Answer

Renal failure

Answer

Ruptured berry aneurysm

Answer

Sepsis

Question 7

An 80-year-old person has developed a posterior circulation (PCA) territory stroke. On ambulatory Holter, he is found to be having atrial fibrillation. What calculation should be used to evaluate for renal insufficiency of the patient?

Accepted Answer

Cockcroft-Gault formula

Answer

NIHSS score

Answer

ABCD2 score

Answer

CHADS2-Vasc score

Question 8

Which of the following is NOT used in the management of hypernatremia?

Accepted Answer

Nil by mouth

Answer

5% dextrose in water

Answer

0.9% saline in 5% dextrose

Answer

Indomethacin

Question 9

Which of the following is an absolute indication for hemodialysis in chronic kidney disease?

Accepted Answer

Uremic pericarditis

Answer

Metabolic acidosis

Answer

Uremic lung

Answer

Hyperkalemia

Question 10

Features of rhabdomyolysis include all of the following, EXCEPT?

Accepted Answer

Hemoglobinuria

Answer

Acute muscular weakness

Answer

Myoglobinuria

Answer

Acute Renal Failure

Nephrology — MCQs

Nephrology — MCQs

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