Nephrology Practice Questions

Q: Nephrocalcinosis is seen in all except:

Medullary cystic kidney disease. **Explanation:** Nephrocalcinosis refers to the generalized deposition of calcium salts within the renal parenchyma (medulla or cortex). The correct answer is **Medullary Cystic Kidney Disease (MCKD)** because it is characterized by the formation of cysts at the corticomedullary junction and progressive interstitial fibrosis, but it does **not** typically involve calcium deposition [1]. **Why the other options are incorrect:** * **Sarcoidosis:** This granulomatous disease involves increased 1-alpha-hydroxylase activity in macrophages, leading to elevated Vitamin D levels, hypercalcemia, and hypercalciuria, which frequently results in medullary nephrocalcinosis. * **Distal Renal Tubular Acidosis (Type 1 RTA):** This is a classic cause of nephrocalcinosis. The inability to secrete hydrogen ions leads to alkaline urine, systemic acidosis (causing bone resorption), and hypocitraturia. This combination promotes the precipitation of calcium phosphate in the renal medulla. * **Milk Alkali Syndrome:** Excessive intake of calcium and absorbable alkali leads to hypercalcemia and metabolic alkalosis. The resulting hypercalciuria and alkaline urine environment facilitate calcium deposition in the kidneys. **NEET-PG High-Yield Pearls:** 1. **Medullary Nephrocalcinosis (95% of cases):** Most common causes are **Hyperparathyroidism**, **Distal RTA**, and **Medullary Sponge Kidney** [1]. 2. **Cortical Nephrocalcinosis (Rare):** Classically seen in **Acute Tubular Necrosis (ATN)**, **Chronic Glomerulonephritis**, and **Ethylene glycol poisoning**. 3. **Medullary Sponge Kidney vs. MCKD:** Do not confuse the two. Medullary Sponge Kidney is associated with nephrocalcinosis and "bouquet of flowers" appearance on IVP, whereas MCKD leads to small kidneys and renal failure without calcification [1].

Q: A patient presents with sudden onset headache and loss of consciousness. Examination reveals renal cysts and evidence of subarachnoid hemorrhage, consistent with a berry aneurysm. What is the most likely diagnosis considering these findings?

Autosomal Dominant Polycystic Kidney Disease (ADPKD). **Explanation:** The clinical presentation of **renal cysts** associated with a **subarachnoid hemorrhage (SAH)** due to a **berry aneurysm** is a classic triad for **Autosomal Dominant Polycystic Kidney Disease (ADPKD)** [1]. **1. Why ADPKD is Correct:** ADPKD is a multisystemic disorder caused by mutations in the *PKD1* (85%) or *PKD2* (15%) genes [1]. While the hallmark is the development of bilateral renal cysts leading to end-stage renal disease, it has significant extra-renal manifestations. The most life-threatening extra-renal complication is **intracranial "berry" aneurysms**, typically located in the Circle of Willis [1]. Rupture of these aneurysms leads to sudden onset "thunderclap" headache and loss of consciousness (SAH) [2]. **2. Why Incorrect Options are Wrong:** * **Haemangioma of the liver:** While liver cysts are the most common extra-renal manifestation of ADPKD, a haemangioma is a vascular tumor and is not specifically associated with renal cysts or berry aneurysms. * **Meningioma:** This is a benign tumor of the meninges. It does not correlate with renal cystic disease or the acute presentation of a ruptured aneurysm. * **Head injury:** While trauma can cause intracranial hemorrhage, it does not explain the presence of pre-existing renal cysts [3]. **3. NEET-PG High-Yield Pearls:** * **Most common extra-renal site:** Liver (Hepatic cysts). * **Most common cause of death:** Cardiovascular disease (Hypertension/LVH). * **Cardiac association:** Mitral Valve Prolapse (MVP). * **Other associations:** Diverticulosis, seminal vesicle cysts, and pancreatic cysts. * **Screening:** MRA is recommended for berry aneurysms only if there is a positive family history of SAH or in high-risk occupations (e.g., pilots).

Q: What is the most common complication of dialysis?

Hypotension. **Explanation:** **Intradialytic Hypotension (IDH)** is the most common complication of hemodialysis [1], occurring in approximately 20–30% of dialysis sessions. The primary mechanism is the **rapid removal of fluid (ultrafiltration)** from the intravascular compartment at a rate that exceeds the compensatory "plasma refill" from the interstitial space. This leads to decreased venous return, reduced cardiac output, and a subsequent drop in blood pressure. Other contributing factors include autonomic dysfunction (common in diabetics) and the use of antihypertensive medications before dialysis. **Analysis of Incorrect Options:** * **B. Anaphylaxis:** This is a rare, acute complication typically associated with "First-use syndrome" (hypersensitivity to ethylene oxide used for sterilizing new dialyzers or polyacrylonitrile membranes). * **C. Dialysis Dysequilibrium Syndrome (DDS):** This occurs due to the rapid removal of urea from the blood, creating an osmotic gradient that shifts water into brain cells (cerebral edema). While high-yield, it is much less common than hypotension and usually occurs during a patient's first few sessions. * **D. Amyloidosis:** Specifically **$̢_2$-microglobulin amyloidosis**, this is a *chronic* complication of long-term dialysis (usually >5–10 years), not an acute complication of the procedure itself. **High-Yield Clinical Pearls for NEET-PG:** * **Management of IDH:** Place the patient in the Trendelenburg position, reduce the ultrafiltration rate, and administer a bolus of normal saline. * **Most common cause of death in dialysis patients:** Cardiovascular disease (Arrhythmias/MI). * **Most common infection in hemodialysis:** Staphylococcus aureus (via vascular access). * **Prevention of DDS:** Use a lower blood flow rate and shorter duration for the initial dialysis sessions.

Q: Which one of the following is not a feature of adult polycystic kidney disease?

Massive proteinuria. **Explanation:** Autosomal Dominant Polycystic Kidney Disease (ADPKD) is primarily a **tubulointerstitial disorder**, not a primary glomerular disease. Therefore, while mild to moderate proteinuria (usually 3.5 g/day or nephrotic range) is not a feature** of ADPKD. If present, it suggests a superimposed glomerular pathology. **Analysis of Options:** * **Hypertension (Option A):** This is the most common early manifestation (seen in 70-80% of patients). It results from intrarenal ischemia caused by cyst expansion, which triggers the **Renin-Angiotensin-Aldosterone System (RAAS)**. * **Intermittent Renal Colic (Option B):** This occurs frequently due to the passage of blood clots (following cyst rupture) or the high incidence of **nephrolithiasis** (calcium oxalate stones) seen in these patients [1]. * **Macroscopic Haematuria (Option C):** A classic feature often precipitated by minor trauma or strenuous exercise [1]. It occurs when a cyst ruptures into the renal collecting system. **High-Yield Clinical Pearls for NEET-PG:** 1. **Extra-renal Manifestations:** The most common is **Liver cysts** (Polycystic Liver Disease). The most serious is **Berry Aneurysms** (Circle of Willis), which can lead to Subarachnoid Hemorrhage (SAH). 2. **Genetics:** Most cases (85%) are due to **PKD1** mutation (Chromosome 16), which progresses to ESRD faster than **PKD2** (Chromosome 4) [1]. 3. **Diagnosis:** Ultrasonography is the screening modality of choice (Ravine’s criteria). 4. **Treatment:** Tolvaptan (V2-receptor antagonist) is used to slow cyst growth and disease progression.

Question 1

Nephrocalcinosis is seen in all except:

Accepted Answer

Medullary cystic kidney disease

Answer

Sarcoidosis

Answer

Distal renal tubular acidosis

Answer

Milk alkali syndrome

Question 2

A patient presents with sudden onset headache and loss of consciousness. Examination reveals renal cysts and evidence of subarachnoid hemorrhage, consistent with a berry aneurysm. What is the most likely diagnosis considering these findings?

Accepted Answer

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer

Haemangioma of the liver

Answer

Meningioma

Answer

Head injury

Question 3

Deficiency of Factor I and Factor H causes which condition?

Accepted Answer

Atypical Hemolytic Uremic Syndrome (HUS)

Answer

Typical Hemolytic Uremic Syndrome (HUS)

Answer

Thrombotic Thrombocytopenic Purpura (TTP)

Answer

Acute Thrombotic Thrombocytopenic Purpura (TTP)

Question 4

A 20-year-old male with end-stage renal failure since age 13 has had progressive renal insufficiency, initially with episodes of painless hematuria. He also has progressive deafness. His brother suffers from a similar illness. What is the most likely diagnosis?

Accepted Answer

Alport syndrome

Answer

Henoch-Schönlein vasculitis

Answer

Familial lupus

Answer

Wegener's granulomatosis

Question 5

What is the most common complication of dialysis?

Accepted Answer

Hypotension

Answer

Anaphylaxis

Answer

Dialysis dysequilibrium syndrome

Answer

Amyloidosis

Question 6

Salt-losing nephritis is a feature of which of the following conditions?

Accepted Answer

Interstitial nephritis

Answer

Polycystic kidney disease

Answer

Lupus nephritis

Answer

Renal amyloidosis

Question 7

Which one of the following is not a feature of adult polycystic kidney disease?

Accepted Answer

Massive proteinuria

Answer

Hypertension

Answer

Intermittent renal colic

Answer

Macroscopic haematuria

Question 8

Nephrocalcinosis is seen in all the following conditions except:

Accepted Answer

Medullary cystic kidney disease

Answer

Sarcoidosis

Answer

Distal RTA

Answer

Milk alkali syndrome

Question 9

Routine use of recombinant erythropoietin in patients with chronic kidney disease obviates the need for which of the following?

Accepted Answer

Regular blood transfusions

Answer

Iron supplementation

Answer

Dialysis

Answer

Hyperkalemia

Question 10

Nephrotic syndrome may be caused by the following except?

Accepted Answer

Rheumatoid arthritis

Answer

Renal cell carcinoma

Answer

Minimal change nephropathy

Answer

Diabetes mellitus

Nephrology — MCQs

Nephrology — MCQs

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