Nephrology Practice Questions

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

Chronic kidney disease due to analgesic nephropathy. 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]

Q: All are seen in Nephrotic syndrome except

Increased protein C levels. ***Increased protein C levels*** - In **nephrotic syndrome**, there is an **increased urinary loss of anticoagulant proteins**, including **Protein C** and **Protein S**, leading to a state of **hypercoagulability**. [1] - Therefore, **Protein C levels are decreased**, not increased, making this the exception. *Atherosclerosis* - **Hyperlipidemia**, a hallmark of nephrotic syndrome, contributes significantly to **accelerated atherosclerosis** due to dysregulation of lipid metabolism. - The increased levels of **LDL cholesterol** and other lipoproteins promote plaque formation and arterial stiffening. *Thrombo-embolism* - Patients with nephrotic syndrome are at a significantly **increased risk of thromboembolic events**, such as deep vein thrombosis and pulmonary embolism, due to a **hypercoagulable state**. - This state results from the **urinary loss of anticoagulant proteins** (e.g., antithrombin III, Protein C, Protein S) and increased levels of procoagulant factors (e.g., fibrinogen, factor V, factor VIII). *Lipiduria* - **Lipiduria**, the presence of lipids in the urine, is a characteristic feature of nephrotic syndrome, often manifested as **oval fat bodies** and **fatty casts**. [1] - This occurs due to the increased glomerular permeability that allows lipoproteins to filter into the urine. [1]

Q: Which of the following symptoms is least likely to be associated with hyponatremia?

Myalgia. Myalgia - While muscle cramps can occur with electrolyte imbalances, generalized myalgia (muscle pain) is not a typical or primary symptom of hyponatremia. - Hyponatremia primarily affects neurological function due to osmotic shifts in the brain. anorexia - Anorexia (loss of appetite) is a common, non-specific symptom of many metabolic disturbances, including hyponatremia, and often accompanies nausea and vomiting. - It arises from the general malaise and gastrointestinal upset associated with the condition. Convulsions - Convulsions are a severe neurological symptom of acute and profound hyponatremia, resulting from cerebral edema and increased intracranial pressure [1]. - This occurs when the brain swells due to the osmotic shift of water into brain cells. Drowsiness - Drowsiness is a frequent neurological manifestation of hyponatremia, indicative of altered mental status [1]. - It reflects impaired brain function due to the osmotic disturbances and potential cerebral edema [1].

Q: Which of the following is the MOST common condition caused by hypernatremia?

Seizure. ***Seizure*** - While not the *most* common initial symptom, **seizure** can be a severe manifestation of hypernatremia, particularly when the serum sodium levels rise rapidly or to very high concentrations leading to significant neuronal dehydration. - **Rapid correction of severe hypernatremia** can also induce seizures if the brain cells swell too quickly. *Altered mental status* - **Altered mental status** such as lethargy, confusion, or irritability, is a very common and often an earlier symptom of hypernatremia due to neuronal dehydration and intracellular water shifts, but it generally precedes more severe neurological complications like seizures.[1] - It is a broad term that encompasses a range of neurological dysfunctions, and while frequent, it is not as specific a severe endpoint as a seizure. *Brain hemorrhage* - **Brain hemorrhage** is a rare and severe complication of hypernatremia, primarily seen when extreme osmotic shifts cause significant brain shrinkage, leading to tension on bridging veins and potential rupture. - This is not a common presentation and typically occurs only in very severe cases of hypernatremia or during overly rapid correction. *Central pontine myelinosis* - **Central pontine myelinolysis (CPM)** is a neurological disorder caused by too rapid correction of *chronic hyponatremia*, not hypernatremia.[1] - It results from osmotic damage to myelin sheaths in the pons, leading to severe neurological deficits such as dysphagia, dysarthria, and even locked-in syndrome.[1]

Q: Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Normal C3 level. ***Normal C3 level*** - In Post-streptococcal glomerulonephritis (PSGN), **C3 levels are typically decreased** due to complement consumption during the inflammatory process. [1] - A **normal C3 level** would not be consistent with PSGN, as it suggests no significant complement activation. *Increased urea* - Increased urea can occur due to **impaired renal function**, which is common in PSGN due to glomerular inflammation. [1] - It's a typical finding reflecting the kidneys' inability to excrete waste products properly. *HTN* - Hypertension is frequently associated with PSGN due to **volume overload** and activation of the renin-angiotensin system. [1] [2] - It is a common clinical feature that results from increased fluid retention. *Increased creatinine* - Increased creatinine levels indicate **renal impairment**, which is characteristic of PSGN as kidney function is affected during this condition. [1] - This finding highlights the reduction in glomerular filtration rate (GFR), typical in glomerulonephritis. [2]

Q: What does the measurement of Glomerular Filtration Rate (GFR) help determine in kidney function?

Stage of kidney disease. Stage of kidney disease - A low GFR indicates impaired kidney function, helping to classify the severity and stage of chronic kidney disease (CKD) [1]. - Monitoring GFR over time is crucial for assessing disease progression and guiding treatment strategies [1]. *Heart rate* - Heart rate is a measure of cardiac function and is not directly assessed by GFR. - Kidney function can indirectly affect heart rate over time (e.g., in advanced kidney disease with fluid overload), but GFR itself doesn't measure it. *Recovery from shock* - While kidney function is important during shock, GFR primarily measures the kidney's filtration capacity at a given moment. - Recovery from shock involves many physiological parameters beyond just kidney filtration, such as blood pressure and organ perfusion. *Blood volume* - Blood volume is regulated by many mechanisms, including hormonal systems (e.g., renin-angiotensin-aldosterone system) and fluid intake/excretion. - Although kidneys play a role in fluid balance, GFR specifically measures the rate of filtration of blood plasma, not the overall blood volume [1].

Q: A diabetic patient presents with hyperkalemia and urinary pH < 5.5. What is the MOST likely underlying cause?

Type IV RTA. ***Type IV RTA*** - Patients with **diabetes mellitus** frequently develop **hyporeninemic hypoaldosteronism**, leading to Type IV RTA [1]. - This condition is characterized by **hyperkalemia** and **acidosis** with a paradoxically low urinary pH (typically < 5.5). *Uremia* - **Uremia** can cause hyperkalemia and acidosis, but it is a broader term for severe kidney failure and not the most specific underlying cause for the given urinary findings. - While patients with uremia can have aciduria, the combination of **diabetic hyperkalemia** and acid urine points more directly to a specific tubular defect. *Primary hyperaldosteronism* - **Primary hyperaldosteronism** is characterized by **hypertension**, **hypokalemia**, and metabolic alkalosis, which is the opposite of the patient's presentation [1]. - This condition involves excessive aldosterone production, leading to increased potassium excretion [1]. *Type I Renal tubular acidosis* - **Type I RTA** (distal RTA) is characterized by the inability to acidify urine, resulting in a **urinary pH > 5.5** despite systemic acidosis [1]. - While it can cause hypokalemia (due to increased distal K+ secretion) and acidosis, the elevated urinary pH is a key differentiating factor from this patient's presentation [1].

Q: Hyperkalemia aciduria is seen in

Type IV Renal Tubular Acidosis. Type IV Renal Tubular Acidosis - This condition is characterized by **hyperkalemia** and **aciduria**, often due to a deficiency in aldosterone or a renal tubular insensitivity to aldosterone [1]. - The impaired aldosterone action leads to reduced potassium excretion and decreased ammonium production, both contributing to **hyperkalemia** and metabolic acidosis [1]. *Type I Renal Tubular Acidosis* - Type I RTA (distal RTA) is characterized by a defect in acid secretion in the distal tubule, leading to **hypokalemia** and metabolic acidosis with persistently high urine pH [2]. - Patients typically excrete an alkaline urine despite systemic acidosis, contrasting with the aciduria seen with hyperkalemia [2]. *Sigmoidocolostomy procedure* - A sigmoidocolostomy can lead to **hyperchloremic metabolic acidosis** due to the reabsorption of chloride and excretion of bicarbonate by the colonic mucosa. - However, it typically causes **hypokalemia** as potassium is secreted into the colonic lumen from the blood. *Type II Renal Tubular Acidosis* - Type II RTA (proximal RTA) involves a defect in bicarbonate reabsorption in the proximal tubule, resulting in **hypokalemia** and metabolic acidosis. - The kidney's ability to acidify urine is still largely intact in the distal nephron once the bicarbonate buffer system is overwhelmed.

Q: Which of the following is a characteristic finding in distal RTA?

Hypercalciuria. ***Hypercalciuria*** - **Hypercalciuria** is a characteristic finding in distal RTA (Type 1), leading to increased calcium in the urine. - This occurs due to reduced **distal tubular reabsorption of calcium** and increased bone resorption from chronic acidosis. *Urine pH 5.5** [1]. - A urine pH < 5.5 would suggest a normal kidney response to systemic acidosis, ruling out distal RTA. *Hypokalemia* - While hypokalemia can occur in distal RTA, it is not always present and is not the most definitive characteristic finding. - **Hypokalemia** is more characteristic of Type 1 RTA due to increased potassium excretion in an attempt to excrete H+ ions. *Nephrolithiasis* - **Nephrolithiasis** (kidney stones) is a common complication of distal RTA due to hypercalciuria and alkaline urine [2]. - However, hypercalciuria is the *reason* for the increased risk of nephrolithiasis, making it a more fundamental characteristic finding.

Question 1

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

Accepted Answer

Chronic kidney disease due to analgesic nephropathy

Answer

Acute pyelonephritis

Answer

Acute kidney injury from snakebite

Answer

Acute kidney injury due to rhabdomyolysis

Question 2

All are seen in Nephrotic syndrome except

Accepted Answer

Increased protein C levels

Answer

Atherosclerosis

Answer

Thrombo-embolism

Answer

Lipiduria

Question 3

Which of the following symptoms is least likely to be associated with hyponatremia?

Accepted Answer

Myalgia

Answer

anorexia

Answer

Drowsiness

Answer

Convulsions

Question 4

Which of the following is the MOST common condition caused by hypernatremia?

Accepted Answer

Seizure

Answer

Altered mental status

Answer

Brain hemorrhage

Answer

Central pontine myelinosis

Question 5

Which of the following is a cause of post-transplantation hypertension? I. Rejection II. Cyclosporine nephrotoxicity III. Renal transplant artery stenosis (RTAS) IV. Recurrent disease in the allograft. Select the correct option.

Accepted Answer

All of the options are correct causes of post-transplantation hypertension.

Answer

None of the above are correct causes.

Answer

I, II, and IV are correct causes.

Answer

I and III are correct causes.

Question 6

Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Accepted Answer

Normal C3 level

Answer

HTN

Answer

Increased urea

Answer

Increased creatinine

Question 7

What does the measurement of Glomerular Filtration Rate (GFR) help determine in kidney function?

Accepted Answer

Stage of kidney disease

Answer

Heart rate

Answer

Recovery from shock

Answer

Blood volume

Question 8

A diabetic patient presents with hyperkalemia and urinary pH < 5.5. What is the MOST likely underlying cause?

Accepted Answer

Type IV RTA

Answer

Uremia

Answer

Primary hyperaldosteronism

Answer

Type I Renal tubular acidosis

Question 9

Hyperkalemia aciduria is seen in

Accepted Answer

Type IV Renal Tubular Acidosis

Answer

Type I Renal Tubular Acidosis

Answer

Sigmoidocolostomy procedure

Answer

Type II Renal Tubular Acidosis

Question 10

Which of the following is a characteristic finding in distal RTA?

Accepted Answer

Hypercalciuria

Answer

Urine pH < 5.5

Answer

Hypokalemia

Answer

Nephrolithiasis

Nephrology — MCQs

Nephrology — MCQs

On this page

Practice by Chapter

Want unlimited practice?