Kidney damage and Glomerular Filtration Rate (GFR) value between 15-29 mL / min / 1.73 m^2 are found in which stage of Chronic Kidney Disease?
Q642
A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy?
Q643
Which one of the following conditions is caused by mutations in the gene that encodes the sodium-potassium-2-chloride cotransporter (NKCC2), and presents with sodium wasting, hypokalaemia, hypomagnesaemia and hypercalciuria?
Q644
Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.
Select the correct answer using the code given below.
Q645
Which of the following is NOT true regarding ‘Renal Carbuncle’?
Q646
A patient presented with complaints of pain in the flank region with hematuria. On investigation, X-ray shows multiple calcification (stones) in both kidneys. What is the probable diagnosis?
Q647
Which type of amyloidosis is seen in the patients going through dialysis?
Which of the following is not true about syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
Q650
A 45-year-old man comes to the emergency department because of hematuria and bilateral flank pain. He has passed urinary stones twice before and has a history of recurrent urinary tract infections. He reports no recent trauma. His father had a history of kidney failure and underwent a kidney transplant. His temperature is 38.0°C (100.4°F), pulse is 110/min, and blood pressure is 155/98 mm Hg. Abdominal examination shows palpable, bilateral flank masses. Results of a complete blood count are within the reference range. His serum creatinine concentration is 2.9 mg/dL. Which of the following findings is most likely to be associated with this patient's condition?
Nephrology Indian Medical PG Practice Questions and MCQs
Question 641: Kidney damage and Glomerular Filtration Rate (GFR) value between 15-29 mL / min / 1.73 m^2 are found in which stage of Chronic Kidney Disease?
A. Stage 4 (severe) (Correct Answer)
B. Stage 3A (mild to moderate)
C. Stage 2 (mild)
D. Stage 5 (kidney failure)
Explanation: ***Stage 4 (severe)***
- **Stage 4 Chronic Kidney Disease (CKD)** is defined by a **Glomerular Filtration Rate (GFR)** in the range of **15-29 mL/min/1.73 m²** [1].
- At this stage, significant kidney damage is present, indicating **severe reduction in kidney function** with increased risk of complications.
*Stage 3A (mild to moderate)*
- **Stage 3A CKD** is characterized by a **GFR** between **45-59 mL/min/1.73 m²**, which is a milder reduction compared to the GFR given in the question [1].
- This stage represents a **mild to moderate decrease** in kidney function, falling above the severe range.
*Stage 2 (mild)*
- **Stage 2 CKD** involves a **GFR** between **60-89 mL/min/1.73 m²**, which is a mild reduction in GFR but typically with persistent kidney damage.
- This GFR range is significantly higher than the 15-29 mL/min/1.73 m² specified in the question, representing **earlier kidney dysfunction**.
*Stage 5 (kidney failure)*
- **Stage 5 CKD** is defined by a **GFR** of **less than 15 mL/min/1.73 m²**, indicating **kidney failure** requiring dialysis or kidney transplant [1].
- The given GFR range of 15-29 mL/min/1.73 m² is higher than that of Stage 5, although it is still considered a **very advanced stage of CKD**.
Question 642: A 52 year old male has uncontrolled diabetes. Which one of the following tests will help in early detection of nephropathy?
A. Blood urea level
B. Urine albumin (Correct Answer)
C. Ultrasonography
D. Serum creatinine level
Explanation: Urine albumin
- **Microalbuminuria**, detected by measuring urine albumin, is often the earliest sign of **diabetic nephropathy**, occurring before changes in GFR or serum creatinine [1], [3].
- **Persistent albuminuria** indicates glomerular damage and is a key marker for monitoring disease progression and treatment effectiveness [3].
*Blood urea level*
- **Blood urea nitrogen (BUN)** levels rise significantly only when there's a substantial decline in **renal function**, making it an insensitive marker for early damage [2].
- Factors like dehydration or protein intake can also influence BUN, reducing its specificity for early nephropathy [2].
*Ultrasonography*
- **Renal ultrasonography** is useful for assessing kidney size, shape, and identifying structural abnormalities like hydronephrosis or stones.
- It is not sensitive enough to detect early-stage changes in **renal function** or microvascular damage characteristic of early diabetic nephropathy.
*Serum creatinine level*
- **Serum creatinine** levels increase only after a significant portion of kidney function (typically >50%) has been lost [2].
- It is a marker of **reduced glomerular filtration rate (GFR)**, but detecting elevated creatinine means the nephropathy is already more advanced than the microalbuminuria stage [1].
Question 643: Which one of the following conditions is caused by mutations in the gene that encodes the sodium-potassium-2-chloride cotransporter (NKCC2), and presents with sodium wasting, hypokalaemia, hypomagnesaemia and hypercalciuria?
A. Bartter syndrome (Correct Answer)
B. Fanconi syndrome
C. Gitelman syndrome
D. Alport syndrome
Explanation: ***Bartter syndrome***
- This syndrome is characterized by **loss-of-function mutations** in the **NKCC2 cotransporter** in the thick ascending limb of the loop of Henle, leading to impaired sodium and chloride reabsorption.
- The resulting electrolyte imbalances include **sodium wasting**, **hypokalemia**, **hypomagnesemia**, and **hypercalciuria**.
*Fanconi syndrome*
- This syndrome involves a generalized defect in the **proximal renal tubules**, leading to impaired reabsorption of multiple substances including glucose, amino acids, phosphate, and bicarbonate.
- It does not specifically involve a mutation in the NKCC2 cotransporter or present with the described electrolyte profile.
*Gitelman syndrome*
- This condition is caused by a mutation in the **thiazide-sensitive Na-Cl cotransporter (NCC)** in the distal convoluted tubule.
- While it shares some features like hypokalemia and hypomagnesemia, it is typically associated with **hypocalciuria**, not hypercalciuria, and a different genetic defect.
*Alport syndrome*
- This is a genetic disorder affecting type IV collagen, primarily impacting the **glomerular basement membrane**, leading to hematuria, proteinuria, and progressive renal failure.
- It is not associated with mutations in electrolyte transporters or the specific electrolyte abnormalities listed in the question.
Question 644: Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20-30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.
Select the correct answer using the code given below.
A. 1, 2 and 4
B. 1, 3 and 4 (Correct Answer)
C. 1, 2 and 3
D. 2, 3 and 4
Explanation: ***1, 3 and 4***
- **Autosomal dominant polycystic kidney disease (ADPKD)** is characterized by the growth of numerous cysts in the kidneys [1], but can also lead to **extrarenal cysts** in organs such as the **liver, pancreas, and arachnoid membrane**.
- **ADPKD** causes both renal and extrarenal manifestations, and **men typically progress to renal failure more rapidly than women**.
*1, 2 and 4*
- This option correctly identifies the presence of cysts in other organs and the rapid progression to renal failure in men, but it incorrectly states that the disease most commonly manifests between **20-30 years of age**.
- While symptoms can appear at any age, **ADPKD** often manifests with symptoms such as pain due to cysts or hypertension later in life [1], and **renal function decline** is typically observed in middle age.
*1, 2 and 3*
- This option incorrectly includes the statement that the disease most commonly manifests between **20-30 years of age**.
- Although the genetic defect is present from birth, significant clinical symptoms leading to diagnosis or renal failure often develop later, typically in the **4th to 6th decades of life**.
*2, 3 and 4*
- This option incorrectly states that the disease most commonly manifests between **20-30 years of age**.
- It also omits the key feature that cysts can occur in other organs like the **liver, pancreas, and arachnoid membrane**, which is a crucial aspect of ADPKD.
Question 645: Which of the following is NOT true regarding ‘Renal Carbuncle’?
A. It occurs in diabetic patient
B. It occurs in intravenous drug abusers
C. It is a type of renal tuberculosis (Correct Answer)
D. It is an abscess in renal parenchyma
Explanation: A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1].
Question 646: A patient presented with complaints of pain in the flank region with hematuria. On investigation, X-ray shows multiple calcification (stones) in both kidneys. What is the probable diagnosis?
A. Polycystic kidney disease
B. Parathyroid Adenoma
C. Renal calculi (Correct Answer)
D. CKD
Explanation: ***Renal calculi***
- The presence of **flank pain**, **hematuria**, and **multiple calcifications (stones) in both kidneys** on X-ray directly points to a diagnosis of renal calculi (kidney stones) [1].
- These stones can cause pain due to obstruction and irritation, leading to blood in the urine [1].
*Polycystic kidney disease*
- This condition is characterized by the development of numerous **cysts in the kidneys**, which are fluid-filled sacs, not calcifications or stones [2].
- While it can cause flank pain and hematuria, the imaging finding of **multiple calcifications** is inconsistent with typical PCKD presentation [2].
*Parathyroid Adenoma*
- A parathyroid adenoma leads to **hyperparathyroidism**, which can cause **hypercalcemia** and subsequently increase the risk of **calcium kidney stones** [1].
- However, the diagnosis directly relates to the presence of stones as seen on X-ray, not the underlying cause of stone formation, and the question does not provide enough information to confirm hyperparathyroidism.
*CKD*
- **Chronic kidney disease (CKD)** is a progressive loss of kidney function over time, representing a *spectrum* of kidney damage.
- While kidney stones can lead to CKD, and CKD can present with various symptoms, the direct finding of **multiple calcifications (stones)** on imaging is a specific indicator of renal calculi rather than CKD itself as the primary diagnosis.
Question 647: Which type of amyloidosis is seen in the patients going through dialysis?
A. A-beta
B. AL
C. A-beta 2 (Correct Answer)
D. aTTR
Explanation: ***A-beta 2***
- **A-beta 2 microglobulin amyloidosis** (also known as dialysis-related amyloidosis) occurs because **beta-2 microglobulin** is not effectively cleared by dialysis and accumulates in tissues [1].
- This condition primarily affects **joints, bones**, and **tendons** in long-term dialysis patients, leading to carpal tunnel syndrome, arthropathy, and bone cysts.
*A-beta*
- **A-beta amyloidosis** refers to the accumulation of **amyloid-beta peptides** that are characteristic of **Alzheimer's disease**, primarily affecting the brain.
- This type of amyloidosis is not directly associated with renal dialysis or systemic amyloid deposits in other organs.
*AL*
- **AL (light chain) amyloidosis** results from the deposition of **monoclonal immunoglobulin light chains** produced by plasma cells, often associated with multiple myeloma.
- While it can affect the kidneys, it is a primary amyloidosis and not caused by dialysis itself, though it can occur in patients who also have kidney failure.
*aTTR*
- **aTTR (transthyretin) amyloidosis** involves the deposition of **abnormal transthyretin protein**, which can be hereditary (mutated TTR) or wild-type (aging-related) [1].
- This form primarily affects the heart and nervous system and is not typically associated with chronic dialysis as its direct cause.
Explanation: ***40***
- The anion gap is calculated using the formula: **Na - (Cl + HCO3)**.
- Plugging in the values: **145 - (90 + 15) = 145 - 105 = 40**.
*28*
- This value would result if there were a different **bicarbonate** or **chloride** level or a miscalculation.
- For example, if the bicarbonate was 30 instead of 15, the calculation would be 145 - (90 + 30) = 145 - 120 = 25, which is closer but still not 28.
*35*
- This value is obtained if there's an error in summing the **anions** or subtracting from **sodium**.
- For instance, if the bicarbonate was incorrectly taken as 20, the calculation would be 145 - (90 + 20) = 145 - 110 = 35.
*12*
- A value of 12 represents a **normal anion gap**, indicating that the patient in this scenario has a high anion gap [1].
- This result would only occur if the sum of **chloride and bicarbonate** were around 133, which is not the case here.
Question 649: Which of the following is not true about syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
A. Patient can be clinically euvolemic to hypovolemic
B. Urine osmolality >100 mOsm/kg
C. Urinary sodium <20 mEq/L (Correct Answer)
D. Serum sodium <135 mEq/L
Explanation: ***Urinary sodium <20 mEq/L***
- In **SIADH**, the inappropriate secretion of ADH leads to increased water reabsorption, causing **dilutional hyponatremia**. [1]
- The kidneys respond by trying to excrete excess water and dilute the urine, leading to **increased urinary sodium concentration**, typically *greater than* 20 mEq/L.
*Patient can be clinically euvolemic to hypovolemic*
- Patients with **SIADH** are typically **euvolemic** because the excess water is retained intracellularly and extracellularly in balanced proportions, without significant edema or dehydration. [1]
- While fluid retention occurs, it's not enough to cause significant clinical volume overload, and they are never truly hypovolemic.
*Urine osmolality >100 mOsm/kg*
- In **SIADH**, the continued action of **ADH** despite hypotonicity results in the reabsorption of water, leading to the production of **concentrated urine**. [1]
- This elevated urine osmolality, typically **greater than 100 mOsm/kg**, indicates an inability to adequately excrete free water. [1]
*Serum sodium <135 mEq/L*
- **SIADH** is defined by **hyponatremia**, a serum sodium concentration **below 135 mEq/L**, due to the excessive retention of water.
- This dilutes the extracellular fluid, leading to a reduction in the relative concentration of sodium.
Question 650: A 45-year-old man comes to the emergency department because of hematuria and bilateral flank pain. He has passed urinary stones twice before and has a history of recurrent urinary tract infections. He reports no recent trauma. His father had a history of kidney failure and underwent a kidney transplant. His temperature is 38.0°C (100.4°F), pulse is 110/min, and blood pressure is 155/98 mm Hg. Abdominal examination shows palpable, bilateral flank masses. Results of a complete blood count are within the reference range. His serum creatinine concentration is 2.9 mg/dL. Which of the following findings is most likely to be associated with this patient's condition?
A. Colonic wall ulcerations
B. Osteolytic bone lesions
C. Cerebral saccular aneurysm (Correct Answer)
D. Vesicoureteral reflux
E. Portal hypertension
Explanation: ***Cerebral saccular aneurysm***
– This patient's presentation with **bilateral flank masses**, elevated **creatinine**, history of recurrent urinary stones, and a family history of kidney failure points strongly to **autosomal dominant polycystic kidney disease (ADPKD)** [1].
– **Cerebral saccular aneurysms** (berry aneurysms) are a well-known extrarenal manifestation of ADPKD, and their rupture can lead to life-threatening subarachnoid hemorrhage.
*Colonic wall ulcerations*
– **Colonic wall ulcerations** are characteristic of inflammatory bowel diseases like Crohn's disease or ulcerative colitis, which are not suggested by the patient's primary renal symptoms.
– While some systemic conditions can have both renal and GI manifestations, the described kidney disease is not typically associated with this specific GI finding.
*Osteolytic bone lesions*
– **Osteolytic bone lesions** are commonly associated with conditions like multiple myeloma, metastatic cancer, or hyperparathyroidism.
– These are not typical extrarenal manifestations of **ADPKD**, which can cause bone cysts but not widespread osteolytic lesions.
*Vesicoureteral reflux*
– **Vesicoureteral reflux** is a condition where urine flows backward from the bladder to the kidneys, often associated with recurrent UTIs, especially in children.
– While the patient has recurrent UTIs and stones, his clinical picture with palpable flank masses and a strong family history is more indicative of a **structural kidney disease** like ADPKD, rather than primarily a reflux issue [1].
*Portal hypertension*
– **Portal hypertension** is typically caused by liver cirrhosis, portal vein thrombosis, or other conditions leading to increased pressure in the portal venous system.
– Although ADPKD can cause **hepatic cysts**, it rarely progresses to significant **portal hypertension** unless there is massive polycystic liver disease, which is not the primary association with the presented symptoms. [1]
