Nephrology — MCQs

Nephrology Indian Medical PG Practice Questions and MCQs

Question 871: Which of the following conditions is associated with hyponatremia and decreased serum osmolality?

A. Hyperproteinemia
B. CHF
C. Irrigation of bladder after TURP (Correct Answer)
D. Hyperlipedemia

Explanation: Irrigation of bladder after TURP - Transurethral resection of the prostate (TURP) syndrome can occur due to the systemic absorption of **hypotonic irrigation fluid** (e.g., glycine solution), leading to **dilutional hyponatremia** and decreased serum osmolality. [2], [4] - The absorbed fluid dilutes the extracellular fluid, causing a drop in **sodium concentration** and overall osmolality. [3] *Hyperlipidemia* - Severe hyperlipidemia can cause **pseudohyponatremia**, where the measured serum sodium is low but the true plasma sodium concentration is normal, due to an increased lipid volume displacing water. - This is an **artifact of measurement** and does not represent true hyponatremia with decreased serum osmolality; the plasma osmolality remains normal. *Hyperproteinemia* - Similar to hyperlipidemia, severe hyperproteinemia can lead to **pseudohyponatremia** by increasing the non-aqueous component of plasma, thus lowering the measured sodium concentration in a given volume of plasma. - This also does not cause a true decrease in **serum osmolality**. *CHF* - Congestive heart failure (CHF) can cause **hyponatremia** due to impaired water excretion, often driven by increased ADH (vasopressin) release. [1], [2] - However, the hyponatremia in CHF is typically **euvolemic or hypervolemic**, and while serum osmolality may be decreased, the primary mechanism is not direct influx of hypotonic fluid but rather impaired free water clearance secondary to systemic hemodynamics and hormonal factors. [2]

Question 872: Which of the following factors contribute to anemia in chronic renal failure?

A. Erythropoietin (EPO) deficiency
B. Shortened red blood cell lifespan
C. Multifactorial causes, including EPO deficiency, shortened RBC lifespan, and nutrient deficiencies (Correct Answer)
D. Nutrient deficiencies (e.g., folate, iron)

Explanation: ***Multifactorial causes, including EPO deficiency, shortened RBC lifespan, and nutrient deficiencies*** - Anemia in chronic renal failure is a complex condition resulting from the interplay of several factors, including insufficient **erythropoietin (EPO) production** by the damaged kidneys, which is crucial for red blood cell formation [1]. - Additionally, the **toxic uremic environment** in chronic kidney disease shortens the lifespan of red blood cells, and **malnutrition** or impaired absorption can lead to deficiencies in essential nutrients like iron and folate, further contributing to anemia [1],[2]. *Erythropoietin (EPO) deficiency* - While **EPO deficiency** is a primary cause of anemia in chronic renal failure due to impaired renal synthesis, it is not the sole contributing factor [1],[2]. - This option overlooks other significant mechanisms that also play a crucial role in the development of anemia in these patients. *Shortened red blood cell lifespan* - The **uremic environment** in chronic kidney disease does indeed lead to a shortened lifespan of red blood cells, contributing to anemia [3]. - However, similar to EPO deficiency, this is only one component of a broader multifactorial etiology. *Nutrient deficiencies (e.g., folate, iron)* - **Nutrient deficiencies**, particularly of iron and folate, are common in chronic renal failure due to poor diet, malabsorption, and increased losses (e.g., during dialysis), and they certainly contribute to anemia [1],[4]. - This option, however, does not encompass the other major contributing factors like EPO deficiency and shortened red blood cell lifespan.

Question 873: 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].

Question 874: The Modification of Diet in Renal Disease (MDRD) formula for estimation of glomerular filtration rate (GFR) does not include which of the following?

A. Body weight (Correct Answer)
B. Sex
C. Race
D. Age

Explanation: The Modification of Diet in Renal Disease (MDRD) formula for estimation of glomerular filtration rate (GFR) does not include which of the following? ***Body weight*** - The **MDRD formula** for GFR estimation does not include body weight as a variable [1]. - While body surface area is indirectly considered in some GFR estimations, the MDRD equation specifically omits actual body weight [1]. *Age* - **Age** is a key component of the MDRD formula, as GFR naturally declines with increasing age. - This adjustment helps account for age-related differences in creatinine production and renal function. *Sex* - **Sex** is included in the MDRD formula because men generally have a higher muscle mass and thus higher serum creatinine levels than women for the same GFR. - This adjustment factor helps to normalize GFR estimation between sexes. *Race* - **Race**, specifically African American ethnicity, is a factor in the MDRD formula due to observed differences in **creatinine generation** and GFR at similar serum creatinine levels. - This adjustment aims to improve the accuracy of GFR estimation across different racial groups.

Question 875: Which of the following is the LEAST common characteristic of nephrotic syndrome?

A. Lipiduria (Correct Answer)
B. Hyperlipidemia
C. Hypoalbuminemia
D. Proteinuria > 3.5 gm per 1.73 m2 per 24 hours

Explanation: ***Lipiduria*** - While lipiduria can occur in nephrotic syndrome, particularly with **severe proteinuria**, it is not a universally present clinical diagnostic criterion. - Its presence is a consequence of lipoprotein filtration rather than a direct defining feature of the syndrome itself. *Hypoalbuminemia* - This is a cardinal feature, defined as **serum albumin < 3.0 g/dL**, resulting from significant urinary protein loss. - It drives the generalized edema characteristic of nephrotic syndrome by reducing plasma oncotic pressure [1]. *Hyperlipidemia* - This is a very common characteristic due to increased hepatic synthesis of lipoproteins and decreased catabolism, often presenting as elevated **cholesterol and triglycerides**. - It is a risk factor for cardiovascular complications in nephrotic patients [1]. *Proteinuria > 3.5 gm per 1.73 m2 per 24 hours* - This is the **defining feature** of nephrotic syndrome, indicating significant damage to the glomerular filtration barrier [1]. - Massive proteinuria leads to the other key clinical manifestations of the syndrome.

Question 876: An asymptomatic patient has proteinuria and hematuria that is glomerular in origin on a routine urinalysis. Which of the following is the most likely diagnosis?

A. immunoglobulin A (IgA) nephropathy (Berger's disease) (Correct Answer)
B. diabetes mellitus (DM) - nephropathy
C. amyloidosis - nephropathy
D. focal glomerulosclerosis - nephropathy

Explanation: ***immunoglobulin A (IgA) nephropathy (Berger's disease)*** - **IgA nephropathy** often presents with **asymptomatic gross or microscopic hematuria** and proteinuria, which can be glomerular in origin [1]. - It is one of the most common causes of **glomerular hematuria** and can be discovered incidentally on routine urinalysis [1]. *diabetes mellitus (DM) - nephropathy* - While **diabetic nephropathy** causes proteinuria, **hematuria is not a primary or prominent feature** in the early stages; it typically presents with progressive proteinuria and kidney function decline [2]. - Patients with **diabetic nephropathy** are usually symptomatic with **long-standing diabetes** and often associated complications. *amyloidosis - nephropathy* - **Nephropathy due to amyloidosis** primarily presents with **heavy proteinuria**, leading to **nephrotic syndrome**, but hematuria is uncommon. - Systemic amyloidosis often involves other organs, and patients typically present with other associated symptoms like **fatigue, weight loss, or organ dysfunction**. *focal glomerulosclerosis - nephropathy* - **Focal segmental glomerulosclerosis (FSGS)** typically presents with **nephrotic syndrome** (heavy proteinuria, edema, hypoalbuminemia), with microscopic hematuria being inconsistent and often mild. - While it can be primary (idiopathic), it more commonly presents with symptoms of **nephrotic range proteinuria** rather than isolated asymptomatic hematuria and proteinuria.

Question 877: Causes of metabolic alkalosis include all the following except:

A. Mineralocorticoid deficiency (Correct Answer)
B. Bartter's syndrome
C. Thiazide diuretic therapy
D. Chronic respiratory acidosis

Explanation: ***Mineralocorticoid deficiency*** - **Mineralocorticoid deficiency** (e.g., in Addison's disease) leads to decreased **aldosterone** secretion, resulting in **hyperkalemia** and **metabolic acidosis**, not alkalosis [1]. - Aldosterone normally promotes **potassium excretion** and **hydrogen ion excretion** in the renal tubules; its absence causes their retention [1]. *Bartter's syndrome* - **Bartter's syndrome** is a genetic disorder affecting the **thick ascending limb of the loop of Henle**, leading to impaired sodium, potassium, and chloride reabsorption. - This results in increased delivery of sodium to the collecting duct, stimulating **aldosterone secretion** and causing **hypokalemia** and **metabolic alkalosis** [1]. *Thiazide diuretic therapy* - **Thiazide diuretics** inhibit sodium and chloride reabsorption in the **distal convoluted tubule**, increasing sodium delivery to the collecting duct. - This promotes **potassium and hydrogen ion excretion**, leading to **hypokalemia** and **metabolic alkalosis** [1]. *Chronic respiratory acidosis* - In **chronic respiratory acidosis**, the kidneys compensate by increasing **bicarbonate reabsorption** and **hydrogen ion excretion**. - If the kidneys overcompensate or other factors are involved, this can sometimes lead to a **metabolic alkalosis** on top of the respiratory acidosis (e.g., in patients with COPD who also receive diuretics).

Question 878: Which of the following advice is not given to a 35-year-old female patient with recurrent renal stones?

A. Increase water
B. Restrict salt
C. Restrict protein
D. Restrict calcium intake (Correct Answer)

Explanation: ***Restrict calcium intake*** - For most types of renal stones (especially **calcium oxalate stones**), restricting dietary calcium is generally **not recommended** as it can ironically lead to increased oxalate absorption and higher stone formation risk. - Adequate calcium intake is important to bind dietary oxalate in the gut, reducing its absorption and subsequent excretion in the urine. *Increase water* - **Increased fluid intake** is a cornerstone in preventing all types of renal stones by promoting a higher urine volume, which dilutes stone-forming substances [1]. - This advice is crucial as it helps reduce the supersaturation of calcium, oxalate, and other mineral salts in the urine, making crystal formation less likely [1]. *Restrict protein* - **High animal protein intake** can increase the excretion of calcium, uric acid, and oxalate, while decreasing citrate excretion, all of which promote stone formation. - Limiting animal protein is a standard recommendation, particularly for patients with a history of **calcium oxalate** and **uric acid stones**. *Restrict salt* - High dietary sodium intake increases urinary calcium excretion and can promote the crystallization of calcium salts in the urine. - Therefore, **reducing salt intake** is a critical recommendation to lower urine calcium levels and prevent recurrent renal stones.

Question 879: A patient presents with pain in the metatarsophalangeal joints and is a known case of chronic renal failure. This is due to the accumulation of:

A. Uric acid (Correct Answer)
B. HLA B27 typing
C. Rheumatoid factor
D. Blood urea nitrogen

Explanation: Uric acid - **Chronic renal failure** impairs the kidney's ability to excrete **uric acid**, leading to its accumulation in the body [1], [2]. - High levels of uric acid can crystalize in joints, particularly the **metatarsophalangeal joints**, causing painful inflammation known as **gout** [2], [3]. *Rheumatoid factor* - **Rheumatoid factor** is an autoantibody primarily associated with **rheumatoid arthritis**, an autoimmune disease. - While it can be present in other conditions, it is not directly responsible for joint pain in the context of renal failure [3]. *Blood urea nitrogen* - **Blood urea nitrogen (BUN)** is a marker of kidney function and accumulates in renal failure. - However, BUN itself does not directly cause joint pain in the metalsophalangeal joints, unlike uric acid. *HLA B27 typing* - **HLA-B27** is a human leukocyte antigen strongly associated with seronegative spondyloarthropathies like **ankylosing spondylitis** and **reactive arthritis**. - It does not accumulate in chronic renal failure and is not directly related to joint pain caused by renal dysfunction.

Question 880: Glomerulonephritis in streptococcal infection is diagnosed by.

A. Blood culture
B. Throat culture
C. ASO Titre (Correct Answer)
D. PCR

Explanation: ***ASO Titre*** - ASO (Antistreptolysin O) **titre** measures antibodies raised against streptococcal toxins, which are elevated following a **streptococcal infection**. - A high or rising ASO titre indicates a **recent streptococcal infection**, which is crucial for diagnosing **post-streptococcal glomerulonephritis**. *Blood culture* - **Blood culture** identifies the presence of bacteria in the bloodstream (bacteremia) but is typically negative in post-streptococcal glomerulonephritis as the infection itself often resolves before nephritis develops. - It would be more useful for diagnosing **active systemic infections**, such as endocarditis or sepsis, rather than a post-infectious immune-mediated complication. *Throat culture* - A **throat culture** detects the presence of *Streptococcus pyogenes* in the pharynx, confirming a current or very recent **streptococcal pharyngitis**. - While helpful for diagnosing the initial infection, it may be negative by the time glomerulonephritis manifests, as the bacteria might have been cleared. *PCR* - **PCR (Polymerase Chain Reaction)** detects bacterial DNA and can confirm the presence of *Streptococcus pyogenes* DNA directly in a sample. - While sensitive for detecting current infection, it does not directly diagnose the **immune-mediated complication** of glomerulonephritis, which is a delayed response.

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Acute Kidney Injury

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Chronic Kidney Disease

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Glomerular Diseases

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Tubulointerstitial Diseases

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Nephrotic and Nephritic Syndromes

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Urinary Tract Infections

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Renal Replacement Therapy

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Fluid and Electrolyte Disorders

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Acid-Base Disorders

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Kidney in Systemic Diseases

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Kidney Stones and Obstructive Uropathy

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Hypertension in Kidney Disease

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Nephrology — MCQs

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