Nephrology Practice Questions

Q: What is the most common inherited cause of renal disease?

Polycystic kidney disease. **Autosomal Dominant Polycystic Kidney Disease (ADPKD)** is the most common inherited cause of renal disease and the leading genetic cause of End-Stage Renal Disease (ESRD) worldwide [1]. It is characterized by the progressive development of numerous fluid-filled cysts in the renal parenchyma, leading to massive kidney enlargement and functional decline [1]. It is most commonly caused by mutations in the **PKD1** (Chromosome 16) or **PKD2** (Chromosome 4) genes [1]. **Analysis of Options:** * **Alport Syndrome:** This is an X-linked dominant (most common) or autosomal recessive disorder caused by mutations in Type IV collagen. While it is a significant cause of hereditary nephritis and deafness, its prevalence is much lower than ADPKD. * **Hypospadias:** This is a common congenital anatomical malformation of the male urethra, not an inherited "renal disease" or parenchymal pathology. * **Ureteropelvic Junction (UPJ) Obstruction:** This is the most common cause of *neonatal hydronephrosis*. While it can be congenital, it is typically a structural/obstructive anomaly rather than a primary inherited genetic renal disease. **High-Yield Clinical Pearls for NEET-PG:** * **Extra-renal manifestations of ADPKD:** Hepatic cysts (most common extra-renal site), Berry aneurysms (Circle of Willis), Mitral Valve Prolapse (MVP), and diverticulosis. * **Diagnosis:** Ultrasonography is the primary screening tool. * **Treatment:** Tolvaptan (Vasopressin V2 receptor antagonist) is used to slow the progression of cyst growth and renal decline. * **Inheritance:** ADPKD follows a "two-hit" hypothesis at the cellular level, though it is clinically inherited in an autosomal dominant pattern.

Q: Hypotension during dialysis is most commonly due to which of the following?

Excessive ultrafiltration. **Explanation:** **Intradialytic Hypotension (IDH)** is the most frequent complication encountered during hemodialysis, occurring in approximately 20–30% of sessions [1]. **1. Why Excessive Ultrafiltration is Correct:** The primary mechanism behind IDH is a **rapid decrease in plasma volume** caused by ultrafiltration (fluid removal) that exceeds the **plasma refilling rate** (the rate at which fluid moves from the interstitial space into the intravascular compartment) [1]. When the rate of fluid removal is too aggressive or the patient has gained excessive interdialytic weight, the compensatory mechanisms—such as peripheral vasoconstriction and increased cardiac output—fail to maintain blood pressure, leading to hypotension. **2. Analysis of Incorrect Options:** * **B. Antihypertensive medications:** While taking blood pressure medication shortly before dialysis can exacerbate hypotension, it is a modifiable risk factor rather than the *most common* primary cause. * **C. Underlying renal disease:** While the patient has renal failure (the reason for dialysis), the disease itself does not cause acute drops in BP during the procedure; rather, the process of fluid shifts does. * **D. Diabetes mellitus:** Diabetic patients are at a *higher risk* for IDH due to autonomic neuropathy (impaired vasoconstriction), but the inciting event remains the fluid removal process. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition:** IDH is typically defined as a decrease in systolic BP by **≥20 mmHg** or a decrease in mean arterial pressure by **10 mmHg** associated with clinical symptoms. * **Management:** Immediate management includes placing the patient in the **Trendelenburg position**, stopping ultrafiltration, and administering a **normal saline bolus**. * **Prevention:** Strategies include limiting interdialytic weight gain, extending dialysis time, or using "sodium modeling" and cool dialysate [1].

Q: Anuria is defined as urine output less than?

4 ml/hr. **Explanation:** In clinical nephrology, **Anuria** is traditionally defined as a urine output of **less than 100 ml in 24 hours**. To convert this into an hourly rate for bedside monitoring (common in ICU settings), the calculation is $100 \text{ ml} / 24 \text{ hours} \approx 4.16 \text{ ml/hr}$. Therefore, **4 ml/hr** is the most accurate hourly threshold representing anuria. [1] * **Option A (4 ml/hr):** Correct. This aligns with the standard definition of <100 ml/day. Anuria often signifies complete urinary tract obstruction, bilateral renal artery occlusion, or severe acute cortical necrosis. * **Options B, C, and D (8, 12, 16 ml/hr):** These values exceed the 100 ml/day threshold. For instance, 16 ml/hr would result in ~384 ml/day, which falls under the category of **Oliguria** rather than Anuria. [1] **Clinical Pearls for NEET-PG:** 1. **Oliguria:** Defined as urine output ** 3 Liters/day**. Common causes include Diabetes Mellitus, Diabetes Insipidus, and the diuretic phase of ATN. 3. **Non-oliguric AKI:** Some patients maintain a urine output >400 ml/day despite a rising creatinine; this carries a better prognosis than oliguric AKI. 4. **Total Anuria (0 ml):** Usually suggests complete obstruction (e.g., stone, malignancy) or a major vascular catastrophe. [1]

Question 1

What is the most common inherited cause of renal disease?

Accepted Answer

Polycystic kidney disease

Answer

Alport syndrome

Answer

Hypospadias

Answer

Ureteropelvic junction obstruction

Question 2

Hypotension during dialysis is most commonly due to which of the following?

Accepted Answer

Excessive ultrafiltration

Answer

Administration of antihypertensive medications

Answer

Underlying renal disease

Answer

Diabetes mellitus

Question 3

What is the most common neurological disorder seen in patients with chronic renal failure?

Accepted Answer

Polyneuropathy

Answer

Dementia

Answer

Restless leg syndrome

Answer

Encephalopathy

Question 4

Anuria is defined as urine output less than?

Accepted Answer

4 ml/hr

Answer

8 ml/hr

Answer

12 ml/hr

Answer

16 ml/hr

Question 5

Hemolytic Uremic Syndrome is characterized by which of the following?

Accepted Answer

Renal failure

Answer

Microangiopathic hemolytic anemia

Answer

Decreased LDH

Answer

Thrombocytopenia

Question 6

Which of the following conditions are associated with the presence of RBC casts?

Accepted Answer

Ankylosing Spondylitis

Answer

Diabetes Mellitus

Answer

Wegener's Granulomatosis

Answer

Systemic Lupus Erythematosus

Question 7

A 45-year-old man, known to have chronic renal failure, develops rugger jersey spine. What is the probable cause?

Accepted Answer

Secondary hyperparathyroidism

Answer

Aluminium intoxication

Answer

Osteoporosis

Answer

Osteomalacia

Question 8

What is the most common kidney disease associated with chronic heroin use?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Answer

Lipoid nephrosis

Answer

Mesangioproliferative GN

Question 9

In a uremic patient, dialysis can reverse all these conditions except -

Accepted Answer

Myopathy

Answer

Peripheral neuropathy

Answer

Seizures

Answer

Pericarditis

Question 10

Which of the following describes a CKD patient classified as G4 A2?

Accepted Answer

GFR between 15-29 ml/min/1.73 m2 and albumin creatinine ratio of 30-300 mg/g

Answer

GFR between 30-44 ml/min/1.73 m2 and albumin creatinine ratio of 30-300 mg/g

Answer

GFR between 45-59 ml/min/1.73 m2 and albumin creatinine ratio of 3-30 mg/g

Answer

GFR between 60-89 ml/min/1.73 m2 and albumin creatinine ratio of 3-30 mg/g

Nephrology — MCQs

Nephrology — MCQs

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