Nephrology Practice Questions

Q: In Henoch-Schönlein purpura, which of the following findings is NOT typically present?

More common in adults. **Explanation:** Henoch-Schönlein Purpura (HSP), now commonly referred to as **IgA Vasculitis**, is the most common systemic vasculitis of childhood. **Why Option D is the correct answer:** HSP is primarily a pediatric disease. Approximately 90% of cases occur in children, with a peak incidence between **3 and 10 years of age**. While it can occur in adults, it is significantly less common in that population, though adult-onset HSP often carries a more severe prognosis regarding renal involvement. **Analysis of Incorrect Options:** * **Option A (Abdominal pain with proteinuria):** Gastrointestinal involvement occurs in ~75% of cases due to submucosal hemorrhage and edema. Renal involvement (HSP Nephritis) occurs in ~30-50% of patients, typically presenting as hematuria or **proteinuria**. * **Option B (Acute arthritis):** This is the second most common feature (seen in ~75%). It typically involves large joints (knees and ankles) and is transient and non-deforming. * **Option C (Rectal bleeding):** GI symptoms can range from colicky pain to occult blood or frank **melena/hematochezia** (rectal bleeding). In severe cases, it can lead to intussusception (typically ileo-ileal). **High-Yield Clinical Pearls for NEET-PG:** * **Classic Tetrad:** Non-thrombocytopenic palpable purpura (essential for diagnosis), arthritis, abdominal pain, and renal disease. * **Pathogenesis:** Deposition of **IgA1-dominant immune complexes** in small vessels. * **Preceding Event:** Often follows an Upper Respiratory Tract Infection (URTI), specifically Group A Strep. * **Platelet Count:** Always **normal** (distinguishes it from ITP). * **Biopsy:** Skin biopsy shows **Leukocytoclastic vasculitis**; Renal biopsy is identical to **IgA Nephropathy (Berger’s disease)**.

Q: A 6-year-old child presents with recurrent episodes of gross hematuria for 2 years. What is the most likely diagnosis?

IgA nephropathy. **Explanation:** The clinical presentation of **recurrent episodes of gross hematuria** in a child is the hallmark of **IgA Nephropathy (Berger’s Disease)**. It is the most common cause of primary glomerulonephritis worldwide. The hematuria is typically "synpharyngitic," meaning it occurs simultaneously with or within 1–2 days of an upper respiratory tract infection (URTI). Between episodes, the child is usually asymptomatic, though microscopic hematuria may persist. **Analysis of Options:** * **A. IgA Nephropathy (Correct):** Characterized by episodic macroscopic hematuria triggered by mucosal infections (URTI or GI infections) due to the deposition of abnormally glycosylated IgA1 in the glomerular mesangium. * **B. Wilm’s Tumor:** While it can cause hematuria, it typically presents as a large, smooth, palpable abdominal mass that does not cross the midline. Recurrent episodes over two years without a mass are highly unlikely. * **C. Henoch-Schönlein Purpura (HSP):** Though related to IgA (IgA vasculitis), HSP presents with a classic tetrad: palpable purpura (lower limbs), arthralgia, abdominal pain, and renal involvement. Isolated recurrent hematuria without systemic symptoms points toward IgA nephropathy. * **D. Neuroblastoma:** This is a sympathetic chain tumor. It usually presents with a painful, irregular abdominal mass crossing the midline, opsoclonus-myoclonus, or systemic symptoms (fever, weight loss). Hematuria is rare. **High-Yield Clinical Pearls for NEET-PG:** * **Synpharyngitic Hematuria:** IgA Nephropathy (occurs <3 days after URTI). * **Post-infectious Hematuria (PSGN):** Occurs 1–3 weeks after URTI/Skin infection (latent period). * **Diagnosis:** Gold standard is **Renal Biopsy**, showing mesangial hypercellularity and IgA deposits on Immunofluorescence. * **Prognosis:** Most common indicator of poor prognosis is persistent hypertension and significant proteinuria.

Q: How does Wilms tumor commonly present in children?

Abdominal mass. **Explanation:** **Wilms Tumor (Nephroblastoma)** is the most common primary renal malignancy in children, typically occurring between the ages of 2 and 5 years. **Why "Abdominal Mass" is correct:** The hallmark presentation of Wilms tumor is a **painless, firm, smooth, and unilateral abdominal mass**. In approximately 80% of cases, this mass is discovered incidentally by a parent while bathing or dressing the child, or during a routine physical examination. Unlike Neuroblastoma, the mass in Wilms tumor typically **does not cross the midline** as it originates within the renal parenchyma. **Analysis of Incorrect Options:** * **A. Hematuria:** While microscopic hematuria occurs in about 25% of cases, gross hematuria is rare. It is a secondary finding rather than the primary presenting complaint. * **B. Abdominal pain:** Pain is present in only about 25–30% of patients, usually due to rapid tumor growth or hemorrhage within the tumor. * **D. Fever:** Fever is a constitutional symptom seen in only 10–20% of cases and is not the most common presenting feature. **High-Yield Clinical Pearls for NEET-PG:** * **Hypertension:** Present in 25% of cases due to increased renin production. * **WAGR Syndrome:** Wilms tumor, Aniridia, Genitourinary anomalies, and intellectual disability (Range of developmental delay). Associated with **WT1 gene** deletion on chromosome 11p13. * **Beckwith-Wiedemann Syndrome:** Macroglossia, hemihypertrophy, and omphalocele. Associated with **WT2 gene** on chromosome 11p15. * **Management Tip:** Avoid vigorous palpation of the abdomen to prevent rupture of the renal capsule and subsequent tumor spillage (upstaging).

Q: A 10-year-old boy with nephrotic syndrome developed peritonitis. Which of the following organisms is most commonly responsible?

Group A streptococci. **Explanation:** Spontaneous Bacterial Peritonitis (SBP) is a common and serious complication in children with Nephrotic Syndrome, particularly during a relapse. **1. Why Group A Streptococci is correct:** In the pediatric population with nephrotic syndrome, the most common causative organism for SBP is **Streptococcus pneumoniae** (Pneumococcus). However, in many standardized exams and classic textbooks, **Group A Streptococci (Streptococcus pyogenes)** is also frequently cited as a primary Gram-positive culprit. These organisms gain entry due to the patient's immunocompromised state, characterized by low levels of immunoglobulins (IgG), loss of complement factors (Factor B and D) in urine, and impaired opsonization. **2. Why the other options are incorrect:** * **E. coli & Klebsiella:** While Gram-negative organisms (like *E. coli*) are the most common cause of SBP in **adults with cirrhosis**, they are traditionally the second most common cause in children with nephrosis. * **Bacteroides fragilis:** Anaerobic infections are extremely rare in SBP. The presence of anaerobes usually suggests secondary peritonitis (e.g., bowel perforation) rather than spontaneous infection. **Clinical Pearls for NEET-PG:** * **Most Common Organism Overall:** *Streptococcus pneumoniae* is the #1 cause of SBP in nephrotic children. * **Shift in Trends:** Recent studies show an increasing incidence of Gram-negative infections (like *E. coli*), but for exam purposes, Gram-positive cocci remain the classic answer. * **Mechanism:** The susceptibility is primarily due to **hypogammaglobulinemia** and decreased **alternative complement pathway** activity. * **Clinical Sign:** A child with nephrotic syndrome presenting with fever and abdominal pain should be investigated for SBP immediately.

Q: Which of the following is NOT true about multicystic dysplastic kidney disease?

Unilateral MCDK leads to Potter sequence.. **Explanation:** **Multicystic Dysplastic Kidney (MCDK)** is a non-inherited developmental anomaly where the renal parenchyma is replaced by multiple non-communicating cysts, resulting in a non-functional kidney. **Why Option C is the correct answer (False statement):** Potter sequence is a constellation of physical findings (flattened facies, clubbed feet, pulmonary hypoplasia) caused by **severe oligohydramnios** (lack of amniotic fluid). Since amniotic fluid is primarily produced by fetal urine, Potter sequence only occurs when there is **bilateral** renal agenesis or dysfunction. In **unilateral MCDK**, the contralateral (other) kidney is usually functional and produces enough urine to maintain normal amniotic fluid levels; therefore, it does **not** lead to Potter sequence. **Analysis of other options:** * **Option A:** True. Unilateral MCDK is the most common form of cystic renal disease in newborns. * **Option B:** True. If the condition is isolated and the other kidney is healthy, the prognosis is excellent, as one functional kidney is sufficient for normal life. * **Option D:** True. Bilateral MCDK is incompatible with life, leading to severe oligohydramnios, pulmonary hypoplasia, and neonatal death (Potter sequence). **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Failure of the ureteric bud to integrate with the metanephric blastema. * **Associated Anomaly:** The most common associated abnormality is **Vesicoureteral Reflux (VUR)** in the contralateral (normal-appearing) kidney (seen in ~30% of cases). * **Management:** Most cases undergo spontaneous involution. Serial ultrasounds are the standard of care; nephrectomy is rarely required. * **Diagnostic Test:** **Renal Scintigraphy (DMSA scan)** shows a "non-visualizing" or "cold" kidney due to lack of function.

Question 1

In Henoch-Schönlein purpura, which of the following findings is NOT typically present?

Accepted Answer

More common in adults

Answer

Abdominal pain with proteinuria

Answer

Acute arthritis

Answer

Rectal bleeding

Question 2

Joubert syndrome is associated with which of the following conditions?

Accepted Answer

Nephronophthisis

Answer

Autosomal dominant polycystic kidney disease

Answer

Medullary cystic kidney disease

Answer

Autosomal recessive polycystic kidney disease

Question 3

A 6-year-old child presents with recurrent episodes of gross hematuria for 2 years. What is the most likely diagnosis?

Accepted Answer

IgA nephropathy

Answer

Wilm's tumor

Answer

Henoch-Schonlein Purpura (HSP)

Answer

Neuroblastoma

Question 4

Which of the following conditions is NOT typically steroid-resistant?

Accepted Answer

Minimal change glomerulonephritis

Answer

Post-streptococcal glomerulonephritis

Answer

Rapidly progressive glomerulonephritis

Answer

Recurrent hematuria

Question 5

How does Wilms tumor commonly present in children?

Accepted Answer

Abdominal mass

Answer

Hematuria

Answer

Abdominal pain

Answer

Fever

Question 6

A child presents with steroid-resistant nephrotic syndrome secondary to focal segmental glomerulosclerosis (FSGS) that is not responsive to methylprednisolone. What is the next recommended treatment?

Accepted Answer

Oral cyclosporine

Answer

Oral cyclophosphamide

Answer

Oral mycophenolate mofetil

Answer

Intravenous cyclophosphamide

Question 7

A 9-year-old child has had steroid-dependent nephrotic syndrome for the last 5 years. He has received corticosteroids almost continuously during this period and has Cushingoid features. His blood pressure is 120/86 mmHg, and there are bilateral subcapsular cataracts. What is the treatment of choice?

Accepted Answer

Cyclophosphamide

Answer

Levamisole

Answer

Cyclosporin A

Answer

Intravenous pulse corticosteroids

Question 8

A 10-year-old boy with nephrotic syndrome developed peritonitis. Which of the following organisms is most commonly responsible?

Accepted Answer

Group A streptococci

Answer

E. coli

Answer

Klebsiella

Answer

Bacteroides fragilis

Question 9

What is the commonest cause of enuresis in children?

Accepted Answer

None of the above

Answer

Urinary tract infection

Answer

Spina bifida

Answer

Psychologic stress

Question 10

Which of the following is NOT true about multicystic dysplastic kidney disease?

Accepted Answer

Unilateral MCDK leads to Potter sequence.

Answer

Unilateral multicystic dysplastic kidney is more common than bilateral.

Answer

Prognosis is good if MCDK is isolated and unilateral.

Answer

Bilateral MCDK has a poor prognosis.

Nephrology — MCQs

Nephrology — MCQs

On this page

Practice by Chapter

Want unlimited practice?