Nephrology — MCQs
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All are features of nephrotic syndrome in children except –
A 5 year old child presented with periorbital swelling and oliguria. Nephrotic syndrome is suspected. Which of the following is the commonest type of nephrotic syndrome in this child?
A 6-month-old infant has poor weight gain, vomiting, episodic fevers, and chronic constipation. Laboratory studies reveal a urinalysis with a pH of 8.0, specific gravity of 1.010, 1+ glucose, and 1+ protein. Urine anion gap is normal. Serum chemistries show a normal glucose and a normal albumin with a hyperchloremic metabolic acidosis. Serum phosphorus and calcium are low. What is the best diagnosis to explain these findings?
Child with proteinuria, generalized edema, hypoproteinemia, and hyperlipidemia - most common cause is?
A 10yr old boy with a known case of nephrotic syndrome since 4 years on treatment brought to the pediatric OPD with chief complaint of difficulty in breathing. There is no history of fever. On examination, respiratory system was normal except slightly reduced breath sounds on right infra-axillary region. Paediatrician thinks of pleural effusion. What is next best modality of investigation to detect pleural effusion?
A five-year-old child presents with ballooning of prepuce after micturition. Examination reveals preputial adhesions. Which of the following is the best treatment?
An infant with severe dehydration secondary to diarrhea suddenly presents with flank mass and blood in urine. The most probable diagnosis is?
A six year old male child presents to a hospital with recurrent gross hematuria for 2 years. There is no h/o burning micturition or pyuria. Urine routine examination demonstrated no pus cells and urine culture was sterile. Serum c3 levels were normal. What is the most Probable diagnosis -
A 7-year-old child with steroid dependent nephrotic syndrome has developed corticosteroid toxicity and posterior subcapsular cataracts. Which of the following is the best alternative for the treatment of the patient?
A child with nephrotic syndrome following an episode of diarrhea presented with acute kidney injury with a creatinine of 4.5. All of the following are possible reasons except?
Nephrology Indian Medical PG Practice Questions and MCQs
Question 201: All are features of nephrotic syndrome in children except –
- A. Hyperalbuminemia (Correct Answer)
- B. Hyperlipidemia
- C. Proteinuria
- D. Lipiduria
Explanation: ***Hyperalbuminemia*** - Nephrotic syndrome is characterized by significant protein loss in the urine, leading to **hypoalbuminemia** (low serum albumin), not hyperalbuminemia. - **Hyperalbuminemia** would suggest excessive albumin in the blood, which is contrary to the pathophysiology of nephrotic syndrome. *Hyperlipidemia* - This is a common feature of nephrotic syndrome, resulting from increased hepatic synthesis of lipoproteins in response to low plasma oncotic pressure and impaired lipid catabolism. - Patients often present with elevated **total cholesterol**, **LDL**, and **triglycerides**. *Proteinuria* - This is a hallmark of nephrotic syndrome, defined by massive urinary protein excretion, typically >3.5 g/day in adults or >40 mg/m²/hour in children. - The proteinuria is primarily due to increased glomerular permeability to proteins, especially **albumin**. *Lipiduria* - This is the presence of lipids in the urine, often seen as **fatty casts** or **oval fat bodies**, and is a characteristic finding in nephrotic syndrome. - It results from the excretion of lipoproteins that have passed through the damaged glomerular filter.
Question 202: A 5 year old child presented with periorbital swelling and oliguria. Nephrotic syndrome is suspected. Which of the following is the commonest type of nephrotic syndrome in this child?
- A. Focal segmental glomerulosclerosis (FSGS)
- B. Chronic glomerulonephritis
- C. Minimal change disease (Correct Answer)
- D. Congenital nephrotic syndrome
Explanation: ***Minimal change disease*** - This is the **most common cause of nephrotic syndrome** in children, accounting for approximately 80% of cases. - It presents with sudden onset of **periorbital edema**, **generalized edema**, and often **oliguria** due to severe proteinuria. *Focal segmental glomerulosclerosis (FSGS)* - While a significant cause of nephrotic syndrome in children, it ranks second to minimal change disease in frequency. - FSGS tends to have a **poorer response to steroids** and a higher risk of progression to **end-stage renal disease**. *Chronic glomerulonephritis* - This is a broad category of glomerular diseases, typically having a **more insidious onset** and often associated with hematuria and hypertension, which are not mentioned in this acute presentation. - It usually presents with features that suggest **nephritic syndrome** (e.g., hematuria, hypertension) rather than primarily nephrotic syndrome features. *Congenital nephrotic syndrome* - This is a **rare genetic condition** that presents within the first 3 months of life, which is much earlier than the 5-year-old age of this patient. - It is characterized by severe proteinuria from birth and is typically part of inherited syndromes.
Question 203: A 6-month-old infant has poor weight gain, vomiting, episodic fevers, and chronic constipation. Laboratory studies reveal a urinalysis with a pH of 8.0, specific gravity of 1.010, 1+ glucose, and 1+ protein. Urine anion gap is normal. Serum chemistries show a normal glucose and a normal albumin with a hyperchloremic metabolic acidosis. Serum phosphorus and calcium are low. What is the best diagnosis to explain these findings?
- A. Hereditary Fanconi syndrome (Correct Answer)
- B. Renal tubular acidosis (RTA) type 1
- C. RTA type 3
- D. RTA type 4
Explanation: ***Hereditary Fanconi syndrome*** - The combination of **poor weight gain**, **vomiting**, and **chronic constipation** in an infant, coupled with **hyperchloremic metabolic acidosis**, **low serum phosphorus and calcium**, and the presence of **glucose** and **protein** in urine despite normal serum glucose, points to a generalized proximal tubular dysfunction. - This syndrome involves impaired reabsorption of multiple substances (glucose, amino acids, phosphate, bicarbonate) in the **proximal tubule**, leading to their excretion in urine. *Renal tubular acidosis (RTA) type 1* - Characterized by impaired **distal tubular acidification**, leading to an inability to excrete acid and typically presents with a **urinary pH > 5.5**, despite metabolic acidosis. - While it causes **hyperchloremic metabolic acidosis** and may be associated with **hypokalemia** and **nephrocalcinosis**, it does not typically involve significant **glucosuria** or **proteinuria** (beyond low molecular weight proteins) or **phosphate wasting** seen in this patient. *RTA type 3* - This is an **obsolete classification** that was historically used to describe a rare infantile variant combining features of both Type 1 and Type 2 RTA. - It is no longer recognized as a distinct entity in modern classification systems, and the clinical picture more strongly aligns with the widespread proximal tubular dysfunction characteristic of Fanconi syndrome. *RTA type 4* - This type is usually caused by **hypoaldosteronism** or **renal resistance to aldosterone**, leading to impaired ammonium excretion and **hyperkalemia**, which is not mentioned in the patient's presentation. - It primarily affects distal potassium and acid secretion and typically does not cause the significant **glucosuria**, **proteinuria**, or **hypophosphatemia** seen in this case.
Question 204: Child with proteinuria, generalized edema, hypoproteinemia, and hyperlipidemia - most common cause is?
- A. Mesangial glomerulonephritis
- B. FSGS
- C. IgA nephropathy
- D. Minimal change nephrotic syndrome (Correct Answer)
Explanation: **Minimal change nephrotic syndrome** - This is the most common cause of **nephrotic syndrome** in children, characterized by the classic tetrad of **proteinuria**, **hypoalbuminemia**, **edema**, and **hyperlipidemia**. - The disease involves **effacement of podocyte foot processes**, visible on electron microscopy, but the glomeruli appear normal on light microscopy. *Mesangial glomerulonephritis* - This condition involves immune complex deposition in the **mesangium**, often presenting with **hematuria** and proteinuria, but not typically the full nephrotic picture in children. - It's a form of **glomerulonephritis**, distinct from the podocytopathy seen in minimal change disease. *FSGN* - **Focal segmental glomerulosclerosis (FSGS)** is a common cause of nephrotic syndrome, but it's less common than minimal change disease as the initial presentation in young children. - It is characterized by **segmental scarring of glomeruli**, which can be seen on light microscopy. *IgA nephropathy* - This is a common cause of **glomerular hematuria**, often presenting after an upper respiratory infection. - While proteinuria can occur, it's typically not severe enough to cause the full-blown **nephrotic syndrome** with generalized edema, hypoproteinemia, and hyperlipidemia in children.
Question 205: A 10yr old boy with a known case of nephrotic syndrome since 4 years on treatment brought to the pediatric OPD with chief complaint of difficulty in breathing. There is no history of fever. On examination, respiratory system was normal except slightly reduced breath sounds on right infra-axillary region. Paediatrician thinks of pleural effusion. What is next best modality of investigation to detect pleural effusion?
- A. Lateral view Chest X-ray
- B. USG (Correct Answer)
- C. Erect Chest X-ray PA view
- D. Lateral decubitus view
Explanation: ***USG*** - **Ultrasound** is the **best first-line investigation** for detecting **pleural effusions** in children due to its **non-invasive nature**, lack of radiation exposure, and ability to detect even small effusions (as little as 5-10 mL). - It can effectively differentiate between pleural fluid and other pathologies (e.g., consolidation, masses) and guide aspiration if needed. - **Real-time bedside availability** makes it ideal for pediatric patients. *Lateral view Chest X-ray* - A lateral Chest X-ray only detects pleural effusion if the fluid volume is at least **75-100 mL**, which might miss smaller effusions. - While it can provide additional information about the lungs and mediastinum, it is not as sensitive as ultrasound for detecting small effusions. *Erect Chest X-ray PA view* - An erect Chest X-ray PA view requires a minimum of **200-300 mL of fluid** to blunt the **costophrenic angle**, potentially missing smaller effusions. - It involves **ionizing radiation**, a concern in pediatric patients, and is less sensitive than ultrasound for early detection. *Lateral decubitus view* - A lateral decubitus view is useful for confirming the presence of **free-flowing pleural fluid** and differentiating it from loculated effusions, typically after an initial effusion is suspected. - While sensitive for detecting small effusions (as little as **50 mL**), it is typically performed as a secondary investigation and involves radiation exposure, unlike ultrasound.
Question 206: A five-year-old child presents with ballooning of prepuce after micturition. Examination reveals preputial adhesions. Which of the following is the best treatment?
- A. Dorsal slit
- B. Circumcision
- C. Adhesionlysis & dilatation
- D. Conservative management (Correct Answer)
Explanation: ***Conservative management*** - In a 5-year-old child, **preputial adhesions** and **ballooning of prepuce** represent **physiological phimosis**, which is a normal developmental finding. - **Ballooning during micturition** is common and benign in young children and does NOT indicate significant obstruction requiring surgical intervention. - **First-line treatment** involves **reassurance, observation**, and if needed, **topical steroid cream** (0.05% betamethasone) applied for 4-6 weeks to facilitate gentle retraction. - Most cases resolve spontaneously with conservative management as the prepuce naturally separates from the glans over time. - Surgical intervention is reserved for **pathological phimosis** (e.g., BXO/lichen sclerosus), recurrent UTIs, or recurrent balanitis. *Adhesionlysis & dilatation* - This invasive approach is **NOT recommended** as routine treatment for physiological phimosis. - Forced retraction and adhesionlysis can cause **trauma, bleeding, scarring**, and potentially convert physiological phimosis into **pathological phimosis**. - Should only be considered in specific cases where conservative management has failed after adequate trial. *Dorsal slit* - This surgical procedure involves making an incision along the dorsal aspect of the prepuce. - It is an **invasive intervention** reserved for cases of **pathological phimosis** or when conservative management has failed. - Not indicated as first-line treatment for physiological phimosis with simple adhesions. *Circumcision* - This involves complete surgical removal of the foreskin. - It is the **most invasive and irreversible** option. - Reserved for **pathological phimosis** (BXO), recurrent infections unresponsive to medical management, or cultural/religious reasons. - Not indicated for routine physiological phimosis in a 5-year-old child.
Question 207: An infant with severe dehydration secondary to diarrhea suddenly presents with flank mass and blood in urine. The most probable diagnosis is?
- A. Renal vein thrombosis (Correct Answer)
- B. Acute glomerulonephritis
- C. Lipoid nephrosis
- D. Pyelonephritis
Explanation: ***Renal vein thrombosis*** - **Dehydration**, especially in infants, is a significant risk factor for **renal vein thrombosis** due to increased blood viscosity and hypercoagulability - The sudden appearance of a **flank mass** (due to renal enlargement and hemorrhage) and **hematuria** (blood in urine) are classic signs of this condition - Classic triad includes flank mass, hematuria, and thrombocytopenia in the setting of predisposing factors like severe dehydration *Acute glomerulonephritis* - While it can cause hematuria, it typically presents with **edema**, **hypertension**, and **oliguria**, which are not mentioned in this scenario - A flank mass is not a typical presentation of acute glomerulonephritis - Usually follows streptococcal infection with latent period *Lipoid nephrosis* - This is a type of **nephrotic syndrome** characterized by **massive proteinuria**, edema, and normal renal function - Does not typically present with a flank mass or gross hematuria - More common presentation is generalized edema and frothy urine *Pyelonephritis* - This is a **bacterial infection of the kidney** that causes fever, flank pain, and dysuria - While it can cause microscopic hematuria, a sudden flank mass and gross hematuria are not typical presentations - Especially unlikely in the context of severe dehydration without signs of infection
Question 208: A six year old male child presents to a hospital with recurrent gross hematuria for 2 years. There is no h/o burning micturition or pyuria. Urine routine examination demonstrated no pus cells and urine culture was sterile. Serum c3 levels were normal. What is the most Probable diagnosis -
- A. Urinary tract Infection
- B. Wilm's tumour
- C. IgA nephropathy (Correct Answer)
- D. Post-streptococcal glomerulonephritis
Explanation: ***IgA nephropathy*** - This is the most common cause of **recurrent gross hematuria** in children, often following a mild upper respiratory tract infection, though it can occur spontaneously. - The absence of **pyuria**, **sterile urine cultures**, and **normal C3 levels** help differentiate it from other causes of hematuria. *Urinary tract Infection* - Urinary tract infections typically involve **dysuria**, **frequency**, and sometimes **fever**, none of which are mentioned. - **Pyuria** (pus cells in urine) and positive urine cultures are characteristic findings in UTIs, which are absent here. *Wilm's tumour* - This renal tumor in children usually presents with a **palpable abdominal mass** and can cause hematuria, but recurrent gross hematuria for two years without other symptoms is less typical. - Absence of a palpable mass or other systemic symptoms makes this diagnosis less probable in this context. *Post-streptococcal glomerulonephritis* - This typically follows a streptococcal infection and is characterized by **low C3 levels** and often dark, smoky urine rather than recurrent episodes of gross hematuria. - The normal C3 levels in this case argue against post-streptococcal glomerulonephritis.
Question 209: A 7-year-old child with steroid dependent nephrotic syndrome has developed corticosteroid toxicity and posterior subcapsular cataracts. Which of the following is the best alternative for the treatment of the patient?
- A. Levamisole
- B. Cyclophosphamide
- C. Rituximab (Correct Answer)
- D. Mycophenolate mofetil
Explanation: ***Rituximab*** - Rituximab is an anti-CD20 monoclonal antibody that targets **B-lymphocytes**, which are implicated in the pathogenesis of steroid-dependent nephrotic syndrome (SDNS). - It is an effective steroid-sparing agent for children with **SDNS** who have developed corticosteroid toxicity, such as posterior subcapsular cataracts. *Levamisole* - Levamisole is an **immunomodulator** used in steroid-dependent nephrotic syndrome but is generally considered for less severe cases or as an initial steroid-sparing agent before significant corticosteroid toxicity develops. - While it can reduce steroid exposure, its efficacy in patients with established severe corticosteroid toxicity requiring a more potent steroid-sparing alternative might be limited compared to rituximab. *Cyclophosphamide* - Cyclophosphamide is an **alkylating agent** that induces remissions in SDNS and can be used as a steroid-sparing agent but carries significant risks, including **gonadal toxicity** and **hemorrhagic cystitis**. - Given the patient's age and existing corticosteroid toxicity, a drug with potentially fewer severe side effects in the long term, like rituximab, would be preferred. *Mycophenolate mofetil* - Mycophenolate mofetil (MMF) is an **immunosuppressant** used in some cases of SDNS as a steroid-sparing agent, often in conjunction with other therapies. - However, MMF is generally less effective than rituximab in achieving and maintaining remission in children with **frequent relapses** or **steroid dependence** who have failed other steroid-sparing agents.
Question 210: A child with nephrotic syndrome following an episode of diarrhea presented with acute kidney injury with a creatinine of 4.5. All of the following are possible reasons except?
- A. Excess furosemide
- B. Renal vein thrombosis
- C. Diarrheal water depletion
- D. Steroid induced diabetes (Correct Answer)
Explanation: ***Steroid induced diabetes*** - Steroid-induced diabetes is a known complication of chronic corticosteroid use but does not directly cause **acute kidney injury (AKI)** or elevated creatinine in the context of nephrotic syndrome. - While hyperglycemia can damage kidneys over time, it's a chronic rather than an acute precipitant for the degree of AKI described. *Excess furosemide* - **Furosemide** can cause **dehydration** and subsequent **prerenal acute kidney injury**, especially in a child already prone to fluid shifts due to nephrotic syndrome and diarrhea. - Excessive diuresis can lead to **intravascular volume depletion**, reducing renal perfusion and causing creatinine elevation. *Renal vein thrombosis* - Children with **nephrotic syndrome** are at increased risk of **thrombotic events** due to hypercoagulability (loss of anticoagulant proteins like antithrombin III in urine). - **Renal vein thrombosis** can cause sudden onset **AKI** due to impaired renal blood flow and ischemia. *Diarrhea water depletion* - Diarrhea leads to significant **fluid and electrolyte loss**, causing **hypovolemia** and **prerenal acute kidney injury**. - This is a common cause of AKI in children, particularly when superimposed on conditions like nephrotic syndrome where fluid balance is already compromised.
Practice by Chapter
Urinary Tract Infections
Practice Questions
Vesicoureteral Reflux
Practice Questions
Glomerulonephritis
Practice Questions
Nephrotic Syndrome
Practice Questions
Acute Kidney Injury
Practice Questions
Chronic Kidney Disease
Practice Questions
Renal Tubular Disorders
Practice Questions
Congenital Anomalies of the Kidney
Practice Questions
Hydronephrosis
Practice Questions
Hypertension in Children
Practice Questions
Hemolytic Uremic Syndrome
Practice Questions
Renal Replacement Therapy in Children
Practice Questions
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