Nephrology Practice Questions

Q: Hypertension in childhood typically complicates

Post-streptococcal glomerulonephritis. ***Post-streptococcal glomerulonephritis*** - This condition is characterized by **inflammation of the glomeruli** following a streptococcal infection, leading to **fluid retention** and **hypertension**. - Renal involvement results in impaired fluid and sodium excretion, causing **volume overload** and elevated blood pressure. *Minimal change disease* - This is a common cause of **nephrotic syndrome** in children, characterized by **proteinuria** and **edema**. - Hypertension is generally rare with this condition, as the primary issue is **protein loss** rather than fluid retention from renal failure. *Acute appendicitis* - This is an **acute inflammation of the appendix** that presents with abdominal pain, fever, and vomiting. - It does not directly cause hypertension; any elevated blood pressure would be secondary to **pain or stress**, not renal dysfunction. *Peptic ulcer disease* - This involves **erosions in the stomach or duodenal lining** caused by *H. pylori* infection or NSAID use. - Symptoms include abdominal pain, nausea, and sometimes bleeding, but there is no direct association with **hypertension in childhood**.

Q: Which of the following statements about Eagle-Barrett syndrome is false?

Scapular hypoplasia. ***Scapular hypoplasia*** - **Scapular hypoplasia** is not a characteristic feature of Eagle-Barrett syndrome. The syndrome primarily affects the abdominal wall, urinary tract, and testes. - The classic triad of Eagle-Barrett syndrome includes **partial or complete absence of abdominal wall musculature**, **urinary tract abnormalities**, and **bilateral cryptorchidism**. *Pulmonary hypoplasia* - **Pulmonary hypoplasia** can be a severe complication of Eagle-Barrett syndrome due to reduced fetal lung development. - This is often secondary to **oligohydramnios** caused by severe urinary tract abnormalities, restricting chest wall movement and fetal breathing. *Bilateral undescended testes* - **Bilateral undescended testes (cryptorchidism)** is a hallmark feature of Eagle-Barrett syndrome. - This is thought to be related to the abdominal wall defect and/or connective tissue abnormalities impacting testicular descent. *Also known as prune belly syndrome* - Eagle-Barrett syndrome is indeed **also known as prune belly syndrome**, a descriptive term referring to the wrinkled appearance of the abdominal wall in affected neonates. - This characteristic appearance is due to the severe hypoplasia or absence of rectus abdominis and oblique muscles.

Q: Which of the following is not a hallmark of nephrotic syndrome in children?

Gross hematuria. ***Gross hematuria*** - While some glomerular disorders that cause nephrotic syndrome can also present with microscopic hematuria, **gross hematuria** is a hallmark feature of **nephritic syndrome**, not nephrotic syndrome. - Nephritic syndrome typically involves significant inflammation and damage to the glomeruli, leading to blood in the urine, often accompanied by hypertension and acute kidney injury. *Severe proteinuria >2 gm/m2/day* - **Severe proteinuria** (typically defined as >40 mg/m2/hr or >50 mg/kg/day, or >3.5 g/day in adults, which translates to high values in children) is a **defining characteristic** of nephrotic syndrome, resulting from increased glomerular permeability. - The excessive loss of protein in the urine is responsible for many of the other clinical manifestations of the syndrome. *Hypoalbuminemia < 2.5 g/dL* - **Hypoalbuminemia** is a direct consequence of the massive proteinuria, as the liver cannot synthesize albumin quickly enough to compensate for its loss. - A serum albumin level of less than 2.5 g/dL is a key diagnostic criterion for nephrotic syndrome. *Edema* - **Edema**, particularly periorbital, scrotal, and lower extremity swelling, is a prominent clinical feature of nephrotic syndrome. - It results from the reduced plasma oncotic pressure due to hypoalbuminemia, leading to fluid shifts from the intravascular space to the interstitial space.

Q: A 7-year-old girl was brought with complaints of generalized swelling of the body. Urinary examination reveals grade 3 proteinuria and the presence of hyaline and fatty casts. She has no history of hematuria. Which of the following statements about her condition is true?

No IgG deposits or C3 deposition on renal biopsy. ***No IgG deposits or C3 deposition on renal biopsy*** - This finding is characteristic of **minimal change disease**, which is common in children and typically presents with **nephrotic syndrome** features [1]. - The absence of **IgG** and **C3** indicates that it is not associated with **immune complex-mediated diseases**. *IgA Nephropathy* - Usually presents with **hematuria** and **IgA deposition**, which are not seen in this case [2]. - In IgA nephropathy, **proteinuria** is typically less than nephrotic levels, contrary to the patient's **grade 3 proteinuria**. *Alpo's syndrome* - There is no such recognized syndrome related to the symptoms described; it likely refers to a misunderstanding or misnomer. - Conditions leading to nephrotic syndrome in children do not include this as a diagnosis. *Her C3 levels will be low* - In minimal change disease, **C3 levels** are typically normal, unlike in **glomerulonephritis** where low levels may be observed [3]. - This condition is not associated with **systemic disease** that would affect complement levels.

Q: A neonate presenting with ascites is diagnosed with urinary ascites. What is the most common cause?

Posterior urethral valve. ***Posterior urethral valve*** - **Posterior urethral valve (PUV)** is the most common cause of **urinary tract obstruction** in male neonates, leading to severe bladder outflow obstruction, often resulting in **urinary ascites** due to urinary extravasation. - The obstruction causes high pressure in the bladder and urinary tract, which can lead to rupture of the urinary system (e.g., bladder, renal pelvis, ureters) and leakage of urine into the peritoneal cavity. *Bilateral PUJ obstruction* - While **pelvic-ureteric junction (PUJ) obstruction** can cause hydronephrosis, bilateral obstruction leading to urinary ascites is less common than PUV. - PUJ obstruction primarily affects the flow of urine from the kidney to the ureter, and although severe, is less likely to cause widespread urinary extravasation into the peritoneum compared to distal urethral obstruction. *Infant polycystic kidney disease* - **Infant polycystic kidney disease (ARPKD)** is characterized by enlarged kidneys with numerous cysts, leading to renal dysfunction and often pulmonary hypoplasia. - While ARPKD can cause significant renal pathology, it does not typically lead to urinary ascites through obstructive mechanisms; ascites, if present, is usually due to liver fibrosis or heart failure, not urinary obstruction. *Meatal stenosis* - **Meatal stenosis** is a narrowing of the urethral opening, which can cause urinary obstruction but is usually a less severe and more distal obstruction compared to PUV. - It might cause symptoms like a thin stream or dysuria but is rarely severe enough in neonates to cause back pressure leading to urinary extravasation and ascites.

Q: An 8-year-old boy during a routine checkup is found to have E. coli 100,000 CFU/mL on a urine culture, obtained by mid-stream clean-catch void. The child is asymptomatic. Which is the most appropriate next step in the management?

No therapy. ***No therapy*** - The presence of **bacteria** in the urine (**bacteriuria**) without any accompanying symptoms like fever, dysuria, or flank pain is defined as **asymptomatic bacteriuria (ASB)**. - In healthy, asymptomatic children, ASB generally requires **no antibiotic treatment**, as it rarely progresses to symptomatic infection or causes renal damage and may even protect against symptomatic UTIs by competitive inhibition. *Treat as an acute episode of urinary tract infection* - This child is **asymptomatic,** therefore, he does not have an acute urinary tract infection (UTI). - Treating asymptomatic bacteriuria can lead to **antibiotic resistance** and unnecessary side effects without clinical benefit. *Prophylactic antibiotics for 6 months* - **Prophylactic antibiotics** are reserved for children with recurrent symptomatic UTIs or significant anatomical abnormalities like **vesicoureteral reflux (VUR)**, which are not indicated here. - Using long-term antibiotics in an asymptomatic child can contribute to the development of **antibiotic-resistant organisms**. *Administer long term urine alkalinizer* - **Urine alkalinizers** are used in specific conditions like certain types of **kidney stones (e.g., uric acid stones)** or to enhance the excretion of certain drugs, not for asymptomatic bacteriuria. - There is **no evidence** to support the use of urine alkalinizers in managing asymptomatic bacteriuria or preventing UTIs.

Q: The most common cause of renal scarring in a 3-year-old child is:

Vesicoureteral reflux-induced pyelonephritis. ***Vesicoureteral reflux-induced pyelonephritis*** - **Vesicoureteral reflux (VUR)** allows urine to flow backward from the bladder to the kidneys, predisposing to recurrent **urinary tract infections (UTIs)** and **pyelonephritis**. - Repeated episodes of **pyelonephritis** in young children, especially those with VUR, can lead to **renal scarring** and permanent kidney damage. *Trauma* - While renal trauma can cause scarring, it is not the most common cause of **diffuse renal scarring** in a 3-year-old child. - Trauma typically causes localized injury rather than the widespread scarring seen with chronic inflammation. *Tuberculosis* - **Renal tuberculosis** can lead to scarring but is relatively rare in young children in many parts of the world. - It usually presents with symptoms beyond just scarring, such as **sterile pyuria** and constitutional symptoms. *Interstitial nephritis* - **Interstitial nephritis** is an inflammation of the spaces between renal tubules and can lead to scarring if chronic. - However, it is less common than VUR-induced pyelonephritis as the primary cause of widespread renal scarring in this age group, and often has other underlying causes like drug reactions or systemic diseases.

Q: Which of the following is the most common renal cause of acute renal failure in children?

Hemolytic uremic syndrome. ***Hemolytic uremic syndrome*** - **Hemolytic uremic syndrome (HUS)** is the most common cause of **acute kidney injury (AKI)** in children due to its characteristic triad: **microangiopathic hemolytic anemia**, **thrombocytopenia**, and **acute renal failure**. - It is often preceded by a diarrheal illness caused by **Shiga toxin-producing E. coli (STEC)**, leading to widespread microvascular damage in the kidneys. *Acute glomerulonephritis* - While a significant cause of AKI in children, **acute glomerulonephritis** is less common overall than HUS as the primary renal cause. - It involves inflammation of the **glomeruli**, often post-streptococcal, leading to hematuria, proteinuria, and hypertension. *Acute tubular necrosis* - **Acute tubular necrosis (ATN)**, usually caused by ischemia or nephrotoxins, is more common in adults and critically ill children. - In children, it is less frequently the primary renal cause of AKI compared to HUS, though it can occur secondary to severe dehydration or sepsis. *Renal dysplasia* - **Renal dysplasia** is a **congenital abnormality** of kidney development, typically presenting as chronic kidney disease or early-onset renal failure. - It is not a common cause of *acute* renal failure, as its effects are usually long-standing and progressive rather than sudden.

Q: Sustained severe hypertension in children is most commonly suggestive of:

Renal parenchymatous disease. ***Renal parenchymatous disease*** - Chronic **renal diseases** are the most common cause of sustained severe hypertension in children, often due to **fluid retention**, **renin-angiotensin system activation**, and decreased **nitric oxide production**. - Conditions like **glomerulonephritis**, **pyelonephritis**, and **renal dysplasia** can lead to significant and persistent blood pressure elevation. *Coarctation of aorta* - While coarctation can cause hypertension, it typically presents with a **discrepancy in blood pressure** between the upper and lower extremities and **absent or delayed femoral pulses**. - It constitutes a smaller proportion of sustained severe hypertension cases compared to renal etiologies in children. *Pheochromocytoma* - This is a rare cause of hypertension in children, characterized by **paroxysmal episodes** of severe hypertension associated with **tachycardia**, **sweating**, and **palpitations** due to excessive catecholamine release. - The hypertension is often episodic rather than sustained, although it can be sustained in some cases. *Drug induced* - Drug-induced hypertension is usually **acute** or directly related to the **ingestion of specific substances**, such as corticosteroids, stimulants, or certain over-the-counter cold medications. - While it can be severe, it typically resolves upon discontinuation of the offending agent and is less common as a cause of sustained severe hypertension in children without a clear history of drug exposure.

Q: Which of the following is the most common renal cystic disease in infants?

Unilateral renal dysplasia. ***Unilateral renal dysplasia*** - This condition is also known as **multicystic dysplastic kidney (MCDK)** and is the **most common renal cystic disease** diagnosed in infants, often prenatally. - It results from abnormal kidney development where the normal renal parenchyma is replaced by multiple **non-communicating cysts** and undifferentiated tissue. *Polycystic kidney* - **Autosomal dominant polycystic kidney disease (ADPKD)** typically presents later in life, often in adulthood, and is rarely symptomatic in infants. - **Autosomal recessive polycystic kidney disease (ARPKD)** can present in infants but is less common than MCDK and usually involves bilateral, uniformly enlarged kidneys with numerous small cysts. *Simple renal cyst* - **Simple renal cysts** are rare in infants and usually benign, often idiopathic, and are generally single and small. - They are much less common than MCDK as a cause of significant neonatal renal cystic disease. *Calyceal cyst* - A **calyceal cyst** is a rare, usually solitary, simple cyst that arises from a calyx and is typically an incidental finding. - It does not represent a widespread renal cystic disease and is much less common than **multicystic dysplastic kidney** in infants.

Question 1

Hypertension in childhood typically complicates

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Minimal change disease

Answer

Acute appendicitis

Answer

Peptic ulcer disease

Question 2

Which of the following statements about Eagle-Barrett syndrome is false?

Accepted Answer

Scapular hypoplasia

Answer

Pulmonary hypoplasia

Answer

Bilateral undescended testes

Answer

Also known as prune belly syndrome

Question 3

Which of the following is not a hallmark of nephrotic syndrome in children?

Accepted Answer

Gross hematuria

Answer

Hypoalbuminemia < 2.5 g/dL

Answer

Edema

Answer

Severe proteinuria >2 gm/m2/day

Question 4

A 7-year-old girl was brought with complaints of generalized swelling of the body. Urinary examination reveals grade 3 proteinuria and the presence of hyaline and fatty casts. She has no history of hematuria. Which of the following statements about her condition is true?

Accepted Answer

No IgG deposits or C3 deposition on renal biopsy

Answer

Her C3 levels will be low

Answer

IgA Nephropathy is the likely diagnosis

Answer

Minimal change disease is characterized by the absence of hematuria and significant proteinuria.

Question 5

A neonate presenting with ascites is diagnosed with urinary ascites. What is the most common cause?

Accepted Answer

Posterior urethral valve

Answer

Bilateral PUJ obstruction

Answer

Infant polycystic kidney disease

Answer

Meatal stenosis

Question 6

An 8-year-old boy during a routine checkup is found to have E. coli 100,000 CFU/mL on a urine culture, obtained by mid-stream clean-catch void. The child is asymptomatic. Which is the most appropriate next step in the management?

Accepted Answer

No therapy

Answer

Prophylactic antibiotics for 6 months

Answer

Administer long term urine alkalinizer

Answer

Treat as an acute episode of urinary tract infection

Question 7

The most common cause of renal scarring in a 3-year-old child is:

Accepted Answer

Vesicoureteral reflux-induced pyelonephritis

Answer

Tuberculosis

Answer

Interstitial nephritis

Answer

Trauma

Question 8

Which of the following is the most common renal cause of acute renal failure in children?

Accepted Answer

Hemolytic uremic syndrome

Answer

Acute glomerulonephritis

Answer

Acute tubular necrosis

Answer

Renal dysplasia

Question 9

Sustained severe hypertension in children is most commonly suggestive of:

Accepted Answer

Renal parenchymatous disease

Answer

Pheochromocytoma

Answer

Drug induced

Answer

Coarctation of aorta

Question 10

Which of the following is the most common renal cystic disease in infants?

Accepted Answer

Unilateral renal dysplasia

Answer

Polycystic kidney

Answer

Simple renal cyst

Answer

Calyceal cyst

Nephrology — MCQs

Nephrology — MCQs

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