Nephrology — MCQs

Nephrology Indian Medical PG Practice Questions and MCQs

Question 271: Most common cause of persistent hypertension in a child with intrinsic renal disease is -

A. CGN (Correct Answer)
B. Obstructive uropathy
C. Renal tumor
D. Chronic Pyelonephritis

Explanation: ***CGN*** - **Chronic glomerulonephritis (CGN)** is a leading cause of persistent hypertension in children with intrinsic renal disease due to widespread glomerular damage leading to **renin-angiotensin-aldosterone system** activation and fluid retention. - The damaged kidneys are unable to filter waste and regulate blood pressure effectively, contributing to sustained hypertension. *Chronic Pyelonephritis* - While chronic pyelonephritis can cause hypertension, it is typically due to **scarring and inflammation** affecting renal function. - However, it is not as common a cause of persistent hypertension as CGN in children with intrinsic renal disease. *Obstructive uropathy* - **Obstructive uropathy** is classified as a **post-renal (obstructive) disorder** rather than intrinsic renal disease, though it can lead to secondary renal parenchymal damage. - It can cause hypertension through renal parenchymal damage and **renin release** due to increased pressure, but it is not a primary intrinsic renal disease. *Renal tumor* - **Renal tumors**, such as Wilms' tumor, can cause hypertension through **compression of renal arteries** or increased renin production. - While a significant cause of hypertension, it is generally less common than CGN as a cause of persistent hypertension in children with *intrinsic renal disease* overall.

Question 272: A 3-month-old infant presents with bilateral medullary nephrocalcinosis. All of the following can cause medullary nephrocalcinosis except:

A. Bartter's syndrome
B. Prolonged use of furosemide
C. ARPKD (Correct Answer)
D. Hyperoxaluria

Explanation: ***Correct: ARPKD (Autosomal Recessive Polycystic Kidney Disease)*** - **ARPKD** is characterized by bilateral enlarged kidneys with numerous cysts originating from the collecting ducts - Primarily presents with **renal failure, hypertension, and hepatic fibrosis** - **NOT typically associated with medullary nephrocalcinosis** - the cystic changes do not lead to calcium deposition - This is the correct answer as it does NOT cause medullary nephrocalcinosis *Incorrect: Hyperoxaluria* - **Primary hyperoxaluria** is a well-established cause of medullary nephrocalcinosis - Leads to **calcium oxalate crystal deposition** in the renal medulla and tubules - Increased oxalate excretion binds with calcium to form insoluble crystals that deposit in the kidney parenchyma *Incorrect: Bartter's syndrome* - Renal salt-wasting disorder causing polyuria, polydipsia, and electrolyte imbalances - Leads to **hypercalciuria** which causes calcium deposition in the renal medulla - Well-recognized cause of medullary nephrocalcinosis in infants and children *Incorrect: Prolonged use of furosemide* - Loop diuretic that inhibits the Na-K-2Cl cotransporter in the thick ascending limb - Causes increased **urinary calcium excretion (hypercalciuria)** - Calcium precipitates in the renal medulla, leading to nephrocalcinosis - Particularly relevant in premature infants receiving prolonged furosemide therapy

Question 273: A 4-year-old girl presented with urinary infection caused by E. coli, pus cells in the urine, dilation of the left ureter with hydroureter, and a micturating cystourethrogram showing a filling defect in the bladder. What is the likely diagnosis?

A. Sacrococcygeal teratoma (a congenital tumor)
B. Ureterocele (a cystic lesion in the ureter) (Correct Answer)
C. Posterior urethral valves (a condition in males)
D. Vesicoureteral reflux (urine backflow into the ureters)

Explanation: ***Ureterocele (a cystic lesion in the ureter)*** - A **ureterocele** is a congenital malformation where the **distal ureter balloons into the bladder**, creating a filling defect on a micturating cystourethrogram (MCUG). - Its presence can lead to **obstruction** and **stasis**, causing recurrent **urinary tract infections (UTIs)**, **hydroureter**, and **hydronephrosis**. *Sacrococcygeal teratoma (a congenital tumor)* - A **sacrococcygeal teratoma** is a tumor typically found at the base of the spine and is usually **palpable externally** or identified prenatally. - While it can cause urinary symptoms due to compression, it would not directly present as a **filling defect within the bladder** on an MCUG. *Posterior urethral valves (a condition in males)* - **Posterior urethral valves** are obstructive membranes found in the **male urethra**, almost exclusively affecting boys. - This condition is unlikely in a 4-year-old girl and typically causes global bladder and upper tract dilation rather than a discrete filling defect from a ureteral anomaly. *Vesicoureteral reflux (urine backflow into the ureters)* - **Vesicoureteral reflux (VUR)** is the **abnormal backflow of urine from the bladder into the ureters** and often presents with UTIs and hydroureter. - However, VUR itself does not create a **filling defect in the bladder** on an MCUG; rather, the contrast would be seen flowing up the ureter.

Practice by Chapter

Urinary Tract Infections

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Vesicoureteral Reflux

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Glomerulonephritis

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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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Nephrology — MCQs

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