Renal Physiology — MCQs

Renal Physiology Indian Medical PG Practice Questions and MCQs

Question 521: Which of the following is the primary mechanism that drives sodium reabsorption in the proximal tubule?

A. Sodium reabsorption through cotransport with amino acids at the luminal membrane.
B. Sodium reabsorption through cotransport with glucose at the luminal membrane.
C. Sodium reabsorption through countertransport with hydrogen ions at the luminal membrane.
D. Active sodium transport via the Na+-K+-ATPase pump at the basolateral membrane. (Correct Answer)

Explanation: ***Active sodium transport via the Na+-K+-ATPase pump at the basolateral membrane.*** - This pump **actively transports sodium out of the cell** into the interstitial fluid, creating a low intracellular sodium concentration. - The **Na+-K+-ATPase** is the primary driver of sodium reabsorption throughout the nephron, creating the electrochemical gradient for other sodium transporters. *Sodium reabsorption through cotransport with amino acids at the luminal membrane.* - While **sodium-amino acid cotransport** does occur in the proximal tubule, it accounts for only a fraction of total sodium reabsorption. - The primary driving force for this cotransport is the **low intracellular sodium concentration** maintained by the Na+-K+-ATPase. *Sodium reabsorption through cotransport with glucose at the luminal membrane.* - **Sodium-glucose cotransporters (SGLTs)** are crucial for glucose reabsorption in the proximal tubule, moving glucose into the cell along with sodium. - However, glucose cotransport represents a specific mechanism for glucose handling, not the overarching mechanism for sodium reabsorption. *Sodium reabsorption through countertransport with hydrogen ions at the luminal membrane.* - The **Na+-H+ exchanger (NHE3)** is significant for exchanging sodium for hydrogen ions at the luminal membrane in the proximal tubule. - This mechanism is important for **acid-base balance** and some sodium reabsorption, but it is secondary to the Na+-K+-ATPase in driving the overall sodium gradient.

Question 522: What is the normal range of renal blood flow in humans?

A. 1 to 1.2 L/min (Correct Answer)
B. 1.5 to 2 L/min
C. 2 to 2.5 L/min
D. 2.5 to 3 L/min

Explanation: ***1 to 1.2 L/min*** - The **kidneys** receive a substantial portion of the **cardiac output**, typically around 20-25%, to perform their filtration and regulatory functions. - This translates to an absolute renal blood flow of approximately **1000 to 1200 mL/min**, or **1 to 1.2 liters per minute**. - This represents the normal physiological range for healthy adults at rest. *1.5 to 2 L/min* - This range is **higher than the normal physiological** renal blood flow. - While renal blood flow can be influenced by various factors, sustained flow in this range would typically be considered **above the average baseline** for healthy individuals. *2 to 2.5 L/min* - This range significantly **exceeds the typical** renal blood flow observed in healthy humans. - Such high flow rates would be **unusual** and are not representative of normal renal perfusion. *2.5 to 3 L/min* - This range represents an **extremely high** renal blood flow, far beyond what is considered normal. - Sustained perfusion at this level would be **pathological** or indicative of an experimental setting rather than a physiological state.

Question 523: Which of the following is the most accurate measure of Glomerular Filtration Rate (GFR)?

A. Cystatin C
B. Serum creatinine
C. Creatinine Clearance
D. Iothalamate Clearance (Correct Answer)

Explanation: ***Iothalamate Clearance*** - **Iothalamate clearance** is considered the **gold standard** for directly measuring GFR in clinical practice because it is a substance that is freely filtered by the glomerulus and is neither reabsorbed nor secreted by the renal tubules. - This method provides the most accurate and precise assessment of kidney function by quantifying the actual GFR, often used in research settings or for precise diagnosis. - **Note:** Inulin clearance is the traditional reference standard, but iothalamate is more practical and widely used clinically as it can be measured using radioactive or non-radioactive methods. *Serum creatinine* - **Serum creatinine** is a commonly used biomarker but is an **imperfect measure** of GFR because it can be influenced by factors like muscle mass, diet, and certain medications. - Its levels can remain within the normal range even when GFR has significantly decreased, especially in the early stages of kidney disease. *Cystatin C* - **Cystatin C** is a protein produced by most nucleated cells and is also freely filtered by the glomerulus, with less influence from muscle mass and diet compared to creatinine. - While considered a better marker than serum creatinine, it is still an **estimated measure** and is more expensive and less widely available than creatinine, and can be affected by inflammation or thyroid dysfunction. *Creatinine Clearance* - **Creatinine clearance** (often estimated using urine and serum creatinine levels over a timed collection) attempts to approximate GFR but can be **inaccurate** due to incomplete urine collection and tubular secretion of creatinine. - The **creatinine secretion** by the renal tubules leads to an overestimation of the true GFR, making it less accurate than direct measurement methods.

Question 524: What is the primary solute responsible for the hyperosmolarity of the renal medulla?

A. urea
B. K
C. Na (Correct Answer)
D. Cl

Explanation: ***Na*** - **Sodium (Na+), along with chloride**, is the primary solute responsible for establishing the **corticomedullary osmotic gradient** in the renal medulla. - Actively reabsorbed in the **thick ascending limb of the loop of Henle** via the Na-K-2Cl cotransporter, creating hyperosmolarity in the outer medulla. - NaCl accounts for the majority of osmolality in the **outer medulla** and provides the foundation for the countercurrent multiplication system. - While **urea contributes significantly to inner medullary hyperosmolarity** (especially during antidiuresis), **sodium chloride** is considered the **primary driving force** for the overall medullary concentration gradient. *K* - **Potassium (K+)** is primarily involved in maintaining intracellular fluid balance and cellular membrane potentials. - While K+ is reabsorbed in the loop of Henle (via Na-K-2Cl cotransporter), it does not accumulate in the medullary interstitium to contribute significantly to hyperosmolarity. *urea* - **Urea** contributes substantially to hyperosmolarity, particularly in the **inner medulla** (accounting for ~40-50% of inner medullary osmolality). - Through **urea recycling** (collecting duct → medullary interstitium → thin limbs), it enhances urinary concentration, especially during water deprivation. - However, the **initial establishment** of the osmotic gradient depends on **NaCl reabsorption** in the ascending limb, making sodium the primary solute. *Cl* - **Chloride (Cl-)** is reabsorbed together with sodium via the Na-K-2Cl cotransporter in the thick ascending limb. - Functionally, **NaCl works as a unit** to create medullary hyperosmolarity, so chloride and sodium are inseparable in this process. - Among the listed options, **sodium** represents this NaCl contribution as the cation driving active transport.

Question 525: Normal renal threshold for glucose is at plasma glucose level ?

A. 100 mg/dl
B. 200 mg/dl (Correct Answer)
C. 300 mg/dl
D. 400 mg/dl

Explanation: ** _200 mg/dl_ ** - The **renal threshold for glucose** represents the plasma glucose concentration at which the kidneys begin to excrete glucose into the urine. - This typically occurs when the glucose level exceeds the reabsorptive capacity of the renal tubules, usually around **180-200 mg/dL**. * _100 mg/dl_ * - A plasma glucose level of **100 mg/dL** is within the normal fasting range and well below the renal threshold. - At this level, virtually all filtered glucose is reabsorbed by the renal tubules, and no glucose appears in the urine. * _300 mg/dl_ * - A plasma glucose level of **300 mg/dL** is significantly above the renal threshold for glucose. - At this concentration, the kidney's reabsorptive capacity is overwhelmed, leading to substantial **glucosuria** (glucose in the urine). * _400 mg/dl_ * - A plasma glucose level of **400 mg/dL** is severely elevated and far exceeds the renal threshold. - This level would result in significant glucose excretion in the urine and is indicative of uncontrolled hyperglycemia, as seen in **diabetes mellitus**.

Question 526: Which of the following is most important in sodium and water retention ?

A. Renin angiotensin system (Correct Answer)
B. ANP
C. BNP
D. Vasopressin

Explanation: ***Renin angiotensin system*** - The **renin-angiotensin-aldosterone system (RAAS)** is the most important mechanism for **both sodium AND water retention**, which is what the question specifically asks about. - **Aldosterone** directly promotes **sodium reabsorption** in the principal cells of the collecting duct by increasing apical ENaC channels and basolateral Na-K-ATPase pumps. - **Angiotensin II** stimulates sodium reabsorption in the proximal tubule and also stimulates ADH release, contributing to water retention. - When sodium is retained, **water follows passively** due to the osmotic gradient, resulting in effective volume expansion. - RAAS is the primary system activated in states of volume depletion and is most important for combined sodium and water retention. *Vasopressin* - **Vasopressin (ADH)** primarily controls **water retention only** by increasing aquaporin-2 channels in the collecting duct. - While crucial for water balance, it has minimal direct effect on sodium reabsorption. - It causes retention of **free water**, which can actually dilute plasma sodium concentration. - ADH is the answer if the question asked about water retention alone, but not for combined sodium and water retention. *ANP* - **Atrial natriuretic peptide (ANP)** promotes **sodium and water excretion** (natriuresis and diuresis). - Released in response to atrial stretch from volume expansion. - Acts to *oppose* retention mechanisms, making it incorrect for this question. *BNP* - **Brain natriuretic peptide (BNP)** similarly promotes **natriuresis and diuresis**. - Released from ventricular myocytes in response to volume overload. - Like ANP, it acts to *excrete* sodium and water, not retain them.

Question 527: Substance that is completely reabsorbed from the kidney?

A. Na+
B. K+
C. Urea
D. Glucose (Correct Answer)

Explanation: ***Glucose*** - In a healthy individual, **virtually all filtered glucose** is reabsorbed in the proximal convoluted tubule via **sodium-glucose cotransporters (SGLTs)**. - This complete reabsorption ensures that this vital energy source is conserved and not excreted in the urine. *Na+* - While a large proportion of filtered **Na+** is reabsorbed to maintain fluid and electrolyte balance, not all of it is reabsorbed; some is excreted in urine. - The reabsorption of Na+ is **regulated** by hormones like **aldosterone** to fine-tune its excretion based on the body's needs. *K+* - **K+** undergoes both reabsorption and secretion in different parts of the nephron, and its excretion is tightly regulated. - Net reabsorption of K+ is not complete; its handling ensures appropriate plasma levels are maintained for muscle and nerve function. *Urea* - Approximately **50% of filtered urea undergoes reabsorption** in the renal tubules, while the other half is excreted. - Urea reabsorption is important for generating the **medullary osmotic gradient**, which is essential for concentrating urine, but it is never completely reabsorbed.

Question 528: ANP acts at which site?

A. Glomerulus
B. Loop of Henle
C. PCT
D. Collecting duct (Correct Answer)

Explanation: ***Collecting duct*** - Atrial Natriuretic Peptide (**ANP**) exerts its primary effect on the **collecting duct** by inhibiting sodium reabsorption, leading to increased sodium and water excretion (natriuresis and diuresis). - This action helps to reduce blood volume and blood pressure in conditions like **hypervolemia**. *Glomerulus* - While ANP does cause **afferent arteriolar dilation** and **efferent arteriolar constriction**, increasing **glomerular filtration rate** (GFR), its direct tubular action is most prominent in the collecting duct. - The primary function of the glomerulus is **filtration**, influenced by many factors including pressure, but it is not the main site of ANP's direct tubular reabsorptive effects. *Loop of Henle* - The loop of Henle is responsible for establishing the **medullary osmotic gradient** and reabsorbing a significant amount of sodium and water. - ANP has minor effects on the loop of Henle, but its most impactful reabsorptive modulation occurs downstream in the collecting duct. *PCT* - The **proximal convoluted tubule (PCT)** is where the bulk of reabsorption of filtered substances (e.g., glucose, amino acids, most sodium and water) occurs. - ANP has very little direct influence on the reabsorptive processes of the PCT.

Question 529: Which substrate is both secreted and filtered by the kidneys?

A. Glucose
B. Urea
C. Uric Acid (Correct Answer)
D. Na+

Explanation: ***Uric Acid*** - **Uric acid** is freely **filtered** at the glomerulus. - It undergoes both **secretion** and reabsorption in the renal tubules, making it a substrate that is both secreted and filtered. *Glucose* - **Glucose** is freely **filtered** at the glomerulus but is almost completely **reabsorbed** in the proximal tubule under normal physiological conditions. - It is not actively secreted by the renal tubules. *Urea* - **Urea** is freely **filtered** at the glomerulus. - It undergoes **reabsorption** (especially in the medullary collecting duct) and some facilitated diffusion, but significant active secretion is not its primary handling mechanism. *Na+* - **Sodium (Na+)** is freely **filtered** at the glomerulus in large quantities. - Its renal handling is dominated by extensive **reabsorption** throughout the nephron, which is crucial for fluid balance and blood pressure regulation, with no active secretion.

Question 530: What happens to the concentration of inulin as fluid passes through the Proximal Convoluted Tubule (PCT)?

A. Concentration of inulin increases (Correct Answer)
B. Concentration of urea remains constant
C. Concentration of HCO3- increases
D. Concentration of Na+ decreases

Explanation: ***Concentration of inulin increases*** - Inulin is **freely filtered** at the glomerulus and is neither reabsorbed nor secreted along the renal tubule, making it an excellent marker for **glomerular filtration rate (GFR)**. - As water is reabsorbed from the PCT, the volume of tubular fluid decreases, causing the concentration of **unreabsorbed solutes**, like inulin, to increase. *Concentration of urea remains constant* - Urea is **reabsorbed** along the tubule, though passively; its concentration typically **increases** initially in the PCT due to water reabsorption, but then decreases as some is reabsorbed. - The statement is incorrect because urea concentration changes significantly throughout the nephron, particularly increasing as water is reabsorbed and then decreasing with some reabsorption. *Concentration of HCO3- increases* - The majority (approximately 80-90%) of **bicarbonate (HCO3-)** is reabsorbed in the PCT, primarily through its conversion to CO2 within the tubular lumen and then back to HCO3- intracellularly. - Therefore, the concentration of HCO3- in the tubular fluid actually **decreases** significantly as fluid passes through the PCT. *Concentration of Na+ decreases* - **Sodium (Na+)** is actively reabsorbed along the entire nephron, with about 65-70% reabsorbed in the PCT. - While Na+ is reabsorbed, water follows passively, so its concentration in the tubular fluid remains relatively **iso-osmotic** with plasma, meaning its concentration does not significantly decrease as fluid passes through the PCT, remaining fairly constant.

Practice by Chapter

Renal Blood Flow and Glomerular Filtration

Practice Questions

Tubular Reabsorption and Secretion

Practice Questions

Concentration and Dilution of Urine

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Acid-Base Regulation by the Kidneys

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Sodium and Water Balance

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Potassium Regulation

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Calcium and Phosphate Handling

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Micturition Physiology

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Renal Function Tests

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Integrative Responses to Fluid Challenges

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