Nephrology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Nephrology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nephrology Indian Medical PG Question 1: Which of following is not seen in nephritic syndrome -
- A. HTN
- B. Hypocholestremia (Correct Answer)
- C. Hematuria
- D. Edema
Nephrology Explanation: ***Hypocholestremia***
- **Hypocholesterolemia** (low cholesterol) is not characteristic of nephritic syndrome; rather, **hypercholesterolemia** is a feature often associated with nephrotic syndrome [1] due to increased hepatic lipoprotein synthesis.
- Nephritic syndrome is primarily associated with **inflammation** and **glomerular damage**, leading to hematuria, proteinuria, and renal impairment [1], without directly causing hypocholesterolemia.
*HTN*
- **Hypertension** is a common finding in nephritic syndrome due to fluid retention [2] and activation of the **renin-angiotensin-aldosterone system** (RAAS) resulting from impaired renal function.
- The inflammatory damage to the glomeruli reduces the kidney's ability to excrete sodium and water, contributing to elevated blood pressure.
*Hematuria*
- **Hematuria** (blood in the urine), often macroscopic or microscopic, is a hallmark of nephritic syndrome due to the inflammatory damage to the **glomerular basement membrane**, allowing red blood cells to leak into the urine [1].
- The presence of **red blood cell casts** in the urine strongly indicates a nephritic process.
*Edema*
- **Edema** (swelling), particularly periorbital and peripheral, is frequently observed in nephritic syndrome as a result of **sodium and water retention** by the impaired kidneys [1][2].
- This fluid overload occurs even with relatively modest proteinuria, differentiating it from the more severe edema seen in nephrotic syndrome which is primarily due to hypoalbuminemia.
Nephrology Indian Medical PG Question 2: The best response to steroids is observed with –
- A. Focal glomerulonephritis
- B. Lipoid nephrosis (Correct Answer)
- C. Membranous GN
- D. Membranoproliferative GN
Nephrology Explanation: ***Lipoid nephrosis***
- Also known as **Minimal Change Disease**, it is the most common cause of **nephrotic syndrome in children** and responds very well to steroid therapy [1].
- The disease involves effacement of podocyte foot processes without significant visible damage under light microscopy, leading to increased glomerular permeability to protein, but the condition is highly responsive to **immunosuppression with corticosteroids** [1].
*Focal glomerulonephritis*
- This term usually refers to **Focal Segmental Glomerulosclerosis (FSGS)**, which typically has a much poorer response to steroids compared to minimal change disease [1].
- While some variants of FSGS can respond to steroids, the response rate is significantly lower than that seen in lipoid nephrosis, and it often progresses to **end-stage renal disease**.
*Membranous GN*
- **Membranous glomerulonephritis** has a variable response to steroids, with some patients achieving remission but many requiring more aggressive immunosuppression or demonstrating steroid resistance.
- It is characterized by **subepithelial immune complex deposition** and glomerular basement membrane thickening, which is a different pathological process from lipoid nephrosis.
*Membranoproliferative GN*
- **Membranoproliferative glomerulonephritis (MPGN)** typically responds poorly to corticosteroids and often requires more potent immunosuppressive agents or specific therapies depending on its underlying cause (e.g., complement-mediated).
- MPGN involves mesangial and endothelial proliferation, along with characteristic changes in the glomerular basement membrane, indicating a more severe and less steroid-responsive form of glomerular injury.
Nephrology Indian Medical PG Question 3: Crescent forming glomerulonephritis is:-
- A. RPGN (Correct Answer)
- B. MCN
- C. All of the options
- D. MPGN
Nephrology Explanation: ***RPGN***
- **Rapidly progressive glomerulonephritis (RPGN)** is a clinical syndrome characterized by a rapid decline in **renal function** over weeks to months, often due to severe glomerular injury.
- The hallmark **histological feature** of RPGN is the formation of **crescents** in more than 50% of the glomeruli, which are proliferations of parietal epithelial cells and infiltrating macrophages [1].
*MCN*
- **Minimal change nephropathy (MCN)** is characterized by **diffuse effacement of podocyte foot processes** on electron microscopy, with normal findings on light microscopy.
- It typically presents as **nephrotic syndrome** and does not involve crescent formation.
*MPGN*
- **Membranoproliferative glomerulonephritis (MPGN)** involves thickening of the glomerular basement membrane with a "tram-track" appearance and mesangial proliferation [2].
- While MPGN can occasionally have focal crescents in some cases, **crescent formation is not a defining or characteristic feature** of MPGN [2].
- MPGN typically presents with nephritic-nephrotic syndrome.
*All of the options*
- This option is incorrect because only RPGN is characterized by **crescent formation** as a defining feature.
- MCN does not involve crescents, and MPGN does not characteristically present with extensive crescent formation, thus invalidating this choice.
**References:**
[1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 528-529.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 925-926.
Nephrology Indian Medical PG Question 4: Podocytes are seen in -
- A. Bowman's capsule (Correct Answer)
- B. Proximal convoluted tubule
- C. Distal convoluted tubule
- D. Collecting tubule of the kidney
Nephrology Explanation: **Bowman's capsule**
- **Podocytes** are specialized epithelial cells that form the **visceral layer** of Bowman's capsule. They have foot processes (pedicels) that interdigitate to form slit diaphragms, which are crucial for the **filtration barrier** of the glomerulus [1].
- These cells facilitate the selective passage of water and small solutes from the blood into Bowman's space, while preventing the filtration of large proteins and blood cells.
*Proximal convoluted tubule*
- The **proximal convoluted tubule** is primarily involved in the **reabsorption** of essential nutrients, ions, and water from the filtrate back into the bloodstream [1].
- Its cells are characterized by a **brush border** (microvilli) and numerous mitochondria, indicating high metabolic activity, and are not podocytes [1].
*Distal convoluted tubule*
- The **distal convoluted tubule** plays a role in fine-tuning the reabsorption of ions and water, under the influence of hormones like **aldosterone** and **ADH**.
- Its cells lack the specialized foot processes and filtration function characteristic of podocytes.
*Collecting tubule of the kidney*
- The **collecting tubule** (or collecting duct) is involved in regulating water reabsorption and acid-base balance, responding to **ADH** to concentrate urine.
- Its epithelial cells are principal cells and intercalated cells, which are different in structure and function from podocytes.
Nephrology Indian Medical PG Question 5: A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath, with a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, with a maculopapular rash on her face, JVP of 4 cm, normal heart sounds, clear lungs, and pedal and periorbital edema. Her creatinine is very high, and a urinalysis reveals many RBCs and RBC casts. For this patient with glomerulonephritis, select the most likely diagnosis on renal biopsy.
- A. diffuse proliferative GN (Correct Answer)
- B. crescentic glomerulonephritis
- C. focal segmental glomerulosclerosis
- D. membranoproliferative glomerulonephritis
Nephrology Explanation: ***diffuse proliferative GN***
- This patient's constellation of symptoms, including **facial rash, hair loss, arthralgias, thrombocytopenia**, and **renal involvement** (elevated creatinine, RBCs, and RBC casts), strongly points to **systemic lupus erythematosus (SLE)** [2], [4].
- **Diffuse proliferative glomerulonephritis (DPGN)** is the **most common and severe form of lupus nephritis** (WHO Class IV), characterized by widespread involvement of glomeruli with significant proliferation and inflammation [1].
- On renal biopsy, DPGN shows **subendothelial immune complex deposits** ("wire loop" lesions) and **proliferation of mesangial and endothelial cells** [1].
*crescentic glomerulonephritis*
- While crescentic glomerulonephritis can cause a rapid decline in renal function and is associated with some autoimmune conditions, it is a **histological pattern** seen in various rapidly progressive glomerular diseases, not a specific underlying disease entity itself [3].
- The clinical picture here strongly suggests SLE, and while crescent formation can occur in severe lupus nephritis, **DPGN is the more specific and prevalent form** of nephritis for this presentation [1].
*focal segmental glomerulosclerosis*
- **Focal segmental glomerulosclerosis (FSGS)** is a common cause of **nephrotic syndrome** and can lead to renal failure, but it is **not typically associated with the systemic symptoms** (rash, arthralgias, hair loss, thrombocytopenia) seen in this patient, which are characteristic of SLE.
- While FSGS can rarely occur in lupus nephritis, it is less common than DPGN and lacks the widespread immune-mediated systemic features.
*membranoproliferative glomerulonephritis*
- **Membranoproliferative glomerulonephritis (MPGN)** can present with nephritic or nephrotic syndrome and may be associated with some autoimmune conditions like **cryoglobulinemia** or chronic infections (Hepatitis C).
- However, the overall clinical context of **systemic inflammation, multi-organ involvement** (rash, arthralgias, thrombocytopenia), and the characteristic findings strongly favor **lupus nephritis**, for which **DPGN is the most characteristic finding** [1].
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 232.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 230-232.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 528-529.
[4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 230.
More Nephrology Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
