Nephrology Practice Questions

Q: Which of the following is not a cause of renal vein thrombosis?

Chronic kidney disease. **Explanation:** Renal Vein Thrombosis (RVT) occurs due to the classic Virchow’s triad: endothelial injury, stasis of blood flow, and hypercoagulability. **Why Chronic Kidney Disease (CKD) is the correct answer:** CKD itself is not a primary cause of RVT. While patients with advanced CKD may have altered coagulation profiles, the condition does not inherently create the acute hypercoagulable state or mechanical obstruction required to trigger RVT. In fact, RVT is more likely to be a *cause* of sudden renal function deterioration rather than a consequence of long-standing CKD. **Analysis of Incorrect Options:** * **Nephrotic Syndrome:** This is the **most common** cause of RVT in adults (especially Membranous Nephropathy). The loss of anticoagulant proteins (Antithrombin III, Protein S) in urine and increased hepatic synthesis of procoagulants create a profound hypercoagulable state. * **Invasive Renal Cell Carcinoma (RCC):** RCC is notorious for direct vascular invasion. The tumor thrombus can extend into the renal vein and even the inferior vena cava (IVC), causing mechanical obstruction and thrombosis. * **Dehydration during pregnancy:** Pregnancy is a physiological hypercoagulable state. When coupled with severe dehydration (which increases blood viscosity and slows flow), the risk of venous thrombosis, including RVT, increases significantly. **High-Yield Clinical Pearls for NEET-PG:** * **Most common association:** Membranous Nephropathy (up to 35% of patients develop RVT). * **Clinical Presentation:** Acute RVT presents with flank pain, hematuria, and an enlarged kidney; chronic RVT is often asymptomatic. * **Gold Standard Investigation:** Renal Venography (though CT Angiography/Doppler is used first-line). * **Pediatric Link:** In neonates, the most common cause is severe dehydration.

Q: Which of the following statements about polycystic kidney disease is true?

Nephrotic range proteinuria is an uncommon finding.. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common hereditary kidney disease [1]. Understanding its systemic and renal manifestations is crucial for NEET-PG. **Why Option D is Correct:** In ADPKD, the primary pathology involves the formation of cysts from the renal tubules, leading to architectural disruption rather than primary glomerular injury [1]. While mild to moderate proteinuria is common due to tubular dysfunction or secondary focal segmental glomerulosclerosis (FSGS), **nephrotic-range proteinuria (>3.5g/day) is very uncommon**. If present, it usually suggests a superimposed glomerular disease. **Analysis of Incorrect Options:** * **Option A:** ADPKD is primarily **Autosomal Dominant**. While the PKD1 gene is indeed on the short arm of **chromosome 16** (85% of cases), the statement incorrectly labels the inheritance as recessive [1]. Autosomal Recessive PKD (ARPKD) is linked to the PKHD1 gene on chromosome 6. * **Option B:** Unlike other causes of chronic kidney disease (CKD), patients with ADPKD often maintain **higher hemoglobin levels**. This is because the cyst epithelial cells produce **erythropoietin**, which can lead to erythrocytosis or at least delay the onset of anemia. * **Option C:** **Colonic diverticula** are actually the most common extra-renal intestinal manifestation of ADPKD, especially in patients with end-stage renal disease. It is not a rare finding. **High-Yield Clinical Pearls for NEET-PG:** * **Extra-renal manifestations:** Berry aneurysms (Circle of Willis), Hepatic cysts (most common extra-renal site), Mitral Valve Prolapse (MVP), and Pancreatic cysts. * **Diagnosis:** Ultrasonography is the first-line screening tool (Ravine’s criteria). * **Treatment:** Tolvaptan (V2 receptor antagonist) is used to slow the progression of cyst growth and renal decline.

Q: Indications for dialysis after failure of medical management include:

Hypotension. The question asks for the condition that is **NOT** an indication for dialysis. In clinical nephrology, the standard indications for urgent dialysis are remembered by the mnemonic **AEIOU**. 1. **A – Acidosis:** Severe metabolic acidosis (pH 6.5 mEq/L or ECG changes) [2]. 3. **I – Intoxication:** Poisoning with dialyzable substances (e.g., Lithium, Salicylates, Ethylene glycol). 4. **O – Overload:** Refractory hypervolemia/pulmonary edema. 5. **U – Uremia:** Symptomatic uremia causing complications like pericarditis, encephalopathy, or neuropathy [3]. **Why Hypotension is the Correct Answer:** Hypotension is a **contraindication** (specifically for hemodialysis) rather than an indication [1]. Hemodialysis requires stable hemodynamics because the process involves extracorporeal circulation and fluid removal, which can further drop blood pressure. In patients with AKI and hypotension, **CRRT** (Continuous Renal Replacement Therapy) is preferred over standard hemodialysis. **Analysis of Incorrect Options:** * **Hypervolemia (A):** Fluid overload unresponsive to diuretics is a classic indication to prevent pulmonary edema. * **Hyperkalemia (B):** Life-threatening potassium levels are the most common acute indication for dialysis [2]. * **Uremia (D):** Uremic complications (especially pericarditis) are absolute indications for initiating dialysis [3]. **NEET-PG High-Yield Pearls:** * **Absolute Indication:** Uremic pericarditis (due to risk of cardiac tamponade). * **Dialyzable Drugs (SLIME):** **S**alicylates, **L**ithium, **I**sopropanol, **M**ethanol, **E**thylene glycol [1]. * **Preferred Access:** Internal Jugular Vein is preferred over Subclavian to avoid stenosis.

Q: Which of the following tests is most sensitive for detecting early diabetic nephropathy?

Microalbuminuria. **Explanation:** **Microalbuminuria** is the earliest clinical marker of diabetic nephropathy [1]. It refers to the excretion of small amounts of albumin (30–300 mg/day or an albumin-to-creatinine ratio of 30–300 mg/g) that are not detectable by standard urine dipstick tests [1]. In the natural history of diabetic kidney disease, glomerular hyperfiltration occurs first, followed by microalbuminuria. Detecting it at this stage is crucial because it represents a **reversible** phase where strict glycemic control and ACE inhibitors/ARBs can halt or delay progression to overt proteinuria. **Why other options are incorrect:** * **Serum Creatinine:** This is a late marker. It typically remains within the normal range until approximately 50% of the nephron function is lost. * **Creatinine Clearance:** While it measures the Glomerular Filtration Rate (GFR), it is not the most sensitive early marker. In early diabetes, GFR may actually be *increased* (hyperfiltration), making it an unreliable screening tool for early damage compared to albumin leakage. * **Ultrasonography:** USG is used to assess kidney size and rule out obstruction. In diabetic nephropathy, kidneys are characteristically **enlarged** or normal-sized even in advanced stages, but USG cannot detect early functional or microscopic damage. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Start screening for microalbuminuria 5 years after diagnosis in Type 1 DM and **at the time of diagnosis** in Type 2 DM. * **Gold Standard:** The preferred screening method is the **random spot urine albumin-to-creatinine ratio (ACR)**. * **Definition of Overt Nephropathy:** Persistent albuminuria >300 mg/day (Macroalbuminuria). * **Kimmelstiel-Wilson (KW) lesions:** The pathognomonic histological finding (nodular glomerulosclerosis) seen on biopsy [2].

Q: Gordon's syndrome is characterized by all of the following except?

Hypotension. **Explanation:** **Gordon’s Syndrome**, also known as **Pseudohypoaldosteronism Type II (PHA II)**, is a rare genetic disorder caused by mutations in WNK kinases (WNK1 and WNK4). These mutations lead to overactivity of the **Sodium-Chloride Cotransporter (NCC)** in the distal convoluted tubule. 1. **Why Hypotension is the correct answer:** Increased NCC activity leads to excessive reabsorption of sodium and chloride. This results in volume expansion and **Hypertension**, not hypotension. Therefore, Option D is the false statement. 2. **Analysis of other options:** * **Hyperkalemia (Option A):** Increased sodium reabsorption in the distal tubule reduces the delivery of sodium to the collecting duct. This decreases the electrical gradient required for potassium secretion, leading to hyperkalemia [1]. * **Metabolic Acidosis (Option B):** The reduced distal delivery of sodium also impairs hydrogen ion secretion, resulting in a hyperchloremic metabolic acidosis [1]. * **Low Renin and Low Aldosterone (Option C):** The chronic volume expansion caused by salt retention suppresses the Renin-Angiotensin-Aldosterone System (RAAS), leading to low levels of both renin and aldosterone. **Clinical Pearls for NEET-PG:** * **"Mirror Image" of Gitelman Syndrome:** While Gitelman’s presents with hypotension and hypokalemia (due to NCC loss-of-function), Gordon’s presents with hypertension and hyperkalemia (due to NCC gain-of-function). * **Treatment:** It is uniquely sensitive to **Thiazide diuretics**, which directly inhibit the overactive NCC transporter. * **Inheritance:** Usually Autosomal Dominant.

Q: The primary cause of anemia in chronic kidney disease (CKD) is:

Erythropoetin deficiency. **Explanation:** The primary cause of anemia in Chronic Kidney Disease (CKD) is **Erythropoietin (EPO) deficiency** [1]. EPO is a glycoprotein hormone produced by the peritubular interstitial cells in the renal cortex [1]. As CKD progresses, the functional renal mass declines, leading to a significant reduction in EPO production [1]. This results in decreased stimulation of the bone marrow, causing a **normochromic, normocytic anemia**. **Analysis of Options:** * **Option A (Chronic inflammation):** While CKD is a pro-inflammatory state that increases **Hepcidin** levels (leading to "anemia of chronic disease") [2], it is considered a secondary contributing factor, not the primary cause. * **Option B (Iron deficiency):** Common in CKD due to poor GI absorption (high hepcidin) [2] or blood loss during hemodialysis, but it is a complicating factor rather than the fundamental underlying mechanism. * **Option D (Diminished RBC survival):** Uremic toxins can shorten the lifespan of red blood cells (from 120 days to ~70-90 days), but the bone marrow could typically compensate for this if EPO levels were normal. **High-Yield Clinical Pearls for NEET-PG:** 1. **Target Hemoglobin:** In CKD patients on Erythropoiesis-Stimulating Agents (ESAs), the target Hb is **10–11.5 g/dL**. Aiming for >13 g/dL increases the risk of stroke and cardiovascular events (CHOIR and CREATE trials). 2. **Iron Stores:** Before starting ESA therapy, ensure adequate iron stores (**Transferrin saturation >30%** and **Ferritin >500 ng/mL**). 3. **Resistance:** The most common cause of resistance to ESA therapy is **iron deficiency**. 4. **Echocardiography:** Anemia in CKD leads to a high-output state, eventually causing **Left Ventricular Hypertrophy (LVH)**.

Question 1

Which of the following is not a cause of renal vein thrombosis?

Accepted Answer

Chronic kidney disease

Answer

Nephrotic syndrome

Answer

Invasive renal cell carcinoma

Answer

Dehydration during pregnancy

Question 2

What is the most common cause of euvolemic hyponatremia?

Accepted Answer

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Answer

Hypothyroidism

Answer

Hypoadrenalism

Answer

Hyperthyroidism

Question 3

Which of the following statements about polycystic kidney disease is true?

Accepted Answer

Nephrotic range proteinuria is an uncommon finding.

Answer

Polycystic kidney disease is an autosomal recessive disorder linked to a causative gene on the short arm of chromosome 16.

Answer

Erythropoietin levels are often low due to progressive renal failure.

Answer

Colonic diverticular disorder is a rare finding.

Question 4

A 48-year-old male with HIV presents with laboratory findings of low albumin, massive proteinuria, and a renal ultrasound showing large, echogenic kidneys. His blood pressure is normal. Which of the following is the most likely cause?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

Minimal change disease

Answer

IgA nephropathy

Answer

Membranoproliferative glomerulonephritis

Question 5

Indications for dialysis after failure of medical management include:

Accepted Answer

Hypotension

Answer

Hypervolemia

Answer

Hyperkalemia

Answer

Uremia

Question 6

Which of the following tests is most sensitive for detecting early diabetic nephropathy?

Accepted Answer

Microalbuminuria

Answer

Serum Creatinine

Answer

Creatinine clearance

Answer

Ultrasonography

Question 7

A 28-year-old woman presents with a recent episode of coughing up blood, frequent nosebleeds, and decreased urine output. Physical examination revealed an ulcerated nasal mucosa. Urinalysis is positive for protein and red blood cells, consistent with glomerulonephritis. Chest X-ray shows two cavitary lesions, and serology is positive for antineutrophil cytoplasmic antibodies (ANCA). Which of the following is the most likely diagnosis?

Accepted Answer

Wegener's granulomatosis

Answer

Bacterial endocarditis

Answer

Goodpasture's syndrome

Answer

Lupus erythematosus

Question 8

Gordon's syndrome is characterized by all of the following except?

Accepted Answer

Hypotension

Answer

Hyperkalemia

Answer

Metabolic acidosis

Answer

Low renin and low aldosterone

Question 9

A 20-year-old female presents with a blood pressure of 160/110 mm Hg. Clinical examination reveals a bruit in both flanks. Which of the following statements about this patient is not true?

Accepted Answer

The condition is nearly always bilateral

Answer

Enalapril may deteriorate renal function

Answer

The most definitive diagnostic procedure is contrast-enhanced angiography

Answer

Surgical intervention may be used

Question 10

The primary cause of anemia in chronic kidney disease (CKD) is:

Accepted Answer

Erythropoetin deficiency

Answer

Chronic inflammation

Answer

Iron deficiency

Answer

Diminished red blood cell survival

Nephrology — MCQs

Nephrology — MCQs

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