Nephrology Practice Questions

Q: Which of the following symptoms is least likely to be associated with hyponatremia?

Myalgia. Myalgia - While muscle cramps can occur with electrolyte imbalances, generalized myalgia (muscle pain) is not a typical or primary symptom of hyponatremia. - Hyponatremia primarily affects neurological function due to osmotic shifts in the brain. anorexia - Anorexia (loss of appetite) is a common, non-specific symptom of many metabolic disturbances, including hyponatremia, and often accompanies nausea and vomiting. - It arises from the general malaise and gastrointestinal upset associated with the condition. Convulsions - Convulsions are a severe neurological symptom of acute and profound hyponatremia, resulting from cerebral edema and increased intracranial pressure [1]. - This occurs when the brain swells due to the osmotic shift of water into brain cells. Drowsiness - Drowsiness is a frequent neurological manifestation of hyponatremia, indicative of altered mental status [1]. - It reflects impaired brain function due to the osmotic disturbances and potential cerebral edema [1].

Q: Which disease does not recur in the kidney after a renal transplant?

Alport syndrome. **Alport syndrome** * **Alport syndrome** is a genetic disorder affecting type IV collagen, primarily in the kidney; recurrence is not observed in a renal allograft because the transplanted kidney provides new, healthy type IV collagen [2]. * The disease is due to a genetic defect in the recipient's collagen genes, so the transplanted kidney, which is genetically distinct, is not susceptible to the same primary disease process [2]. *Amyloidosis* * **Amyloidosis** can recur in the transplanted kidney, as it is a systemic disease where abnormal proteins continue to deposit in various organs, including the new kidney. * The underlying cause of amyloid production is typically not cured by a kidney transplant, making the new organ vulnerable to recurrence. *Goodpasture's syndrome* * **Goodpasture's syndrome** is an autoimmune disease where antibodies target type IV collagen in the glomerular basement membrane; these autoantibodies can attack the new kidney if they are still present at the time of transplant or re-emerge [1]. * Recurrence is a significant concern, although it can often be prevented by ensuring the patient is antibody-negative before transplantation and through immunosuppression [1]. *Diabetic nephropathy (due to uncontrolled diabetes)* * **Diabetic nephropathy** almost invariably recurs in the transplanted kidney if the recipient's diabetes remains uncontrolled after transplantation. * The metabolic environment, characterized by hyperglycemia, directly contributes to the damage of the new kidney, leading to the development of diabetic nephropathy over time.

Q: Which of the following is NOT a common cause of acute renal failure?

Chronic kidney disease due to analgesic nephropathy. Chronic kidney disease due to analgesic nephropathy - This is a cause of chronic kidney disease, characterized by gradual, irreversible kidney damage over a long period due to prolonged use of certain analgesics. [1] - It does not present as an acute, sudden decline in kidney function, which is the hallmark of acute renal failure. [1] Acute pyelonephritis - Severe cases of acute pyelonephritis (kidney infection) can lead to acute kidney injury due to sepsis, inflammation, and potential obstruction. [1] - The systemic inflammatory response and direct tissue damage can impair kidney function rapidly. [1] Acute kidney injury from snakebite - Snake envenomation can cause acute kidney injury through various mechanisms, including hemolysis, rhabdomyolysis, direct nephrotoxicity, and systemic hypotension. - These effects can lead to rapid and severe kidney damage. Acute kidney injury due to rhabdomyolysis - Rhabdomyolysis involves the breakdown of skeletal muscle tissue, releasing large amounts of myoglobin into the bloodstream. [1] - Myoglobin is toxic to the renal tubules, leading to acute tubular necrosis and rapid onset of acute kidney injury. [1]

Q: Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Normal C3 level. ***Normal C3 level*** - In Post-streptococcal glomerulonephritis (PSGN), **C3 levels are typically decreased** due to complement consumption during the inflammatory process. [1] - A **normal C3 level** would not be consistent with PSGN, as it suggests no significant complement activation. *Increased urea* - Increased urea can occur due to **impaired renal function**, which is common in PSGN due to glomerular inflammation. [1] - It's a typical finding reflecting the kidneys' inability to excrete waste products properly. *HTN* - Hypertension is frequently associated with PSGN due to **volume overload** and activation of the renin-angiotensin system. [1] [2] - It is a common clinical feature that results from increased fluid retention. *Increased creatinine* - Increased creatinine levels indicate **renal impairment**, which is characteristic of PSGN as kidney function is affected during this condition. [1] - This finding highlights the reduction in glomerular filtration rate (GFR), typical in glomerulonephritis. [2]

Q: What does the measurement of Glomerular Filtration Rate (GFR) help determine in kidney function?

Stage of kidney disease. Stage of kidney disease - A low GFR indicates impaired kidney function, helping to classify the severity and stage of chronic kidney disease (CKD) [1]. - Monitoring GFR over time is crucial for assessing disease progression and guiding treatment strategies [1]. *Heart rate* - Heart rate is a measure of cardiac function and is not directly assessed by GFR. - Kidney function can indirectly affect heart rate over time (e.g., in advanced kidney disease with fluid overload), but GFR itself doesn't measure it. *Recovery from shock* - While kidney function is important during shock, GFR primarily measures the kidney's filtration capacity at a given moment. - Recovery from shock involves many physiological parameters beyond just kidney filtration, such as blood pressure and organ perfusion. *Blood volume* - Blood volume is regulated by many mechanisms, including hormonal systems (e.g., renin-angiotensin-aldosterone system) and fluid intake/excretion. - Although kidneys play a role in fluid balance, GFR specifically measures the rate of filtration of blood plasma, not the overall blood volume [1].

Q: Which of the following is not a feature of distal renal tubular acidosis

Hyperkalemia. ***Hyperkalemia*** - **Distal renal tubular acidosis (dRTA)** is characterized by impaired acid excretion, leading to metabolic acidosis. The impaired excretion of acid is often accompanied by impaired potassium secretion, resulting in **hypokalemia**, not hyperkalemia. - While hyperkalemia is a feature of **type 4 RTA**, which is characterized by hypoaldosteronism or renal tubular unresponsiveness to aldosterone, it is not a feature of **distal RTA (type 1)**. [1] *Normal anion gap* - **Distal RTA** is a form of **normal anion gap metabolic acidosis**, also known as **hyperchloremic metabolic acidosis**. [1] - The anion gap is calculated as [Na+] - ([Cl-] + [HCO3-]), and in dRTA, the bicarbonate loss is compensated by an increase in chloride, maintaining a normal anion gap. *Renal hypercalciuria* - **Distal RTA** is associated with **impaired acid excretion**, which leads to chronic metabolic acidosis. - This **acidosis** promotes the dissolution of bone, releasing calcium, and decreases tubular reabsorption of calcium, resulting in **hypercalciuria**. *Alkaline urine* - In **distal RTA**, the distal tubule is unable to acidify the urine due to a defect in hydrogen ion secretion. - This leads to a persistent **urine pH > 5.5** (typically alkaline or inappropriately normal) despite systemic acidosis, making it a key diagnostic feature. [1]

Q: Which of the following is a sign of Bartter's syndrome?

Low potassium levels. ***Low potassium levels*** * Bartter's syndrome is characterized by **renal salt wasting** and subsequent volume depletion, which activates the **renin-angiotensin-aldosterone system** [1]. * This leads to increased aldosterone levels, causing increased potassium secretion in the collecting ducts, resulting in **hypokalemia** [2]. *High potassium levels* * **Hyperkalemia** is not a feature of Bartter's syndrome; instead, it is marked by persistent potassium loss [1]. * Conditions causing hyperkalemia typically involve impaired renal potassium excretion or increased potassium release from cells. *Acidic blood* * Bartter's syndrome usually presents with **metabolic alkalosis** due to hydrogen ion loss in the urine, not acidic blood [2]. * Acidic blood (**acidemia**) would imply a state of respiratory or metabolic acidosis. *High sodium levels* * Bartter's syndrome primarily involves **renal salt wasting**, leading to **normal or low sodium levels** rather than high sodium levels. * High sodium levels (**hypernatremia**) are usually due to inadequate water intake or excessive water loss.

Q: Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

End stage Renal disease. ***End stage Renal disease*** - Calciphylaxis frequently occurs in patients with **end-stage renal disease**, primarily associated with **secondary hyperparathyroidism** [1] and **calcium-phosphate imbalance**. - It leads to **cutaneous ischemia** and necrosis, often requiring aggressive management due to its high **mortality rate**. *Parathyroidectomy* - While parathyroidectomy may affect calcium levels, it is not directly linked to calciphylaxis. - Calciphylaxis more commonly develops due to underlying **chronic renal failure** [1] rather than surgical interventions. *Hyperthyroidism* - Hyperthyroidism primarily causes symptoms related to metabolism, **thyroid hormone excess**, and does not lead to calciphylaxis. - There is no direct correlation between hyperthyroid states and the pathophysiology of calciphylaxis. *Medullary carcinoma thyroid* - This condition involves **medullary thyroid carcinoma**, associated with calcitonin production and does not cause calciphylaxis. - Patients typically experience **thyroid-related symptoms** rather than the vascular complications seen in calciphylaxis.

Q: Interstitial nephritis is common with

Nonsteroidal anti-inflammatory drugs (NSAIDs). ***Nonsteroidal anti-inflammatory drugs (NSAIDs)*** - **NSAIDs** are a known cause of **acute interstitial nephritis** (AIN), an inflammatory condition affecting the tubules and interstitium of the kidney [1]. - This adverse reaction often manifests as **fever**, **rash**, **eosinophilia**, and **acute kidney injury**, typically 7-10 days after drug exposure. *Black water fever* - **Blackwater fever** is a severe complication of **malaria**, characterized by massive hemolysis leading to **hemoglobinuria**, which darkens the urine. - It primarily causes **acute kidney injury** through **acute tubular necrosis** due to hemoglobin precipitation in the renal tubules, not interstitial nephritis. *Rhabdomyolysis* - **Rhabdomyolysis** involves the breakdown of muscle tissue, releasing myoglobin into the bloodstream, which is toxic to the kidneys. [1] - This condition leads to **acute kidney injury** predominantly through **acute tubular necrosis** due to myoglobin casts obstructing tubules and direct toxicity, not interstitial inflammation. *Tumor lysis syndrome* - **Tumor lysis syndrome** occurs when large numbers of cancer cells are rapidly destroyed, releasing intracellular contents like potassium, phosphate, and nucleic acids. - The high concentration of **uric acid** and **phosphate** in the renal tubules leads to crystal formation, causing **acute kidney injury** primarily through **acute uric acid nephropathy** and **phosphate nephropathy**, rather than interstitial nephritis [1].

Question 1

Which of the following symptoms is least likely to be associated with hyponatremia?

Accepted Answer

Myalgia

Answer

anorexia

Answer

Drowsiness

Answer

Convulsions

Question 2

Which disease does not recur in the kidney after a renal transplant?

Accepted Answer

Alport syndrome

Answer

Amyloidosis

Answer

Goodpasture's syndrome

Answer

Diabetic nephropathy (due to uncontrolled diabetes)

Question 3

Which of the following is NOT a common cause of acute renal failure?

Accepted Answer

Chronic kidney disease due to analgesic nephropathy

Answer

Acute pyelonephritis

Answer

Acute kidney injury from snakebite

Answer

Acute kidney injury due to rhabdomyolysis

Question 4

Which of the following is a cause of post-transplantation hypertension? I. Rejection II. Cyclosporine nephrotoxicity III. Renal transplant artery stenosis (RTAS) IV. Recurrent disease in the allograft. Select the correct option.

Accepted Answer

All of the options are correct causes of post-transplantation hypertension.

Answer

None of the above are correct causes.

Answer

I, II, and IV are correct causes.

Answer

I and III are correct causes.

Question 5

Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Accepted Answer

Normal C3 level

Answer

HTN

Answer

Increased urea

Answer

Increased creatinine

Question 6

What does the measurement of Glomerular Filtration Rate (GFR) help determine in kidney function?

Accepted Answer

Stage of kidney disease

Answer

Heart rate

Answer

Recovery from shock

Answer

Blood volume

Question 7

Which of the following is not a feature of distal renal tubular acidosis

Accepted Answer

Hyperkalemia

Answer

Renal hypercalciuria

Answer

Normal anion gap

Answer

Alkaline urine

Question 8

Which of the following is a sign of Bartter's syndrome?

Accepted Answer

Low potassium levels

Answer

High potassium levels

Answer

Acidic blood

Answer

High sodium levels

Question 9

Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

Accepted Answer

End stage Renal disease

Answer

Parathyroidectomy

Answer

Medullary carcinoma thyroid

Answer

Hyperthyroidism

Question 10

Interstitial nephritis is common with

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer

Black water fever

Answer

Rhabdomyolysis

Answer

Tumor lysis syndrome

Nephrology — MCQs

Nephrology — MCQs

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