Nephrology — MCQs
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What is the most common presentation for IgA nephropathy?
What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?
In which of the following conditions is hypomagnesemia not typically observed?
Distal renal tubular acidosis is associated with:
What is the frequency of renal involvement in Henoch-Schönlein purpura (HSP)?
Most common cause of nephrotic syndrome in adults?
Renal vein thrombosis is associated with all of the following conditions except:
In diabetic nephropathy, all of the following are true, except:
Which of the following is NOT a feature of hypernatremia?
Which is the most common symptom of medullary sponge kidney disease?
Nephrology Indian Medical PG Practice Questions and MCQs
Question 811: What is the most common presentation for IgA nephropathy?
- A. Nephritic syndrome
- B. Nephrotic syndrome
- C. Microscopic hematuria
- D. Repeated gross hematuria (Correct Answer)
Explanation: ***Repeated gross hematuria*** - The hallmark of **IgA nephropathy** is recurrent episodes of **gross hematuria**, particularly following **respiratory infections** [1]. - It is often associated with **renal impairment** but can present initially with **visible blood** in the urine [1]. *Nephritic syndrome* - While IgA nephropathy can lead to nephritic features, it does not commonly present primarily as **nephritic syndrome**, which includes hypertension and edema. - Nephritic syndrome is characterized by significant **proteinuria** and acute renal failure, rather than the classic presentation of hematuria [2]. *Microscopic hematuria* - Although **microscopic hematuria** can occur in IgA nephropathy, it is not the most common and noticeable presentation; **gross hematuria** is more characteristic [1]. - Microscopic hematuria lacks the acute visual symptoms seen in cases proving the diagnosis. *Nephritic syndrome* - This option is a repetition of and does not provide any additional unique characteristics specific to **IgA nephropathy**. - It shares the same clinical features discussed previously and is thus not representative of the most common presentation.
Question 812: What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?
- A. Oral Iron Therapy
- B. Erythropoietin Stimulating Agents (Correct Answer)
- C. Blood transfusion
- D. Androgenic Steroids
Explanation: ***Erythropoietin Stimulating Agents*** - **Erythropoietin Stimulating Agents (ESAs)** are the cornerstone of anemia treatment in CRF because the primary cause of anemia in these patients is inadequate production of **endogenous erythropoietin** by the damaged kidneys [1]. - ESAs stimulate the bone marrow to produce red blood cells, effectively reversing the anemia and improving symptoms like fatigue and exercise intolerance [1]. *Oral Iron Therapy* - While **iron deficiency** often coexists with **anemia of chronic disease** in CRF patients, oral iron alone is usually insufficient to correct the anemia; it only addresses the iron component. - Many CRF patients have **functional iron deficiency** due to chronic inflammation, which impairs iron utilization, making oral iron less effective even with adequate stores. *Blood transfusion* - **Blood transfusions** provide a rapid increase in hemoglobin but are not the preferred long-term treatment for anemia in CRF due to risks of **iron overload**, **alloreactions**, and potential sensitization, which can complicate future transplantation. - Transfusions are typically reserved for acute, severe anemia or specific circumstances where ESAs are ineffective or contraindicated. *Androgenic Steroids* - **Androgenic steroids** can stimulate erythropoiesis, but their use is limited due to significant side effects such as **hepatotoxicity**, **virilization**, and **cardiac complications**, making them a less favorable option compared to ESAs. - They are considered a secondary or tertiary option, often in patients unresponsive to primary treatments or when other options are exhausted.
Question 813: In which of the following conditions is hypomagnesemia not typically observed?
- A. Diarrhea
- B. Gitelman syndrome
- C. Diabetes mellitus (Correct Answer)
- D. Bartter syndrome
Explanation: Diabetes mellitus - While hypomagnesemia can occur in poorly controlled diabetes due to osmotic diuresis, it is not a typical or defining feature of the condition itself in the same way as other options. - Many individuals with controlled diabetes may have normal magnesium levels, and it's often associated with complications rather than the primary disease process. Diarrhea - Chronic or severe diarrhea leads to significant gastrointestinal losses of electrolytes, including magnesium. - This is a common cause of hypomagnesemia, as the body loses fluids and minerals before they can be absorbed. Gitelman syndrome - This is a renal tubular disorder characterized by a defect in the thiazide-sensitive Na-Cl cotransporter in the distal convoluted tubule. - It leads to hypomagnesemia (due to increased renal excretion) and hypokalemia, along with metabolic alkalosis. Bartter syndrome - This syndrome involves a defect in the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle. - It results in significant renal wasting of magnesium [1], leading to hypomagnesemia, along with hypokalemia and metabolic alkalosis.
Question 814: Distal renal tubular acidosis is associated with:
- A. Hypocitraturia
- B. Oxalate stones
- C. Calcium stones (Correct Answer)
- D. Uric acid stones
Explanation: ***Calcium stones*** - Distal renal tubular acidosis (Type 1 RTA) causes metabolic acidosis due to impaired distal tubular **hydrogen ion secretion**. - This leads to **increased urinary calcium excretion** (hypercalciuria) and decreased urinary citrate, creating an environment favorable for the formation of **calcium phosphate renal stones**. *Oxalate stones* - While oxalate is a component of some calcium stones (calcium oxalate), **primary hyperoxaluria** or dietary excess of oxalate are the main causes, not directly distal RTA. - Distal RTA specifically promotes **calcium phosphate stone formation** due to pH changes and hypercalciuria. *Hypocitraturia* - **Hypocitraturia** is indeed a feature of distal RTA as the kidney attempts to excrete acid by reabsorbing citrate, making the urine less inhibitory to stone formation. - However, the most direct and common clinically observed consequence in stone formation is the development of **calcium stones**, as hypocitraturia combined with hypercalciuria facilitates their formation. *Uric acid stones* - **Uric acid stones** typically form in persistently **acidic urine** and are associated with conditions like gout or myeloproliferative disorders. - While distal RTA results in systemic acidosis, the urine pH in distal RTA is typically **alkaline or inappropriately neutral**, which does not favor uric acid stone formation.
Question 815: What is the frequency of renal involvement in Henoch-Schönlein purpura (HSP)?
- A. 25-35%
- B. 60-80%
- C. 40-60% (Correct Answer)
- D. 5-10%
Explanation: ***40-60%*** - Renal involvement in Henoch-Schönlein purpura (HSP) is common, affecting approximately **40-60% of patients**. - Renal complications can range from microscopic hematuria to proteinuria, and in some cases, **progressive glomerulonephritis** leading to renal failure. *25-35%* - This percentage underestimates the actual frequency of **renal complications** in HSP. - While mild symptoms might fall within this range, a broader spectrum of renal manifestations is observed. *60-80%* - This percentage overestimates the reported frequency of **renal involvement** in HSP. - Although it is common, a majority of patients do not develop renal symptoms. *5-10%* - This range is too low for the frequency of **renal involvement** in HSP. - Even though it's benign in many cases, some form of renal pathology like hematuria is quite frequent.
Question 816: Most common cause of nephrotic syndrome in adults?
- A. Minimal change disease
- B. Acute GN
- C. Membranous glomerulonephritis
- D. Focal Segmental Glomerulosclerosis (FSGS) (Correct Answer)
Explanation: ***Membranous glomerulonephritis*** - Membranous glomerulonephritis is the **most common cause of nephrotic syndrome** in adults, often associated with **autoimmune diseases** or certain medications. [1] - Patients typically present with **heavy proteinuria**, edema, and a normal renal function in early stages. *Focal GN* - Focal glomerulosclerosis typically affects young individuals and may not usually present as nephrotic syndrome. - It is associated with **obesity** and **HIV**, often leading to more significant renal impairment compared to membranous glomerulonephritis. [1] *Acute GN* - Acute glomerulonephritis generally presents with **hematuria**, **hypertension**, and **renal failure**, rather than nephrotic syndrome. [1] - It can have different causes, such as infections or systemic diseases, but is not the primary condition leading to nephrotic syndrome in adults. *Minimal change disease* - Minimal change disease is more prevalent in **children** [1], and while it can occur in adults, it is less common as a cause of nephrotic syndrome in this demographic. - It is characterized by **responsive edema** to steroids, but its incidence is not as high as membranous glomerulonephritis in adults.
Question 817: Renal vein thrombosis is associated with all of the following conditions except:
- A. Nephrotic syndrome
- B. Dehydration
- C. Sickle cell anemia
- D. Trauma (Correct Answer)
Explanation: **Trauma** - While trauma to the abdomen can cause **renal injury** and other vascular issues, isolated **renal vein thrombosis** is not a common direct association or complication [1]. - Renal vein thrombosis typically results from conditions that lead to a **hypercoagulable state** or local vascular stasis. *Sickle cell anemia* - Individuals with **sickle cell anemia** are prone to **vaso-occlusive crises** from sickled red blood cells obstructing blood flow [2]. - This can lead to **renal medullary ischemia** and infarction, making them highly susceptible to **renal vein thrombosis**. *Nephrotic syndrome* - **Nephrotic syndrome** is a significant risk factor for **renal vein thrombosis** due to the urinary loss of **antithrombin III**, a natural anticoagulant. - This loss creates a **hypercoagulable state**, increasing the likelihood of thrombus formation in renal veins. *Dehydration* - Severe **dehydration** leads to **hemoconcentration** (increased blood viscosity) and reduced blood flow. - These factors promote a **hypercoagulable state**, increasing the risk of thrombotic events, including **renal vein thrombosis**, especially in vulnerable populations like infants or the elderly.
Question 818: In diabetic nephropathy, all of the following are true, except:
- A. Micro and macro albuminuria can occur
- B. ACE inhibitors can reduce micro albuminuria
- C. Cardiovascular abnormalities can occur
- D. Insulin requirement becomes high (Correct Answer)
Explanation: ***Insulin requirement becomes high*** - In advanced diabetic nephropathy, especially when renal function significantly declines, the **kidneys' ability to metabolize and excrete insulin decreases**. - This leads to a **prolonged half-life of insulin in the body**, often resulting in a *reduction* in required insulin doses as the disease progresses, rather than an increase. *Cardiovascular abnormalities can occur* - **Diabetic nephropathy** is a major risk factor for developing **cardiovascular disease**, including **hypertension**, atherosclerosis, and heart failure [3]. - The coexistence of these conditions accelerates disease progression and increases morbidity and mortality in diabetic patients [2]. *Micro and macro albuminuria can occur* - **Diabetic nephropathy** characteristically begins with **microalbuminuria** (small amounts of albumin in the urine), which is an early sign of kidney damage [1]. - As the disease progresses, it often advances to **macroalbuminuria** (larger amounts of albumin), indicating more severe kidney damage [1]. *ACE inhibitors can reduce micro albuminuria* - **Angiotensin-converting enzyme (ACE) inhibitors** are a cornerstone of treatment for diabetic nephropathy due to their **renoprotective effects**. - They effectively reduce **glomerular hydrostatic pressure** and **albuminuria**, thereby slowing the progression of kidney disease.
Question 819: Which of the following is NOT a feature of hypernatremia?
- A. Altered mental status
- B. Muscle weakness due to hypokalemia (Correct Answer)
- C. Elevated intracranial tension
- D. Convulsions
Explanation: Muscle weakness due to hypokalemia - **Hypernatremia** does not directly cause **hypokalemia**; these are distinct electrolyte imbalances. Muscle weakness in hypernatremia is more likely due to direct effects on cell excitability rather than low potassium. - While muscle weakness can occur in severe hypernatremia, it is not typically attributed to **hypokalemia**, making this statement inaccurate as a direct feature of hypernatremia. *Convulsions* - Severe **hypernatremia** leads to cellular dehydration, especially in brain cells, which can cause significant neurological symptoms including **convulsions**. - The rapid fluid shifts across the blood-brain barrier due to high extracellular osmolality can disrupt neuronal function, leading to seizures. *Elevated intracranial tension* - **Hypernatremia** causes water to shift out of brain cells into the hyperosmolar extracellular fluid, leading to **brain shrinkage** rather than elevated intracranial tension [1]. - This cellular dehydration reduces brain volume, which would typically lower, not elevate, intracranial tension [1]. *Altered mental status* - **Hypernatremia** causes significant neurological dysfunction due to cellular dehydration in the brain. - This can manifest as various degrees of **altered mental status**, from lethargy and confusion to coma.
Question 820: Which is the most common symptom of medullary sponge kidney disease?
- A. Anuria
- B. Anemia
- C. Azotemia
- D. UTI (Correct Answer)
Explanation: ***UTI*** - **Medullary sponge kidney disease** often leads to **urinary stasis** within the dilated collecting ducts, creating a favorable environment for **bacterial growth** and recurrent **urinary tract infections (UTIs)** [1]. - The abnormal kidney structure and presence of stones can also cause **obstruction**, further increasing the risk of UTIs [1], [2]. *Anuria* - **Anuria**, the absence of urine production, is a severe symptom usually indicative of **acute kidney injury** or **bilateral urinary obstruction**. - While medullary sponge kidney can lead to complications, **anuria** is a rare initial or primary presentation. *Anemia* - **Anemia** in kidney disease is typically associated with **chronic kidney disease** stages where there is reduced **erythropoietin production**. - Medullary sponge kidney alone does not commonly cause significant **anemia**, unless it progresses to advanced chronic kidney disease, which is not its most common presentation. *Azotemia* - **Azotemia** refers to elevated levels of **nitrogenous waste products** (like urea and creatinine) in the blood, indicating **impaired kidney function**. - While medullary sponge kidney can sometimes lead to impaired function due to recurrent infections or stones, **azotemia** is not the most common direct symptom; **UTIs** are more frequent [2].
Practice by Chapter
Acute Kidney Injury
Practice Questions
Chronic Kidney Disease
Practice Questions
Glomerular Diseases
Practice Questions
Tubulointerstitial Diseases
Practice Questions
Nephrotic and Nephritic Syndromes
Practice Questions
Urinary Tract Infections
Practice Questions
Renal Replacement Therapy
Practice Questions
Fluid and Electrolyte Disorders
Practice Questions
Acid-Base Disorders
Practice Questions
Kidney in Systemic Diseases
Practice Questions
Kidney Stones and Obstructive Uropathy
Practice Questions
Hypertension in Kidney Disease
Practice Questions
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