Nephrology Practice Questions

Q: A child was diagnosed as a case of pauci-immune crescentic glomerulonephritis. The treatment to be given in this child is –

Prednisolone + Cyclophosphamide. ***Prednisolone + Cyclophosphamide*** - **Pauci-immune crescentic glomerulonephritis** (also known as ANCA-associated vasculitis) is a rapidly progressive and severe autoimmune condition affecting the kidneys. - **Combination therapy** with a corticosteroid (like prednisolone) and an immunosuppressant (like cyclophosphamide) is the standard and most effective initial treatment to control inflammation and suppress the immune response. *Immunoglobulins* - **Intravenous immunoglobulins (IVIG)** are sometimes used in autoimmune diseases, but they are not the first-line treatment for pauci-immune crescentic glomerulonephritis due to its aggressive nature. - IVIG might be considered as an **adjunctive therapy** or in specific cases of refractory disease, but not as monotherapy. *Cyclophosphamide* - While **cyclophosphamide** is a critical component of treatment for **pauci-immune crescentic glomerulonephritis** due to its potent immunosuppressive effects, it is not used alone. - It is typically combined with a **corticosteroid** (such as prednisolone) to achieve a more rapid and comprehensive anti-inflammatory and immunosuppressive effect. *Methylprednisolone* - **Methylprednisolone** (a corticosteroid) is routinely used in the initial management of **pauci-immune crescentic glomerulonephritis** to rapidly reduce inflammation. - However, it is generally part of a **combination regimen** and is not sufficient as monotherapy for inducing remission in this severe form of glomerulonephritis.

Q: All of the following are true about childhood polycystic kidney disease, except –

Autosomal dominant. ***Autosomal dominant*** - Childhood polycystic kidney disease (CPKD) refers to **autosomal recessive polycystic kidney disease (ARPKD)**, which is inherited in an **autosomal recessive pattern**. - The autosomal dominant form, **autosomal dominant polycystic kidney disease (ADPKD)**, typically presents in adulthood, though it can rarely manifest in childhood. *Renal cyst present at birth* - In **ARPKD**, renal cysts are often present and detectable **at birth** or even prenatally, leading to significantly enlarged kidneys. - These cysts result from malformations of the **collecting ducts**, which are crucial for kidney function. *Hepatic fibrosis* - **Congenital hepatic fibrosis** is a common and serious extra-renal manifestation of **ARPKD**. - This hepatic involvement can lead to **portal hypertension** and associated complications. *Pulmonary hypoplasia* - Severe **oligohydramnios** due to poor fetal kidney function in **ARPKD** can result in **pulmonary hypoplasia**. - This underdeveloped lung tissue is a major cause of mortality in affected neonates.

Q: A one-year-old male child presented with a poor urinary stream since birth. The initial investigation of choice for evaluation is:

Voiding cystourethrography (VCUG). ***Voiding cystourethrography (VCUG)*** - A **one-year-old male child with poor urinary stream since birth** is highly suggestive of **posterior urethral valves (PUV)**, the most common cause of bladder outlet obstruction in male infants. - **VCUG is the investigation of choice** for diagnosing PUV as it directly visualizes the posterior urethra during voiding and can demonstrate the characteristic findings: dilated posterior urethra, valve leaflets, bladder trabeculation, and vesicoureteral reflux. - While it involves catheterization and radiation, in this classic presentation, VCUG provides definitive diagnosis and is essential for surgical planning. *USG bladder* - Ultrasound is a useful **non-invasive screening tool** that can detect secondary findings such as hydronephrosis, bladder wall thickening, and increased post-void residual. - However, **USG cannot visualize the urethral valves** themselves and cannot definitively diagnose PUV. - In practice, many centers may perform ultrasound first, but it must be followed by VCUG for definitive diagnosis in this clinical scenario. *Uroflowmetry* - This test measures the **rate of urine flow** and requires patient cooperation with voiding. - A **one-year-old child cannot reliably follow instructions** to perform uroflowmetry. - It is more useful in older, cooperative children and adults. *Intravenous urography* - **Intravenous urography (IVU)** involves contrast administration and multiple X-rays to visualize the urinary tract. - It has been largely **replaced by ultrasound and CT urography** due to better imaging quality and safety profile. - IVU does not adequately visualize the urethra or diagnose urethral pathology like PUV.

Q: Which of the following is an indication for renal biopsy in a child with nephrotic syndrome?

Low blood C3 levels. ***Low blood C3 levels*** - A persistently **low C3** level in a child with nephrotic syndrome suggests **membranoproliferative glomerulonephritis (MPGN)** or **lupus nephritis**, which require histological diagnosis and specific treatment. - This finding indicates immune complex-mediated disease or complement dysregulation, necessitating a renal biopsy to identify the underlying pathology and guide therapy. *Highly selective proteinuria* - **Highly selective proteinuria** (primarily albuminuria, selectivity index < 0.1) is a hallmark of **minimal change disease (MCD)**, the most frequent cause of nephrotic syndrome in children. - High selectivity favors a steroid-responsive lesion and argues *against* the need for biopsy; empiric corticosteroid therapy is given first. *Serum albumin less than 1g/dL* - Severe hypoalbuminemia is an expected consequence of heavy protein loss in nephrotic syndrome; it reflects disease severity rather than a specific underlying pathology. - It does not, by itself, serve as an indication for renal biopsy. *Age at onset 2–6 years* - The age range of **2–6 years** is the classic age for **minimal change disease**, which is corticosteroid-sensitive. - This typical demographic actually argues *against* early biopsy; empiric steroid therapy is initiated first. - Biopsy is indicated for atypical ages ( 8–10 years).

Q: In case of PSGN complication commonly seen are all except :

Bleeding diathesis. ***Bleeding diathesis*** - **Post-streptococcal glomerulonephritis (PSGN)** typically does not cause **bleeding diathesis**. Bleeding diathesis is primarily associated with **liver disease**, **bone marrow suppression**, or certain genetic disorders, not directly with PSGN. - While severe kidney failure can indirectly affect coagulation, it's not a common or direct complication leading to **bleeding diathesis** in PSGN. *Hypertensive encephalopathy* - PSGN often leads to **fluid overload** and **renin-angiotensin system activation**, causing severe **hypertension** [1]. - Uncontrolled hypertension can result in **hypertensive encephalopathy**, characterized by headaches, seizures, and altered mental status. *Hyperkalemia* - Renal insufficiency, common in PSGN, impairs the kidneys' ability to excrete **potassium**. - This can lead to **hyperkalemia**, a life-threatening electrolyte imbalance that can cause cardiac arrhythmias. *LVF* - **Fluid overload** and severe **hypertension** in PSGN can overwhelm the heart's pumping capacity [1]. - This can precipitate **left ventricular failure (LVF)**, leading to symptoms like dyspnea and pulmonary edema.

Q: Steroid resistance nephrotic syndrome is defined as failure to achieve remission after:-

8 weeks of daily Corticosteroid therapy. 8 weeks of daily Corticosteroid therapy - **Steroid-resistant nephrotic syndrome** is precisely defined as the failure to achieve remission after a full 8-week course of daily oral corticosteroids. - Remission is typically characterized by urine protein excretion of less than 0.3 mg/day or a urine protein-to-creatinine ratio of less than 0.2 mg/mg for three consecutive days. 12 weeks of daily Corticosteroid therapy - This duration is **longer than the standard definition** for assessing steroid resistance in nephrotic syndrome. - After 8 weeks, if remission is not achieved, further management strategies are usually considered, rather than simply extending the initial steroid course. 4 weeks of daily Corticosteroid therapy - This period is **too short** to definitively classify a patient as having steroid-resistant nephrotic syndrome. - A 4-week course is often considered an initial trial, but many patients will respond to steroids with a slightly longer duration of treatment. 6 weeks of daily Corticosteroid therapy - While a significant duration of steroid therapy, **6 weeks is still considered insufficient** to declare steroid resistance. - The consensus guidelines for defining steroid resistance specify a minimum of 8 weeks of daily treatment due to variability in individual response times.

Q: A child presents with brown colored urine and oliguria for last 3 days. He has mild facial and pedal edema. His blood pressure is 126/90. He has +3 proteinuria with 100 red cell and a few granular casts. His creatinine is 0.9, urea is 56. What is his diagnosis?

PSGN. ***PSGN*** - The presentation with **brown urine**, **oliguria**, **edema**, **hypertension**, and **hematuria with red cell casts** is classic for an acute nephritic syndrome. - Given the patient is a child, and the constellation of symptoms including **sudden onset**, **significant hypertension**, and **granular casts**, **Post-Streptococcal Glomerulonephritis (PSGN)** is the most likely diagnosis. - PSGN typically follows streptococcal pharyngitis or skin infection by 1-3 weeks and presents with acute nephritic syndrome. *FSGS* - **Focal Segmental Glomerulosclerosis (FSGS)** typically presents with **nephrotic syndrome** (heavy proteinuria, hypoalbuminemia, severe edema), not primarily with nephritic features. - While it can cause proteinuria, the presence of **red cell casts** and significant hematuria with acute hypertension points to an inflammatory glomerulonephritis, not FSGS. *IgA Nephropathy* - **IgA Nephropathy (Berger's disease)** can also cause nephritic syndrome in children with hematuria and RBC casts. - However, it typically presents with **recurrent episodes of gross hematuria** occurring **during or immediately after** upper respiratory infections (synpharyngitic hematuria), rather than the delayed presentation seen here. - It usually has a more chronic course with less prominent edema and hypertension compared to PSGN. *Nephrolithiasis* - **Nephrolithiasis (kidney stones)** would typically present with **colicky flank pain** and hematuria. - It would not explain the prominent **edema**, **hypertension**, **significant proteinuria**, or presence of **red cell casts** seen in this patient.

Q: Unilateral renal agenesis is associated with:

Single umbilical artery. ***Single umbilical artery*** - **Unilateral renal agenesis** is often associated with other congenital anomalies, including the presence of a **single umbilical artery** (2-vessel cord instead of the normal 3-vessel cord). - Both conditions can be part of **VACTERL association** (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb anomalies). - The **single umbilical artery** is a marker for increased risk of **urogenital and cardiovascular malformations**, which fits with renal agenesis. - Found in approximately **7-10% of cases with renal anomalies**. *Hiatus Hernia* - A **hiatal hernia** is a condition where part of the stomach pushes up through the diaphragm. - Not a recognized or common association with **unilateral renal agenesis**. - While it can be congenital, it arises from different developmental pathways than renal agenesis. *Hypogonadism* - **Hypogonadism** involves reduced function of the gonads and is not directly associated with **renal agenesis**. - Renal agenesis results from problems with the **metanephric blastema** and **ureteric bud** development, not the reproductive axis. *Polycystic disease of pancreas* - **Polycystic disease of the pancreas** is an extremely rare condition and does not have a well-established association with **unilateral renal agenesis**. - This should not be confused with **polycystic kidney disease**, which is a completely different entity.

Q: Acute urinary retention in a male child may be due to:

Meatal ulcer with scabbing. ***Meatal ulcer with scabbing*** - A **meatal ulcer** in a male child, often caused by ammonia dermatitis or balanitis, can lead to **scabbing** that physically obstructs the urethral meatus. - This physical obstruction prevents the outflow of urine, causing acute urinary retention. - This is one of the **most common causes** of acute urinary retention in male children. *Psychogenic urinary retention* - **Psychogenic urinary retention** (previously termed 'hysterical retention') is rare in male children and is a diagnosis of exclusion. - While psychological factors can influence micturition, a physical obstruction is a more common and direct cause in children with acute retention. - Requires psychiatric evaluation and management. *Prostatic radiotherapy* - **Prostatic radiotherapy** is a treatment for **prostatic cancer**, a condition that primarily affects older adult males. - Prostate cancer and its treatments are virtually nonexistent in male children, making this an irrelevant option. *Urethral stricture* - While a **urethral stricture** can cause urinary retention, particularly in adult males, it is a less common cause of **acute urinary retention** in male children compared to meatal obstruction. - Congenital strictures are possible, but an acute presentation due to meatal scabbing is a more typical scenario in the pediatric population.

Question 1

A child was diagnosed as a case of pauci-immune crescentic glomerulonephritis. The treatment to be given in this child is –

Accepted Answer

Prednisolone + Cyclophosphamide

Answer

Immunoglobulins

Answer

Cyclophosphamide

Answer

Methylprednisolone

Question 2

All of the following are true about childhood polycystic kidney disease, except –

Accepted Answer

Autosomal dominant

Answer

Renal cyst present at birth

Answer

Hepatic fibrosis

Answer

Pulmonary hypoplasia

Question 3

A one-year-old male child presented with a poor urinary stream since birth. The initial investigation of choice for evaluation is:

Accepted Answer

Voiding cystourethrography (VCUG)

Answer

USG bladder

Answer

Uroflowmetry

Answer

Intravenous urography

Question 4

Which of the following is an indication for renal biopsy in a child with nephrotic syndrome?

Accepted Answer

Low blood C3 levels

Answer

Serum albumin less than 1g/dL

Answer

Age at onset 2-6 years

Answer

Highly selective proteinuria

Question 5

In case of PSGN complication commonly seen are all except :

Accepted Answer

Bleeding diathesis

Answer

Hypertensive encephalopathy

Answer

Hyperkalemia

Answer

LVF

Question 6

Steroid resistance nephrotic syndrome is defined as failure to achieve remission after:-

Accepted Answer

8 weeks of daily Corticosteroid therapy

Answer

12 weeks of daily Corticosteroid therapy

Answer

4 weeks of daily Corticosteroid therapy

Answer

6 weeks of daily Corticosteroid therapy

Question 7

A child presents with brown colored urine and oliguria for last 3 days. He has mild facial and pedal edema. His blood pressure is 126/90. He has +3 proteinuria with 100 red cell and a few granular casts. His creatinine is 0.9, urea is 56. What is his diagnosis?

Accepted Answer

PSGN

Answer

FSGS

Answer

IgA Nephropathy

Answer

Nephrolithiasis

Question 8

Unilateral renal agenesis is associated with:

Accepted Answer

Single umbilical artery

Answer

Hiatus Hernia

Answer

Hypogonadism

Answer

Polycystic disease of pancreas

Question 9

An otherwise asymptomatic child was found to have hypertension. On further evaluation, his urine analysis revealed 2-3 pus cells/HPF and 2-4 RBCs. Which of the following would be the most likely diagnosis?

Accepted Answer

Chronic Reflux-Associated Pyelonephritis (Reflux Nephropathy)

Answer

Idiopathic RPGN

Answer

Post-Streptococal GN

Answer

IgA nephropathy

Question 10

Acute urinary retention in a male child may be due to:

Accepted Answer

Meatal ulcer with scabbing

Answer

Psychogenic urinary retention

Answer

Prostatic radiotherapy

Answer

Urethral stricture

Nephrology — MCQs

Nephrology — MCQs

On this page

Practice by Chapter

Want unlimited practice?