Nephrology Practice Questions

Q: All of the following are causes of hematuria in a child except?

Porphyria. **Explanation:** The core concept in this question is distinguishing between **true hematuria** (presence of intact RBCs in urine) and **discoloration of urine** (pseudohematuria). **Why Porphyria is the correct answer:** In **Porphyria**, the urine turns a characteristic "port-wine" or dark red color upon standing. This is due to the oxidation of porphobilinogen (PBG) into porphobilin or the presence of uroporphyrins. Crucially, there are **no red blood cells** present in the urine. Therefore, it causes red-colored urine but not hematuria. **Analysis of incorrect options:** * **Polycystic Kidney Disease (PCKD):** Both Autosomal Dominant (ADPKD) and Autosomal Recessive (ARPKD) forms can cause hematuria. In ADPKD, it often results from cyst rupture or associated nephrolithiasis. * **Renal Vein Thrombosis (RVT):** This is a classic cause of hematuria in neonates (often presenting with a flank mass and thrombocytopenia). The venous congestion leads to capillary rupture and bleeding into the collecting system. * **Idiopathic Hypercalciuria:** This is one of the most common causes of isolated asymptomatic microscopic hematuria in children. High urinary calcium levels cause micro-calculi that irritate the urothelium, leading to bleeding even in the absence of a visible stone. **High-Yield Clinical Pearls for NEET-PG:** * **Dipstick vs. Microscopy:** If a urine dipstick is positive for blood but microscopy shows **no RBCs**, consider **Hemoglobinuria** (intravascular hemolysis), **Myoglobinuria** (rhabdomyolysis), or **Porphyria** (though Porphyria may not always trigger the heme-reagent strip). * **Dysmorphic RBCs:** Presence of acanthocytes or dysmorphic RBCs suggests a **glomerular** source of hematuria (e.g., Post-streptococcal glomerulonephritis). * **Commonest cause:** The most common cause of gross hematuria in children is **UTI**, while the most common glomerular cause is **IgA Nephropathy** (Berger’s disease).

Q: Which of the following nasal sprays is very effective in the control of enuresis?

Desmopressin. **Explanation:** **Desmopressin (DDAVP)** is the correct answer because it is a synthetic analogue of the antidiuretic hormone (ADH/Vasopressin). In the management of nocturnal enuresis, it works by binding to **V2 receptors** in the renal collecting ducts, increasing water reabsorption and reducing the volume of urine produced overnight to less than the functional bladder capacity. It is particularly effective in children with "nocturnal polyuria." While available as an oral melt or tablet, the nasal spray was historically the first-line delivery method (though its use in children is now more cautious due to the risk of hyponatremia). **Analysis of Incorrect Options:** * **A. Pitressin:** This is a sterile solution of synthetic Vasopressin. Unlike Desmopressin, it acts on both V1 (vasoconstriction) and V2 receptors. Its short half-life and significant pressor effects make it unsuitable for the long-term management of enuresis. * **C. Lipressin:** This is Lysine-vasopressin. It has a shorter duration of action and more pronounced pressor (V1) effects compared to Desmopressin, making it less effective and less safe for treating bedwetting. **High-Yield Clinical Pearls for NEET-PG:** * **First-line management:** Always start with behavioral modifications (fluid restriction, bladder training) and **Enuresis Alarms** (highest long-term cure rate). * **Desmopressin:** Provides the most rapid symptomatic relief; ideal for short-term use (e.g., camps or sleepovers). * **Side Effect Warning:** The most serious side effect of Desmopressin is **hyponatremic encephalopathy**. Patients must restrict fluid intake 1 hour before and 8 hours after administration. * **Imipramine:** A TCA used as a second-line drug for enuresis but carries a risk of cardiotoxicity in overdose.

Q: Which of the following is a true statement about pyelonephritis in children?

All of the above.. **Explanation:** Pyelonephritis in the pediatric population often presents with a clinical spectrum that varies significantly by age, making a high index of suspicion crucial for diagnosis. * **Option A (Neonates):** In neonates and young infants, the clinical presentation is notoriously **non-specific**. Instead of localized urinary symptoms, they often present with systemic signs such as irritability, poor feeding, lethargy, jaundice, or vomiting. * **Option B (Flank Pain):** As children grow older (typically school-age and adolescents), they are better able to localize pain. In these age groups, classic signs of upper urinary tract involvement, such as **flank pain and costovertebral angle tenderness**, become common findings. * **Option C (Fever of Unknown Cause):** Urinary Tract Infection (UTI) is one of the most common bacterial causes of **Fever Without a Source (FWS)** in children under 2 years. Current guidelines mandate that pyelonephritis must be ruled out in any young child with an unexplained fever, as delayed treatment can lead to permanent renal scarring. Since all three statements accurately describe the clinical reality of pediatric pyelonephritis, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Urine culture obtained via midstream catch (older children) or supra-pubic aspiration/catheterization (infants). * **Most Common Organism:** *E. coli* (80-90%). * **Imaging:** The first-line imaging is a **Renal Bladder Ultrasound (RBUS)**. A **Voiding Cystourethrogram (VCUG)** is indicated if the ultrasound is abnormal or if there is a recurrence of febrile UTI. * **Gold Standard for Scarring:** DMSA Scan (Dimercaptosuccinic acid) is the most sensitive test to detect acute pyelonephritis and late renal scarring.

Q: What is true about Nephrotic syndrome in a child?

Proteinuria of 4 gm/m2/hr is characteristic.. **Explanation:** Nephrotic Syndrome (NS) is defined by a triad of massive proteinuria, hypoalbuminemia ( 2 mg/mg. * **24-hour urine collection:** >40 mg/m²/hr. * **Dipstick:** 3+ or 4+. * *Note:* The option "4 gm/m²/hr" is a common typographical representation in exams for **40 mg/m²/hr** (or >3.5g/24hr in adults). In the context of competitive exams, this quantitative threshold is the physiological definition of the disease. **2. Analysis of Incorrect Options:** * **Option A:** While Minimal Change Disease (MCD) is indeed the most common cause of NS in children (approx. 80%), Option B is a more definitive physiological characteristic used to define the syndrome itself. (In many versions of this question, Option A is also considered true; however, if forced to choose the "most" characteristic feature, the protein threshold is the diagnostic gold standard). * **Option C:** The mainstay of therapy for the first episode of NS is **Corticosteroids (Prednisolone)**, not steroid-sparing agents like Cyclosporine or Azathioprine. * **Option D:** While Spontaneous Bacterial Peritonitis (SBP) is a known complication of NS (often due to *Streptococcus pneumoniae*), it is a **complication**, not a characteristic feature of the disease itself. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Infections (due to loss of IgG and Complement factors in urine). * **Most common infection:** Peritonitis (Organism: *S. pneumoniae*). * **Hyperlipidemia:** Occurs due to increased hepatic synthesis of lipids in response to low oncotic pressure. * **Hypercoagulability:** Due to loss of Antithrombin III and increased levels of Factor VIII and fibrinogen.

Q: A child presents with a blood pressure of 190/110 mmHg, pedal edema ++, facial edema, and gross hematuria. Ascites is absent. What is the most likely diagnosis?

Acute Glomerulonephritis. ### Explanation The clinical presentation of **hypertension (190/110 mmHg)**, **gross hematuria**, and **edema** (facial and pedal) constitutes the classic **Nephritic Syndrome** triad. **1. Why Acute Glomerulonephritis (AGN) is correct:** AGN, most commonly Post-Streptococcal Glomerulonephritis (PSGN) in children, is characterized by an inflammatory process in the glomeruli. This leads to a decrease in Glomerular Filtration Rate (GFR), resulting in salt and water retention. The hallmark features are: * **Hematuria:** "Coke-colored" or smoky urine due to RBC leakage. * **Hypertension:** Significant elevation due to fluid overload and renin-angiotensin activation. * **Edema:** Typically periorbital/facial in the morning, becoming generalized. * **Absence of Ascites:** Edema in AGN is usually mild to moderate; massive edema/ascites is more characteristic of Nephrotic Syndrome. **2. Why the other options are incorrect:** * **Nephrotic Syndrome:** Characterized by massive proteinuria (>3.5g/day), hypoalbuminemia, and **generalized edema (Anasarca)** including ascites. Hypertension and gross hematuria are uncommon. * **Renal Thrombosis:** Usually presents in neonates with a palpable flank mass, thrombocytopenia, and hematuria, but not typically with this degree of systemic hypertension and facial edema. * **Renal Amyloidosis:** Rare in children; typically presents as chronic Nephrotic Syndrome rather than acute nephritic features. **3. NEET-PG High-Yield Pearls:** * **Most common cause of AGN in children:** PSGN (follows skin infection by 3–6 weeks or throat infection by 1–2 weeks). * **Best initial test:** Urinalysis (shows RBC casts and dysmorphic RBCs). * **Serology:** Low C3 levels are characteristic of PSGN (normalize within 6–8 weeks). * **Management:** Primarily supportive (fluid restriction, diuretics, and antihypertensives like Nifedipine).

Q: Deficiency of abdominal muscles is associated with which of the following conditions?

Eagle-Barrette syndrome. **Explanation:** The correct answer is **Eagle-Barrett Syndrome**, more commonly known as **Prune Belly Syndrome**. This is a rare congenital anomaly characterized by a classic triad: 1. **Deficiency of abdominal wall musculature:** This leads to the characteristic wrinkled, "prune-like" appearance of the overlying skin. 2. **Urinary tract abnormalities:** These typically include a large, thin-walled bladder (megacystitis), dilated ureters (megaureter), and renal dysplasia. 3. **Bilateral cryptorchidism:** Failure of the testes to descend into the scrotum. **Analysis of Options:** * **A. Eagle-Barrett Syndrome:** This is the definitive diagnosis for the triad mentioned above. The muscle deficiency is thought to result from fetal abdominal distension caused by early urinary tract obstruction. * **B. Christopher Syndrome:** This is not a recognized medical term related to abdominal wall defects or nephrology. * **C & D. Megacystitis and Megaureter:** While these are *components* or features of Eagle-Barrett syndrome, they are descriptive terms for dilated bladders and ureters, respectively. They can occur independently due to other obstructive pathologies (like Posterior Urethral Valves) and do not inherently imply a deficiency of abdominal muscles. **High-Yield Clinical Pearls for NEET-PG:** * **Epidemiology:** Occurs almost exclusively in **males** (95%). * **Associated Findings:** Often associated with pulmonary hypoplasia (due to oligohydramnios) and orthopedic deformities like clubfoot. * **Prognosis:** Depends largely on the degree of renal dysplasia and pulmonary hypoplasia. * **Radiology:** Voiding cystourethrogram (VCUG) often shows a dilated prostatic urethra and massive vesicoureteral reflux.

Q: An 8-month-old boy is referred for evaluation following a urinary tract infection. Ultrasound examination of the abdomen is normal. What is the most appropriate investigation to evaluate his lower urinary tract?

Micturating cystourethrogram. **Explanation:** The investigation of choice for evaluating the lower urinary tract in a pediatric patient following a UTI is a **Micturating Cystourethrogram (MCUG)**, also known as a Voiding Cystourethrogram (VCUG). **Why MCUG is the Correct Choice:** MCUG is the gold standard for diagnosing **Vesicoureteral Reflux (VUR)** and visualizing the anatomy of the **urethra**. In a male infant, it is crucial to rule out **Posterior Urethral Valves (PUV)**, which can only be accurately identified during the voiding phase of this study. While ultrasound is a screening tool for hydronephrosis, it often misses VUR and urethral pathology, necessitating an MCUG for definitive evaluation. **Analysis of Incorrect Options:** * **Radionuclide Cystogram (RNC):** While it involves less radiation than MCUG, it provides poor anatomical detail. It is used for screening siblings or follow-up of known VUR, but it cannot diagnose PUV or other urethral abnormalities. * **Intravenous Pyelogram (IVP):** This primarily evaluates the upper urinary tract (kidneys and ureters). It is largely obsolete in pediatric UTI workups due to radiation and the superiority of USG and CT/MRU. * **Cystoscopy:** This is an invasive procedure. It is reserved for therapeutic interventions or when imaging is inconclusive; it is never the first-line investigation for a routine UTI workup. **Clinical Pearls for NEET-PG:** * **DMSA Scan:** The gold standard for detecting **renal scarring** (acute pyelonephritis). * **DTPA/MAG-3 Scan:** Used to evaluate renal function and **obstructive uropathy** (e.g., PUJ obstruction). * **AAP Guidelines:** Recommend an MCUG if the initial USG shows hydronephrosis, scarring, or if there is a recurrence of a febrile UTI. However, in the context of evaluating the *lower* tract specifically, MCUG remains the answer.

Q: A 3-year-old child presented with a history of abdominal mass, polyuria, and polydipsia. Investigations, including intravenous pyelography, revealed a streaky appearance of the kidneys. What is the chromosomal location of the gene involved in this condition?

6p. ### Explanation The clinical presentation described—a 3-year-old with an abdominal mass, polyuria, polydipsia, and a characteristic **"streaky appearance"** on intravenous pyelography (IVP)—is classic for **Autosomal Recessive Polycystic Kidney Disease (ARPKD)**. **1. Why 6p is Correct:** ARPKD is caused by a mutation in the **PKHD1 gene**, which is located on the **short arm of chromosome 6 (6p)**. This gene encodes **fibrocystin** (also known as polyductin), a protein found in the primary cilia of epithelial cells in the renal tubules and bile ducts. In ARPKD, the kidneys undergo fusiform dilation of the collecting ducts. On IVP, the contrast fills these dilated ducts, creating the pathognomonic **"sunburst" or "streaky" appearance**. Polyuria and polydipsia occur due to a defect in the concentrating ability of the distal tubules. **2. Why Other Options are Incorrect:** * **6q:** While the gene is on chromosome 6, it is specifically located on the short arm (p), not the long arm (q). * **14p/14q:** These locations are not associated with ARPKD. However, mutations in **PKD1** (Chromosome **16p**) and **PKD2** (Chromosome **4q**) are responsible for Autosomal Dominant Polycystic Kidney Disease (ADPKD), which typically presents in adulthood. **3. Clinical Pearls for NEET-PG:** * **Hepatic Involvement:** ARPKD is universally associated with **Congenital Hepatic Fibrosis**. If the patient survives the neonatal period, they often develop portal hypertension and splenomegaly. * **Potter Sequence:** Severe cases present at birth with pulmonary hypoplasia, limb deformities, and characteristic facies due to oligohydramnios. * **Ultrasound Finding:** Bilateral, symmetrically enlarged, echogenic ("bright") kidneys with loss of corticomedullary differentiation. * **Differential:** Unlike ADPKD, the cysts in ARPKD are microscopic and represent dilated collecting ducts, not discrete macrocysts.

Question 1

All of the following are causes of hematuria in a child except?

Accepted Answer

Porphyria

Answer

Polycystic kidney disease (PCKD)

Answer

Renal vein thrombosis

Answer

Idiopathic hypercalciuria

Question 2

A 5-year-old male child presents with complaints of fever and abdominal distension. On examination, there are 6-8 pus cells/hpf in urine. WBC count shows 78% neutrophils. What is the best line of management?

Accepted Answer

Send urine for culture and sensitivity and start antibiotics immediately.

Answer

Send urine for culture and sensitivity and wait for results.

Answer

Send urine for culture and perform an USG.

Answer

Radionuclide scan.

Question 3

Which of the following nasal sprays is very effective in the control of enuresis?

Accepted Answer

Desmopressin

Answer

Pitressin

Answer

Lipressin

Answer

None of the above

Question 4

Which of the following is a true statement about pyelonephritis in children?

Accepted Answer

All of the above.

Answer

Neonates can present with non-specific symptoms.

Answer

Flank pain is a common finding.

Answer

Pyelonephritis should be suspected in all children less than 2 years of age with fever of unknown cause.

Question 5

A 12-year-old boy complains of swelling of his feet for the past 3 weeks. He is otherwise healthy, with no known previous illness. Vital signs are normal. Physical examination reveals pitting edema of the lower legs and a swollen abdomen. Urinalysis shows 4+ protein but no RBCs or WBCs. Which of the following are the most likely diagnoses to consider in your evaluation of this patient?

Accepted Answer

Minimal change disease, focal segmental glomerulosclerosis

Answer

Henoch-Schonlein purpura, lupus nephritis

Answer

Malignant hypertension, renal vein thrombosis

Answer

Pyelonephritis, acute tubular necrosis

Question 6

What is true about Nephrotic syndrome in a child?

Accepted Answer

Proteinuria of 4 gm/m2/hr is characteristic.

Answer

Minimal change disease is the commonest cause.

Answer

Cyclosporine and Azathioprine are the mainstay of therapy.

Answer

Spontaneous bacterial peritonitis is associated with it.

Question 7

A child presents with a blood pressure of 190/110 mmHg, pedal edema ++, facial edema, and gross hematuria. Ascites is absent. What is the most likely diagnosis?

Accepted Answer

Acute Glomerulonephritis

Answer

Nephrotic Syndrome

Answer

Renal Thrombosis

Answer

Renal Amyloidosis

Question 8

Deficiency of abdominal muscles is associated with which of the following conditions?

Accepted Answer

Eagle-Barrette syndrome

Answer

Christopher syndrome

Answer

Megacystitis

Answer

Megaureter

Question 9

An 8-month-old boy is referred for evaluation following a urinary tract infection. Ultrasound examination of the abdomen is normal. What is the most appropriate investigation to evaluate his lower urinary tract?

Accepted Answer

Micturating cystourethrogram

Answer

Radionuclide cystogram

Answer

Intravenous pyelogram

Answer

Cystoscopy

Question 10

A 3-year-old child presented with a history of abdominal mass, polyuria, and polydipsia. Investigations, including intravenous pyelography, revealed a streaky appearance of the kidneys. What is the chromosomal location of the gene involved in this condition?

Accepted Answer

6p

Answer

6q

Answer

14p

Answer

14q

Nephrology — MCQs

Nephrology — MCQs

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