Renal MCQs

A 6-year-old boy presents with tea-colored urine. He

was diagnosed with an upper respiratory tract infection
2 days ago. His parents report that a similar episode
occurred 4 months ago. There is no history of trauma.
Findings include: blood pressure, 105/70 mm Hg;
temperature, 38C (100.4F); and absence of rash or
joint abnormalities. Serum complement level is normal.
The MOST likely explanation of these findings is
A.
B.
C.
D.
1.

Alport hereditary nephritis

idiopathic hypercalciuria
immunoglobulin A nephropathy (Berger disease)
postinfectious acute glomerulonephritis
E. thin glomerular basement membrane nephropathy

A 2-week-old male infant is being seen for a routine health

supervision visit. Physical examination reveals a
distended abdomen, and the bladder can be palpated
above the symphysis pubis. The mother has noticed that
urine dribbles from his urethra.
Of the following, the MOST likely diagnosis is
A. posterior urethral valves
B. prune belly syndrome
C. urethral diverticula
D. urethral meatal stenosis
E. urethral stricture

Question . 6. A 5-yr-old girl presents with cola-colored urine, oliguria,

and
body edema 2 wk after being treated for group A -hemolytic
streptococcal
pharyngitis. Her complement C3 is noted to be very low at 15 mg/dL.
When
should this patient's complement C3 level be repeated in order to
confirm
your suspected diagnosis?
A)In 1 week
B)In 2 wk
C)In 3 wk
D)In 4 wk
E)In 8 wk

Question . 3. The presence of renal

parenchymal scarring due to
vesicoureteral reflux is best determined by:
A) DMSA scan
B) Renal ultrasonography
C) VCUG
D) CT scan
E) Intravenous pyelography

Q) All true about Gitlman syndrome except :

A) Metabolic alkalosis.
B) Hypokalemia.
C) Hypertension.
D) Hypocalcuria.
E) Hypomagnesemia

Question . 45. An asymptomatic 16-yr-old African-American

girl with
hypertension is found to have 3+ proteinuria by dipstick
testing on mid-day
and first morning voided urine samples. The microscopic
analysis shows 0-2 red blood cells per high-power field.
The most likely diagnosis is:
A)Postinfectious glomerulonephritis
B)Diabetic nephropathy
C) Minimal-change disease
D) Focal segmental glomerulosclerosis
E) Lupus nephritis

Question . 49. A 3-yr-old girl presents to the emergency

department with
anasarca. The urinalysis shows 4+ proteinuria and is
negative for blood.
Serum albumin is 1.2 mg/dL and serum creatinine is 0.4
mg/dL. The most
likely diagnosis is:
A) Postinfectious glomerulonephritis
B) Minimal-change disease
C) IgA nephropathy
D) Lupus nephritis
E) Focal segmental glomerulosclerosis

Question . 54. A 10-yr-old girl presents with edema and gross

hematuria. Her
evaluation reveals serum creatinine 1.4 mg/dL, serum albumin 2.3
mg/dL, 24hr urine protein excretion 5.5 g, and C3 12 mg/dL. The most likely
cause of her
nephrotic syndrome is:
A) Membranoproliferative glomerulonephritis
B) Minimal-change disease
C) IgA nephropathy
D) Membranous nephropathy
E) Focal segmental glomerulosclerosis

Question . 16. An 8-yr-old girl presents with dysuria, abdominal pain,

and
intermittent pink urine. A urinalysis reveals specific gravity of 1.020, pH
of 6.0,
2+ hematuria, no protein, and 50 red blood cells per high-power field. A
24-hr
urine specimen reveals 6 mg/kg body weight of calcium. Which of the
following is an acceptable treatment for this patient's problem?
A)Increased intake of sodium-containing fluids
B)Dietary calcium restriction
C)Single daily dose of hydrochlorothiazide
D)Vitamin D supplementation
E)Vitamin C supplementation

Question . 23. All of the following statements regarding

poststreptococcal
glomerulonephritis (PSGN) are true except:
A) PSGN is common in children 2 to 5 yr of age
B) The acute phase of PSGN usually resolves in 6-8 wk
C ) Microscopic hematuria may persist for 1-2 yr following the
initial presentation of PSGN
D) The serum C3 level is usually reduced in the acute phase
of PSGN
E) The best single antibody titer to document cutaneous
streptococcal infection is the deoxyribonuclease (DNase)
B antigen

You are evaluating an 8-year-old girl in your office who has

fever and mild abdominal pain. Physical examination
reveals a temperature of 40.0C (104.0F) and a soft and
nontender abdomen without flank or suprapubic
tenderness. Urinalysis and microscopy are negative
except for a positive dipstick test of 100 mg/dL of protein
(+2).
Of the following, the MOST likely cause of the proteinuria is
A. collagen vascular disease
B. high fever
C. nephrotic syndrome
D. postinfectious acute glomerulonephritis
E. urinary tract infection

Question . 55. A newborn infant develops anasarca and

poor urine output
during the first week of life. Serum creatinine is 0.3 mg/dL
and serum albumin
is 1.0 mg/dL. Which of the following clinical findings is least
likely?
A) Enlarged placenta
B) Prematurity
C) Rapid response to steroid therapy
D) Elevated maternal serum -fetoprotein
E) Massive proteinuria

Question . 64. A 14-yr-old girl develops acute renal failure

related to HenochSch nlein purpura glomerulonephritis. Laboratory findings
may include all of
the following except:
A) Hypercalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hyperphosphatemia
E) Hypoalbuminemia

Question . 2. Risk factors for urinary tract

infections include all of the
following except:
A)Uncircumcised penis
B) Sexual activity
C) Reflux nephropathy
D) Double-ureter systems
E) Chronic use of antibiotics

A 15-year-old boy presents with red urine following football

practice. Findings on physical examination are normal.
Urinalysis reveals pH, 6.0; specific gravity, 1.020; blood,
+4; protein, trace; and 0 to 2 red blood cells per high
power field.
Among the following, the MOST likely explanation for the
red color of the urine is
A. hematuria
B. ingestion of food coloring
C. myoglobinuria
D. presence of urates
E. trauma

In addition to vascular thrombosis, the MOST

likely complications observed in children
who have minimal-change nephrotic
syndrome are:
A. acute renal failure
B. chronic renal failure
C. hypercholesterolemia
D. hypernatremia
E. hyponatremia

Question . 13. A 3-yr-old girl presents to your office with acute onset of
lethargy and pallor. The child's mother reports that the child had bloody
diarrhea for 5 days that cleared one day prior to presenting to your
office. She
also notes acute onset of cola-colored urine. On examination, the
patient is
pale and lethargic. Blood pressure is 120/80 mm Hg. The most
appropriate
next step in diagnosis would be:
A)Urinalysis
B)X-ray examination of the abdomen
C)Urine culture
D)Complete blood cell count
E)Prothrombin time

A 2-month-old infant is evaluated for vomiting and diarrhea.

Findings include: edema; abdominal distension; wide
fontanelles and cranial sutures; blood pressure, 100/60
mm Hg; urinalysis, +4 protein; and serum albumin, 1.2
g/dL. The mother says that she had preeclampsia and
that the placenta was large. You suspect congenital
nephrotic syndrome.
The MOST important management strategy for a good
outcome is
A. administration of 25% albumin and furosemide
B. administration of high-dose corticosteroids
C. intensive medical follow-up, including referral for dialysis
and renal transplantation
D. restriction of dietary protein
E. restriction of fluid and salt intake

You are examining a 1-day-old girl who was delivered

vaginally at term. Prenatal fetal ultrasonography had
revealed the presence of left hydronephrosis. On
physical examination, blood pressure is 75/50 mm Hg,
and the abdomen is soft, with palpable fullness in the
right flank.
Of the following, the MOST likely diagnosis is
A. posterior urethral valves
B. ureterocele
C.ureteropelvic junction obstruction
D.ureterovesical obstruction
E. vesicoureteral reflux

Question . 43. Urine dipstick testing of a specimen obtained

from a febrile 4yr-old child with acute viral gastroenteritis shows specific
gravity 1.030, pH
5.0, 2+ proteinuria, and no blood cells. The most likely
cause of the patient's
proteinuria is:
A) Transient proteinuria
B) Nephrotic syndrome
C) Orthostatic proteinuria
D) Acute glomerulonephritis
E) Chronic glomerulonephritis

Question . 2. A 3-yr-old boy presents to your office with sudden onset of cola
colored urine, progressive facial swelling over the past 3 days, and decrease
urine volume over the past day. His examination is notable for blood pressur
130/80 mm Hg, periorbital edema, bibasilar rales, and ankle swelling. His
urinalysis is remarkable for 3+ hematuria, 1+ proteinuria, 100 red blood cells
per high-power field, and red blood cell casts. His serum electrolytes are
normal and the serum albumin is 3.2 g/liter. This clinical presentation is mos
consistent with:
A)Acute renal failure
B)Acute pyelonephritis
C)Nephrotic syndrome
D)Acute glomerulonephritis
E)Chronic renal failure

Question . 5. A 15-yr-old boy with a 12-yr history of microscopic

hematuria is
noted to have bilateral high-frequency sensorineural hearing loss,
blood
pressure of 140/90 mm Hg, serum creatinine of 1.5 mg/dL, and urinary
protein
of 2,000 mg/24 hr. This patient's mother also has microscopic
hematuria. The
most likely mode of inheritance for this child's glomerular disease is:
A)Autosomal dominant with incomplete penetrance
B)X-linked dominant
C)Autosomal recessive
D)X-linked recessive
E)Autosomal dominant

You discover a right-sided, palpable abdominal mass in a

newborn male who has had an uncomplicated perinatal
course. Laboratory evaluation reveals: creatinine, 0.7
mg/dL; normal findings on urinalysis; and platelet count,
350,000/mm.
Of the following, the MOST likely cause of this mass is
A. autosomal recessive polycystic kidney disease
B. midgut volvulus
C. renal vein thrombosis
D. ureteropelvic junction obstruction
E. Wilms tumor

A 5-year-old girl visited her doctor 2 weeks ago to treat a sore throat.
He prescribed an antibiotic that she took, but the parents cannot
recall its name. She presents at the emergency department today
with gross hematuria and periorbital edema. She has a blood
pressure of 150/95 mm Hg. The attending physician suspects she
has acute postinfectious glomerulonephritis (PIAGN). Urinalysis
reveals too numerous-to-count red blood cells and 2+ protein. To
confirm the diagnosis, you measure serum complement levels; the
C3 is 57 mg/dL (5.7 g/L) (low) and the C4 is 24 mg/dL (2.4 g/L)
(normal). Within 3 days, the gross hematuria and hypertension
resolve spontaneously. Six weeks later you see her in your office.
Of the following, the laboratory results that would be consistent with
resolving PIAGN are:
C3
Hematuria
Protein
A. Low
Microscopic
Negative
B. Low
Microscopic
Positive
C. Normal
Microscopic
Negative
D. Normal
Microscopic
Positive
E. Low
None
Negative

You are examining a newborn in the nursery and

palpate a large mass in the abdomen.
Of the following, the MOST likely diagnosis is:
A.autosomal dominant polycystic kidney disease
B.horseshoe kidney
C. multicystic kidney dysplasia
D. renal vein thrombosis
E.Wilms tumor

A 5-year-old boy who has nephrotic syndrome has

developed anasarca. Findings include: blood pressure,
90/60 mm Hg; blood urea nitrogen, 40 mg/dL; creatinine,
0.6 mg/dL; albumin, 1.5 g/dL; normal C3 level; and 4+
proteinuria. After receiving furosemide, he lost 2 L of fluid
but developed abdominal pain, hematuria, and
hypertension. Urinalysis shows >100 red blood cells per
high-power field.
Of the following, the MOST likely diagnosis is
A. acute glomerulonephritis
B. acute tubular necrosis
C. hemorrhagic cystitis
D. interstitial nephritis
E. renal vein thrombosis

Question . 28. A 4-mo-old boy is noted to have poor growth

at a routine well
child visit. Results of laboratory studies include serum
sodium 140 mmol/L,
potassium 3.5 mmol/L, chloride 116 mmol/L, and
bicarbonate 13 mmol/L. All of
the following should be considered in the differential
diagnosis except:
A) Distal renal tubular acidosis
B) Chronic diarrhea
C) Proximal renal tubular acidosis
D) Lactic acidosis
E) Renal Fanconi syndrome

A 5-year-old boy presents with flank pain and short stature.

Findings include: creatinine, 0.5 mg/dL; sodium, 139
mEq/L; potassium, 3.8 mEq/L; chloride, 113 mEq/L;
bicarbonate, 15 mEq/L; calcium, 9.0 mg/dL; phosphorus,
4.0 mg/dL; urinalysis, 5 to 20 red blood cells per highpower field; plain radiography, bilateral renal
calcifications.
The MOST likely cause of these renal calcifications is
A. cystinuria
B. distal renal tubular acidosis (type 1)
C. primary hyperparathyroidism
D. proximal renal tubular acidosis (type 2)
E. vitamin D intoxication

You are evaluating a 2-month-old infant for microscopic

hematuria. He has a history of respiratory distress
syndrome and bronchopulmonary dysplasia and
currently is receiving caffeine and furosemide. Urinalysis
reveals: specific gravity, 1.010; pH, 6.5; 15 to 20 red
blood cells; no protein; and 0 to 2 white blood cells.
Electrolyte levels are normal.
Of the following, the MOST likely cause of the hematuria is:
A. benign familial hematuria
B. hypercalciuria
C. multicystic kidney dysplasia
D. tumor
E. urinary tract infection

he mother and maternal grandfather of a 6-month-old boy

both have Alport syndrome.
Of the following, the MOST appropriate statement to
include in counseling this boy's mother about Alport
syndrome is that:
A. affected boys frequently suffer from acroparesthesias
B. the boy has an increased risk for developing Wilms tumor
C. the disorder is more severe in males than in females
D. there is a 25% chance that her son has Alport syndrome
E. there is no need to monitor her son for complications of
the disorder until he is

Urinalysis obtained during a health supervision visit of a 10year-old boy reveals 2+ protein. The remainder of the
urinalysis is normal. Results of family and personal
medical histories as well as physical examination of the
boy are negative.
Of the following, the BEST next step is to:
A. arrange consultation with a nephrologist
B. examine the urine of family members
C. obtain a 24-hour urine sample for protein quantification
D. obtain renal ultrasonography
E. perform a urinalysis on the first morning void

One month ago, a 10-year-old boy presented to you with edema of the
face, hands, and feet. Urinalysis revealed 20 to 25 red blood cells
and 4+ protein. You diagnosed nephrotic syndrome and placed him
on a recommended regimen of oral steroids. His face now exhibits
cushingoid features, but his edema has not subsided. Urinalysis
today reveals 4+ protein and moderate blood.
Of the following, the MOST likely diagnosis at this time is:
A.
B.
C.
D.
E.

focal segmental glomerulosclerosis

Henoch-Schnlein purpura
immunoglobulin A nephropathy
minimal-change nephrotic syndrome
postinfectious acute glomerulonephritis

A newborn male has excess abdominal skin,

deficiency of the abdominal musculature, and
cryptorchidism.
Of the following, the MOST likely etiology of these
findings is:
A.chronic amniotic fluid leakage during pregnancy
B.early urethral obstruction
C.extrophy of the bladder
D.polycystic kidneys
E.renal agenesis

A prenatal ultrasonographic examination of a male

fetus at 32 weeks' gestation reveals bilateral
renal aplasia.
When the infant is delivered several weeks later,
the condition MOST likely to be evident is:
A.bladder wall hypertrophy
B.cryptorchidism
C.
incomplete development of the sacrum
D.
prune belly (wrinkled abdominal skin)
E.pulmonary hypoplasia

A 13-month-old child has growth retardation, polyuria and

polydipsia. Results of laboratory evaluation include:
serum creatinine, 17.7 mcmol/L (0.2 mg/dL); blood urea
nitrogen, 3.57 mmol/L of urea (10 mg/dL); sodium, 135
mmol/L (135 mEq/L); potassium, 3 mmol/L (3 mEq/L);
chloride 112 mmol/L (112 mEq/L); bicarbonate, 13 mmol/L
(13 mEq/L); calcium, 2.17 mmol/L (8.7 mg/dL);
phosphorus, 2.0 mg/dL; uric acid, 2.0 mg/dL; serum
glucose, 5.0 mmol/L (90 mg/dL); generalized amino
aciduria; phosphaturia; kaliuresis; and glycosuria.
Of the following, the MOST appropriate test to define the
etiology of this child's illness is
A. antidiuretic hormone levels
B. leukocyte cystine levels
C. plasma renin activity
D. serum magnesium
E. slitlamp examination

A 2-year-old girl is admitted to the hospital for treatment of

dehydration and diarrhea. Initial laboratory evaluation
showed: serum creatinine, 70.7 mcmol/L (0.8 mg/dL);
blood urea nitrogen, 14.3 mmol/L of urea (40 mg/dL);
sodium, 135 mmol/L (135 mEq/L); potassium, 4 mmol/L
(4 mEq/L); chloride, 100 mmol/L (100 mEq/L);
bicarbonate, 15 mmol/L (15 mEq/L); urine pH, 5.0; urine
sodium, 10 mmol/L (10 mEq/L); urine potassium, 10
mmol/L (10 mEq/L); and urine chloride, 40 mmol/L (40
mEq/L). Despite hydration, a normal anion gap metabolic
acidosis persists.
Of the following, the MOST likely diagnosis is
A. acute renal failure
B. chloride-losing nephropathy
C. extrarenal losses of bicarbonate
D. renal tubular acidosis, type IV
E. renal tubular acidosis, type I

A 3-year-old girl presents with fever, left flank pain, and

dysuria. On physical examination, blood pressure is 100/58
mm Hg, temperature is 39C (102.2F), and there is left
costovertebral angle tenderness. A catherized urine culture
grows more than 100,000 CFU/mm3 of Escherichia coli.
Results of renal ultrasonography are normal, and voiding
cystourethrography shows bilateral grade 3 vesicoureteral
reflux (VUR). You prescribe antibiotics for 10 days.
Of the following, the next BEST step is
A. no prophylaxis
B. periodic urine cultures for 6 months
C. prophylaxis with antibiotics for 6 months
D. prophylaxis with antibiotics until the VUR resolves
E. referral to a urologist for surgical correction

Question . 4. A 10-yr-old boy is noted to have hematuria and proteinuria on a

routine physical examination. He is without complaints, and examination
findings are normal. Results of blood chemistry studies are also normal, but
analysis of the 24-hr urine specimen reveals 2 g of protein and a normal
creatinine clearance. A renal biopsy is performed, which reveals mesangial
proliferative glomerulonephritis with very bright immunoglobulin A deposits
in the mesangium on immunofluorescence. Which of the following statements
is true regarding this child's form of glomerulonephritis?
A)This disease is more common in females
B)The primary treatment is blood pressure control
C)Progressive kidney disease occurs in a majority of
children
D)The complement C3 value is usually low
E)Children with this disease rarely present with gross
hematuria

The following are recognised presentations

of AR polycystic kidney disease except :
A Berry aneurysm
B Nephrogenic diabetes insipidus
C Bilateral flank masses at birth
D Presentation with Hypertension
E Potter's Syndrome

Question . 65. A 12-yr-old boy presents with a long-standing history of

polyuria and polydipsia, progressive fatigue, decreased appetite,
morning
nausea and emesis, weight loss, and impaired growth velocity. In
addition, he
has had no response to a 6-mo course of iron therapy for treatment of
anemia.
Initial laboratory evaluation reveals BUN of 125 mg/dL and serum
creatinine of
8.7 mg/dL. Other expected laboratory features include all of the
following
except:
A)Elevated parathyroid hormone level
B)Increased anion gap metabolic acidosis
C)Decreased levels of growth hormone
D)Small, echogenic kidneys on ultrasonography
E)Hypocalcemia

Question . 6. Multicystic dysplastic kidneys are

characterized by all of the
following except:
A) Usually unilateral
B) Incidence of 1:2,000
C) Autosomal dominant inheritance
D) Most common neonatal abdominal mass
E) No function

These features are associated with renal

osteodystrophy except :
A increased gut absorption of calcium
B distal myopathy
C hypophosphataemia
D raised serum alkaline phosphatase

Which of the following is characteristic of Bartter's

Syndrome?
1.
2.
3.
4.
5.

Available marks are shown in brackets

Secondary hyperaldosteronism
Hyperkalaemia
Metabolic acidosis
Reduced renal concentrating ability Diarrhoea

Question . 12. All of the following glomerular

diseases often manifest with
rapidly progressive glomerulonephritis except:
A)Wegener's granulomatosis
B)Systemic lupus erythematosus
C)Membranoproliferative glomerulonephritis
D)Goodpasture syndrome
E)Focal segmental glomerulosclerosis

A 7-day-old infant is hospitalized because of lethargy. Findings include:

blood pressure, 80/40 mm Hg; pulse, 140 beats/min; respiratory
rate, 60 breaths/min; creatinine, 0.6 mg/dL; sodium,140 mEq/L;
potassium, 5.0 mEq/L; chloride, 100 mEq/L; bicarbonate, 10 mEq/L;
blood glucose, 90 mg/dL; white blood cell count, 12,000/mm;
normal cerebrospinal fluid; and urine pH of 5.5.
Of the following, the MOST likely diagnosis is
A.
B.
C.
D.
E.

meningitis
organic acidemia
renal tubular acidosis, type 1
renal tubular acidosis, type 2
urea cycle defect

Question . 14. A 7-mo-old white male infant presents with

failure to thrive and
a BUN of 75 mg/dL. He has a history of a poor urinary
stream. The most likely
diagnosis is:
A) Renal artery stenosis
B) Renal hypoplasia
C) Urogenic bladder
D) Posterior urethral valves
E) Nephrolithiasis

Question . 10. Cystitis is associated with all

of the following except:
A)Urgency
B)Adenovirus
C)Fever
D)Absence of renal scarring
E)Sexual activity in females