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Nephrology > Approach to Renal Diseases > Flashcards

Approach to Renal Diseases Flashcards

1
Q

Which of the following is a common cause of prerenal acute kidney injury?
A. Rhabdomyolysis
B. Bladder outlet obstruction
C. Heart failure
D. Tumor lysis syndrome

A

C

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2
Q

Which urine output pattern is most characteristic of postrenal acute kidney injury?
A. Oliguria
B. Anuria or polyuria
C. Normal
D. Polyuria only

A

B

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3
Q

What is the hallmark finding on urinalysis in renal acute kidney injury due to acute tubular necrosis (ATN)?
A. Hyaline casts
B. “Muddy brown” granular casts
C. Blood clots
D. Crystalluria

A

B

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4
Q

In prerenal AKI, the fractional excretion of sodium (FENa) is typically:
A. ≤1%
B. 1–3%
C. >3%
D. Unreliable

A

A

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5
Q

Which clinical history is most suggestive of postrenal acute kidney injury?
A. Hemolysis
B. Trauma or burns
C. Extrinsic ureteral obstruction
D. Hypotension

A

C

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6
Q

Which imaging finding is most indicative of postrenal acute kidney injury?
A. Hydronephrosis on ultrasound
B. Bilateral cortical necrosis
C. “Muddy brown” casts
D. Low FENa

A

A

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7
Q

Which laboratory finding is most consistent with prerenal acute kidney injury?
A. High BUN/Cr ratio
B. Low BUN/Cr ratio
C. Hypercalcemia
D. Eosinophilia

A

A

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8
Q

What is the primary urinary finding in nephritic syndromes?
A. Gross hematuria with blood clots
B. Hematuria, proteinuria, and cellular casts
C. High urine sodium content
D. Polyuria with dilute urine

A

B

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9
Q

In a patient with glomerulonephritis, which finding is typically associated with macroscopic hematuria?
A. Cola or “tea-colored” urine
B. Bright red blood clots in the urine
C. Frothy urine
D. Pale yellow urine

A

A

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10
Q

Which of the following is most likely to cause gross hematuria in glomerulonephritis?
A. IgA nephropathy
B. Postinfectious glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Chronic glomerulonephritis

A

A

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11
Q

What distinguishes acute glomerulonephritis from chronic glomerulonephritis in terms of pathologic findings?
A. Necrotizing lesions vs. sclerotic and atrophic findings
B. Cellular casts vs. hyaline casts
C. Cola-colored urine vs. blood clots
D. High urine sodium vs. low urine sodium

A

A

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12
Q

What is the most likely explanation for cola-colored urine in glomerulonephritis?
A. Blood clots from lower urinary tract bleeding
B. Acidic urine reacting with hemoglobin from red cells
C. Excessive protein filtration
D. Crystal formation in urine sediment

A

B

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13
Q

______ is the classic example of acute GN, a complementmediated immune complex response, to a bacterial antigen occurring 10 days to 3 weeks after a specific nephritogenic strain of group A streptococcal pharyngitis, or after skin infection such as impetigo.

A

Postinfectious glomerulonephritis (PIGN)

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14
Q

PIGN:
____-C3 complement.

A

Low

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15
Q

IgA Nephropathy:
_____ C3 complement.

A

Normal

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16
Q

What is the usual time frame for the onset of postinfectious glomerulonephritis (PIGN) following a nephritogenic streptococcal pharyngitis?
A. 1–2 days
B. 5–7 days
C. 10 days to 3 weeks
D. 4–6 weeks

A

C

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17
Q

Which of the following findings is most characteristic of postinfectious glomerulonephritis?
A. Normal C3 complement levels
B. Gross hematuria during viral pharyngitis
C. Low-C3 complement levels in the blood
D. IgA deposition in the glomeruli during active infection

A

C

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18
Q

How can postinfectious glomerulonephritis (PIGN) be distinguished from IgA nephropathy?
A. Presence of low-C3 complement in PIGN
B. Presence of high-C3 complement in PIGN
C. IgA nephropathy occurs only in children
D. PIGN occurs only during active bacterial infections

A

A

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19
Q

hat is a distinguishing feature of synpharyngitic hematuria related to IgA nephropathy compared to postinfectious glomerulonephritis?
A. Synpharyngitic hematuria is associated with low-C3 complement
B. Synpharyngitic hematuria is triggered by viral pharyngitis
C. Synpharyngitic hematuria involves staphylococcal antigens
D. Synpharyngitic hematuria occurs weeks after pharyngitis resolves

A

B

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20
Q

It is associated with a proliferation of glomerular parietal epithelial cells and inflammatory cells called cellular crescents surrounding the capillary that, over time, becomes fibrotic and atrophic with global loss of the glomerular tuft.

A

RPGN

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21
Q

The syndrome can lead to complete and irreversible loss of kidney function, as well as fatal pulmonary hemorrhage when associated with lung vasculitis.

A

RPGN

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22
Q

Which pathologic feature is most characteristic of rapidly progressive glomerulonephritis (RPGN)?
A. Hyaline casts in urine
B. Cellular crescents in glomeruli
C. Tubular atrophy without inflammation
D. Thickened glomerular basement membrane

A

B

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23
Q

What distinguishes IgA vasculitis (Henoch-Schonlein purpura) from other immune complex-mediated causes of RPGN?
A. Normal C3 complement levels
B. Low C4 complement levels
C. Positive anti-GBM antibodies
D. Absence of palpable purpura

A

A

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24
Q

In rapidly progressive glomerulonephritis caused by cryoglobulinemia, which laboratory findings are most commonly seen?
A. High C3 complement and positive ANCA
B. Low C4 complement and high rheumatoid factor
C. Normal C3 complement and anti-GBM antibodies
D. Elevated IgA levels and palpable purpura

A

B

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25
Q

In rapidly progressive glomerulonephritis, which conditions are particularly associated with pulmonary and upper respiratory disease?

A

Granulomatous vasculitis (formerly known as Wegener’s granulomatosis)

Microscopic polyangiitis

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26
Q

More often seen in young males who smoke or have a history of inhaling hydrocarbon solvents.

A

Goodpasture disease

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27
Q

_______ comprises inflammatory disorders of the renal tubules and interstitium, which may be caused by infection, autoimmune disease, allergic immunologic responses to certain drugs (Fig. 308-2) and have a time course ranging from days to weeks and months.

A

Tubulointerstitial nephritis (TIN)

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28
Q

Acute allergic or immune interstitial nephritis (AIN) usually occurs _____ following exposure to an offending drug and may be associated with a rapid and potentially reversible loss of kidney function, which may occur in the setting of a change in dose or the restarting of a previously used medication.

A

1 day to 2 weeks

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29
Q

Which of the following is a common time frame for the onset of acute allergic interstitial nephritis (AIN) after drug exposure?
A. Within hours of the first dose
B. 1 day to 2 weeks
C. 3–6 weeks
D. 2–3 months

A

B

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30
Q

Which urinalysis finding is most characteristic of acute interstitial nephritis (AIN)?
A. Hyaline casts
B. Red blood cell casts
C. Pyuria and white blood cell casts
D. Crystals and hematuria

A

C

The urinalysis usually shows pyuria and at times eosinophiluria, but the most characteristic cell types are activated T lymphocytes and plasma cells, along with some white blood cell casts.

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31
Q

Granulomatous TIN may occur in _____.

A

sarcoidosis

32
Q

In a patient with photophobia and red painful eye, the clinician should look at renal function and the urinalysis for evidence of _______.

A

tubulointerstitial nephritis uveitis (TINU) syndrome

33
Q

Patients who have hypercalcemia or hyperoxaluria may develop nephrocalcinosis, a form of interstitial nephritis characterized by calcifications within the renal parenchyma, often at the______boundary.

A

cortical medullary

34
Q

When _____ and _____ are concurrent, the most common etiologies include hypercalcemic disorders, particularly primary hyperparathyroidism and congenital medullary sponge disease (tubular ectasia), as well as hereditary distal RTA.

A

nephrocalcinosis

nephrolithiasis

35
Q

Any detectable albuminuria on ____ is called overt proteinuria

A

dipstick

36
Q

Type of albuminuria associated with focal kidney diseases involving <50% of glomeruli.

A

Subnephrotic Albuminuria

37
Q

Which of the following is the hallmark feature of microalbuminuria in diabetes mellitus (DM)?
A. Albumin excretion >300 mg/day
B. Albumin excretion of 30–300 mg/day
C. Detectable by urinary dipstick protein analysis
D. Associated with light-chain nephropathy

A

B

38
Q

Which type of proteinuria is most commonly associated with multiple myeloma?
A. Glomerular proteinuria
B. Overflow proteinuria
C. Tubular proteinuria
D. Nephrotic proteinuria

A

B

Overflow proteinuria occurs when kappa or lambda light chains freely cross the glomerular barrier, as seen in multiple myeloma

39
Q

Which of the following protein types is commonly associated with tubular proteinuria?
A. Albumin
B. Kappa light chains
C. Lambda light chains
D. β-2 microglobulin

A

D

40
Q

A dipstick test for proteinuria has the highest sensitivity for detecting which type of protein?
A. β-2 microglobulin
B. Kappa and lambda light chains
C. Albumin
D. Immunoglobulins

A

C

41
Q

Nephrotic syndrome (NS) has three defining features: ______

A

edema

hypoalbuminemia (<3.5 g/dL)

proteinuria >3.5 g/day.

42
Q

_____ is often associated with lipid abnormalities such as a high LDL, low HDL, and lipiduria.

A

Nephrotic syndrome

43
Q

A characteristic finding of rapid-onset hypoalbuminemia in NS is horizontal linear white lines in the nail bed, known as ____

A

Muehrcke’s line

44
Q

Age is important in the onset of NS, in that young children <6 years of age frequently have _____.

A

MCD

45
Q

When NS is associated with Fanconi’s syndrome (glycosuria, phosphaturia, uricosuria, and aminoaciduria), one must consider ______ in the adult.

A

multiple myeloma

46
Q

Recently, 70% of patients with primary MN have been found to have circulating levels of an autoantibody to the ______in the subepithelial region of the glomerular basement membrane.

A

phospholipase A2 receptor (anti-PLA2R)

47
Q

A 20-year-old presenting with NS may have ______

A

MCD, FSGS, or membranous nephropathy (MN).

48
Q

MN is the NS most often associated with ____
Caused by urinary loss of antithrombin-3, plasminogen, hyperfibrinogenemia.

A

RVT

49
Q

Which of the following is a defining feature of nephrotic syndrome?
A. Proteinuria >3.5 g/day
B. Serum albumin >4 g/dL
C. High HDL levels
D. Nephrogenic diabetes insipidus

A

A

50
Q

Which urinary finding is characteristic of lipid abnormalities in nephrotic syndrome?
A. Dysmorphic red blood cells
B. Oval fat bodies with Maltese crosses under polarized light
C. Hyaline casts
D. β-2 microglobulin

A

B

51
Q

Which primary nephrotic syndrome is most commonly associated with circulating anti-PLA2R antibodies?
A. Focal segmental glomerulosclerosis (FSGS)
B. Minimal change disease (MCD)
C. Membranous nephropathy (MN)
D. Amyloidosis

A

C

52
Q

Which of the following conditions is most associated with renal vein thrombosis in nephrotic syndrome?
A. Minimal change disease (MCD)
B. Amyloidosis
C. Membranous nephropathy (MN)
D. Diabetic nephropathy

A

C

Membranous nephropathy is commonly associated with renal vein thrombosis due to urinary loss of antithrombin-3, plasminogen, and hyperfibrinogenemia

53
Q

A 20-year-old presenting with NS may have
A. MCD
B. FSGS
C. membranous nephropathy (MN).
D. All of the above

A

D

54
Q

True hematuria can be distinguished from hemoglobinuria and myoglobinuria by ____.

A

urinalysis

55
Q

Hematuria associated with flank pain or ureteral colic is more characteristic of a ____ source, such as a stone or an obstructing lesion

A

lower urinary tract

56
Q

Which of the following is a distinguishing feature of lower urinary tract bleeding?
A. Hematuria with dysmorphic red blood cells
B. Hematuria most pronounced at the beginning of the stream
C. Hematuria with persistent microscopic findings after exercise
D. Hematuria associated with nephrotic syndrome

A

B

57
Q

Which condition is most likely to cause hematuria that resolves after 1–2 weeks of rest?
A. Strenuous exercise
B. IgA nephropathy
C. Thin basement membrane disease
D. Prostatic hypertrophy

A

A

58
Q

It is defined by the retention of nitrogenous solutes such as urea, uric acid, and creatinine.

A

Acute kidney injury (AKI)

59
Q

_____ states are often related to a decreased perfusion pressure to the glomerular capillaries or some other interference with filtration.

A

Prerenal

60
Q

Prerenal/Intrinsic/Postrenal

All of these will decrease perfusion pressure and decrease GFR while stimulating sodium and water reabsorption.

A

Intrinsic

61
Q

Postrenal states accompanied by anuria suggest _____ obstruction to the flow of urine, while polyuria and bland urinary sediment suggest ______ obstruction combined with ADH unresponsiveness.

A

complete

incomplete

62
Q

Fractional Excretion of Sodium (FENa):

_____ states: FENa >1–2%.

Prerenal syndromes: FENa <1%.

A

Postrenal

63
Q

Which substance is associated with prerenal AKI due to vasoconstriction?
A. Aminoglycosides
B. Cocaine
C. Cisplatinum
D. Penicillin

A

B

vasoconstrictive substances including cocaine, iodinated IV contrast media, hemoglobin or myoglobin, and certain antibiotics like vancomycin, cyclosporine, and tacrolimus (calcineurin inhibitors); other vasoconstrictive drugs like nonsteroidals; and renal nerve stimulation.

64
Q

What distinguishes prerenal AKI from intrinsic AKI in terms of urinary sodium excretion?
A. Prerenal AKI has FENa >2%
B. Prerenal AKI has FENa <1%
C. Intrinsic AKI has FENa <1%
D. Both have FENa >2%

A

B

65
Q

What is the effect of correcting hypoxemia in prerenal AKI?
A. Increases potassium excretion
B. Causes vasoconstriction
C. Leads to a diuretic effect
D. Reduces urine output

A

C

66
Q

Which of the following is one of the most frequent cause of oliguric intrinsic AKI?
A. Renal artery stenosis
B. Acute tubular necrosis (ATN)
C. Tumor lysis syndrome
D. Chronic interstitial nephritis

A

B

67
Q

Which imaging finding is most indicative of urinary tract obstruction in postrenal AKI?
A. Hydronephrosis on ultrasound
B. Shrunken kidneys on CT
C. Hyperechoic kidney on ultrasound
D. Dilated renal vein on ultrasound

A

A

68
Q

Which drug is NOT a known cause of ATN?
A. Aminoglycosides
B. Methotrexate
C. Vancomycin
D. NSAIDs

A

C

69
Q

Which of the following is a typical finding in chronic kidney disease (CKD) but not in acute kidney disease?
A. Normal-sized kidneys on ultrasound
B. Thinning of the renal cortex
C. Elevated calcitriol levels
D. Low parathyroid hormone (PTH) levels

A

B

70
Q

Which of the following conditions is associated with hypertension but does NOT progress to renal failure?
A. Fibromuscular dysplasia
B. Polyarteritis nodosum
C. IgA nephropathy
D. Diabetic nephropathy

A

A

71
Q

Which of the following conditions is associated with hypertension but does NOT progress to renal failure?
A. Fibromuscular dysplasia
B. Polyarteritis nodosum
C. IgA nephropathy
D. Diabetic nephropathy

A
72
Q

Which hereditary kidney disease is characterized by hematuria, hearing loss, and ocular deformities?
A. Polycystic kidney disease (PCKD)
B. Alport syndrome
C. Thin basement membrane disease
D. Horseshoe kidney

A

B

73
Q

Which symptom in CKD patients indicates a loss of the ability to concentrate urine?
A. Weight loss
B. Restless legs syndrome
C. Nocturia
D. Loss of appetite

A

C

74
Q

Which distinguishing feature helps differentiate Gitelman’s syndrome from Bartter’s syndrome in CKD-related tubular dysfunction?
A. Hypercalciuria in Gitelman’s syndrome
B. Hypocalciuria in Bartter’s syndrome
C. Hypercalciuria in Bartter’s syndrome
D. Hypochloremia in Bartter’s syndrome

A

C

75
Q

A CKD patient presents with polyuria, free water losses, and ADH insensitivity. Which condition is most likely?
A. Fanconi’s syndrome
B. Nephrogenic diabetes insipidus
C. Hypokalemic metabolic alkalosis
D. Secondary hyperparathyroidism

A

B

76
Q

The ______is the standard test for nephrolithiasis but carries the risk of accumulative radiation.

A

renal-limited noncontrast CT scan

77
Q
A

Nephrology (10 decks)

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