Nephrology

Question 1

A 5-year-old hospitalized and receiving penicillin IV for 10days, developed rash, eosinophilia, eosinophiluria, pyuria (sterile), hematuria, moderate proteinuria (usually

Answer 1

Antibiotic-induced allergic interstitial nephritis

Question 2

A 4-year-old had throat infection 2weeks ago, teacolored urine, BP is slightly elevated, RBC casts in urine, low C3 and normal C4

Answer 2

Postinfectious glomerulonephritis

Question 3

History of impetigo, tea-colored urine, hypertension, periorbital edema, C3 is low, normal C4, azotemia, normal ASO titer, positive anti-DNAse, oliguria, and RBC casts in urine

Answer 3

Postinfectious glomerulonephritis

Question 4

Low C3 and cola-colored hematuria (RBC casts) 2–3weeks after upper respiratory tract infection

Answer 4

Postinfectious glomerulonephritis

Question 5

Normal C3 and episodic gross hematuria (RBC casts) during acute upper respiratory tract infection

Answer 5

IgA nephropathy

Question 6

The most common cause of gross hematuria in children

Answer 6

IgA nephropathy

Question 7

Can antibiotics prevent acute postinfectious glomerulonephritis?

Answer 7

No

Question 8

Can antibiotics prevent acute rheumatic fever?

Answer 8

Yes

Question 9

After poststreptococcal glomerulonephritis (PSGN) does the C3 level normalize immediately after the illness?

Answer 9

No—at least 6weeks before C3 levels return to normal

Question 10

Are steroids indicated in PSGN?

Answer 10

No—only supportive care measures and BP control as needed

Question 11

Adolescent female with rapidly progressive glomerulonephritis, hypertension, and both C3 and C4 are decreased

Answer 11

Lupus nephritis

Question 12

A healthy child with proteinuria, morning specimen is negative for proteinuria

Answer 12

Benign orthostatic proteinuria

Question 13

A 3-year-old, swelling of the face and generalized edema, normal blood pressure, 4+ proteinuria, no hematuria, hyperlipidemia, hypoalbuminemia, normal C3 and C4, urine is negative for protein after 3weeks of steroid therapy

Answer 13

Nephrotic syndrome due to minimal change disease

Question 14

Child with nephrotic syndrome not responding to treatment and progressing to chronic kidney disease

Answer 14

Focal segmental glomerulosclerosis

Question 15

Adolescent with nephrotic syndrome, microscopic hematuria, and hypertension

Answer 15

Focal segmental glomerulosclerosis

Question 16

Adolescent presents with proteinuria, hematuria, hypertension, persistent low C3, hyperlipidemia, renal failure

Answer 16

Membranoproliferative glomerulonephritis

Question 17

Child presents with persistent proteinuria, history of hepatitis B virus infection

Answer 17

Membranous glomerulonephritis

Question 18

Child develops acute kidney injury and within 4weeks progresses to end-stage renal disease, renal biopsy shows crescents formation in most glomeruli

Answer 18

Rapidly progressive (crescentic) glomerulonephritis

Question 19

Which serologic marker can be positive in rapidly progressive glomerulonephritis?

Answer 19

P-ANCA

Question 20

A 5-year-old has blood in urine, urine is positive for hematuria, RBC casts, renal function is normal, no hypertension, positive family history of hematuria with every generation affected

Answer 20

Familial thin basement membrane nephropathy (autosomal dominant)

Question 21

Microhematuria, proteinuria, absent patella, dystrophic nails, dysplasia of elbows

Answer 21

Nail-patella syndrome (autosomal dominant)

Question 22

A 7-year-old, failure to thrive, polyuria, polydipsia, anemia, ocular apraxia, retinitis pigmentosa, coloboma, nystagmus, aplasia of the cerebellar vermis, loss of differentiation between cortex and medulla on renal US

Answer 22

Juvenile nephronophthisis

Question 23

Boy with a sensorineural hearing loss, proteinuria, mother’s brother died from renal failure

Answer 23

Alport syndrome (X-linked disease)

Question 24

Upper respiratory infection a week ago, now with petechiae on the buttocks and lower extremities, abdominal pain, arthralgia, and hematuria

Answer 24

Henoch-Schönlein purpura

Question 25

Bloody diarrhea, which resolves, but then the child becomes pale and tired and is found to have hemolytic anemia, thrombocytopenia, elevated BUN and creatinine. A stool culture is positive for Escherichia coli (E. coli) O157: H7

Answer 25

Hemolytic uremic syndrome

Question 26

The most common causes of oliguric acute kidney injury requiring dialysis in children

Answer 26

Nephrotoxins and rhabdomyolysis

Question 27

Child on amphotericin B developed kidney stones, and blood work showed non-anion gap metabolic acidosis. What is the most likely cause?

Answer 27

Renal tubular acidosis (RTA) type 1

Question 28

Child with polyuria, polydipsia, dehydration, growth failure, non-anion gap metabolic acidosis, hypokalemia, hypophosphatemia, proteinuria, glucosuria

Answer 28

Fanconi syndrome

Question 29

Type of renal tubular acidosis associated with Fanconi syndrome

Answer 29

RTA type 2

Question 30

Type of renal tubular acidosis associated with hyperkalemia

Answer 30

RTA type 4

Question 31

Hemoptysis, hematuria, proteinuria, positive antiglomerular basement membrane antibodies (anti-GBM)

Answer 31

Goodpasture syndrome

Question 32

Child on Lasix, presents with oliguria, elevated creatinine; urine osmolality is > 400 mOsm/L, urine Na

Answer 32

Prerenal acute kidney injury

Question 33

Child after a car accident and crush injury presents with high BUN/Cr, oliguria, urine osmolality 300 mOsm/L. FeNa > 1%, urine Na > 20, large muddy brown granular cast

Answer 33

Acute tubular necrosis (intrarenal acute kidney injury)

Question 34

A male infant with posterior urethral valves, born prematurely and is found to have high BUN/Cr, elevated FeNa, normal urine osmolality, elevated urine Na

Answer 34

Postrenal acute kidney injury

Question 35

Status post-cardiac arrest, BUN and creatinine are elevated, hyperkalemia, hyponatremia, hyperphosphatemia, hypocalcemia, urine shows muddy brown, and granular casts

Answer 35

Acute tubular necrosis secondary to ischemia

Question 36

Adolescent with severe muscle cramps, numbness, low blood pressure, fatigue, metabolic alkalosis, hypochloremia, hypokalemia, hyponatremia, hypomagnesemia, polyuria, low urine calcium, and high urinary chloride 70 mEq/L. High aldosterone and renin levels

Answer 36

Gitelman syndrome (metabolic alkalosis and high urine chloride, low serum Mg, and low urine Ca)

Question 37

An infant with failure to thrive, dehydration, low blood pressure, metabolic alkalosis, hypochloremia, hypokalemia, hyponatremia, normal serum magnesium level, polyuria, normal urine calcium, and high urinary chloride 70 mEq/L. High aldosterone and renin levels. High urinary prostaglandin level

Answer 37

Bartter syndrome (metabolic alkalosis and high urine chloride, normal serum Mg, and normal or high urine Ca)

Question 38

Child with a positive family history of hypertension (parents) presenting with headache, hypertension, hypokalemia, metabolic alkalosis, and high urinary chloride

Answer 38

Liddle syndrome (autosomal dominant)

Question 39

Adolescent with mild glomerulonephritis, history of allergies/asthma with elevated eosinophil levels on CBC

Answer 39

Churg Strauss syndrome

Question 40

An older child with a prolonged history of fever, weight loss, hematuria, and hemoptysis. Radiograph shows necrotizing granuloma and C-ANCA positive

Answer 40

Granulomatosis with polyangiitis (formerly Wegner granulomatosis)

Question 41

A young child with palpable kidneys bilaterally, hypertension, and associated with a history of oligohydramnios

Answer 41

Autosomal recessive polycystic kidney disease

Question 42

The predominant type of polycystic kidney disease seen in adults

Answer 42

Autosomal dominant polycystic kidney disease

Question 43

How is hypertension defined in children?

Answer 43

BP > 95th percentile for age, height, and gender on 3 different occasions or greater than 130/90 mmHg in children aged 13 years and older

Question 44

How is elevated blood pressure defined in children?

Answer 44

BP ≥ 90th (≥ 13 years BP > 120/80 mmHg matching new adult guideline)

Question 45

Adolescent with severe muscle weakness after exercise, hypophosphatemia, hypokalemia and elevated CPK with myoglobinuria

Answer 45

Rhabdomyolysis—heme positive urine but no RBC

Question 46

Child with nausea, severe flank pain, and hematuria

Answer 46

Renal stone

Question 47

The most common type of stones in children

Answer 47

Calcium oxalate

Question 48

Type of kidney stone associated with staghorn calculi and Proteus?

Answer 48

Struvite stones

Question 49

Type of stone associated with an autosomal recessive pattern

Answer 49

Cystine stones

Question 50

First-line therapy for children with primary monosymptomatic nocturnal enuresis

Answer 50

Bedwetting alarm and desmopressin (both)

Question 51

Recommended lifestyle changes in all cases of monosymptomatic nocturnal enuresis

Answer 51

Adequate hydration during the day Limit fluids before bed (≤ 200 mL) Void before bed Regular sleep and wake schedule

Question 52

Diurnal enuresis after continence

Answer 52

Requires prompt evaluation