QUESTIONS ON THE KIDNEY AND URINARY TRACT

1) AKI is defined by a rise in serum creatinine –

A) 0.3mg/dL in 48 hours
B) 0.5mg/dL in 72hours
C) 50% higher than baseline in 48 hours
D) 0.3mg/dL in one week

Answer A) HARRISON’S 19th edition , chap 334,page 1805

2) Contrast nephropathy has all of the following characterstics except –

A) Rise in SCr within 1-2 days
B) Peak in SCr between 1-2 days
C) Resolution within 5-7 days
D) Common with iodinated contrast

Answer B) HARRISON’S 19th edition , chap 334,page 1806

3) RBC casts may be seen in all of the following situation except-

A) Glomerulonephritis
B) Vasculitis
C) Interstitial nephritis
D) Malignant hypertension

Answer C) HARRISON’S 19th edition , chap 334,page 1807

4) WBC’s and WBC casts may be seen in all of the following situations except –
A) Interstitial nephritis
B) Glomerulonephritis
C) Allograft rejection
D) Malignant hypertension

Answer D) HARRISON’S 19th edition , chap 334,page 1807

5) All of the following can cause FeNa <1% except –

A) Pre renal azotemia
B) Early sepsis
C) Contrast nephropathy
D) Ischemia asscociated AKI

Answer D) HARRISON’S 19th edition , chap 334,page 1806

 6) All of the following are novel and upcoming biomarkers for kidney damage except –
A) Neutrophil gelatinase associated lipocalin
B) Kidney injury molecule -1
C) IL-18
D) Cytokeratin 8

Answer D) HARRISON’S 19th edition , chap 334,page 1806

7) Protein requirement in patients of AKI on dialysis is

A) 0.8-1g/kg/ day
B) 1-1.5g/kg / day
C) 0.5-1g/kg/day
D) 1.7g/kg/day

Answer B) HARRISON’S 19th edition , chap 334,page 1810

8) Secondary hyperparathyroidism starts to occur at a GFR of –

A) 45mL/min
B) 60mL/min
C) 90mL/min
D) <30mL/min

Answer B) HARRISON’S 19th edition , chap 335,page 1815

9) All of the following is true about FGF-23 except –

A) Part of family of phosphatonins , increased early in the course of CKD
B) Independent risk factor for mortality in CKD
C) Secreted by osteoclast
D) Decreases calcitriol formation

Answer C) HARRISON’S 19th edition , chap 335,page 1815

10) Which is not true regarding osteitis fibrosa cystica

A) Bone histology shows abnormal osteoid , bone marrow fibrosis
B) Formation of bone cysts in the advanced stages
C) Also called brown tumors
D) Associated with low bone turnover

Answer D) HARRISON’S 19th edition , chap 335,page 1815

11) Most common acute complication of hemodialysis

 A) Hypoglycemia
B) Dialysis disequilibrium syndrome
C) Hypotension
D) Muscle cramps

Answer C) HARRISON’S 19th edition , chap 336,page 1824

12) Post streptoglomerulonephritis is prototypical of

A) Extracapillary proliferative glomerulonephritis
B) Acute endocapillary proliferative glomerulonephritis
C) Membranous glomerulonephritis
D) Mesangiocapillary glomerulonephritis

Answer B) HARRISON’S 19th edition , chap 338,page 1837

13) All of the following features are seen in PSGN except –

A) Children between 2-14 years of age
B) More common in males
C) Typical after 2-6 weeks of streptococcal pharyngitis
D) SPEB and NAP1r are nephritis associated plasmin receptors implicated

Answer C) HARRISON’S 19th edition , chap 338,page 1837

14) Regarding lupus nephritis what is not true

A) Class I and class II lesions are associated with minimal renal manifestations
B) Class VI lesions are associated with sclerosis of glomeruli
C) Class III lesions have the most varied course
D) Class V lesions have diffuse subendothelial deposits

Answer D) HARRISON’S 19th edition , chap 338,page 1837

15) SLE nephritis is characterized by all except –

A) Most severe in African American females
B) Upto 50% patients have renal manifestations at diagnosis
C) Anti dsDNA antibodies correlate best with renal disease
D) Allograft survival rates are poorer as compared to transplants due to other reasons

Answer D) HARRISON’S 19th edition , chap 338,page 1837- 1839

16) Goodpasture’s syndrome is anti glomerular basement membrane disease .It has all of the
following features except –
A) Target epitope is the tertiary structure of alpha 3, NC1 domain of collagen IV
B) Bimodal peak
 C) Disease in younger age group explosive
D) Lung hemorrhage as a presentation is associated with better outcome

Answer A ) HARRISON’S 19th edition , chap 338,page 1839

17) Regarding Goodpasture’s syndrome all is true except

A) Linear immunofluorescent staining for IgG
B) P-ANCA is found in 10-15% patients
C) ANCA antibodies against MPO is associated with poor prognosis
D) Oliguria at presentation is a poor prognostic indicator

Answer C) HARRISON’S 19th edition , chap 338,page 1839

18) Ig A nephropathy is characterized by all of the following except

A) Episodic hematuria
B) Peak in the 2nd and 3rd decades
C) Synpharyngitic hematuria
D) Presence of macroscopic hematuria is associated with poorer outcomes

Answer D) HARRISON’S 19th edition , chap 338,page 1840

19 ) MPGN type 1 disease is caused by all except

A) Subacute bacterial endocarditis

B) Hepatitis C
C) Hepatitis B
D) C3 nephritic factor associated

Answer D) HARRISON’S 19th edition , chap 338,page 1841

20 ) All of the following features characterize MPGN ( membranoproliferative glomerulonephritis )

except –

A) Type 1 most proliferative

B) Type 1 associated with double contouring or tram tracking
C) Low serum c3 levels and dense deposits characterize type 1 MPGN
D) Type II MPGN is associated with autoantibodies that stabilize C3 convertase

Answer C) HARRISON’S 19th edition , chap 338,page 1841

21 ) All of the following features are seen in minimal change disease except
 A) Abrupt onset edema
B) 30% children have hypertension
C) 30% children have decreased renal function
D) 30% adults have atopic/allergic symptoms

Answer C ) HARRISON’S 19th edition , chap 338,page 1842

22) Relapses in minimal change nephrotic syndrome are characterized by all except

A) 70-75% children have relapse after first remission

B) early relapses predict subsequent relapses

C) frequency of relapses increases especially after puberty

D) relapses are more resistant to therapy in adults

Answer C ) HARRISON’S 19th edition , chap 338,page 1842

23 ) Regarding Membranous glomerulonephritis ( MGN) what is true

A) >90% cases of nephrotic syndrome in adults

B) Peak incidence between 20-30 years
C) MGN has the highest reported incidence of renal vein thromsosis
D) Nearly 50 % patients develop renal failure

Answer C ) HARRISON’S 19th edition , chap 338,page 1844

24 ) All are true regarding autosomal dominant polycystic kidney disease ( ADPKD ) except

A) Bilateral formation of renal cysts

B) Incidental discovery of hypertension , abdominal /flank pain
C) Gross hematuria occurs in nearly 40 % patients
D) > 90 % patients with ADPKD are clinically diagnosed in their lifetime

Answer D ) HARRISON’S 19th edition , chap 338,page 1851

25) regarding genetics of ADPKD all are true except

A) 85% mutations occur in PKD1

B) estimated prevalence is 1:400- 1:1000

C) every cell carries a somatic mutant allele of PKD1 / PKD 2

D) autosominal dominant with complete penetrance , variable expressivity

Answer C ) HARRISON’S 19th edition , chap 338,page 1851

26 ) Regarding complications of ADPKD include all are true except

A) Infection is the second most common of death

B) Renal carcinoma is a frequent complication , with ADPKD being at a higher risk for RCC
C) Hypertension is frequent and occurs before reduction in GFR
D) Major cause of mortality is cardiovascular in ADPKD

Answer B) HARRISON’S 19th edition , chap 338,page 1852

27 ) Most common extra renal manifestations in ADPKD is

A) Mitral valve prolapse

B) Saccular berry aneurysm
C) Liver cysts
D) Colonic divrerticula

Answer C ) HARRISON’S 19th edition , chap 338,page 1853

28 ) Absolute indications for corticosteroids in interstitial nephritis include all except –

A) Sjogren’s syndrome
B) Adults with TINU ( tubulointerstitial nephritis with uveitis )
C) SLE interstitial nephritis
D) Children with TINU

Answer D) HARRISON’S 19th edition , chap 340 ,page 1857

29 ) Regarding thrombotic microangiopathies all are true except –

A) HUS and TTP are prototypes for MAHA ( microangiopathic hemolytic anemia )
B) HUS is defined by presence of MAHA and renal impairement
C) Most cases of D+ HUS involve children < 5 years
D) Bloody diarrhea with fever typically characterize D+ HUS

Answer D) HARRISON’S 19th edition , chap 341,page 1863

30 ) Thrombotic thrombocytopenic purpura is characterized by all except

A) MAHA , thrombocytopenia , neurologic symptoms , fever , renal failure

B) Accumulation of ultra large multimers of VWF
C) Marked decrease in the activity of ADAMTS13
D) Self limiting , with mortality rates being < 50% in untreated cases

Answer D ) HARRISON’S 19th edition , chap 341 , page 1863