A 56-year-old man presents with flank pain and haematuria. His plasma creatinine concentration is 368 m mol/l and renal ultrasound reveals bilateral 14-cm kidneys with multiple cysts. There are also cysts scattered through the liver.
What is the cause of this condition?
1- Bilateral ureteric reflux from childhood
2- Genetic defect in the gene encoding polycystin
3- Genetic defect in the von Hippel-Landau gene
4- Genetic defect in the gene encoding type-IV collagen
5- Genetic defect in the gene encoding cystinosin
Answer: 2- Genetic defect in the gene encoding polycystin
A 45-year-old woman with a long history of steroid-treated sarcoidosis presents with extreme thirst and nocturia five times per night. Her serum calcium concentration is 2.3 mmol/l, glucose is 4.6 mmol/l and potassium is 3.5 mmol/l. After an overnight fast, her serum Na+ is 149 mmol/l.
What is the cause of her symptoms?
1- Chronic cystitis
2- Cranial diabetes insipidus
3- Hypokalaemia-induced polyuria
4- Iatrogenic adrenal insufficiency
5- Psychogenic polydipsia
Answer: 2- Cranial diabetes ins
All of the following are considered as a possible causes of anaemia in the setting of acute kidney injury:
- Concealed haemorrhage
- RBC haemolysis
- Poor appetite
- Bleeding tendency
- All of the above
Answer: 3- Poor appetite
A 36-year-old man presents with a history of red urine. This has occurred intermittently over the previous 3 years but he is otherwise well. His blood pressure is 160/95 mmHg and urinalysis shows +3 blood and +3 protein, with red-cell casts evident on microscopy. He excretes 1.6 g of protein/24 hours in his urine.
What would a renal biopsy most probably show?
1- Focal segmental glomerulosclerosis with IgA deposition
2- Mesangioproliferative glomerulonephritis with IgA deposition
3- Mesangioproliferative glomerulonephritis with IgM deposition
4- Proliferative glomerulonephritis with deposition of C3, IgG and IgM
5- Normal light microscopy with thin basement membranes on EM
Answer: 2- Mesangioproliferative glomerulonephritis with IgA deposition
A 35 years old nurse is presented with history of periorbital puffiness, bilateral leg oedema with frothy urine. Urinalysis show protein +++ & 24 hours urine collection for protein was 4 gram / day. What is the rational initial step can be done for this patient?
- Send the patient for abdominal & pelvic ultrasound
- Send the patient for hepatitis B virology screen
- Send the patient for tumor markers of breast CA & ovarian cancer
- Send the patient for blood film and bone marrow biopsy
- Send the patient for renal biopsy
Answer: 2- Send the patient for hepatitis B virology screen
A 46-year-old Asian woman complains of dysuria and flank discomfort. Her blood pressure is 200/100 mmHg despite taking three medications. Urine microscopy shows leucocytes and red cells, but there is no significant bacterial growth. Renal ultrasound shows two 9-cm kidneys with medullary calcification and mild hydronephrosis on the left.
What is the most likely cause of this presentation?
1- Acute pyelonephritis
2- Aristolochic acid nephropathy
3- Medullary cystic disease
4- Renal tract tuberculosis
5- Reflux nephropathy
Answer: 4- Renal tract tuberculosis
A 39-year-old man undergoes treatment for a large tumour-burden, non-Hodgkin’s lymphoma with a regimen that includes cyclophosphamide, doxorubicin, vincristine and prednisolone. The treatment is complicated by Gram-negative sepsis, which is treated with gentamicin and ceftazidime. The day after completing the first course of treatment, he is found to be oligoanuric (urine output 250 ml/24 h). His blood pressure is 150/60 mmHg and he has +1 peripheral oedema. Urinalysis shows a pH of 5.6 and +1 protein, and urine microscopy reveals numerous reddish-brown, rosette-like crystals. Plasma creatinine concentration is 200 m mol/l, calcium is 1.76 mmol/l and phosphate is 2.7 mmol/l.
What is the cause of the oliguria?
1- Ceftazidime-induced interstitial nephritis
2- Gentamicin nephrotoxicity
3- Lymphomatous infiltration of the kidney
4- Tumour lysis syndrome
5- Vincristine nephropathy
Answer: 4- Tumour lysis syndrom
A 22-year-old married woman is evaluated for a 1-week history of burning micturition with lower abdominal discomfort. She reports no fever, or back pain. Medical history is insignificant only a previous allergic reaction to sulfa drugs, which cause a generalized rash. On physical examination, temperature is 36.8 °C, blood pressure is 120/80 mm Hg, pulse rate is 72/min, and respiration rate is 13/min. Mild suprapubic tenderness but no costovertebral angle tenderness are noted on abdominal examination. The remainder of the examination is noncontributory. GUE examination reveal the following result: color: cloudy , specific gravity : 1.025, WBC : 8-10 cells/hpf, RBC: 2- 4 cells/hpf, albumin: nil, nitrites: positive , crystals: nil, squamous epithelial cell: 15 cells/hpf. The most appropriate next step in this patient management is :
- Start empirical antibiotic therapy with oral cotrimoxazole
- Start empirical antibiotic therapy with oral ciprofloxacin
- Start empirical antibiotic therapy with 3rd generation cephalosporin
- Send a urine sample for culture & sensitivity
- Send the patient for Venereal Diseases Research Laboratory (VDRL) test
Answer: 2- Start empirical antibiotic therapy with oral ciprofloxacin
An 80-year-old man with a long history of poor urinary stream and nocturia presented with malaise and vomiting. His plasma creatinine concentration was 1242 mmol/l and his urea 65 mmol/l. Renal ultrasound showed gross bilateral hydronephrosis with thin cortices. A urinary catheter was placed and he passed 7.6 litres of urine over the next 24 hours, during which time he received no supplemental iv fluid. His blood pressure is now 80/50 mmHg, he has no oedema and his neck veins are flat. His serum Na+ is 150 mmol/l and urine osmolality is 198 mOsm/l.
Which of the following most accurately describes the hormonal milieu?
1- High ADH, high aldosterone, high renin
2- High ADH, high aldosterone, low renin
3- High ADH, low aldosterone, low renin
4- Low ADH, high aldosterone, high renin
5- Low ADH, low aldosterone, high renin
Answer: 1- High ADH, high aldosterone, high renin
A 63-year-old woman presents with malaise, ankle swelling and shortness of breath. Her blood pressure is 215/140 mmHg, she has +2 peripheral oedema and the skin over her fingers appears very tight. Fundoscopy discloses bilateral papilloedema. Plasma creatinine concentration is 370 mmol/l, potassium is 4.9 mmol/l, haemoglobin is 8.9 g/dl and her platelet count is 90 x 109/ml.
What is the pathological hallmark of this condition?
1- Aneurysm formation in the medium-sized arteries
2- Autoimmune destruction of red blood cells
3- Functioning adenoma of the adrenal cortex
4- Mucoid intimal thickening of vascular endothelium
5- Stenosis of one or both main renal arteries
Answer: 4- Mucoid intimal thickening of vascular endothelium
A 65-year-old man is seen in the Emergency Department complaining of muscle weakness and lethargy.Admission blood tests show the following:
Na+ 138 mmol/l
K+ 6.3 mmol/l
Bicarbonate 15 mmol/l
Urea 200 mg/dl
Creatinine 7 mg/dl
What is the most appropriate initial treatment to lower the serum potassium level?
- Intravenous bicarbonate
- Haemodialysis
- Insulin/dextrose infusion
- Intravenous calcium gluconate
- Oral calcium resonium
Answer: 3- Insulin/dextrose infusion
Which one of the following features is characteristic of Bartter’s syndrome?
1- Hypokalaemia with hypertension
2- Reduced urinary excretion of potassium and chloride
3- Good response to ACE inhibitors
4- Low renin and aldosterone
5- Hyperplasia of the juxtaglomerular apparatus
Answer: 5- Hyperplasia of the juxtaglomerular apparatus
A 34-year-old woman with known SLE presents with ankle swelling. Her blood pressure is 170/100 mmHg and she has marked lower limb oedema. Urine dipstick discloses +3 protein with no haematuria. Plasma creatinine concentration is 101 mmol/l, albumin is 12 g/dl and urinary protein excretion rate is 6.9 g/24 h.
What is the cause of this presentation?
1- Amyloidosis
2- Class II lupus nephritis
3- Class V lupus nephritis
4- Fibrillary glomerulonephritis
5- Pericardial effusion
Answer: 3- Class V lupus nephritis
An 18-year-old girl who is deaf and has a history of renal impairment is reviewed in clinic. She has previously been diagnosed with Alport’s syndrome but is thinking about having children and asks about the risks of passing the condition on. What is the mode of inheritance of Alport’s syndrome in the majority of cases?
- X-linked recessive
- X-linked dominant
- Autosomal recessive
- Autosomal dominant
- Mitochondrialinheritance
Answer: 2- X-linked dominant
Which one of the following conditions is most commonly associated with large kidneys despite advanced renal failure?
1- Amyloidosis
2- Hypertensive nephrosclerosis
3- Membranous glomerulonephritis
4- Systemic sclerosis
5- Analgesic nephropathy
Answer: 1- Amyloidosis
A 30-year-old woman presents for a second opinion with severe, unrelenting, left flank pain with episodes of red urine. This has been present intermittently for 2 years. In addition, she complains of headache and a sensation of her own heartbeat. Urinalysis reveals +3 blood with no protein; urine microscopy discloses numerous dysmorphic red cells with some red cell casts. The urine is sterile on culture. Renal ultrasound shows normal kidneys and no calculi are visible on plain X-ray. Her plasma creatinine concentration is 65 m mol/l and her blood pressure is 90/60 mmHg.
What is the probable diagnosis?
1- IgA nephropathy
2- Loin pain-haematuria syndrome
3- Recurrent pyelonephritis
4- Renal abscess
5- Renal-cell carcinoma
Answer: 2- Loin pain-haematuria syndrom
A patient with type 1 diabetes mellitus is reviewed in the nephrology outpatient clinic. He is known to have stage1 diabetic nephropathy. Which of the following best describes his degree of renal involvement?
- Hyperfiltration
- End-stage renal failure
- Overt nephropathy
- Microalbuminuria
- Latent phase diabetic nephropathy
Answer: 1-Hyperfiltration
A 23-year-old man presents to his GP with rapidly increasing shortness of breath and haemoptysis for the second time within 3 weeks. He is referred urgently to the medical on-call team. Apart from smoking 20 cigarettes per day and having mild asthma, he has no other significant past medical history. Urinalysis reveals microscopic haematuria and proteinuria. Chest X-ray reveals fluffy pulmonary infiltrates. Haemoglobin is 10.5 g/dl, serum creatinine is 345 m mol/l, serum-ANCA is negative.
What diagnosis fits best with this clinical picture?
1- Bronchopneumonia
2- Goodpasture’s syndrome
3- Wegener’s granulomatosis
4- SLE
5- Sarcoidosis
Answer: 2- Goodpasture’s syndrome
You are reviewing a 65-year-old in the renal clinic. He has been on haemodialysis for chronic kidney disease forthe past 6 years. What is he most likely to die from?
- Electrolytes disturbances e.g. Hyperkalaemia
- Dilated cardiomyopathy
- Dialysis related sepsis
- Ischaemic heart disease
- Air embolism during haemodialysis
Answer: 4- Ischaemic heart disease
82-year-old man presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day. ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
What diagnosis fits best with this clinical picture?
1- Cardiac failure
2- Cirrhosis
3- Nephritic syndrome
4- Nephrotic syndrome
82-year-old man presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day. ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
What diagnosis fits best with this clinical picture?
1- Cardiac failure
2- Cirrhosis
3- Nephritic syndrome
4- Nephrotic syndrome
Answer: 4- Nephrotic syndrome
A 32-year-old Afro-Caribbean man with a 5-year history of HIV infection presents with swollen ankles. He has been treated with highly active antiretroviral therapy (HAART) for 2 years, with partial response. His plasma creatinine concentration is 358 mmol/l, albumin is 12 g/dl, CD4 count is 35/m l and 24-hour urine protein excretion rate is 6.8 g. Renal ultrasound shows echogenic kidneys 13.5 cm in length.
What would a renal biopsy show?
1- Focal necrotising crescentic nephritis
2- Kimmelstiel-Wilson lesions
3- Membranous nephropathy
4- Microcystic tubular dilatation and collapsing FSGS
5- Minimal-change disease
Answer: 4- Microcystic tubular dilatation and collapsing FSGS
A 19-year-old woman complains of stiff joints and a facial rash. Her blood pressure is 145/95 mmHg, she has +1 oedema, slightly swollen metacarpophalangeal joints and some ulceration of her buccal mucosa. Plasma creatinine is 92 m mol/l, Hb is 8.9 g/dl and platelet count is 92 x 1012/l. Urinalysis shows +3 blood and +3 protein. High titres of double-stranded DNA antibodies are detectable in her serum.
What would histological examination of renal tissue demonstrate?
1- Diffuse proliferative glomerulonephritis with deposits of IgG, IgM and C3
2- Fibrillary glomerulonephritis
3- Focal segmental glomerulosclerosis
4- Pauci-immune diffuse proliferative glomerulonephritis
5- Pauci-immune focal necrotising crescentic nephritis
Answer: 1- Diffuse proliferative glomerulonephritis with deposits of IgG, IgM and C3
A 65-year-old man, who has been on haemodialysis for 12 years, presents with gradually increasing bone pain. He underwent subtotal parathyroidectomy 4 years ago. Current medications include alfacalcidol 1 m g/day and calcium carbonate 500 mg three times daily. His serum calcium concentration is 2.97 mmol/l (2.2-2.6), phosphate is 2.7 mmol/l (0.8-1.4) and intact parathyroid hormone level is 90 pmol/l (0.9-5.4).
What is the most probable cause of his symptoms?
1- Adynamic bone disease
2- Dialysis amyloid
3- Hyperparathyroid bone disease
4- Osteoporosis
5- Vitamin D-induced hypercalcaemia
Answer: 3- Hyperparathyroid bone disease
Calcium homeostasis is dependent on the fact that:
1- Most of the serum calcium exists as free calcium ions
2- Body calcium content is mainly regulated by kidneys
3- 99% of filtered Ca is reabsorbed in the kidneys
4- Calcitonin decreases renal calcium excretion
5- Decreased renal excretion leads to hypercalcaemia in sarcoidosis
Answer: 3- 99% of filtered Ca is reabsorbed in the kidneys
