Medicine
Nephrology
A patient with advanced CKD has persistent metabolic acidosis. Which chronic complication can acidosis worsen?
A. Bone and muscle catabolism
B. Polycythemia
C. Hypercalcemia from excess calcitriol
D. Respiratory alkalosis only
Correct Answer: A
Chronic metabolic acidosis in CKD contributes to muscle wasting and bone buffering/demineralization.
Medicine
Nephrology
A 28-year-old woman develops cola-colored urine 2 days after an upper respiratory infection. Which diagnosis is most likely?
A. IgA nephropathy
B. Poststreptococcal glomerulonephritis
C. Membranous nephropathy
D. Amyloidosis
Correct Answer: A
IgA nephropathy classically causes synpharyngitic hematuria occurring during or within a few days of a respiratory infection.
Medicine
Nephrology
A patient with edema has urine protein 5 g/day, hypoalbuminemia and hyperlipidemia. This pattern is called:
A. Nephrotic syndrome
B. Nephritic syndrome
C. Prerenal azotemia
D. Fanconi syndrome
Correct Answer: A
Heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia define the nephrotic syndrome.
Medicine
Nephrology
Which change is expected shortly after starting an ACE inhibitor in bilateral renal artery stenosis?
A. Marked rise in creatinine
B. Severe hypoglycemia
C. Nephrotic-range proteinuria always resolves
D. Serum potassium always falls
Correct Answer: A
In bilateral renal artery stenosis, filtration depends on angiotensin II-mediated efferent arteriolar constriction, so ACE inhibition can sharply reduce GFR.
Medicine
Nephrology
A patient with autosomal dominant polycystic kidney disease should be counseled about increased risk of which extrarenal condition?
A. Intracranial berry aneurysm
B. Achalasia
C. Myasthenia gravis
D. Celiac disease
Correct Answer: A
ADPKD is associated with intracranial aneurysms, hepatic cysts and certain valvular abnormalities.
Medicine
Nephrology
A patient has recurrent kidney stones, hypercalcemia and elevated PTH. Which stone composition is most likely?
A. Calcium oxalate or calcium phosphate
B. Cystine only
C. Struvite only
D. Pure cholesterol
Correct Answer: A
Primary hyperparathyroidism increases urinary calcium and predisposes to calcium-containing renal stones.
Medicine
Nephrology
A man with CKD has pruritus, high phosphate, low calcium and elevated PTH. What mechanism best explains the high PTH?
A. Secondary hyperparathyroidism from CKD-mineral bone disorder
B. Primary adrenal failure
C. Thyrotoxicosis
D. Excess calcitonin
Correct Answer: A
Phosphate retention, reduced calcitriol and hypocalcemia stimulate secondary hyperparathyroidism in advanced CKD.
Medicine
Nephrology
A patient has metabolic acidosis with normal anion gap and urine pH persistently above 5.5. Which renal tubular acidosis is most likely?
A. Distal type 1 RTA
B. Proximal type 2 RTA
C. Type 4 RTA only
D. Respiratory acidosis
Correct Answer: A
Distal RTA reflects impaired distal hydrogen secretion, producing non-anion-gap acidosis with inappropriately high urine pH.
Medicine
Nephrology
Which indication is an accepted emergency reason to initiate dialysis in acute kidney injury?
A. Refractory pulmonary edema
B. Mild asymptomatic azotemia only
C. Creatinine 1.4 mg/dL alone
D. Microscopic hematuria alone
Correct Answer: A
Refractory volume overload causing pulmonary edema is a classic urgent indication for kidney replacement therapy.
Medicine
Nephrology
A patient with small-cell lung cancer has sodium 116 mmol/L, low serum osmolality, concentrated urine and appears euvolemic. What is the likely diagnosis?
A. SIADH
B. Diabetes insipidus
C. Primary hyperaldosteronism
D. Osmotic diuresis
Correct Answer: A
Hypotonic euvolemic hyponatremia with inappropriately concentrated urine is typical of SIADH.
Medicine
Nephrology
A patient with nephrotic syndrome suddenly develops flank pain and hematuria. Which complication should be suspected?
A. Renal vein thrombosis
B. Acute appendicitis
C. Ureteric reflux only
D. Pyelonephritis is impossible
Correct Answer: A
Nephrotic syndrome creates a hypercoagulable state and can be complicated by renal vein thrombosis.
Medicine
Nephrology
A diabetic patient has persistent albuminuria and hypertension. Which antihypertensive class is preferred for kidney protection when tolerated?
A. ACE inhibitor or ARB
B. Alpha blocker only
C. Short-acting nitrate
D. Hydralazine alone
Correct Answer: A
Renin-angiotensin system blockade reduces intraglomerular pressure and albuminuria in albuminuric diabetic CKD.
Medicine
Nephrology
Which urinary finding is most characteristic of glomerulonephritis?
A. Red blood cell casts
B. Fatty casts only
C. Hexagonal crystals
D. Broad waxy casts only
Correct Answer: A
RBC casts indicate bleeding within the nephron and strongly support a glomerular inflammatory process.
Medicine
Nephrology
A patient has oliguria after prolonged hypotension. Urinalysis shows muddy brown granular casts. What is the most likely diagnosis?
A. Acute tubular necrosis
B. Minimal change disease
C. Postrenal obstruction
D. Renal vein thrombosis
Correct Answer: A
Ischemic acute tubular injury commonly produces muddy brown granular casts after significant hypotension or shock.
Medicine
Nephrology
A patient with severe hyperkalemia has peaked T waves and QRS widening. Which treatment should be given first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral sodium bicarbonate only
C. Furosemide by mouth
D. Kayexalate alone
Correct Answer: A
Intravenous calcium rapidly stabilizes the cardiac membrane in hyperkalemia with ECG changes; other therapies then lower serum potassium.
Medicine
Nephrology
Which finding in a patient with renal colic mandates urgent urologic assessment?
A. Pain that improves with analgesia
B. Microscopic hematuria alone
C. A small nonobstructing stone
D. Fever with an obstructed collecting system
Correct Answer: D
An infected obstructed system is a urologic emergency requiring source control.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Ureteric stone causing renal colic?
A. Venous thromboembolism
B. Rapid deterioration in kidney function
C. Infected obstructed kidney
D. Cardiac arrest
Correct Answer: C
An obstructed urinary tract with infection can rapidly cause sepsis and requires urgent drainage.
Medicine
Nephrology
A patient is diagnosed with Ureteric stone causing renal colic. Which is the most appropriate management principle?
A. Control blood pressure and kidney-risk factors, use kidney-protective therapy when indicated and avoid nephrotoxins
B. Provide analgesia and assess for obstruction, infection and need for urologic intervention
C. Treat the underlying glomerular disease and manage edema, blood pressure, thrombosis risk and proteinuria
D. Treat the underlying glomerulonephritis and control volume overload, hypertension and kidney complications
Correct Answer: B
Most uncomplicated stones are managed conservatively, but infected obstruction, renal failure or uncontrolled symptoms require escalation.
Medicine
Nephrology
In a patient with suspected Ureteric stone causing renal colic, which investigation or diagnostic approach is most appropriate at this stage?
A. Noncontrast CT of the urinary tract in many nonpregnant adults when imaging is required
B. Urinalysis with microscopy and assessment for ischemic or nephrotoxic exposures
C. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
D. Quantify proteinuria and evaluate for primary or secondary glomerular disease
Correct Answer: A
Noncontrast CT is highly sensitive for urinary stones; ultrasound is preferred in selected groups such as pregnancy.
Medicine
Nephrology
A patient has sudden severe colicky flank pain radiating to the groin with microscopic hematuria. What is the most likely diagnosis?
A. Prerenal acute kidney injury
B. Acute tubular necrosis (acute tubular injury)
C. Chronic kidney disease (CKD)
D. Ureteric stone causing renal colic
Correct Answer: D
Classic colicky flank-to-groin pain with hematuria strongly suggests ureteric calculi.