Medicine
Nephrology
Which urine test is commonly used to quantify albuminuria in CKD?
A. Urine ketone strip only
B. Urine pregnancy test
C. Urine albumin-to-creatinine ratio
D. Stool occult blood test
Correct Answer: C
Spot urine ACR is widely used to classify albuminuria and kidney risk.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Chronic kidney disease (CKD)?
A. Infected obstructed kidney
B. Hyperkalemia and metabolic acidosis
C. Progression to ischemic acute tubular injury
D. Severe electrolyte or acid-base disturbance requiring dialysis
Correct Answer: B
Advanced CKD reduces potassium and acid excretion and causes multiple systemic complications.
Medicine
Nephrology
A patient is diagnosed with Chronic kidney disease (CKD). 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. Give controlled hypertonic saline with close sodium monitoring
C. Provide analgesia and assess for obstruction, infection and need for urologic intervention
D. Restore effective circulating volume and correct the underlying cause
Correct Answer: A
CKD care focuses on slowing progression, reducing cardiovascular risk and treating complications.
Medicine
Nephrology
In a patient with suspected Chronic kidney disease (CKD), which investigation or diagnostic approach is most appropriate at this stage?
A. Immediate serum potassium confirmation when appropriate with continuous ECG monitoring
B. Serum osmolality, urine osmolality and urine sodium while emergency stabilization proceeds
C. Noncontrast CT of the urinary tract in many nonpregnant adults when imaging is required
D. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
Correct Answer: D
CKD risk stratification uses both filtration and albuminuria, not creatinine alone.
Medicine
Nephrology
A patient has reduced estimated GFR and/or markers of kidney damage persisting for more than three months. What is the most likely diagnosis?
A. Acute nephritic syndrome
B. Severe hyperkalemia
C. Chronic kidney disease (CKD)
D. Severe symptomatic hyponatremia
Correct Answer: C
Chronicity over at least three months distinguishes CKD from an isolated acute decline.
Medicine
Nephrology
Which urine-microscopy finding is classically associated with acute tubular injury?
A. Oval fat bodies only
B. Muddy brown granular casts
C. Isolated eosinophils as the defining finding
D. Hexagonal cystine crystals
Correct Answer: B
Pigmented granular casts are a classic sediment finding in acute tubular injury.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Acute tubular necrosis (acute tubular injury)?
A. Severe electrolyte or acid-base disturbance requiring dialysis
B. Hyperkalemia and metabolic acidosis
C. Venous thromboembolism
D. Rapid deterioration in kidney function
Correct Answer: A
Intrinsic AKI can cause refractory hyperkalemia, acidosis, volume overload and uremic complications.
Medicine
Nephrology
A patient is diagnosed with Acute tubular necrosis (acute tubular injury). Which is the most appropriate management principle?
A. Restore effective circulating volume and correct the underlying cause
B. Control blood pressure and kidney-risk factors, use kidney-protective therapy when indicated and avoid nephrotoxins
C. Treat the underlying glomerular disease and manage edema, blood pressure, thrombosis risk and proteinuria
D. Provide supportive care, stop nephrotoxins, optimize hemodynamics and manage fluid and electrolyte complications
Correct Answer: D
There is no specific reversal drug for most ATN; management supports recovery and treats complications.
Medicine
Nephrology
In a patient with suspected Acute tubular necrosis (acute tubular injury), 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. Volume-status assessment, urinalysis and serial kidney-function testing
C. Urinalysis with microscopy and assessment for ischemic or nephrotoxic exposures
D. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
Correct Answer: C
Urine sediment can support tubular injury while evaluation identifies the precipitating insult.
Medicine
Nephrology
A patient has persistent acute kidney injury after prolonged hypotension and urine microscopy shows granular muddy-brown casts. What is the most likely diagnosis?
A. Severe symptomatic hyponatremia
B. Acute tubular necrosis (acute tubular injury)
C. Ureteric stone causing renal colic
D. Prerenal acute kidney injury
Correct Answer: B
Ischemic or toxic tubular injury classically produces granular casts and intrinsic AKI.
Medicine
Nephrology
Which urinary finding is more compatible with uncomplicated prerenal AKI than acute tubular necrosis?
A. Relatively bland sediment with concentrated urine
B. Numerous muddy brown granular casts
C. Heavy red-cell casts
D. Massive proteinuria as the defining feature
Correct Answer: A
Prerenal physiology often preserves tubular concentrating ability and has a relatively bland urine sediment.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Prerenal acute kidney injury?
A. Rapid deterioration in kidney function
B. Cardiac arrest
C. Osmotic demyelination from overly rapid correction
D. Progression to ischemic acute tubular injury
Correct Answer: D
Prolonged renal hypoperfusion can cause intrinsic tubular damage.
Medicine
Nephrology
A patient is diagnosed with Prerenal acute kidney injury. Which is the most appropriate management principle?
A. Treat the underlying glomerular disease and manage edema, blood pressure, thrombosis risk and proteinuria
B. Treat the underlying glomerulonephritis and control volume overload, hypertension and kidney complications
C. Restore effective circulating volume and correct the underlying cause
D. Stabilize the myocardium with IV calcium when ECG changes are present, shift potassium intracellularly and remove potassium
Correct Answer: C
Prerenal AKI is potentially reversible when perfusion is restored before sustained ischemic tubular injury occurs.
Medicine
Nephrology
In a patient with suspected Prerenal acute kidney injury, which investigation or diagnostic approach is most appropriate at this stage?
A. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
B. Volume-status assessment, urinalysis and serial kidney-function testing
C. Quantify proteinuria and evaluate for primary or secondary glomerular disease
D. Urinalysis with microscopy plus complement and serologic evaluation guided by the suspected cause
Correct Answer: B
Clinical context and urine findings help distinguish reduced perfusion from intrinsic renal injury.
Medicine
Nephrology
A patient has vomiting and diarrhea followed by oliguria and a rise in creatinine, with clinical volume depletion. What is the most likely diagnosis?
A. Prerenal acute kidney injury
B. Acute tubular necrosis (acute tubular injury)
C. Chronic kidney disease (CKD)
D. Nephrotic syndrome
Correct Answer: A
Reduced renal perfusion from volume loss is a common cause of prerenal AKI.