Nephrology MCQs

Medicine · 5 free questions with answers & explanations.

1. A 25-year-old man presents with nephrotic syndrome: 4+ proteinuria (protein:creatinine ratio 7 g/g), serum albumin 1.8 g/dL, and peripheral edema. Serum creatinine is normal. Renal biopsy on light microscopy shows no abnormality. Electron microscopy reveals diffuse effacement of podocyte foot processes. Immunofluorescence is negative. What is the MOST likely diagnosis?
2. A 55-year-old woman with a 20-year history of type 2 diabetes mellitus presents with serum creatinine of 2.4 mg/dL (eGFR 28 mL/min/1.73 m²) and urine albumin:creatinine ratio of 850 mg/g. Her blood pressure is 148/92 mmHg on lisinopril 10 mg daily. Which additional agent has demonstrated the greatest cardiorenal protective benefit in this patient?
3. A 30-year-old woman presents with gross hematuria, fever, flank pain, and arthralgia 2 weeks after a streptococcal pharyngitis. Urinalysis shows red cell casts and proteinuria. Serum complement C3 is markedly reduced with normal C4. Anti-streptolysin O (ASO) titre is elevated. What is the MOST likely underlying mechanism of glomerular injury?
4. A 40-year-old man presents with acute kidney injury: creatinine has risen from a baseline of 0.9 to 4.2 mg/dL over 3 days. He had a 7-day course of gentamicin for gram-negative bacteremia. Urinalysis shows muddy brown granular casts and renal tubular epithelial cells. Urine sodium is 52 mEq/L and fractional excretion of sodium (FENa) is 3.8%. What is the MOST likely diagnosis?
5. A 65-year-old man with CKD stage 4 (eGFR 22 mL/min) presents with serum potassium of 6.8 mEq/L. ECG shows tall peaked T-waves, widened QRS (140 ms), and a sine-wave pattern. He is alert and blood pressure is stable. What is the IMMEDIATE first step in management?