18th August 2024 – Nephrology
Dr. Chanaka Aberathne - 8:00am – 10:00am
01. A 72-year-old man with hepatitis C–related cirrhosis complicated by ascites and grade 2 esophageal varices is
admitted for management of increasing ascites and edema. He had been adherent with escalating doses of
furosemide and spironolactone. Paracentesis shows no evidence of spontaneous bacterial peritonitis. He is initially
treated with intravenous diuretics, but subsequently develops AKI with a rise in the serum creatinine (SCr) level
from 0.8 mg/dl on admission to 1.8 mg/dl 3 days later. The kidney function continues to worsen, and oliguria ensues
over the next 2 days despite discontinuation of diuretics and treatment with albumin 1 g/kg per day. On physical
examination, the BP is 100/65 mmHg. He has modest ascites and 21 leg edema. Laboratory studies now show SCr
3.4 mg/dl, albumin 2.6 g/dl, and bilirubin 4.5 mg/dl. The fractional excretion of sodium is 0.05%. The urinalysis is
negative for protein, and the urinary sediment shows no casts or cellular elements. An abdominal ultrasound shows
moderate ascites. The kidney size and echogenicity are normal. There is no hydronephrosis. Which ONE of the
following is the MOST likely diagnosis?
1.Abdominal compartment syndrome
2.Acute tubular necrosis
3.Prerenal azotemia
4.Hepatorenal syndrome
5.Infection Related Glomerulonephritis
02. A24-year-old Asian man who is a graduate student is discovered to have asymptomatic microscopic hematuria
during a routine examination for a sports-related injury. The BP is 118/72 mmHg. His body mass index (BMI) is 33
kg/m2. The remainder of the history and physical examination is unremarkable. The serum creatinine level is 0.78
mg/dl. The urine sediment reveals 10–15 erythro cytes per high power field, of which 50% are dys morphic. A spot
urine albumin-to-creatinine ratio is 39 mg/g. The fasting blood glucose is 110 mg/dl. Which ONE of the following
lesions is MOST likely to be found on renal biopsy?
1.FSGS
2.Thin basement membrane nephropathy
3.Minimal change disease
4.IgA nephropathy
5.Early diabetic glomerulosclerosis
03. A 29-year-old black patient with long-standing HIV secondary to past intravenous drug use in jured his leg and
was admitted to the hospital with an active cellulitis in the area of the injury. Staphylococcus was cultured from the
leg. He had been on combined antiretroviral therapy for years, and his HIV viral load has been undetectable. He had
never had kidney problems but developed renal insufficiency and nephrotic-range proteinuria with acanthocytes
and red blood cell casts in his urine sediment. Which ONE of the following is the MOST likely diagnosis?
1.Collapsing FSGS
2.Postinfectious GN
3. IgA–dominant, infection–related GN
4.Hepatitis C–associated membranous nephropathy
5.Minimal Change Disease
04. A 22-year-old man presented with a 2-week history of bilateral ankle swelling and mild ankle pain. He had no
past medical history and was not taking any medication. He worked as a shop assistant, and neither smoked nor
used recreational drugs.
On examination, his BP was 110/55 mmHg, and he had pitting oedema to his mid-calf. His chest and abdomen were
normal. He had small lymph nodes palpable in his groin. Urinalysis showed blood 2+, protein 4+.
Investigations:
serum sodium 141 mmol/L (137–144)
serum potassium 4.1 mmol/L (3.5–4.9)
serum creatinine 101 µmol/L (60–110)
serum albumin 14 g/L (37–49)
urine protein:creatinine ratio 762 mg/mmol (<30)
What investigation is most likely to lead to the diagnosis?
1.ANCA
2.Antinuclear antibodies
3.Epstein–Barr virus serology
4.Serum cryoglobulin
5.Serum protein electrophoresis
05. A 78-year-old man presented with a 2-week history of ankle swelling and headache. He had a 4-year history of
rheumatoid arthritis. His medication, which had remained unaltered for 3 years, comprised methotrexate 10 mg
weekly, folic acid 5 mg daily and diclofenac 75 mg daily.
On examination, his BP was 188/122 mmHg. He had bilateral ankle oedema. There were chronic changes of
rheumatoid arthritis in his hands, but no evidence of active synovitis. Examination of the optic fundi showed grade 3
hypertensive retinopathy.
Investigations:
serum creatinine 258 µmol/L (60–110)
serum albumin 33 g/L (37–49)
serum CRP 17 mg/L (<10)
24-h urinary total protein 2.4 g (<0.2)
What is the most likely diagnosis?
1.Amyloidosis
2.Analgesic nephropathy
3.Hypertensive nephropathy
4.Idiopathic membranous nephropathy
5.Methotrexate nephrotoxicity
06. A 54-year-old diabetic man presents for review. His annual review bloods reveal a raised creatinine of 165
µmol/l, potassium of 5.9 mmol/l and bicarbonate of 19 mmol/l. Urinary protein excretion is normal. What diagnosis
fits best with this clinical picture?
1.Renal tubular acidosis (RTA)-type 4
2.Diabetic nephropathy
3.Renal tubular acidosis-type 2 Your answer
4.Renal tubular acidosis-type 1
5.Diabetic ketoacidosis
07. Question Browser: MRCP 1 Question Browser Exam Builder Saved Exams 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 Gramnegative 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 reddishbrown, rosette-like
crystals. Plasma creatinine concentration is 200 µmol/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
08. Indications for renal Bx
1.Asymptomatic proteinuria
2.SLE
3.Acute transplant rejection
4.ARF with UFR showing red cells
5.Diabetic nephropathy
09.Increase in serum creatinine irrespective of reduction of GFR
1.Probenecid
2.Trimethoprim
3.Liver disease
4.DKA
5.Elderly
10.PCKD
1.24hr Protein excretion of >4g is expected
2.Gene is located in chromosome 16
3.Cerebral aneurisms are recognized association
4.Dialysis is needed frequently at the age of 20
5.Cysts are developed in all parts of the Nephrone
11. T/F regarding, Renal artery stenosis
1.Reduce uptake of DTPA scan
2.Proteinuria > 1g is an expected finding
3.Rise in serum creatinine with ACEI
4.Majority is seen in young females
5.Renal angiography is the confirmatory test
12.Renal papillary necrosis is seen in
1.Diabetes mellitus
2.Sickle cell disease
3.Medullary sponge kidney
4.NSAIDs nephropathy
5.Pyelonephritis
13.Low level of inorganic phosphates found in
1.Osteomalasia
2.Hyperparathyroidism
3.Chronic Renal Failure
4.Pseudo pseudo hypoparathyroidism
5.Pseudo hypoparathyroidism
14. Renal involvement of infective endocarditis
1.FSGN
2.Pyelonephritis
3.Diffuse proliferative GN
4.Multiple renal infarct
5.IRGN
15.Thrombosis of the nephrotic syndrome
1.Commonly occur in membranous glomerulopathy
2.Arterial thrombosis is commoner than venous thrombosis
3.Anticoagulation may be required
4.Aggregation of platelets is a contributory factor
5.Has increased incidence of myocardial infarction
Dr Chanaka Aberathne
Consultant Nephrologist
