Nephrotic syndrome is characterized by

(A) hematuria, proteinuria,

hypertension
(B) pyuria, oliguria, hematuria
(C) hematuria, azotemia, hypertension
(D) proteinuria, edema, hyperlipidemia
(E) bacteriuria, azotemia, hypertension
A 35-year-old man has an episode of hemoptysis
following an upper respiratory infection. He has
30-pack year history of smoking. Fluffy
pulmonary infiltrates are noted on chest x-rays.
Physical examination demonstrates edema and
hypertension. Urinalysis reveals hematuria and red
cell casts as well as proteinuria.
Immunofluorescence staining demonstrates diffuse
linear IgG and C3 deposits along the glomerular
basement membrane. These findings are most
consistent with the diagnosis of
(A) acute post-streptococcal glomerulonephritis
(B) Goodpasture syndrome
(C) lupus nephritis
(D) systemic lupus erythematosus
(E) Wegener granulomatosis
Minimal change disease and membranous
glomerulonephritis share which of the
following characteristics?

(A) nephrotic syndrome

(B) IgG deposits in glomeruli
(C) good prognosis with steroid therapy

(D) capillary loop thickening by light

microscopy
Electron-dense deposits in glomeruli
represent

(A) blunted or fused foot processes

(B) thickened basement membrane
(C) antigen-antibody complexes
(D) anti-glomerular basement membrane
antibody
(E) necrotic inflammatory cells
Membranous glomerulonephritis and acute
proliferative glomerulonephritis are similar in
that they both
(A) are self-limiting and transient renal
diseases
(B) are commonly associated with the
nephrotic syndrome
(C) present initially with gross hematuria
(D) are mediated by immune complex
formation in the glomerulus
(E) occur most frequently following an
infectious disease
A patient with hemoptysis and renal
failure has a renal biopsy which reveals
crescentic proliferative
glomerulonephritis.
Immunofluorescence reveals linear
deposits of IgG. The diagnosis is
(A) acute post-infectious
glomerulonephritis
(B) IgA nephropathy
(C) Goodpasture syndrome
(D) Henoch-Schnlein syndrome
(E) membranous glomerulonephritis
A patient who has been receiving gold salts
for rheumatoid arthritis develops severe
edema and proteinuria. A renal biopsy
shows spikes of new basement membrane
projecting toward epithelial cells.
Immunofluorescence is positive for IgG and
C3 in a granular pattern. The diagnosis is
(A) glomerulosclerosis of rheumatoid
arthritis
(B) minimal change disease
(C) membranoproliferative glomerulonephritis

(D) membranous glomerulonephritis

(E) diffuse proliferative glomerulonephritis
Highly selective proteinuria (only lower
molecular weight proteins in the urine)
is most likely to occur with which of
the following diseases?
(A) acute tubulointerstitial nephritis
(B) diabetic glomerulosclerosis
(C) membranoproliferative
glomerulonephritis
(D) minimal change disease
An example of a circulating immune
complex-mediated glomerulonephritis is
(A) anti-GBM disease
(B) lupus nephritis
(C) minimal change disease
(D) amyloid nephropathy
The most consistent finding in glomeruli
of patients with the nephrotic
syndrome is
(A) crescent formation
(B) electron-dense deposits
(C) enlargement of the mesangium
(D) obliteration of epithelial cell foot
processes
(E) scarring in parts of glomeruli
In which of the following situation(s)
would you expect the patient to have a
24 hour urine protein greater than 6
grams?
(A) acute proliferative
glomerulonephritis
(B) chronic pyelonephritis
(C) membranous glomerulonephritis
(D) nephrosclerosis
(E) polycystic kidney disease
A patient with a linear pattern seen on
immunofluorescence microscopy of a
renal biopsy would most likely have
(A) acute proliferative
glomerulonephritis
(B) diabetic nephropathy
(C) Goodpasture syndrome
(D) lupus nephritis
(E) membranoproliferative
glomerulonephritis
Hematuria is an expected finding in
(A) acute proliferative
glomerulonephritis
(B) amyloidosis
(C) diabetic glomerulosclerosis
(D) lipid nephrosis
(E) membranous glomerulonephritis
Renal disease associated with edema,
hematuria, proteinuria, and recent
history of a sore throat is most likely
to be associated with
(A) antigen-antibody complexes in
glomeruli
(B) rapidly fatal course
(C) necrosis of renal tubules
(D) urine culture positive for beta-
hemolytic streptococci
The nephrotic syndrome results in
edema due to
(A) altered plasma osmotic pressure
(B) impaired venous drainage
(C) increased capillary hydrostatic
pressure
(D) increased vascular permeability
A 24-year-old man with the acquired
immunodeficiency syndrome has the
nephrotic syndrome and azotemia. He
is a known intravenous drug abuser.
The most likely finding on renal biopsy
would be
(A) diffuse proliferative
glomerulonephritis
(B) focal segmental glomerulosclerosis
(C) IgA nephropathy
(D) membranous glomerulonephritis
(E) minimal change disease
A 10-year-old boy presents with puffy
eyes and ankle edema. Urinalysis
reveals 4-plus protein and oval fat
bodies without RBCS or RBC casts.
These findings are most consistent with

(A) acute proliferative

glomerulonephritis
(B) Goodpasture syndrome
(C) IgA nephropathy
(D) minimal change disease
(E) rapidly progressive
Multiple subepithelial dense deposits
without significant cellular proliferation
are typically found in
(A) acute proliferative
glomerulonephritis
(B) Goodpasture syndrome
(C) IgA nephropathy
(D) membranous glomerulonephritis
(E) minimal change disease
A 10-year-old boy presents with puffy
eyes ankle edema. Urinalysis reveals
urine specific gravity 1.022; 4+
protein. This data is most consistent
with
(A) acute papillary necrosis
(B) acute proliferative
glomerulonephritis
(C) acute pyelonephritis
(D) minimal change disease
(E) rapidly progressive
glomerulonephritis
A 6-year-old boy has peripheral edema
and massive proteinuria. He has no
hematuria or hypertension. On a renal
biopsy, the glomeruli appear normal.
Electron microscopy demonstrates foot
process "fusion". What conclusion can
be best made?
(A) hearing loss likely
(B) initiated by streptococcal infection
(C) rapid response to steroids probable
(D) transformation to membranous
glomerulonephritis common
A 12-year-old boy was hospitalized with
ketoacidosis one year ago and has required
exogenous insulin since then. He now
develops azotemia, hypertension, edema, low
grade proteinuria and hematuria with
occasional red blood cell casts. The main
finding on renal biopsy would most likely be
(A) acute proliferative glomerulonephritis
(B) acute tubular necrosis
(C) nodular mesangial sclerosis
(D) polyarteritis Nodosa
A 63-year-old woman with a long history of
rheumatoid arthritis, which has progressed
despite a variety of therapeutic
interventions, develops nephrotic syndrome.
Renal function is normal and the urine shows
only protein, no cells and no casts. Of the
following, the most likely kidney pathology is
(A) acute tubular necrosis
(B) congenital nephrotic syndrome
(C) membranous glomerulonephritis
(D) mesangial IgA nephropathy
(E) thrombotic microangiopathy
A patient with IgA nephropathy (Berger
disease) usually presents with
(A) nephrotic syndrome
(B) acute renal failure
(C) hypocomplementemia
(D) skin lesions and gastrointestinal
hemorrhage
(E) recurrent hematuria
Immune complexes in the mesangium is
characteristic of
(A) acute proliferative
glomerulonephritis
(B) Goodpasture syndrome
(C) IgA nephropathy
(D) membranous glomerulonephritis
(E) minimal change disease
A 24-year-old man comes to your office
because of an abnormal "rusty" or "coke"
color of his urine. On physical exam, he is
noted to have moderate periorbital edema
and a blood pressure of 160/108 mmHg.
Urinalysis reveals 2+ protein, 25-30
RBC/hpf and several RBC casts. The most
likely diagnosis would be
(A) acute cystitis
(B) acute proliferative glomerulonephritis
(C) chronic pyelonephritis
(D) focal segmental glomerulosclerosis
(E) membranous glomerulonephritis
A 25-year-old otherwise healthy man presented to the
emergency room with painless hematuria which came on 3
days after the onset of a sore throat and fever. He was
taking penicillin given by his family practitioner for the
sore throat. Physical examination was normal. BUN was
15 mg/dL. Urinalysis showed a pH of 5.5, a trace of
protein, and a large amount of blood. On urine
microscopy, red cell casts were identified. He has had
five similar episodes over the past two years. Which of
the following is a typical feature of this disorder?
(A) large subepithelial deposits of IgG
(B) low serum complement
(C) mesangial IgA deposits
(D) parietal epithelial cell proliferation
(E) positive serum ANCA
A 40-year-old woman has had a
chronic illness for 25 years, is partially
blind, and now presents with nephrotic
syndrome. She most likely has
(A) Berger disease
(B) membranous glomerulopathy
(C) minimal change disease
(D) nodular glomerulosclerosis
(E) post-infectious glomerulonephritis
A 40-year-old woman presents with a 2-month
history of generalized edema. Review of systems
revealed a history of "foamy" urine for about a
year. She takes no medications. Physical exam
reveals a puffy face and ankle edema. The blood
pressure is 110/70 mm Hg. Serum creatinine is
1.0 g/dL. Urine sediment is normal and a 24-hour
urine collection revealed 10 g protein. Which of
the following is the most likely diagnosis?
(A) crescentic glomerulonephritis
(B) diabetic nephropathy
(C) diffuse proliferative glomerulonephritis
(D) focal segmental glomerulonephritis
(E) membranous glomerulonephritis
A teenage boy has recurrent episodes of
gross hematuria but has no other signs or
symptoms. His mother reports that both she
and her mother have a long history of
hematuria, but both are otherwise in good
health. Which of the following is most
likely?
(A) dense deposit disease
(B) Goodpasture syndrome
(C) IgA nephropathy
(D) lupus nephritis
(E) post-streptococcal glomerulonephritis
A patient is being evaluated for
proteinuria. Five grams per 24 hours of
protein are being lost in the urine.
What other laboratory finding is most
likely?
(A) cytotoxic antibody
(B) decreased serum complement
(C) hypercholesterolemia
(D) microcytic anemia
(E) positive direct antiglobulin
Dialysis removes waste products of
metabolism from the bloodstream
mostly by
(A) absorption
(B) active transport
(C) diffusion
(D) excretion
(E) ultrafiltration
The most common pathogenetic defect
resulting in acute renal failure is
(A) defect in peripheral wall of
glomerular capillaries
(B) intravascular hemolysis
(C) obstruction of lower urinary tract
(D) renal cortical ischemia
(E) toxic injury to peripheral tubular
epithelia
A 60-year-old woman presents with high
blood pressure, nocturia and polyuria,
pruritus, a sallow complexion and easy
bruisability. Further evaluation includes a
BUN of 90 mg/dL (nl. = 7-18), low blood
pH and bicarbonate, and renal
osteodystrophy. These findings suggest the
clinical diagnosis of
(A) acute renal failure
(B) nephrogenic diabetes
(C) nephrolithiasis
(D) nephrotic syndrome
(E) uremia
A patient undergoing an experimental
protocol to examine renal function using
inulin clearance method had the following lab
data: urine excreted over 6 hours = 360 ml;
urine inulin concentration = 100 mg%; urine
Na+ concentration = 70 mEq/L; plasma inulin
concentration = 1.0 mg%; and plasma Na+
concentration = 135 mEq/L. What is the
glomerular filtration rate of this patient?
(A) 10 ml/min
(B) 50 ml/min
(C) 100 ml/min
(D) 125 ml/min
(E) 130 ml/min
The use of a diuretic for the
treatment of nephrotic syndrome should
be done with caution since
(A) diuretics may cause anorexia,
further worsening the hypoalbuminemia
(B) filtered fraction is already low
(C) patient's intravascular volume is
already low
(D) proteinuria may significantly
increase causing more edema
(E) total body water is already low
A patient with sickle cell disease would
have severely impaired ability to
concentrate urine because
(A) glomerular filtration rate is
significantly increased
(B) NaCl pump has been altered
(C) proximal tubular reabsorption is
considerably compromised
(D) responsiveness of the collecting
duct to ADH is markedly diminished
(E) vasa recta blood flow becomes quite
sluggish