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In obstructive uropathy

A. The presence of polyuria rules out obstruction.

B. The absence of hydronephrosis on ultrasound examination rules out urinarytract obstruction.

C. Infection is a frequent complication*.

D. Hypertension is uncommon.

. !enal tubular acidosis "!TA#$ type I%$ can occur*

&embranous nephropathy

A. &ay occur as a result of a systemic illness or be a primary "intrinsic#

disorder *

B. &erits an evaluation for mali'nancy (hen found in a patient older than a'e

) years*

C. Infrequently improves (ithout treatment

D. Does not recur in the transplanted +idney

. is the most common cause of idiopathic nephrotic syndrome in adults

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,eatures of ma'nesium depletion include

A. Hypo+alemia*

B. Hi'h serum parathyroid hormone levels

C. -rolon'ation of the -! and T intervals*

D. Amelioration of cardiac toxicity of cardiac 'lycosides*. Can occur (ith amino'lycoside administration*

/hich of the follo(in' statement"s# is0are true about the renal hypoperfusion

syndrome

A. 1alt avidity and hyperreninemia are usually observed.*

B. ffective circulatin' volume has a 'reater effect on systemic blood pressure

than does renin secretion in the settin' of renal hypoperfusion*C. 2cclusive arterial disease causes renal hypoperfusion$ elevated renin

secretion$ and hypertension in the settin' of a normal effective circulatin'

volume.*

D. 3nilateral renal arterial occlusive disease is not associated (ith a4otemia if

the contralateral +idney maintains normal function.*

. 5onsteroidal anti6inflammatory a'ents can exacerbate renal hypoperfusion in

predisposed individuals*

5ormal pre'nancy is associated (ith

A. Increased 'lomerular filtration rate "7,!# and renal blood flo(*

B. !espiratory al+alosis*

C. Hypouricemia*

D. &ild non6anion6'ap type metabolic acidosis

. 1li'ht increase in blood pressure

/hich of the follo(in' statement"s# is0are true concernin' creatinine clearance

A. Creatinine clearance normally exceeds 8true8 measurements of 7,!$*

B. Cimetidine and trimethoprim can bloc+ the secretory component of creatinine

clearance.*

C. 3nnary cmatinine excretion is primarily influenced by the muscle mass in the

steady state.*

D. The secretory component of creatinine excretion may become more apparent

(hen serum creatinine concentrations are elevated.*

. Creatinine clearance is directly related to the serum creatinine concentration

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/hich of the follo(in' statement"s# is0are true concernin' urinary chloride

excretion rates

A. 3rinary chloride excretion provides an index of extracellular fluid volume*

B. 3rinary chloride excretion is increased in metabolic al+alosls caused by

excessive use of furosemide or thia4ides*

C. 9axative abuse is associated (ith increased urinary chloride excretion

D. Increase adrenocortical hormone activity increases urinary chloride

excretion.*

. %omitin' is associated (ith increased urinary chloride excretion

/hich of the follo(in' statement"s# is0are true concernin' calcium0phosphatebalance in chronic renal failure

A. Increased circulatin' level of parathyroid hormone "-TH# is uncommon in

chronic +idney disease.

B. Hyperphosphatemia is related to reduced renal excretion and reduces -TH

secretion.

C. xtrarenal production of :)6hydroxyvitamin D is increased in chronic renal

failure.

D. ;$:)"2H# : %itamin D "calcitriol# increases 'ut absorption of calcium and

phosphorus.*

. A normal calcemic response to -TH is not observed in chronic renal failure

(ith ;$:)"2H#: vitamin D "calcitriol# deficiency*

/hich of the follo(in' statement"s# is0are true concernin' 8uremic8 pericarditis

A. A friction rub$ pleuritic chest pain$ and enlar'ed cardiac si4e are typical

findin's in uremic pericarditis.*

B. Hypotension$ tachycardia$ and raised

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A. rythropoietin deficiency is primarily related to the loss of renal mass.*

B. Iron deficiency and hyperparathyroidism are important causes of resistance

to erythropoietin response.*

C. 5ormali4in' the hematocrit can increase mortality in this population of

patients.*

D. Increased release of oxy'en from hemo'lobin is an important factor in theadaptation to anemia in chronic renal failure.*

. rythropoietin reduces blood transfusion requirements and the incidence of

iron overload and transfusion6related infections in the 1!D

population*

/hich of the follo(in' statement"s# is0are true concernin' chronic ambulatory

peritoneal dialysis

A. !elatively reduced peritoneal surface limits the usefulness of this approach in

children.

B. Insulin6dependent diabetics have severe problems (ith 'lycemic control

because of the lar'e amounts of dextrose absorbed from the peritoneal dialysate.

C. The dialysis prescription is tailored to the characteristics of the patient'

peritoneal membrane.*

D. ,luid removal is ad

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A. This a'ent has dramatically improved renal allo'raft survival.*

B. The use of more specific$ tar'eted immunosuppressants "cydosporine# has

reduced the incidence of opportunistic infections.*

C. Cyclosporine mar+edly slo(s the recovery from acute tubular necrosis "AT5#

and potentiates the adverse effects of other nephrotoxic a'ents.*

D. 1ide effects of cyclosporine include nephrotoxicity $ tremor$hyper'lycemia$hypertension$ and hyper+alemia.*

. Calcium6channel bloc+ers that include verapamil and diltia4em increase

serum concentrations of cyclosporine.*

/hich of the follo(in' statements about membranoproliferative

'lomerulonephritis "&-75# is0are true

A. &-75 does not recur after renal transplantation.B. This clinicopatholo'ic entity occurs primarily in youn' adults*.

C. Hypocomplementemia may be severe.*

D. &-75 may be a primary "intrinsic# renal lesion or may occur in systemic

illnesses$ includin' hepatitis B anti'enemia and other infections and systemic

lupus erythematosus.*

. The incidence of primary "intrinsic# &-75 is increasin'

/hich of the follo(in' statements about hemolytic6uremic syndrome "H31#is0are true

A. H31 may occur after 'astroentenns$ especially vero6toxin6producin'

scherichia coli infections.*

B. H31 has a particularly poor renal pro'nosis in children.

C. An H31 syndrome may occur (ith pre'nancy or the use of oral contraceptive

a'ents*

D. Important features of H31 indude micro6an'iopathic hemolytic anemia$

thrombocytopenia$ reduced hapto'lobin levels$ and minimal evidence of

disseminated intravascular coa'ulation. *

. !elapse of H31 does not occur

/hich of the follo(in' is0are true of the nephrotic syndrome

A. -lasma volume is usually increased.

B. It is usually associated (ith renal sodium (astin'.

C. It occurs (ith diffuse and focal forms of 'lomerulonephritis.*

D. The incidence of infection is increased.*

. Albumin infusions are of si'nificant benefit for treatment of hypoalbuminemiaand edema

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/hich of the follo(in' is0are the direct results of chronic$ but rarely acute$ renal

failure

A. levated al+aline phosphatase from bone*

B. !adio'raphic si'ns of renal osteodystrophy*

C. Bilaterally small +idneys*

D. Hyposthenuria

. Hypertension

/hich of the follo(in' is0are features of anal'esic6associated nephropathy

A. qual 'ender distributionB. 5ormal6si4ed +idneys

C. Anemia out of proportion to a4otemia*

D. 1terile pyuria*

. -apillary necrosis*

A ?@6year6old man has an excretory uro'ram for investi'ation of microscopic

hematuria discovered on a routine urinalysis. He is apparently healthy and

entirely (ithout complaints. idneys are of normal si4e$ (ith calcification of andcollection of dye in dilated medullary structures. 1erum electrolytes$ blood urea

nitro'en "B35#$ creatinine$ calcium$ phosphorus$ and uric acid are normal.

Creatinine clearance is ; m3minute. 3rinalysis reveals rare red blood cells

and no protein. /hich of the follo(in' is0are true of this patient

A. There is a si'nificant chance that he (ill develop symptomatic renal stones.*

B. There is a si'nificant chance that he has hypercalciuria.*

C. He is li+ely to have impaired urine6concentratin' ability.*

D. His condition is li+ely to pro'ress 'radually to 1!D.

. His children each have a l6in6: chance of developin' the same condition

A :6year6old man has a ;)6year history of diabetes melfitus. His serum

creatinine concentration is :. m'0d+. A dia'nosis of diabetic nephropathy is

established by renal biopsy. /hich of the follo(in' is0are true of this patient

A. An'iotensin6convemn' en4yme "AC# inhibitors are unli+ely to help this

condition at this time.

B. He has a less than = chance of havin' hypertension at this time.

C. He has a )= chance of havin' the nephrotic syndrome at this time.D. Because of his a'e$ nephropathy is li+ely to be his only ma

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diabetic complicauon to date.

. He is li+ely to develop 1!D requitin' dialysis (ithin the next ? years.*

31TI251 :;6::

A 57-year old woman presents for evaluation of malaise and edema. She has been

previously healthy and takes no medicines. A comprehensive physical examination,

including routine laboratory tests, was performed months ago and was entirely

normal. !he patient reports these symptoms for a "ew weeks. She has noted no

change in her urine volume but does report nocturia. #hysical examination shows

a mildly ill woman with hypertension and pedal edema. $o other remarkable

physical findings were noted. %aboratory studies show

/hich of the follo(in' renal syndromes is0are li+ely to have this clinical and

histolo'ic picture

A. I'A nephropathy

B. -olyarteritis nodosa

C. /e'eners 'ranulomatosis

D. -ost6streptococcal 'lomerulonephritis

. -rimary "idiopathic# crescentic 'lomerulonephritis*

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/hich of the follo(in' therapy is0are appropriate at this time

A. Hemodialysis

B. -lasmapheresis

C. 2bservation

D. Intravenous methylprednisolone.*. /arfarin and dipyridamole

/hich of the follo(in' is0are true of uremic acidosis

A. 3rine pH is usually >..

B. Hyper+alemia (orsens acidosis by suppressin' ammonia production.*

C. Anion 'ap acidosis develops only (hen the 7,! falls E : m90minute.*D. !enal ammonia production and excretion are lo($ considerin' the de'ree of

acidosis.*

. Bicarbonate (astin' is observed (hen isotonic bicarbonate is infused to

restore the serum bicarbonate to normal levels.*

/hich of the follo(in' statements about amino'lycoside induced tubule dama'e

is0are true

A. ,unctional tubular abnormalities may cause hypo+alemia and

hypoma'nesemia.*

B. 2li'uric acute renal failure is the rule.

C. Toxicity is related to the dose of amino'lycoside and the duration of therapy.*

D. !is+ factors include the a'e of the patient$ the baseline serum creatinine

concentration$ and extracellular fluid volume depletion.*

. All amino'lycosides are equally nephrotoxic

/hich of the follo(in' statements about pre'nancy6induced hypertension

"preeclampsia# is0are true

A. 2nset is associated (ith elevation of the serum uric acid level.*

B. 5ephrotic6ran'e " .) '0day# proteinuria can occur.*

C. This syndrome typically occurs at bet(een ;: and :? (ee+s of 'estation.

D. 7,! and renal blood flo( are usually unchan'ed in preeclampsia.

. Clinical manifestations of preeclampsia 'enerally resolve (ithin > (ee+s after

delivery*

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/hich of the follo(in' statements about renal calcuh is0are true

A. Crystals seen on urinalysis confirm their formation in the +idney

B. Treatment of all patients (ith renal calculi should

include a hi'h fluid inta+e "minimum : 9# if tolerated.*

C. Hexa'onal6shaped crystals in the urine are al(ays patholo'ic.*D. &a'nesium ammonium phosphate crystals are associated (ith urinary tract

infections (ith urea6splittin' or'anisms.*

. Al+alini4ation of the urine (ith potassium citrate may be effective in

preventin' the formation of both uric acid and calcium stones

/hich of the follo(in' statements about autosomal6dominant polycystic +idney

disease "AD-D# is0are true

A. AD-D is a most common hereditary disease*

B. Hepatic cysts support the dia'nosis of AD-D.*

C. Althou'h half of the offsprin' of one affected parent (ill inherit the 'ene that

produces AD-D$ expression of the disease is variable.*

D. !enal calculi are uncommon in AD-D.

. &icroscopic and macroscopic hematuria can occur.*

,. The incidence of intracranial aneurysms is hi'her in patients (ith AD-D

than the 'eneral population.*

Clinical features of the syndrome of acute 'lomerulonephritis include

A. Hypertension*

B Hypercholesterolemia*

C. !ed blood cell casts in the urinary sediment*

D. dema*

. Hypoalbuminemia*

Causes of the syndrome of acute 'lomerulonephritis associated (ith

hypocomplementemia include

A. 1ystemic lupus erythematosus.*

B. &embranoproliferative 'lomerulonephntis

C. /e'eners 'ranulomatosis.*

D. Infective endocarditis.*

. Hemolytic6uremic syndrome

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Disease states associated (ith profound salt retention alon' (ith lo( fractional

sodium excretion include

A. Acute 'lomerulonephritls*

B. AT5

C. Acute interstitial nephritisD. Hepatorenal syndrome*

. Hypovolemic shoc+*

Common causes of AT5 include

A. Beta69actam antibiotics

B. Amino'lycoside antibiotics*

C. Cholesterol embolic diseaseD. !adiocontrast media*

. %ancomycin

!is+ factors for radiocontrast a'ent6induced acute renal failure include

A. %olume depletion*

B. &ultiple myeloma*

C. Hypercalcemia*D. Diabetes melhtus*

. Chronic renal insufficiency*

ffective strate'ies for minimi4in' the ris+ of radiocontrast nephropathy in

diabenc patients (ith renal insufficiency include

A. 9o(6dose dopamlne infusion

B. Atrial natriuretic peptide infusionC. %olume expansion (ith .?)= saline solution*

D. Intravenous furosemide

. Intravenous mannitol

In the treatment of the nephrotic syndrome$ interventions that decrease urinary

protein excretion include

A. Dihia4em*

B. AC mhibitors*

C. 5onsteroidal anti6inflammatory a'ents*

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D. Alpha6Adrener'ic receptor anta'onists

. 9o( protein diet*

Causes of the syndrome of acute 'lomerulonephritis associated (ith

hypocomplementemia include

A. 1ystemic lupus erythematosus*

B. &embranoproliferative 'lomerulonephntis*

C. /e'eners 'ranulomatosis

D. Infective endocarditis*

. Hemolytic6uremic syndrome