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-Schönlein 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 glomerulonephritis

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