Nephrology (CKD, glomerular diseases) Practice Questions

Q: A 28-year-old man presents with periorbital edema, tea-colored urine, and mild hypertension for 1 week. He had pharyngitis 2 weeks ago that resolved without treatment. Laboratory studies show: serum creatinine 1.8 mg/dL, BUN 32 mg/dL, urinalysis shows RBC casts and dysmorphic RBCs with 2+ protein. Serum complement C3 is 45 mg/dL (normal 90-180). What is the most appropriate next step?

Supportive care with monitoring. ***Supportive care with monitoring*** - The clinical triad of **hematuria** (tea-colored urine), **edema**, and **hypertension** following pharyngitis suggests **Post-streptococcal glomerulonephritis (PSGN)**. - Management is primarily **supportive**, focusing on controlling **blood pressure** and **fluid overload**, as most cases in young patients resolve spontaneously. *Kidney biopsy to confirm diagnosis* - This is generally not required for typical cases of **PSGN** unless there is a **rapid decline in renal function** or atypical features (e.g., normal complement levels). - The constellation of **low C3**, **RBC casts**, and recent infection is highly diagnostic without invasive testing. *Start pulse-dose methylprednisolone* - **Corticosteroids** are not indicated for the treatment of **PSGN** as the disease is typically **self-limiting** and does not respond to immunosuppression. - High-dose steroids are reserved for **Rapidly Progressive Glomerulonephritis (RPGN)** involving crescent formation. *Start plasmapheresis* - This intervention is used for conditions like **Goodpasture syndrome** or **ANCA-associated vasculitis** where circulating autoantibodies must be removed. - It has no role in the management of simple **Post-streptococcal glomerulonephritis**. *Start cyclophosphamide and prednisone* - This aggressive immunosuppressive regimen is used for **Lupus Nephritis** or **Wegener's Granulomatosis**, not for PSGN. - Use of these agents would introduce significant **toxicity** without benefit in a self-limiting post-infectious condition.

Question 1

A 28-year-old man presents with periorbital edema, tea-colored urine, and mild hypertension for 1 week. He had pharyngitis 2 weeks ago that resolved without treatment. Laboratory studies show: serum creatinine 1.8 mg/dL, BUN 32 mg/dL, urinalysis shows RBC casts and dysmorphic RBCs with 2+ protein. Serum complement C3 is 45 mg/dL (normal 90-180). What is the most appropriate next step?

Accepted Answer

Supportive care with monitoring

Answer

Start pulse-dose methylprednisolone

Answer

Start plasmapheresis

Answer

Kidney biopsy to confirm diagnosis

Answer

Start cyclophosphamide and prednisone

Question 2

A 45-year-old woman with type 2 diabetes mellitus presents for routine follow-up. Laboratory studies show: serum creatinine 1.4 mg/dL (baseline 0.9 mg/dL 6 months ago), eGFR 52 mL/min/1.73m², urinalysis shows 2+ protein, urine albumin-to-creatinine ratio 450 mg/g. HbA1c is 8.2%. Blood pressure is 145/92 mmHg. What is the most appropriate initial pharmacologic intervention?

Accepted Answer

Start ACE inhibitor for blood pressure and proteinuria

Answer

Start calcium channel blocker for blood pressure control

Answer

Start hydrochlorothiazide for blood pressure control

Answer

Start statin for cardiovascular risk reduction

Answer

Start insulin for better glycemic control

Nephrology (CKD, glomerular diseases) — MCQs

Nephrology (CKD, glomerular diseases) — MCQs

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