Free Nephrology Practice Questions

Question 1

A 72-year-old woman has nausea, tinnitus, and a respiratory rate of 30/min after repeatedly taking aspirin for back pain. Sodium is 140 mmol/L, chloride 104 mmol/L, bicarbonate 12 mmol/L, and albumin 4.0 g/dL. Arterial blood gas shows pH 7.45 and PaCO2 18 mm Hg. Which acid-base interpretation accounts for all of these results?

Accepted Answer

High-anion-gap metabolic acidosis with a superimposed respiratory alkalosis

Answer

High-anion-gap metabolic acidosis with appropriate respiratory compensation

Answer

Primary respiratory alkalosis with appropriate chronic renal compensation

Answer

High-anion-gap metabolic acidosis with a superimposed respiratory acidosis

Question 2

On the third hospital day after septic shock, a man has a creatinine of 2.8 mg/dL, compared with 0.9 mg/dL before admission. He is off vasopressors after fluid resuscitation, has no orthostasis, and has a normal lactate. Fractional excretion of sodium is 0.4%. Urine microscopy shows numerous muddy-brown granular casts and renal tubular epithelial cells, with no erythrocyte casts. He has not received a diuretic. Taken together, these findings favor:

Accepted Answer

Sepsis-associated acute tubular injury

Answer

Persistent prerenal azotemia

Answer

Drug-induced acute interstitial nephritis

Answer

Infection-related glomerulonephritis

Question 3

During overnight automated peritoneal dialysis, a 54-year-old man develops persistent diffuse abdominal pain. Effluent collected after a 45-minute dwell contains 78 leukocytes/µL, with 84% neutrophils. He is afebrile and hemodynamically stable; examination shows mild diffuse tenderness without guarding. The exit site is clean, and effluent has been sent for culture. What should be done before the culture result is available?

Accepted Answer

Start intraperitoneal antibiotics covering gram-positive and gram-negative organisms.

Answer

Defer antibiotics until a cell count from a longer dwell exceeds 100 leukocytes/µL.

Answer

Arrange immediate catheter removal and transfer to hemodialysis for this first episode.

Answer

Treat this as mechanical drain pain and adjust the cycler settings without antibiotics.

Question 4

A kidney biopsy obtained for 4.2 g/day of proteinuria shows glomerulomegaly, perihilar segmental sclerosis, and patchy rather than diffuse foot-process effacement. The patient is a 46-year-old man with a BMI of 43 kg/m² and a solitary kidney following childhood nephrectomy. His serum albumin is 3.9 g/dL, he has no edema, and eGFR has remained near 56 mL/min/1.73 m² for two years. Which approach fits the clinical-pathologic pattern?

Accepted Answer

Use renin-angiotensin system blockade and weight reduction without immunosuppression.

Answer

Start high-dose prednisone because protein excretion is in the nephrotic range.

Answer

Start tacrolimus as initial therapy to avoid glucocorticoid-associated weight gain.

Answer

Give rituximab to treat a presumed circulating permeability factor causing primary FSGS.

Question 5

A 66-year-old woman calls after seeing a lower eGFR on her laboratory report. She started empagliflozin 10 mg daily for type 2 diabetes with persistent albuminuria two weeks ago; eGFR is now 34 mL/min/1.73 m², previously 38. Her weight is unchanged, blood pressure is 126/74 mm Hg without orthostasis, potassium is 4.5 mmol/L, and bicarbonate is 25 mmol/L. She feels well and has normal food and fluid intake. Losartan dosing is unchanged. What should she be advised about empagliflozin?

Accepted Answer

Continue empagliflozin 10 mg daily with routine renal monitoring.

Answer

Withhold empagliflozin until eGFR returns to baseline.

Answer

Reduce empagliflozin to 10 mg every other day.

Answer

Switch to sitagliptin because eGFR is below 45 mL/min/1.73 m².

Question 6

At 31 weeks of a first pregnancy, a previously normotensive woman has blood pressures of 152/96 and 150/94 mm Hg four hours apart. Creatinine is 1.4 mg/dL, compared with 0.55 mg/dL in the first trimester. Urine protein/creatinine ratio is 0.14 mg/mg, platelets are 208,000/µL, and liver enzymes are normal. Evaluation finds no volume depletion, infection, obstruction, or other explanation for the renal impairment. How should this hypertensive disorder be classified?

Accepted Answer

Preeclampsia with severe features

Answer

Gestational hypertension without preeclampsia

Answer

Preeclampsia without severe features

Answer

Chronic hypertension with superimposed preeclampsia

Question 7

A dialysis-unit review identifies an anuric patient receiving hemodialysis three times weekly. Properly collected predialysis and postdialysis BUN concentrations are 80 and 30 mg/dL, respectively; delivered single-pool Kt/V is 1.10. He reports feeling well. Which statement correctly combines his urea reduction ratio with an assessment of the delivered small-solute dose?

Accepted Answer

URR is 62.5%; delivered Kt/V is below the recommended minimum.

Answer

URR is 37.5%; delivered Kt/V is below the recommended minimum.

Answer

URR is 62.5%; his symptom-free status establishes that the delivered dose is adequate.

Answer

URR is 37.5%; Kt/V is adequate for this schedule.

Question 8

A malnourished man with heavy alcohol use presents at 08:00 with a seizure and a serum sodium of 107 mmol/L. Hyponatremia had been documented for more than 48 hours. Hypertonic saline is stopped at 10:00 when sodium reaches 112 mmol/L and the seizure has resolved. By 16:00, sodium is 119 mmol/L, urine output is 600 mL/hour, and urine osmolality is 65 mOsm/kg. He is awake and neurologically intact. Which intervention best limits his neurologic risk now?

Accepted Answer

Give desmopressin and titrate intravenous dextrose 5% in water to relower sodium.

Answer

Restrict fluids and recheck sodium in four hours.

Answer

Replace hourly urine losses with an equal volume of 0.9% saline.

Answer

Observe because sodium is still below normal and the seizure has resolved.

Question 9

Nephrotic-range proteinuria in a 28-year-old woman with systemic lupus erythematosus prompts kidney biopsy. Her eGFR is 29 mL/min/1.73 m², urine protein excretion is 6.1 g/day, and complement concentrations are low. Active endocapillary proliferative lesions with subendothelial deposits involve 70% of sampled glomeruli. Diffuse subepithelial deposits are also present, with little chronic scarring. Which classification and treatment framework follow from the biopsy?

Accepted Answer

Class IV plus V; use an active proliferative lupus nephritis regimen.

Answer

Class III plus V; use an active proliferative lupus nephritis regimen.

Answer

Class V alone; use a membranous nephritis regimen.

Answer

Class VI; use supportive care for irreversible kidney injury.

Question 10

A 49-year-old woman with confirmed primary aldosteronism asks whether a 1.6-cm left adrenal nodule on CT can simply be removed. The right adrenal gland appears normal. She has resistant hypertension and spontaneous hypokalemia, is a suitable surgical candidate, and prefers surgery if hormone excess is unilateral. Pheochromocytoma and autonomous cortisol secretion have been excluded. What is the most appropriate next step in planning surgery?

Accepted Answer

Obtain bilateral adrenal-vein sampling.

Answer

Proceed with left adrenalectomy.

Answer

Obtain adrenal MRI with chemical-shift imaging.

Answer

Repeat aldosterone-suppression testing.

Free Nephrology Practice Questions

Domain 3: Hypo/Hypernatremia (2-6%)

Question 1

Domain 5: Acid-base disorders/Renal tubular disorders (8-12%)

Question 2

Domain 6: Acute kidney injury (7-11%)

Question 3

Domain 7: Pregnancy and the kidney (1-3%)

Question 4

Domain 9: Primary glomerular disease (5-9%)

Question 5

Domain 10: Secondary glomerular disease (4-8%)

Question 6

Domain 11: Diabetic nephropathy (2-6%)

Question 7

Domain 12: Hypertension (3-7%)

Question 8

Domain 14: Peritoneal dialysis (3-7%)

Question 9

Domain 15: Hemodialysis (6-10%)

Question 10

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