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Nephrotic syndrome

Quiz by Nada Hassan Ahmed Abdelrahman

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15 questions
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  • Q1

    A 53-year-old diabetic and smoker male presents with worsening peripheral oedema over the last 2 months,  together with significant weight loss. Blood showed:Hb 115 g/L Male: (135-180, Creatinine 130 µmol/L (55 - 120), Albumin 23 g/L (35 - 50)

    CRP 45 mg/L (< 5), HbA1c 48mmol/mol (<48) . CXR showed a peripheral, well-circumscribed lesion on his right lung. Renal biopsy confirmed findings of membranous nephropathy. Anti-phospholipase A2 receptor antibodies were negative. What is the most likely cause of his membranous nephropathy?

    Type 2 diabetes


    Primary membranous nephropathy

    Lung cancer

  • Q2

    A35_yar_old lady known case of nephrotic syndrome secondary to rheumatoid arthritis. Her urine output dropped suddenly, and further investigation demonstrated the deterioration of her renal function. Renal ultrasound showed renal artery stenosis.

    what is the likely underlying cause for the patient's condition?

    Factor V Leiden mutation

    Prothrombin gene mutation

    what is the likely underlying cause for the patient's condition?

    Protein C deficiency 

  • Q3

    A 39-year-old man with nephrotic syndrome due to membranous glomerulonephritis. He has no relevant past medical history and is not currently taking any medication. Investigations rule out the possibility of an infectious, autoimmune or malignant primary cause. Which further investigation is most likely to identify the diagnosis?68%13%ELISA test9%

    dsDNA antibodies


    Venereal disease research laboratory test

    Anti-phospholipase A2

  • Q4

    A 15-year-old boy presents with facial swelling that started five days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), his pulse is 107/min, and his blood pressure is 94/67 mm Hg. Examination shows pitting oedema of the upper and lower extremities as well as periorbital oedema. The abdomen is mildly distended. Laboratory studies show Low albumin, high cholesterol and proteinuria.

    A renal biopsy of this patient is most likely to show which of the following findings?

    Subepithelial dense deposits on electron microscopy

    Mesangial proliferation on light microscopy

    Granular subepithelial deposits of IgG, IgM, and C3 on immunofluorescence

    Normal light microscopy findings

  • Q5

    A 20-year-old  man presents with swelling of his face and legs for 5 days. He had   an episode of sore throat 2 weeks ago. His temperature is 37°C , pulse is 90/min, and blood pressure is 145/87 mm Hg. Examination shows periorbital edema and 3+ pitting edema of the lower extremities. Laboratory studies showed:

    Albumin 2.4 g/dL

    Hepatitis B surface antigen-positive

    Hepatitis B surface antibody negative

    Complement C4 decreased

    Further evaluation is most likely to show which of the following additional findings

    Antistreptolysin O titers in serum

    Subepithelial deposits on renal biopsy

    Antineutrophil cytoplasmic antibody level in serum

    Eosinophilic nodules on renal biopsy

  • Q6

    A 35-year-old man known case of HIV presented with  progressive swelling of his legs over the past 2 months. He was diagnosed as a case of nephrotic syndrome.

    A kidney biopsy is most likely to show which of the following findings under light microscopy?

    Segmental sclerosis

    No changes

    Segmental sclerosis

    Nodules within glomeruli

  • Q7

    A 47-year-old lady presents with worsening lower extremity oedema. In addition, her urine has appeared more foamy than usual. Past medical history includes HIV, hypertension, type II diabetes mellitus, and intravenous heroin use. The patient subsequently undergoes a renal biopsy with the light microscopy findings as above.

    Which of the following is the most likely diagnosis?  

    Question Image

    Focal segmental glomerulosclerosis

    Minimal change disease

    Rapidly progressive glomerulonephritis 

    Diffuse proliferative glomerulonephritis 

  • Q8

    A 16-year-old man presents with facial puffiness, lower limb oedema and frothy urine.   Which of the following pathophysiologic processes is most likely contributing to this patient’s clinical presentation? 

    Poor cardiac ejection fraction

    Increased oncotic pressure

    Increased aldosterone and ADH secretion

    Decreased lipoprotein synthesis 

  • Q9

    A 62-year-old woman presents with progressive fatigue, weight loss, and ankle swelling for the past two months. Physical examination shows 2+ pitting edema around the ankles. Cardiovascular and respiratory examinations are non-contributory. Laboratory results show a serum creatinine level of 3.1 mg/dL, albumin of 2.2 g/dL, and total cholesterol concentration of 290 mg/dL. Urinalysis results show 3+ proteinuria without hematuria or red cell casts. Renal biopsy is performed, and the results are shown above

        Which of the following is the most likely explanation for this patient’s condition?

    Question Image

    Light chain nephropathy

    Diabetic glomerulonephropathy

    Membranous nephropathy

    Focal segmental glomerulosclerosis

  • Q10

    A 52-year-old female diagnosed with nephrotic syndrome.  A renal biopsy is performed, and the following is visualized on light microscopy above.

    Which of the following is most suggestive of this patient’s underlying diagnosis? 

    Question Image

    Positive glomerular immunostaining for IgA

    IgG4 antibodies against phospholipase A2 receptor 

    Mutation in type IV collagen

    Decreased serum levels of C3

  • Q11

    A 14-year-old male with a history of non-Hodgkin lymphoma presents with leg swelling.  On physical exam he is noted to have bilateral periorbital edema and 2+ pitting edema of the lower extremities. Urinalysis demonstrates 4+ protein and is negative for blood. The patient subsequently undergoes a kidney biopsy. Which of the following findings is most likely to be observed on electron microscopy?

    Podocyte foot effacement

    Thickened basement membrane with a spike and dome appearance

    Mesangial immune complex deposition

    Subepithelial immune complex humps

  • Q12

    A 25-year-old man presents with decreased urination, decreased appetite, fatigue and generalized oedema for a week. Medical history includes HIV infection. Laboratory tests show: serum albumin is 2.6 g/dL, LDL is 200 mg/dL, an HDL is 28 mg/dL, triglycerides are 525 mg/dL, and creatinine is 2.5 mg/dL. Which of the following is the most likely diagnosis in this patient?

    Membranous nephropathy  

    Acute tubular necrosis (ATN)

    IgA nephropathy

    Focal segmental glomerulosclerosis

  • Q13

    A 36-year-old man presents with progressive swelling in all of his limbs for the past month.  His current medications include ibuprofen for chronic back pain. Physical examination shows a palpable liver edge 2cm below the right costal margin and anasarca. Laboratory blood studies are positive for the presence of HBsAg and negative for Anti-HBsAg. Urinalysis shows 4+ protein and a follow-up 24-hour urine collection shows a loss of 4.1g of protein. A kidney biopsy is performed and shows thickened capillaries and glomerular basement membrane on light microscopy with subepithelial deposits seen on electron microscopy. Which of the following is the most likely diagnosis?

    Poststreptococcal glomerulonephritis

    Minimal change disease

    Membranous glomerulonephritis

    Alport syndrome
  • Q14

    A 30-year-old lady presents with progressive swelling of her face and legs for 2 weeks. Examination shows 3+ pitting oedema in both lower extremities. Urinalysis shows 4+ protein. Past medical history is significant for type I diabetes. Which of the following is the most appropriate test to confirm the diagnosis?Elimination toolA.    B.Complete blood count C.    D.

    Serum protein electrophoresis 

    Renal ultrasonography.

    24-hour urine for protein

    Complete metabolic panel  

  • Q15

    A 50-year-old man presents with foamy urine for 6 weeks. His medical history includes osteoarthritis, gout, and type II diabetes mellitus. Examination shows decreased fine sensation on both feet bilaterally and a leg ulcer.  Laboratory investigations show there are no erythrocytes on urinalysis, and that the albumin/creatinine ratio is 42 mg/mmol.

    Which of the following is the most likely diagnosis?

    Renal artery stenosis

    Diabetic nephropathy

    Nephrotic syndrome

    Nephritic syndrome


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