Important MCQ's in Nephrology for NEET SS Pediatrics

Q1. A 6-year-old boy is brought to the emergency department with complaints of decreased urine output, swelling in the feet and legs, and general malaise. On examination, he is found to have hypertension and pallor. A urinalysis reveals proteinuria and hematuria. Which emerging biomarkers could help diagnose the cause of his acute kidney disease?

1. Neutrophil Gelatinase-Associated Lipocalin (NGAL)

2. Urinary Alpha-1 Microglobulin (α1M)

3. Cystatin C

4. Kidney Injury Molecule-1 (KIM-1)

Ans. 1) Neutrophil Gelatinase-Associated Lipocalin (NGAL) 

Also read: NEET SS Pediatrics Most Important MCQS

Q2. A 7-year-old boy is brought to the pediatrician's office by his parents with a complaint of recurrent blood in his urine. The parents report that the child also has a history of hearing loss. Upon further inquiry, the parents reveal that the child has not been experiencing pain or discomfort while urinating. The pediatrician performs a physical examination, which reveals no significant findings. Based on the child's presentation, which of the following is the most likely diagnosis?

1. IgA nephropathy
2. Alport syndrome
3. Thin basement membrane disease
4. Henoch-Schönlein purpura (HSP)

Ans. 2) Alport syndrome

Q3. A 10-year-old girl comes to the office with frequent urination, pedal swelling and worsening fatigue. Laboratory evaluation reveals a creatinine of 4 mg/dL and potassium of 5.8 mg/dL. GFR is 40 mL/min/1.73m2. Which of the following is the stage of CKD in this patient?

1. Stage 2
2. Stage 3
3. Stage 4
4. Stage 5 

Ans. 2) Stage 3 

Q4. A 9-year-old child with a history of CKD is seen in the office due to bone pain, nausea and vomiting. His GFR is 29 ml/min/1.73m2, creatinine is 3 mg/dL, and calcium is 7 mg/dL. Serum PTH is also high. Which of the following is the most likely cause of his symptoms?

1. Parathyroid adenoma
2. Secondary hyperparathyroidism
3. Multiple myeloma
4. Vitamin D excess 

Ans. 2) Secondary hyperparathyroidism 

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Q5. A 9-year-old child with stage 3 chronic kidney disease (CKD) secondary to posterior urethral valves presents to the clinic. His blood pressure is 130/80 mmHg, and his serum creatinine is 1.5 mg/dL. Which of the following interventions is most appropriate for this patient?

1. Initiate angiotensin-converting enzyme inhibitor (ACEi) therapy

2. Start erythropoietin therapy

3. Initiate sodium bicarbonate supplementation

4. Initiate loop diuretic therapy

Ans. 1) Initiate angiotensin-converting enzyme inhibitor (ACEi) therapy

Q6. A 10-year-old girl with a history of hematuria and proteinuria presents to the clinic. Her blood pressure is 128/84 mmHg, and laboratory results show a serum creatinine of 1.9 mg/dL and an estimated GFR of 30 mL/min/1.73m². A renal biopsy is planned to establish the underlying diagnosis. Which of the following is the most likely diagnosis in this patient?

1. Minimal change disease

2. Focal segmental glomerulosclerosis

3. Membranous nephropathy

4. IgA nephropathy

Ans. 2) Focal segmental glomerulosclerosis

Q7. A 10-year-old girl with a past medical history of frequent upper respiratory tract infections presents to the clinic with a 6-month history of recurrent gross hematuria. The patient reports no dysuria or flank pain, and there is no family history of renal disease. Physical examination findings are unremarkable. Urine analysis reveals the presence of red blood cells, but no proteinuria. Renal ultrasound and voiding cystourethrogram results are normal. In the context of this patient's clinical presentation and available laboratory results, what would be the most appropriate next step for management?

1. Reassurance and observation

2. Empiric treatment with antibiotics

3. Repeat urine analysis in 3 months

4. Renal biopsy

Ans. 4) Renal biopsy

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Q8. A 3-year-old boy with an intellectual disability, proximal renal tubular dysfunction, a history of congenital cataracts, hypotonia, seizures, and difficulty feeding is found to have a characteristic facial appearance, including bitemporal narrowing, epicanthal folds, and a small jaw on examination. What underlying genetic defect is associated with this patient’s presentation?

1. Deletion of the OCRL1 gene

2. Mutation in the CLCN5 gene

3. Mutation in the ATP6AP2 gene

4. Mutation in the NPHS1 gene

Ans. 1) Deletion of the OCRL1 gene

Q9. A 4-year-old boy is accompanied by his mother to the pediatrician with a complaint of growth retardation, frequent urination, and rickets-like symptoms. The child's blood pressure is normal, and laboratory investigations reveal hypophosphatemia, glucosuria, generalized aminoaciduria, and hypokalemia. Which diagnosis is most likely based on the clinical presentation and test results?

1. Classic Bartter syndrome
2. Gitelman-syndrome
3. Fanconi syndrome
4. Fanconi-Bickel syndrome

Ans. 4) Fanconi-Bickel-syndrome

Q10. A 5-year-old boy presents to the emergency department with a history of abdominal pain and bloody diarrhoea for the last 3 days. He has not had any vomiting but has had a fever of 38.5°C (101.3°F). Upon examination, the child appears pale and has mild oedema in his lower extremities. His blood pressure is 110/70 mmHg, and his heart rate is 120/min. Laboratory studies show a low platelet count, elevated serum creatinine, and anaemia. Urine studies reveal proteinuria and hematuria. A peripheral blood smear is shown below. What is the most likely diagnosis for this patient?

1. Post-streptococcal glomerulonephritis

2. Hemolytic uremic syndrome

3. Acute interstitial nephritis

4. Acute glomerulonephritis

Ans. 2) Hemolytic Uremic Syndrome

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Q11. A 7-year-old male child presents to the emergency department with a 3-day history of fever, vomiting, and abdominal pain for 2 days. He was diagnosed with streptococcal pharyngitis two weeks ago and completed a 10-day course of amoxicillin. His vital signs are stable, and his physical examination reveals diffuse abdominal tenderness and decreased urine output. The child's weight is 25 kg (55 lb), and his baseline serum creatinine is 0.4 mg/dL. Which of the following findings is most likely to be seen on the physical examination of this child?

1. Hypertension

2. Hypotension

3. Periorbital Edema

4. Skin Rash

Ans. 2) Hypotension

Q12. A 10-year-old boy with a history of underlying chronic kidney disease presents to the emergency department with severe oliguria, oedema, and hypertension. Lab results show an elevated serum creatinine level and metabolic acidosis. The child is started on fluid and electrolyte management, but his condition deteriorates and requires renal replacement therapy. Which of the following types of dialysis is the most appropriate for this patient?

1. Intermittent Hemodialysis

2. Continuous Renal Replacement Therapy (CRRT)

3. Peritoneal Dialysis

4. Sustained Low-Efficiency Dialysis (SLED)

Ans. 2) Continuous Renal Replacement Therapy (CRRT)

Q13. A 16-year-old boy presents with an acute onset of severe, colicky flank pain that radiates to the groin and is associated with nausea and vomiting. The patient has a family history of nephrolithiasis, and physical exam reveals costovertebral angle tenderness. Urinalysis shows gross hematuria. Non-contrast abdominal CT scan confirms the presence of a 12 mm left-sided renal stone. Which of the following is the most appropriate next step in management?

1. Observation and hydration alone

2. Extracorporeal shock wave lithotripsy (ESWL)

3. Ureteroscopy with laser lithotripsy

4. Percutaneous nephrolithotomy (PCNL)

Ans. 3) Ureteroscopy with laser lithotripsy

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Q14. A 9-year-old child is brought to the clinic with his mother with the complaint of fever and malaise for 5 days. His mother tells him that the child looks puffy for a few days. On examination, there is mild edema and swelling of the face. Vital signs are normal.Keeping in view the diagnosis of nephrotic syndrome what should be the initial investigation of choice in this patient?

1. 24-hour urine protein urine

2. Urine dipstick

3. Urine protein to creatinine ratio

4. Serum creatinine

Ans. 2) Urine dipstick 

Q15. A 7-year-old boy presents to the pediatrician with swelling around his eyes, legs, and abdomen for 1 week. On examination, he has puffy eyelids, generalized oedema, and a distended abdomen. His blood pressure is 110/70 mmHg. Urinalysis shows heavy proteinuria 4+. His serum albumin is 1.8 g/dL (3.4 to 5.4 g/dL) and his cholesterol level is 300 mg/dL (<170 mg/dL). Which of the following is the most likely diagnosis?

1. Nephritic syndrome

2. Glomerulonephritis

3. Nephrotic syndrome

4. Acute renal failure

Ans. 3) Nephrotic syndrome

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