Which renal disorder is most common in hospitalized patients?

A) Acute tubular necrosis

B) Acute interstitial nephritis

C) Chronic pyelonephritis

D) Polyomavirus nephropathy

A. Acute tubular necrosis

During renal ischemia, which nephron regions are especially vulnerable to acute tubular injury?

A) Glomerulus and collecting duct

B) PCT and thick ascending limb

C) DCT and thin descending limb

D) Macula densa and podocytes

B. PCT and thick ascending limb

These segments do a lot of active transport, so they need a lot of ATP and oxygen.

Ischemia → ↓ oxygen → ↓ ATP → active transport fails → tubular cell injury/necrosis

Which nephron segment is particularly vulnerable to toxic injury?

A) Thick ascending limb only

B) Collecting duct only

C) Proximal convoluted tubule only

D) Distal convoluted tubule only

C. Proximal convoluted tubule only

The PCT reabsorbs a lot of filtered substances, so toxins can become concentrated inside these cells.

A patient enters the earliest phase of acute tubular injury after an ischemic insult. Which change best fits the inciting phase?

A) Polyuria with hypokalemia

B) Infection risk with diuresis

C) Stable BUN with alkalosis

D) Oliguria with rising BUN

D. Oliguria with rising BUN

ischemic insult → tubular injury begins → ↓ GFR/tubular function → ↓ urine output → BUN rises

A patient with acute tubular injury has severe oliguria, rising BUN, metabolic acidosis, and hyperkalemia. Which phase is this?

A) Recovery phase

B) Maintenance phase

C) Inciting phase

D) Reparative diuresis phase

B. Maintenance phase

Inciting phase = initial injury, oliguria starts, BUN rises
Maintenance phase = worst oliguria + rising BUN + acidosis + hyperkalemia
Recovery phase = urine output increases, hypokalemia can become a problem

A patient recovering from acute tubular injury develops increasing urine output and electrolyte wasting. Which complication becomes especially important?

A) Hypokalemia

B) Hyperkalemia

C) Metabolic acidosis

D) Rising BUN

A. Hypokalemia

A patient recovering from acute tubular injury has rising urine output and impaired tubular function. Which additional risk increases during recovery?

A) Hypertensive crisis

B) Infection vulnerability

C) Renal papillary necrosis

D) Glomerular crescent formation

B. Infection vulnerability

Inflammation involving renal tubules, interstitium, and renal pelvis is best termed what?

A) Glomerulonephritis

B) Nephrolithiasis

C) Pyelonephritis

D) Papillary necrosis

C. Pyelonephritis

A woman develops pyelonephritis after untreated cystitis spreads upward. Which route most commonly causes pyelonephritis?

A) Hematogenous seeding

B) Ascending infection

C) Autoimmune glomerular spread

D) Direct renal trauma

B. Ascending infection

Because bacteria usually start outside the body and enter the urinary tract from below.

cystitis → bacteria ascend ureters → renal pelvis/kidney inflammation → pyelonephritis

Most urinary tract infections are caused by organisms with which Gram stain and shape?

A) Gram-positive cocci

B) Gram-negative bacilli

C) Acid-fast bacilli

D) Gram-negative diplococci

B. Gram-negative bacilli

Which organism set best matches common Gram-negative bacilli causing UTIs?

A) Proteus, Klebsiella, E. coli

B) Staph, Strep, Enterococcus

C) Candida, Cryptococcus, Aspergillus

D) Neisseria, Chlamydia, Mycoplasma

A. Proteus, Klebsiella, E. coli

A patient develops pyelonephritis from hematogenous spread rather than ascending infection. Which patient type is most typical?

A) Healthy adolescent

B) Pregnant adult

C) Immunosuppressed patient

D) Athletic young adult

C. Immunosuppressed patient

A hospitalized patient with a urethral catheter develops dysuria and fever. This device increases risk for which complication?

A) UTI and possible pyelonephritis

B) Polyomavirus nephropathy only

C) Bile cast nephropathy

D) Multiple myeloma nephropathy

A. UTI and possible pyelonephritis

A child with vesicoureteral reflux develops recurrent ascending urinary infections. Reflux primarily increases risk for what?

A) Gouty nephropathy

B) Urinary tract infection

C) Bile cast formation

D) Amyloid kidney disease

B. Urinary tract infection

A kidney biopsy from acute pyelonephritis shows inflammatory cells in tubules and interstitium. Which cell predominates?

A) Macrophages

B) Plasma cells

C) Neutrophils

D) Eosinophils

C. Neutrophils

In acute pyelonephritis, which renal structure is typically spared despite tubulointerstitial inflammation?

A) Glomerulus

B) Renal pelvis

C) Tubule

D) Interstitium

A. Glomerulus

Because pyelonephritis usually comes from an ascending UTI, so the infection enters the kidney from the urine side, not the blood-filtering side.

urethra → bladder → ureter → renal pelvis → collecting ducts/tubules → interstitium

A patient develops sloughed renal papillae during severe urinary infection. Which condition predisposes to papillary necrosis?

A) Minimal change disease

B) Diabetes mellitus

C) Multiple myeloma

D) Acute rheumatic fever

B. Diabetes mellitus

Which additional risk set is associated with renal papillary necrosis?

A) NSAIDs, sickle cell, obstruction

B) Penicillins, IgE, eosinophils

C) Proteus, giant cells, plasma cells

D) HLA-B27, sacroiliitis, uveitis

A. NSAIDs, sickle cell, obstruction

A pregnant patient develops fever, malaise, flank pain, and CVA tenderness. Pregnancy predisposes to which renal disorder?

A) Polyomavirus nephropathy

B) Bile cast nephropathy

C) Acute tubular injury

D) Pyelonephritis

D. Pyelonephritis

A urinalysis in suspected pyelonephritis reveals many leukocytes. Which cast type would strongly support renal parenchymal infection?

A) RBC casts

B) Fatty casts

C) WBC casts

D) Bile casts

C. WBC casts

A patient with recurrent kidney infections has deformed calyces, corticomedullary scars, and flattened papillae. Which diagnosis best fits?

A) Acute tubular injury

B) Chronic pyelonephritis

C) Drug-induced interstitial nephritis

D) Polyomavirus nephropathy

B. Chronic pyelonephritis

A renal biopsy shows enlarged tubular epithelial nuclei with intranuclear inclusions and crystalline-lattice structures. Which diagnosis is most likely?

A) Polyomavirus nephropathy

B) Xanthogranulomatous pyelonephritis

C) Acute pyelonephritis

D) Bile cast nephropathy

A. Polyomavirus nephropathy

polyomavirus infects tubular epithelial cells → viral replication inside nucleus → enlarged nuclei with inclusions

A biopsy from chronic pyelonephritis shows chronic inflammatory infiltration. Which cell type predominates?

A) Neutrophils

B) Basophils

C) Macrophages

D) Mast cells

C. Macrophages

A patient with recurrent Proteus infection develops renal inflammation containing giant cells, plasma cells, and foamy macrophages. Which diagnosis is likely?

A) Acute tubular necrosis

B) Xanthogranulomatous pyelonephritis

C) Drug-induced AIN

D) Polyomavirus nephropathy

B. Xanthogranulomatous pyelonephritis

A patient with chronic pyelonephritis develops massive proteinuria from a secondary nephrotic process. Which syndrome can occur?

A) Membranous nephropathy

B) Minimal change disease

C) Diffuse diabetic sclerosis

D) Focal segmental glomerulosclerosis

D. Focal segmental glomerulosclerosis

unlike acute, in chronic we have glomerular issues over time bc of kidney damage and scarring.

After pyelonephritis, which condition is described as the second most common cause of acute kidney injury?

A) Drug/toxin-induced TIN

B) Renal artery stenosis

C) Poststreptococcal GN

D) Multiple myeloma

A. Drug/toxin-induced TIN

A patient develops acute tubulointerstitial nephritis after starting antibiotics. Which drug class most commonly causes this?

A) Loop diuretics

B) Synthetic penicillins

C) Beta blockers

D) Calcium channel blockers

B. Synthetic penicillins

A drug-induced acute interstitial nephritis biopsy shows an allergic-type inflammatory pattern. Which cells predominate?

A) Neutrophils and monocytes

B) Lymphocytes and mast cells

C) Macrophages and eosinophils

D) Plasma cells and basophils

C. Macrophages and eosinophils

A patient develops fever and rash after starting a synthetic penicillin, followed by renal dysfunction. Which immunoglobulin is often elevated?

A) IgA

B) IgG

C) IgM

D) IgE

D. IgE

synthetic penicillin → allergic interstitial reaction → fever/rash/eosinophils → kidney dysfunction

A severe case of drug-induced acute interstitial nephritis can produce which urinary findings?

A) Hematuria, proteinuria, leukocyturia

B) Glycosuria, ketonuria, bilirubinuria

C) Myoglobinuria, crystalluria, anuria

D) Hemoglobinuria, chyluria, phosphaturia

A. Hematuria, proteinuria, leukocyturia

A patient with malignancy develops tubulointerstitial nephropathy due to excess abnormal proteins. Which cancer is implicated?

A) Renal cell carcinoma

B) Multiple myeloma

C) Acute leukemia

D) Transitional carcinoma

B. Multiple myeloma

A patient with severe liver disease develops pigmented casts in renal tubules. Which cast type is expected?

A) RBC casts

B) WBC casts

C) Fatty casts

D) Bile casts

D. Bile casts

Which sequence best matches phases of acute tubular injury with major clinical changes?

A) Recovery—hyperkalemia; inciting—polyuria

B) Inciting—oliguria; maintenance—acidosis

C) Maintenance—hypokalemia; recovery—anuria

D) Inciting—infection; maintenance—diuresis

B. Inciting—oliguria; maintenance—acidosis

Which pairing best distinguishes acute from chronic pyelonephritis?

A) Acute—macrophages; chronic—neutrophils

B) Acute—WBC casts; chronic—calyceal scarring

C) Acute—crystalline lattice; chronic—IgE

D) Acute—bile casts; chronic—papillary sparing

B. Acute—WBC casts; chronic—calyceal scarring

Which pairing best matches renal disorders with characteristic associations?

A) Polyomavirus—bile casts

B) Xanthogranulomatous—Proteus infection

C) Drug-induced AIN—low IgE

D) Chronic pyelo—minimal proteinuria

B. Xanthogranulomatous—Proteus infection

A patient with ascending renal infection has fever, flank pain, and leukocyturia. Which finding best localizes inflammation to kidney rather than bladder alone?

A) Squamous epithelial cells

B) Nitrite-positive urine

C) White blood cell casts

D) Low urine specific gravity

C. White blood cell casts