A normal kidney ….all are true except

1.   ?    erythropoieten is secreted by peritubular cells in response to hypoxia
2.   ?    hydroxylates 1- hydroxycholecalciferol to its active form
3.   ?    renin is secreted from the juxta glomerular apparatus
4.   ?    locally produced prostaglandins have a very important role in maintaining renal perfusion
5.   ?    90% of the erythropoietin comes from the kidneys and 10 % from the liver.

Normal adult kidneys…all are true except

1.   ?    its length is about 11-14 cm (about 3 vertebral bodies)
2.   ?    both kidneys rise and descend several centimeters during respiration
3.   ?    each kidney contains approximately 10 million nephrons
4.   ?    both kidneys receive about 20-25% of the cardiac output
5.   ?    the right kidney is usually few centimeters lower than the left .

Causes of polyuria...all are true except

1.   ?    excessive fluid intake
2.   ?    hyperglycemia
3.   ?    early stage of chronic renal failure
4.   ?    tubulointerstitial diseases
5.   ?    heavy smoking

Renal ultrasound examination.. all are true except

1.   ?    its disadvantage is that it is highly operator dependent
2.   ?    quick, rapid, cheap and non-invasive and often the only required method of renal imaging
3.   ?    it can show the renal size, position, dilatation of the collecting system and other abdominal pathologies like cystic liver.
4.   ?    in chronic renal failure, the density of the renal cortex is unfortunately decreased and there is loss of cortico-medullary differentiation.
5.   ?    by utilizing the Doppler techniques, much information can be gained like the resistivity index

IVU is commonly used in clinical nephrology. All are true except

1.   ?    risky in diabetes mellitus
2.   ?    risky in myeloma
3.   ?    risky in pre-existent renal disease
4.   ?    the risk of contrast nephropathy can be reduced by avoiding dehydration and by giving diuretics
5.   ?    The risk of contrast nephropathy can be reduced by using less hyperosmolar (yet expensive) contrast media

Disadvantages of IVU…all are true except

1.   ?    time consuming
2.   ?    needs and injection
3.   ?    dependence on adequate renal function for good images
4.   ?    risk of exposure to contrast media (allergic reaction, nephro-toxicity)
5.   ?    unfortunately, poor definition of the collecting system on AP films

Anterograde pyelography ….which one is true

1.   ?    it is the injection of a contrast media into kidney through the bladder and ureters
2.   ?    it is usually done blindly
3.   ?    much more difficult and hazardous in a non-obstructed kidney
4.   ?    usually used in cases of glomerulonephritis
5.   ?    poorly out line the collecting system

Micturating cystourethrogram …all are wrong except

1.   ?    not used in the diagnosis and assessment of the severity of vesicicoureteric reflux
2.   ?    usually used in conjunction with urodynamic studies
3.   ?    it is part of the last stages of IVU
4.   ?    not indicated in those with recurrent UTI
5.   ?    not indicated in those with renal scars and not indicated in those with chronic renal failure of unknown cause

Renal angiography and venography …all are true except

1.   ?    the main indication of renal angiography is the diagnosis of renal artery stenosis and renal hemorrhage
2.   ?    therapeutic intervention may be undertaken at the same time of doing renal angiography like dilatation and stenting of renal artery stenosis and occluding and AV fistula
3.   ?    unlike IVU, there is a risk of cholesterol athero-embolisation
4.   ?    when compared to IVU, the risk is contrast nephropathy is lower
5.   ?    renal venography mainly used in the diagnosis of renal vein thrombosis and renal cell carcinoma extension

Renal biopsy….all are indications except

1.   ?    unexplained acute renal failure
2.   ?    chronic renal failure with normal sized kidneys
3.   ?    atypical childhood nephrotic syndrome
4.   ?    isolated hematuria with normal looking RBCs
5.   ?    nephrotic syndrome in adults

Contraindications to renal biopsy …all are true except

1.   ?    severe hemophilia
2.   ?    platelets count of 10000 /mm3
3.   ?    uncontrooled hypertension
4.   ?    renal size less than 80% predicted
5.   ?    biopsy from a single kidney is a relative contraindication

Causes of DARK urine …….all are true except

1.   ?    all cases of porphyria
2.   ?    intervertebral dics calicification with dark ears
3.   ?    a Parkinsonian patient
4.   ?    pulmonary TB patient
5.   ?    massive crushing trauma pateint

Protienuria ……..are true except

1.   ?    standard sticks usually Miss bence john's protein
2.   ?    in myoloma it is due to protein Overflow rather than amyloidosis
3.   ?    the majority of the daily excreted protein is Tamm Horesful mucoprotien
4.   ?    albumin / creatinin ratio on a random urine sample is less than 2.5 in females and less than 3.5 in males
5.   ?    Positive dipstick for protein may occur in fever per se

Acute renal failure…all are wrong except

1.   ?    prerenal causes are uncommon
2.   ?    85% of intrinsic renal causes of acute renal failure are due to acute tubular necrosis
3.   ?    underperfusion causes of acute renal failure are usually irreversible
4.   ?    stones as a cause of acute obstructive uropathy are very common causes
5.   ?    15% of intrinsic acute renal failure is due to acute glomerulonephritis

Regarding prognosis in acute renal failure …all are true except

1.   ?    in uncomplicated renal failure e.g. due to bleeding or drugs, the mortality is low
2.   ?    serious infection complicating acute renal failure portends bad prognosis
3.   ?    multiple end organ failure portends a poor prognosis
4.   ?    complicated acute renal failure may have a mortality approaching 15- 30 %
5.   ?    the outcome and prognosis is determined by the severity of the underlying disease and by complications rather than by renal failure per se

Rapid respiratory rate in acute renal failure may be due to all but one of the followings

1.   ?    acidosis per se
2.   ?    iv overload and pulmonary edema
3.   ?    ARDS picture
4.   ?    chest infection
5.   ?    hyperkalemia

Anemia in the setting of acute renal failure is very common and usually multifactorial…all are causes except

1.   ?    hemolysis
2.   ?    excessive bleeding
3.   ?    profound suppression of erythropoiesis
4.   ?    drug induced
5.   ?    hyperphophatemia

General urine examination (GUE) is one of the commonest investigations done every day ……all are true except:

1.   ?    elevated urinary concentration of ascorbic acids gives a false negative results for bilirubin dipsticks
2.   ?    elevated urinary concentration of ascorbic acids gives a false negative results for glucose dipsticks
3.   ?    gross hematuria gives false positive results for protein
4.   ?    significant glycosuria gives a falsely low specific gravity
5.   ?    MESNA gives false positive results for ketone sticks

Urine Dipstick tests are commonly used in the medical ward side labs by nurses, juniors and senior house officers …….all are true except

1.   ?    false negative results for nitrite may be due to short bladder transit time
2.   ?    False negative results for nitrite may be due to infecting organisms lacking nitrates and nitrate reductase
3.   ?    high urinary level of tetracycline gives false negative results for leukocyte esterase
4.   ?    high urinary level ascorbic acid gives false negative results for nitrite
5.   ?    medications which discolor urine will give false negative for nitrite

Specific gravity is measured in some clinical conditions like diabetes insipidus ……..do you know how it s measured? ….it is measured by all of the following methods except

1.   ?    freezing point depression
2.   ?    vapor pressure technique
3.   ?    using a refractormeter
4.   ?    using a hydrometer
5.   ?    calorimetric reagent strips

In microalbuminuria ……all are true except

1.   ?    is defined as prtienuria between 30-300 mg / day
2.   ?    Is defined as proteinuria between 20-200 microgram / minute
3.   ?    always protein dipstick negative
4.   ?    improtant in the follow up of type II not type I diabetes mellitus
5.   ?    persisrent proteinuria has been associated with the development of atherosclerorsis

Daily excretion of urinary protein…all are true except

1.   ?    up t 150 mg /day is normal
2.   ?    300-500 mg/ day will be dipstick test positive
3.   ?    more than 3.5 gram/day is called nephritic range proteinuria
4.   ?    more than 2.5 gram/ day, a glomerular source is more likely than a tubular source
5.   ?    between 0.5-2 gram/ day usually indicates a glomerular source

In diagnosing pre-renal failure...all of the followings when present are highly suggestive …except which one

1.   ?    the history may be compatible eg excessive bleeding
2.   ?    compatible clinical finding
3.   ?    a progressive rise in blood urea and creatinin
4.   ?    urine osmolality more than 500 mosm/ Kg
5.   ?    fractional sodium excretion more than 2

In chronic renal failure …all are true except

1.   ?    the commonest causes world wide are hypertension and diabetes
2.   ?    urea frost is a useful early sign
3.   ?    itching is multi factorial rather than due to hyperphosphatemia alone
4.   ?    hypotension and dehydration may be seen
5.   ?    in clinical practice, about 4-18 % of cases are of unknown or uncertain etiology

Although chronic renal failure is an irreversible process, there are many "reversible factors" that may accelerate the course …all of the following factors are true except

1.   ?    nephrotoxic medications
2.   ?    renal artery stenosis
3.   ?    hypotension due to drug therapy
4.   ?    any infection per se
5.   ?    normal blood pressure

Endocrinal abnormalities are common in chronic renal failure …all of the following statements are true except

1.   ?    hyperprolactenemia may be seen but unfortunately many cases don’t respond to bromocryptine
2.   ?    the half life of insulin is shortened
3.   ?    amenorrhoea is common in females
4.   ?    loss of libido in both sexes is very common
5.   ?    hypothyroidism like picture

In the management of chronic renal failure...all are true except

1.   ?    hypertriglyceridemia is common and hypercholesteremia is almost universal in those who have significant proteinuria
2.   ?    ACE inhibitors for hypertension have significantly been shown to retard the disease progression especially in diabetics
3.   ?    profound protein restriction is unwise as this may produce malnutrition
4.   ?    replacing sodium and chloride with high fluid intake should be avoided in all patients
5.   ?    hypocalcemia is very common and should be corrected by vitamin D metabolites.

Regarding the prognosis of chronic renal failure …all are true except

1.   ?    the commonest cause of death is vascular events
2.   ?    5 year survival of " home hemodialysis " patients is about 80%
3.   ?    5 year survival following renal transplantation is about 80%
4.   ?    5 year survival for "hospital hemodialysis " patien