1. 6 years old patient with clinical signs of periorbital edema, proteinuria - 6.

5 g a day;
hypoalbuminemia, albumin level – 23 g/l; hypercholesterolemia Chol – 9.5 mg/dl; serum creatinine -
75 mmol/l; Urea- 4.5 mmol/l; Blood pressure – 90/56 mm. Hg; What is most likely diagnose for this
patient?
A. Minimal change glomerulonephritis
B. Membranose glomerulonephritis
C. IgA nephropathy
D. Alport’s syndrome
2. 25 years old patient with clinical signs of peripheral pitting edema, proteinuria - 5.5 g a day;
hypoalbuminemia, albumin level – 20 g/l; hypercholesterolemia and lipiduria; What is the most likely
diagnostic test which should be performed with this patient?
A. Renal scan with Tec – 99;
B. Urine culture
C. Kidney biopsy
D. CT scan
3. Which of the following statement is most likely to be performed kidney biopsy?
A. Diabetic nephropathy already known with retinopathy
B. Isolated non-nephrotic range proteinuria without hematuria
C. Isolated hematuria
D. Acute unexplained kidney injury

4. Which of the following disease can be associated with secondary FSGS , beside?
A. Reflux nephropathy
B. Obesities
C. Cystitis
D. HIV infection

5. Which of the following are true, in relation to an adult with nephrotic syndrome?
A. A renal biopsy is mandatory
B. Their protein intake should be restricted
C. A low calcium diet should be followed
D. ACE – infibitors are effective in treatment of hypertension
6. 45 years old patient with renal failure, hearing problems and arterial hypertension, which of the
following disease may the patient have?
A. Membranoprolipherative glomerulonephrits type I
B. IgA nephropathy
C. Alport’s syndrome
D. minimal change glomerulonephritis
7. 18 years old patient 2 weeks ago had upper respiratory infection, which followed hematuria, arterial
hypertension, Kidney biopsy was performed , which revealed subepithelial dense deposits - humps;
Which of the following disease patient may have?
A. IgA nephropathy
B. Alport’s syndrome
C. Membranoprolipherative glomerulonephritis
D. Postinfective glomerulonephritis

8. A patient with acute renal failure has a K 6.5 mol/l and ECG changes. Which is the most appropriate
immediate management step?
A. 10 u insulin in 50 mL 50% dextrose intravenously
B. 10 mL 10% calcium gluconate intravenously
C. 40 mg intravenous furosemide
D. Oral calcium resonium
9. 23 Female patient with complains with fever, dysuria, urgency, urinalysis revealed WBC and pyuria;
What is the most likly diagnostic test which should be performed for this patient?
A. Urine culture
B. Kidney biopsy
C. Renal scan
D. Serum creatinine

10. 42 years old patient 3 years on peritoneal dialysis, suddenly developed the bloody appearance on
dyalisate fluid. Which of the following complication patient may have?
A. Hemoperitoneum
B. Peritonela catheter mulposition
C. Exit site infection
D. Peritonitis
11. Which of the following features suggest that renal failure is acute rather than chronic?
A. Pericardial friction rub
B. Anuria
C. K + 6.4 mmol/L
D. Peripheral oedema

12. 44 years old male patient with recurrent microscopic hematuria, has a family history of kidney
disease, ocular problems, arterial hypertension TA – 160/70, serum crea – 70 mmol/l; serum albumin-
38 g/l; protein excretion in 24hour urine – 1350mg. What is the most likely treatment option for this
patient?
A. ACE inhibitors
B. Fluid intake
C. Steroids
D. Cyclosporine
13. 44 years old male patient with recurrent microscopic hematuria, has a family history of kidney
disease, ocular problems, arterial hypertension TA – 160/70, serum crea – 70 mmol/l; serum albumin-
38 g/l; protein excretion in 24hour urine – 1350mg. What is the most likely diagnose for this patient?
A. Thin basement membrane
B. IgA nephropathy
C. Alport’s syndrome
D. Nutcracker syndrome
14. 24 years old male patient with recurrent gross hematuria and left flank pain. What is the most likely
diagnose for this patient?
A. Thin basement membrane
B. IgA nephropathy
C. Nutcracer syndrome
D. Alport’s syndrome

15. Which of the following features suggest that renal failure is acute rather than chronic?
A. Normal renal function 1 month previously
B. Hypocalcaemia
C. Normal - sized kidneys on US examination
D. Acute - onset anuria

16. With regard to FSGS, which of the following are true?

A. It commonly presents as nephritic syndrome.
B. It can be associated with obesity and HIV infection.
C. It does not recur in renal transplants.
D. There are not familial forms, caused by mutations in nephrin and podocin.

17. A 55 - year - old male with ESRF secondary to diabetic nephropathy presents 9 months post transplant
with a BP 160/90 mmHg) and a gradually rising creatinine (130 to 190 μ mol/L over a 3 - month
period). Decoy cells are identifi ed in his urine on microscopy. What is the most likely diagnose for this
patient?
A. Acute T-cell mediated rejection
B. BK- polioma viral infection
C. CMV – infection
D. Urinary tract infection
18. A 33 - year - old woman with ESRF secondary to alport’s syndroe biopsied 2 months following a living
donor kidney transplant (2 - 1 - 1 mismatch) due to a rise in creatinine with normal US scan. Her
maintenance immunosuppression is prednisolone, tacrolimus and mycophenolate mofetil. Kideny
biopsy revealed acute T –cell mediated rejection Banff classification grade 2 B; What is the most likely
effective treatment for this patient?
A. Puls –therapy methylprednizone, IVIG;
B. Puls-therapy methylprednosone, ATG,
C. Puls- therapy methylprednosone,;
D. Puls- therapy methylpredinisone, plasma exchang, IVIG;

19. A 53 - year - old male with ESRF secondary to diabetic nephropathy presents 4 months post transplant
with a BP 140/80 mmHg) and a sudden raised creatinine (90 to 220 μ mol/L ). Urinary sediment
revealed WBC – lymphocytes in his urine on microscopy. What is the most likely diagnose for this
patient?
A. Acute T-cell mediated rejection
B. BK- polioma viral infection
C. CMV – infection
D. Urinary tract infection

20. A 56 - year - old male with ESRF secondary to diabetic nephropathy presents 2 months post transplant
with a BP 120/80 mmHg, fever, t-38C, diarrhea, nausea and vomiting; CBC revealed leucopenia and a
sudden raised creatinine (130 to 190 μ mol/L ). What is the most likely diagnose for this patient?
A. Acute T-cell mediated rejection
B. BK- polioma viral infection
C. CMV – infection
D. Urinary tract infection

21. A 56 - year - old with clinical signs of nausea and vomiting, arterial hypertension blood pressure
170/90 mm. Hg, peripheral edema, laboratory tests revealed: serum crea- 560 mmol/l; Urea- 42
mmol/l; K-6.5 mmol/l; HCO3- 13 mmol/l; iPTH – 390 pg/ml; P- 2.5 mmol/l; Ca- 1.9 mmol/l; Ultrasound
of kidney revealed small with increased eckogenicity. What is the most likely diagnose?
A. Acute kidney disease
B. Chronic kidney disease
C. Nephritic syndrome
D. Urinary tract infection
22.15 years old male patient complains with periorbital and peripheral edema.
Laboratory test revealed hypoalbumnemia, hypercholesterolemia, protein
excretion in 24 hour urine sample is 9.4g; Kidney biopsy revealed normal
glomeruli under the light microscope and foot effacement under electron
microscope. What is the most likely diagnose?
A. Focal-segmental glomerulosclerosis
B. Membranose glomerulonephritis
C. Minimal change disease
D. Membranoprolipherative gloemrulonephritis

23.55 years old male patient who comes to the emergency complaining of left flank
pain, nausea vomiting and gross hematuria. Ultrasound revealed hydronephrosis
on left side. What is the most lily diagnose?
A. Urinary track infection
B. Acute nephritic syndrome
C. Renal calculi
D. Cystitis
24. A 38 -year -old girl who presents with a 2-week history of lethargy, headache and seizers. She
also noticed that she is passing less urine than usual, temperature of 38 ° C and looks mildly
jaundiced.The patient has diarrhea. Laboratory tests revealed: Hb 6.9 g/dL, MCV 100, WBC
14.4 × 10 9 /L (neutrophils), Platelets 37 × 10 9 /L; Clotting: normal; Haptoglobin: low Blood
film: fragmented red cells; LDH – 4200; Urea - 27.4 mmol/L, Creatinine- 668 μ mol/L;
Urinanalysis: protein ++, blood +++ negative for leucocytes, stool culture did not indicate the
presence of any pathogenic micro –organisms. What is the most likely diagnose?
A. Thrombotic microangiopathic purpura
B. Goodpasture’s disease
C. IgA nephropathy
D. Membranoproliphertive glomerulonephritis

25. Patient with hyperkalemia should receive the following treatment to decrease the serum potassium
beside:
A. Calcium acetate
B. Sodiumbicarbonate
C. 10% Calcium gluconate
D. IV Sol. Glocose + insulin
26. 66 years old patient already had been on hemodialysis around 5 yearsm developed secondary
hyperparathyroidism, iPTH – 760, which of the following medication is indicative to treat secondary
hyperpathyroidism?
A. Calcitriol
B. ACE – inhibitors
 C. Calcium carbonate
D. Sevelamer
27. What is the treatment of patients with CMV infection?

A. L-carnitin;
B. valganciclovire
C. Aciclovire
D. Valaciclovire;
28. Intrinsic acute kidney injury can be caused by:
A. Hepato-renal syndrome
B. ATN- acute tubular necrosis
C. Kidney stones
D. Cardiogenic shock
29. 22 years old patient has complains: hemoptisis, arterial hypertension, microhematuria, acute kidney
failure, sudden decrease kidney function, serum creatinine – 350mmol/l; Urinalysis: Pro-1.5 g/l; RBC-
250; WBC – neg; Kidney biopsy was performed, which revealed the following: creastent formation on
light microscope, and linear staining with IgG; What is the most likely disease for this patient?
A. Membranouse glomerulonephritis
B. Minimal change glomerulonephritis
C. Goodpasture disease
D. Rabdomiolysis

30. 54 years old patient already known to have liver cirrhosis due to hepatitis C, was receiving Verospiron
and Furosemide, suddenly developed anuria, increased serum creatinine, creatinine – 450mmol/l;
hyperkalemia – 6.2mmol/l; What is the most likely disease for this patient?
A. Acute intrinsic kidney disease
B. Acute post renal disease
C. Acute nephritic syndrome
D. Acute prerenal disease

31. 16 years old girl presents to her pediatrition after awaking with a swollen face. Blood pressure is
80/59 mmHg. There is swelling of the face, abdomen and legs. Serum creatinine is 0.74 mg/dl;
(normal range up to 1.0 mg/dl); Albumin is 1.9 g/dl; (normal range 3.5-4.5 g/dl); The 24 hour urine
excretion is 9.7g. What is the most likely diagnostic test should be perfumed?
A. Kidney biopsy
B. Renal scan with Tc-99
C. CT scan
D. MRI
 32. 44 years old patient 3 years ago was performed kidney transplantation, developed increased serum
creatinine level, creatinine -280mmol/l; Urinalysis revealed: Pro-1.5 g/dl; RBC-250; WBC-neg; Patient
was treated with Puls-methylprednisone, after the treatment serum creatinine normalized; What is
the most likely disease for this patient?
A. Acute T cell mediated rejection
B. Antibody mediated rejection
C. Cytomegaloviral infection
D. Acute kidney injury

33. A 43-year-old Caucasian man comes to the physician because of fatigue and body swelling that has
developed over the last few weeks. He has no significant medical history, and takes no medications. He
does not smoke or drink alcohol, and exercises 3 times weekly. He is afebrile with a blood pressure of
128/86 mmHg, heart rate of 88 beats per minute, and respiratory rate of 16 breaths per minute. On
physical examination, there is noticeable periorbital edema with diffuse edema of the extremities. His
laboratory values are shown below. Sodium 138 mEq/L; Potassium 4.5 mEq/L; Chloride 104 mEq/L;
Bicarbonate 24 mEq/L; Blood urea nitrogen 8 mg/dL; Creatinine 0.9 mg/dL; Glucose 146 mg/dL; Albumin
2.8 g/dL; Urine dipstick 3+ protein; Which of the following is also likely to be present in this patient?
A. HIV infection

B. Hypercholesterolemia

C. S3 on cardiac auscultation

D. Hematuria

34. A 68-year-old man presents to the hospital with nausea, vomiting, muscle weakness, and palpitations. He has a history of ischemic
carvedilol, simvastatin, and aspirin. He recently started taking spironolactone due to an increase in heart failure symptoms. There are no rece
any chest pain or shortness of breath. His screening chemistry panel is shown below. Sodium 135 mEq/L; Potassium 7.0 mEq/L; Chloride 101
urea nitrogen 18 mg/dL; Creatinine 1.2 mg/dL; Glucose 145 mg/dL; Which of the following treatments is LEAST beneficial in the acute setting?

A. Insulin
B. Calcium gluconate
C. Sodium polystyrene sulfonate
E. Furosemide

34. A 54-year-old presents to the hospital with a 3-day history of severe nausea, vomiting, and diarrhea. He has been unable to keep down
past few days and has become progressively weak. He also endorses subjective fevers and occasional abdominal pain. The patient’s med
hypertension and chronic low back pain, for which he takes lisinopril and ibuprofen. He has a 4-year-old child that he picks up from dayc
examination, the patient is tachycardic with a blood pressure of 104/84 mmHg. He appears weak with dry mucus membranes. Routine
show a blood urea nitrogen (BUN) and creatinine of 40 mg/dL and 2.1 mg/dL, respectively. He denies any history of renal disease. Of the
most helpful in determining the etiology of this patient’s renal failure?

A. Urine dipstick
B. Urine sodium
C. Fractional excretion of sodium (FENa)
D. Renal ultrasound

35. In determining prognosis for a patient with CKD, progression of the disease is predicted in most cases by
A. Size of kidney on ultrasound
B. Abnormalities sodium water balance
C. Chronically elevated A1 c levels
D. - The degree of proteinuria
36. In prescribing nutritional therapy for patients with CKD, which of the following parameters should be
used to guide vitamin D dosage levels?
A. Serum vitamin D levels
B. Levels of dietary vitamin D
C. Parathyroid hormone concentrations
D. Serum calcium levels
37. What does the peritoneal dialysate contain?
A. Electrolytes
B. Dextrose
C. Lactate
D. All above
38. Which of the following can be the side effect of the Haemodialysis?
A. Nausea
B. Cramps

C. Weakness

D. All of the above

39. Haemodialysis and peritoneal dialysis are the two types of dialysis which are used. The most prevalent type
of dialysis is haemodialysis. Blood is taken from your body into the dialyser during this dialysis. A dialyser
removes all pollutants from your blood before pumping it back into your body. Peritoneal dialysis involves
inserting a catheter in the abdominal wall, in which the peritoneum, a membrane which surrounds the
abdominal organs, transports any waste compounds present in the blood. Which of the following is the main
principle of Dialysis?
A. Capillary action
B. Reverse – Osmosis
C. Adhesion
D. None of the above
40. What is the composition of the membrane that is used in Dialysis?
A. Polyvinyl Chloride

B. Polyethylene

C. Cellulose

D. None of the above