1. An adult patient has a serum urea nitrogen of 50 mg/dL with creatinine 5.8 mg/dL.

The presence of which of the following urinalysis findings is most indicative of glomerulonephritis as a cause for these findings: A. Oval fat bodies B. Proteinuria C. Red blood cell casts D. Broad waxy casts E. White blood cell casts

2. A 32-year-old woman has had a cough for several days along with increasing weakness. She is surprised by the appearance of a small amount of red-tinged sputum. Over the next day she notes some small nodular purple lesions beneath the skin of her lower extremities. There are no significant findings on physical examination. Her chest x-ray shows bilateral interstitial markings but no areas of consolidation and no masses. A urinalysis reveals microscopic hematuria and proteinuria. Her antinuclear antibody test is negative, but she has antineutrophil cytoplasmic autoantibodies. A renal biopsy shows a necrotizing glomerulonephritis without immune deposition. These findings are most characteristic for which of the following diseases: : A. Diffuse scleroderma B. Systemic lupus erythematosus C. Post-infectious glomerulonephritis D. Microscopic polyarteritis E. Hemolytic-uremic syndrome

3. A 40-year-old man has the sudden onset of severe lower abdominal pain one evening. He notes the presence of bloody urine. Physical examination reveals no abdominal tenderness or masses, and bowel sounds are active. An abdominal CT scan reveals a small bright rounded object in the region of the left ureter. The underlying cause for these findings is most likely to be: A. Hypercalciuria B. Hyperparathyroidism C. Urinary tract infection D. Gout E. Cystinosis

4. A 57-year-old man has been bothered by arthritis. As a consequence, without reading the labels on over-the-counter medications, he has consumed large quantities (greater than 3 gm per year) of analgesics (aspirin, phenacitin, acetaminophen) for the past 10 years. He now has chronic renal failure. Which of the following is the most likely pathologic finding in this patient A. Acute tubular necrosis B. Transitional cell carcinoma C. Chronic interstitial nephritis D. Diffuse glomerulosclerosis E. Urinary tract lithiasis

5. If the foot processes are effaced in minimal change disease, then why do serum proteins leak into the urine more readily: A. Fenestrations in endothelial cells are enlarged. B. The anionic charge barrier is lost. C. The basement membrane is attenuated. D. Type IV collagen is lost. E. Glomerular filtration pressure is increased.

6. A 61-year-old man with a history of diabetes mellitus has been on hemodialysis for the past 12 years. During that time he has continued working and has had no major illnesses. Which of the following findings most likely would be present in his kidneys as a consequence of the chronic hemodialysis A. Multiple cystic dilations of medullary collecting ducts B. Normal left kidney but enlarged right right kidney with variably-sized cysts C. Markedly enlarged kidneys with multiple cysts along with a polycystic liver D. Bilaterally enlarged cystic kidneys along with congenital hepatic fibrosis E. Multiple 1 to 2 cm cortical and medullary cysts within small kidneys bilaterally

7. The microscopic findings at autopsy of slightly small kidneys with a granular surface and the microscopic appearance of scattered hyalinized glomeruli, interstitial fibrosis with focal tubular atrophy, and arteriolar thickening in a 75-year-old woman with normal renal function most strongly suggests: A. Nodular glomerulosclerosis B. Malignant nephrosclerosis C. Analgesic abuse nephropathy D. Benign nephrosclerosis E. Chronic pyelonephritis

8. A 26-year-old African-American man has had a history of painful abdominal crises. He has a hemoglobin electrophoresis performed that shows 96% Hgb S, 3% Hgb A2, and 1% Hgb F. Which of the following findings is LEAST likely to be present: A. Decreased renal concentrating ability B. Heamaturia C. Reduced viscosity of blood D. Renal infarcts E. Papillary necrosis

9. A 28-year-old man has increasing malaise with myalgias and arthralgias for the past month. He notes a lot of foam in the toilet when he urinates. He is developing peripheral edema. A urinalysis shows: sp gr 1.012, pH 6, 4+ protein, 1+ blood, and no glucose or ketones. he has a positive antinuclear antibody and negative antineutrophil cytoplasmic autoantibody. He receives a course of corticosteroid therapy and does not improve. A renal biopsy is performed and shows increased mesangial cells and matrix, with reduplication of basal lamina seen by electron microscopy. There is granular deposition of C3 and IgG on immunofluoresence. Which of the following diseases is he most likely to have: : A. Nodular and diffuse glomerulosclerosis B. Rapidly progressive glomerulonephritis C. Focal segmental glomerulosclerosis D. Membranoproliferative glomerulonephritis E. Minimal change disease

10. A 6-year-old girl has had dysuria with multiple bacterial urinary tract infections diagnosed over the past 2 years. There are no abnormal findings on physical examination. A urinalysis reveals increased WBCs but no hematuria, proteinuria, or glucosuria. An abdominal ultrasound reveals that the kidneys are of normal size and consistency, but that there is mild hydroureter on the right. Voiding cystourethrography reveals obstruction on the right at the level of the bladder. Which of the following conditions is most likely to be present: A. Transitional cell carcinoma B. Abnormal ureteral insertion (Vesicoureteral reflex) C. Schistosomiasis D. Ureteritis cystica E. Ureteral calculus

11. A 60-year-old woman has anemia, vertebral bone

pain, and sudden onset of renal failure. A renal biopsy shows pink, amorphous, irregular glomerular deposits which by immunohistochemical staining contain only irregular fibrils in a beta-pleated sheet. She has a serum urea nitrogen of 48 mg/dL, creatinine 2.8 mg/dL, total protein 8.5 g/dL, and albumin 3.9 g/dL. The most likely diagnosis is A. Multiple myeloma B. Systemic lupus erythematosus C. Metastatic breast carcinoma D. Diabetes mellitus E. Chronic lymphocytic leukemia

12. A 51-year-old woman has had multiple urinary tract infections for most of her adult life. She does not have any other significant medical problems. A physical examination reveals no abnormal findings. A variety of bacterial organisms, including Streptococcus, Proteus, and Escherichia have been cultured, and the infections have responded to antibiotic therapy. An intravenous urogram and voiding cystourethrogram have shown no evidence for obstruction. Which of the following long-term renal complications is most likely to develop in this patient: A. Polycystic change B. Acute pyelonephritis C. Transitional cell carcinoma D. Obstructive nephropathy E. Benign nephrosclerosis

13. An 11-year-old boy was seen by the family physician because of increasing lethargy. Urinalysis revealed 3+ proteinuria, found to be due to both albumin and transferrins, but no glucosuria or blood was present. A 24 hour urine protein was 2.1 gm. His serum complement C3 and C4 were normal. His antinuclear antibody test was negative. The child did improve by corticosteroid therapy. The most likely diagnosis is: A. Membranous glomerulonephritis B. Minimal change disease (MCD) C. Systemic lupus erythematosus D. Focal segmental glomerulosclerosis E. Membranoproliferative glomerulonephritis

14. A 40-year-old man comes to the emergency room early in the morning because of excruciating pain in the lower abdomen. The pain has come in waves for several hours. A urinalysis reveals hematuria, but no proteinuria, glucosuria, or WBCs. The most likely underlying problem in this setting is: A. Transitional cell carcinoma of the bladder B. Prostatic hyperplasia with obstructive uropathy C. Idiopathic hypercalciuria with calcium oxalate stone D. Acute pyelonephritis with staghorn calculus E. Gout with uric acid stone

15. A 46-year-old African-American man died suddenly, and the medical examiner investigated. She found a large right basal ganglia hemorrhage that resulted from arteriosclerosis of small cerebral arterial branches. Which of the following findings was most likely to have been present in his kidneys: A. Fibromuscular dysplasia B. Vasculitis with mononuclear cell infiltrates C. A linear pattern of glomerular capillary IgG deposition by immunofluorescence D. Arteriolar fibrinoid necrosis with microhemorrhages E. Nodular glomerulosclerosis