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Nephro: 25 Practice MCQs (Nephrology)

TL;DR

Nephro: 25 Practice MCQs (Nephrology) is a focused revision resource for MRCP Part 1, designed to mirror exam-style thinking rather than passive reading. It covers the most tested renal themes, highlights common traps, and includes a sample MCQ with explanation. Use this alongside a Qbank and timed mocks to build accuracy and speed.


Why this matters

Nephrology is a high-yield subject in MRCP Part 1, often integrated with physiology, acute medicine, and biochemistry. Questions are rarely straightforward—they test interpretation of lab values, pattern recognition, and clinical reasoning. Practising MCQs is essential, but equally important is understanding why each answer is correct.

This guide reflects the logic behind 25 high-yield nephrology MCQs, helping you anticipate exam patterns and avoid common mistakes.


Core sections

1. Acute kidney injury (AKI): classification & exam clues

AKI questions frequently hinge on identifying the underlying category:

  • Pre-renal: hypovolaemia, low urine sodium (<20 mmol/L), high urea:creatinine ratio

  • Intrinsic:

    • Acute tubular necrosis (muddy brown casts)

    • Acute interstitial nephritis (eosinophils, drug history)

  • Post-renal: obstruction (hydronephrosis on ultrasound)

Exam tip: Always integrate history + biochemistry + urine findings.

2. Chronic kidney disease (CKD): staging and complications

  • Staged using eGFR (G1–G5)

  • Proteinuria significantly impacts prognosis

  • Early complications: anaemia, bone mineral disease

  • Late complications: metabolic acidosis, hyperkalaemia

High-yield concept: Small kidneys on ultrasound suggest chronicity.

3. Electrolyte disorders (very high yield)

Commonly tested scenarios include:

  • Hyponatraemia:

    • SIADH → euvolaemic, high urine sodium

    • Hypovolaemic → low urine sodium

  • Hyperkalaemia: ECG progression (peaked T waves → widened QRS)

  • Calcium imbalance: PTH-dependent vs independent causes

4. Glomerulonephritis: pattern recognition

Two major syndromes:

  • Nephritic: haematuria, RBC casts, hypertension

  • Nephrotic: heavy proteinuria, oedema, hypoalbuminaemia

Classic associations:

  • IgA nephropathy → haematuria within days of URTI

  • Post-streptococcal GN → delayed onset + low complement

  • Membranous nephropathy → malignancy, hepatitis B

5. Acid–base disorders (stepwise approach)

Always follow a structured method:

  1. Assess pH

  2. Identify primary disorder

  3. Check compensation

  4. Calculate anion gap

This systematic approach is frequently tested in MCQs.

6. Renal tubular disorders

  • Type 1 RTA (distal): impaired H⁺ secretion

  • Type 2 RTA (proximal): bicarbonate wasting

  • Type 4 RTA: hyperkalaemia due to aldosterone deficiency

7. Dialysis indications (AEIOU mnemonic)

  • Acidosis

  • Electrolyte imbalance

  • Intoxication

  • Overload

  • Uraemia

8. Hypertension and renal causes

  • Suspect secondary hypertension in:

    • Young patients

    • Resistant cases

  • Renal artery stenosis → flash pulmonary oedema

  • ACE inhibitors: small creatinine rise is expected

9. Nephrotic vs nephritic syndrome (quick comparison)

Feature

Nephrotic Syndrome

Nephritic Syndrome

Proteinuria

>3.5 g/day

Mild–moderate

Haematuria

Rare

Common

Oedema

Marked

Mild

Blood pressure

Normal or ↑

↑

Urine casts

Fatty casts

RBC casts

10. Investigations you must interpret

  • Urine microscopy (very testable)

  • Ultrasound (size and obstruction)

  • Renal biopsy (diagnostic gold standard in many cases)


Practical examples / mini-cases

Sample MCQA 28-year-old man presents with visible haematuria 2 days after a sore throat. Blood pressure is mildly elevated. Urinalysis shows red cell casts. Complement levels are normal.

Most likely diagnosis? A. Post-streptococcal glomerulonephritisB. IgA nephropathyC. Minimal change diseaseD. Membranous nephropathy

Answer: B. IgA nephropathy

Explanation:

  • Timing is key: haematuria occurring within days of infection suggests IgA nephropathy

  • Post-streptococcal GN presents later (1–3 weeks) with low complement

  • RBC casts confirm a nephritic process

Focused study session for MRCP Part 1 nephrology revision

Common pitfalls (5 bullets)

  • Confusing SIADH with hypovolaemic hyponatraemia

  • Ignoring medication history in AKI (e.g., ACE inhibitors, NSAIDs)

  • Miscalculating or overlooking anion gap

  • Missing timing differences in glomerulonephritis

  • Neglecting urine microscopy findings


FAQs

1. How important is nephrology in MRCP Part 1?

Nephrology contributes significantly, often integrated with physiology and acute medicine. It is a core scoring area.

2. What is the most tested nephrology topic?

Electrolyte disorders and acid–base balance are consistently among the most frequently tested areas.

3. Are renal calculations difficult in MRCP?

Most calculations are straightforward (e.g., anion gap), but interpretation is key rather than arithmetic complexity.

4. How should I revise nephrology efficiently?

Combine theory with practice—use a Qbank, review explanations, and reinforce weak topics using notes or lectures.

5. Do I need to memorise all glomerulonephritis types?

Focus on patterns and key associations rather than memorising exhaustive lists.


Ready to start?

Strengthen your preparation with structured resources:

For deeper conceptual clarity, explore lectures at:https://www.crackmedicine.com/lectures


Sources

 
 
 

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