Acute renal failure MCQs With Answer offers B.Pharm students a focused, exam-oriented review of acute kidney injury (AKI) fundamentals, pharmacology, diagnostics, and management. This concise introduction highlights causes (pre-renal, intrinsic, post-renal), key biomarkers (creatinine, BUN, NGAL), classification systems (RIFLE/AKIN/KDIGO), electrolyte disturbances, and drug-induced nephrotoxicity. Emphasis is on clinical reasoning, drug adjustments, renal replacement therapy, and prevention strategies relevant to pharmacy practice. Carefully crafted MCQs reinforce pathophysiology, therapeutic decisions, and safe medication use in AKI, helping students prepare for university exams and clinical roles. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which is the most commonly used clinical marker for detecting acute renal failure (AKI)?
- Blood urea nitrogen (BUN)
- Serum creatinine
- Urine specific gravity
- Serum sodium
Correct Answer: Serum creatinine
Q2. Which classification system is widely used for staging AKI based on serum creatinine and urine output?
- NYHA
- RIFLE/AKIN/KDIGO
- APGAR
- SOFA
Correct Answer: RIFLE/AKIN/KDIGO
Q3. Pre-renal acute kidney injury is primarily caused by:
- Obstruction of urinary tract
- Intrinsic tubular necrosis
- Reduced renal perfusion
- Autoimmune glomerulonephritis
Correct Answer: Reduced renal perfusion
Q4. Which parameter helps differentiate pre-renal AKI from intrinsic renal failure?
- Serum potassium
- Fractional excretion of sodium (FENa)
- Serum albumin
- Serum phosphate
Correct Answer: Fractional excretion of sodium (FENa)
Q5. A FENa less than 1% typically suggests:
- Intrinsic renal damage
- Pre-renal azotemia
- Post-renal obstruction
- Acute tubular necrosis
Correct Answer: Pre-renal azotemia
Q6. Which of the following drugs is most commonly associated with acute tubular necrosis (ATN)?
- Hydrochlorothiazide
- Aminoglycosides (e.g., gentamicin)
- Loratadine
- Metformin
Correct Answer: Aminoglycosides (e.g., gentamicin)
Q7. Contrast-induced nephropathy risk is increased by all EXCEPT:
- Pre-existing chronic kidney disease
- Dehydration
- High contrast volume
- Use of non-ionic low-osmolar contrast in low-risk patients
Correct Answer: Use of non-ionic low-osmolar contrast in low-risk patients
Q8. Which biomarker rises earlier than serum creatinine in AKI and can indicate tubular injury?
- C-reactive protein (CRP)
- Neutrophil gelatinase-associated lipocalin (NGAL)
- ALT
- Troponin
Correct Answer: Neutrophil gelatinase-associated lipocalin (NGAL)
Q9. A BUN:creatinine ratio greater than 20:1 commonly suggests which type of AKI?
- Intrinsic renal failure
- Pre-renal azotemia
- Post-renal obstruction
- Chronic glomerulonephritis
Correct Answer: Pre-renal azotemia
Q10. Which electrolyte abnormality is the most life-threatening complication of AKI?
- Hyponatremia
- Hyperkalemia
- Hypocalcemia
- Hypophosphatemia
Correct Answer: Hyperkalemia
Q11. In AKI, which medication class should be used cautiously or withheld due to risk of hyperkalemia?
- Beta-blockers
- ACE inhibitors/ARBs
- Proton pump inhibitors
- Loop diuretics
Correct Answer: ACE inhibitors/ARBs
Q12. Which diuretic is preferred when trying to manage fluid overload in AKI patients who still have some urine output?
- Amiloride
- Furosemide (loop diuretic)
- Hydrochlorothiazide
- Spironolactone
Correct Answer: Furosemide (loop diuretic)
Q13. Acute interstitial nephritis is most commonly caused by which drug class?
- ACE inhibitors
- NSAIDs and certain antibiotics (e.g., penicillins)
- Statins
- Antacids
Correct Answer: NSAIDs and certain antibiotics (e.g., penicillins)
Q14. Which urinary finding is classical for acute tubular necrosis?
- Red blood cell casts
- Waxy casts
- Granular (muddy brown) casts
- Hyaline casts only
Correct Answer: Granular (muddy brown) casts
Q15. Post-renal AKI is most commonly due to:
- Renal artery stenosis
- Bladder outlet obstruction
- Acute glomerulonephritis
- Volume depletion
Correct Answer: Bladder outlet obstruction
Q16. Which imaging modality is first-line to evaluate suspected post-renal obstruction?
- Non-contrast CT abdomen
- Renal ultrasound
- MR angiography
- Intravenous urography
Correct Answer: Renal ultrasound
Q17. Which intravenous fluid is generally preferred for initial resuscitation in pre-renal AKI?
- 0.9% normal saline
- 5% dextrose
- Half-normal saline (0.45%)
- Hypertonic saline
Correct Answer: 0.9% normal saline
Q18. In AKI, dosing of renally excreted drugs should be adjusted based on:
- Body mass index alone
- Estimated glomerular filtration rate (eGFR) or creatinine clearance
- Serum albumin only
- Age only
Correct Answer: Estimated glomerular filtration rate (eGFR) or creatinine clearance
Q19. Which drug used for hyperkalemia shifts potassium intracellularly by stimulating insulin-mediated uptake?
- Sodium bicarbonate
- Salbutamol (beta-2 agonist)
- Calcium gluconate
- Sodium polystyrene sulfonate
Correct Answer: Salbutamol (beta-2 agonist)
Q20. Which intervention stabilizes myocardium in severe hyperkalemia?
- Insulin with glucose
- Calcium gluconate or calcium chloride
- Sodium bicarbonate
- Sodium polystyrene sulfonate
Correct Answer: Calcium gluconate or calcium chloride
Q21. Renal replacement therapy is indicated emergently in AKI for all EXCEPT:
- Refractory hyperkalemia
- Severe metabolic acidosis (pH <7.1)
- Symptomatic uremia (pericarditis, encephalopathy)
- Stable mild azotemia with no complications
Correct Answer: Stable mild azotemia with no complications
Q22. Which dialysis modality provides continuous slow fluid and solute removal, useful in hemodynamically unstable AKI patients?
- Intermittent hemodialysis (IHD)
- Continuous renal replacement therapy (CRRT)
- Peritoneal dialysis only
- Hemoperfusion
Correct Answer: Continuous renal replacement therapy (CRRT)
Q23. Which antibiotic dosing strategy is most appropriate in AKI to avoid accumulation?
- Maintain standard dosing intervals and amounts
- Reduce dose or lengthen dosing interval based on renal function
- Double the dose due to poor tissue penetration
- Avoid any dose adjustments
Correct Answer: Reduce dose or lengthen dosing interval based on renal function
Q24. Which acid-base disturbance commonly occurs in AKI due to reduced acid excretion?
- Metabolic alkalosis
- Respiratory alkalosis
- Metabolic acidosis with an increased anion gap
- Respiratory acidosis
Correct Answer: Metabolic acidosis with an increased anion gap
Q25. Which of the following is NOT a typical sign of uremia in severe AKI?
- Pericardial rub
- Uremic encephalopathy
- Pruritus
- Hyperthyroidism symptoms
Correct Answer: Hyperthyroidism symptoms
Q26. Which medication is nephroprotective by blocking angiotensin II but may worsen AKI in volume-depleted patients?
- Furosemide
- Lisinopril (ACE inhibitor)
- Metoprolol
- Allopurinol
Correct Answer: Lisinopril (ACE inhibitor)
Q27. Which urinary electrolyte pattern is expected in intrinsic renal failure like ATN?
- Low urine sodium and low FENa
- High urine sodium and high FENa (>2%)
- Very low urine osmolarity and low sodium excretion
- High urine sodium with FENa <1%
Correct Answer: High urine sodium and high FENa (>2%)
Q28. Which diuretic type can cause nephrogenic diabetes insipidus and worsen polyuria in AKI?
- Loop diuretics
- Thiazide diuretics
- Potassium-sparing diuretics
- Osmotic diuretics (mannitol)
Correct Answer: Osmotic diuretics (mannitol)
Q29. Which of the following is a common cause of intrinsic renal AKI due to ischemia or toxins?
- Dehydration alone
- Acute tubular necrosis (ATN)
- Ureteral stone
- Benign prostatic hyperplasia
Correct Answer: Acute tubular necrosis (ATN)
Q30. What is the primary mechanism of renal damage for aminoglycoside antibiotics?
- Immune-complex deposition
- Direct tubular epithelial cell toxicity
- Glomerular basement membrane rupture
- Ischemic vasoconstriction only
Correct Answer: Direct tubular epithelial cell toxicity
Q31. Which laboratory test is most useful to monitor progression of AKI over days?
- Serial serum creatinine measurements
- Single baseline urinalysis only
- Serum amylase
- Thyroid function tests
Correct Answer: Serial serum creatinine measurements
Q32. Which drug used for contrast nephropathy prevention has controversial evidence and is not routinely recommended?
- Intravenous isotonic saline
- N-acetylcysteine
- Low-osmolar contrast agents
- Antibiotics
Correct Answer: N-acetylcysteine
Q33. Which condition predisposes patients to drug-induced AKI due to decreased renal perfusion?
- Hypertension with euvolemia
- Volume depletion (dehydration)
- Well-controlled diabetes without complications
- Mild hyperlipidemia
Correct Answer: Volume depletion (dehydration)
Q34. Which potassium-lowering treatment actually removes K+ from the body?
- Insulin with glucose
- Beta-2 agonist nebulization
- Sodium polystyrene sulfonate
- Calcium gluconate
Correct Answer: Sodium polystyrene sulfonate
Q35. Which acidifying agent may be used to treat metabolic alkalosis when present in AKI?
- Sodium bicarbonate
- Acetazolamide (carbonic anhydrase inhibitor)
- Loop diuretics
- Calcium carbonate
Correct Answer: Acetazolamide (carbonic anhydrase inhibitor)
Q36. Which of the following laboratory urine findings suggests glomerular cause of AKI?
- Predominant proteinuria with RBC casts
- Isolated high specific gravity
- Low urinary osmolality with hyaline casts
- Purely tubular epithelial cell casts
Correct Answer: Predominant proteinuria with RBC casts
Q37. Which preventive measure reduces the risk of aminoglycoside nephrotoxicity?
- Prolonged continuous infusion with dose optimization and monitoring trough levels
- Give maximum daily dose without monitoring
- Avoid hydration
- Use in combination with other nephrotoxins freely
Correct Answer: Prolonged continuous infusion with dose optimization and monitoring trough levels
Q38. Which metabolic disturbance in AKI can be initially managed with intravenous sodium bicarbonate?
- Severe hyperkalemia with EKG changes
- Metabolic acidosis with dangerously low pH
- Hyponatremia
- Hypokalemia
Correct Answer: Metabolic acidosis with dangerously low pH
Q39. Which renal replacement option is effective for removal of water-soluble small-molecule toxins in AKI?
- Intermittent hemodialysis
- Gastric lavage
- Activated charcoal alone
- Topical chelation
Correct Answer: Intermittent hemodialysis
Q40. Which laboratory index helps estimate urine concentrating ability in AKI?
- Serum osmolality only
- Urine osmolality and specific gravity
- Serum albumin
- Liver function tests
Correct Answer: Urine osmolality and specific gravity
Q41. Which of the following is a reversible cause of AKI that pharmacists should screen for?
- Drug-induced interstitial nephritis
- Polycystic kidney disease
- Chronic irreversible diabetic nephropathy
- Genetic nephronophthisis
Correct Answer: Drug-induced interstitial nephritis
Q42. Which agent is contraindicated or used cautiously in AKI because it accumulates and increases neurotoxicity risk?
- Vancomycin (with dose adjustments)
- Insulin
- Paracetamol
- Vitamin C
Correct Answer: Vancomycin (with dose adjustments)
Q43. Which monitoring parameter is essential when administering IV contrast to a patient with CKD to prevent AKI?
- Baseline and serial serum creatinine
- Lipid profile
- Thyroid stimulating hormone
- Fasting blood glucose only
Correct Answer: Baseline and serial serum creatinine
Q44. Which statement about mannitol in AKI is correct?
- Mannitol is always safe in severe AKI with anuria
- Mannitol is an osmotic diuretic used to reduce intracranial pressure but may worsen volume status in AKI
- Mannitol corrects hyperkalemia permanently
- Mannitol is a potassium-sparing agent
Correct Answer: Mannitol is an osmotic diuretic used to reduce intracranial pressure but may worsen volume status in AKI
Q45. Which procedure can rapidly relieve post-renal obstruction causing AKI from benign prostatic hyperplasia?
- Renal biopsy
- Urethral catheterization or Foley catheter insertion
- Peritoneal dialysis
- Administration of ACE inhibitors
Correct Answer: Urethral catheterization or Foley catheter insertion
Q46. Which laboratory effect does severe AKI have on drug protein binding and free drug concentration?
- Increased protein binding leading to lower free drug
- Reduced albumin and uremic toxins may increase free (unbound) drug concentration
- No change in free drug concentrations
- Immediate decrease in drug half-life
Correct Answer: Reduced albumin and uremic toxins may increase free (unbound) drug concentration
Q47. Which commonly used analgesic is strongly associated with chronic interstitial nephritis and should be avoided to prevent AKI?
- Acetaminophen in moderate use
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- Ibuprofen in occasional low doses
- Loratadine
Correct Answer: NSAIDs (nonsteroidal anti-inflammatory drugs)
Q48. Which urine microscopy finding favors a diagnosis of acute glomerulonephritis?
- White blood cell casts and eosinophils
- Many dysmorphic RBCs and RBC casts
- Pure fatty casts
- Predominantly granular casts only
Correct Answer: Many dysmorphic RBCs and RBC casts
Q49. Which approach helps prevent AKI in hospitalized patients receiving potentially nephrotoxic drugs?
- Routine concurrent use of multiple nephrotoxins without monitoring
- Ensure adequate hydration, monitor renal function, and adjust doses
- Ignore baseline renal impairment
- Use highest possible doses for efficacy
Correct Answer: Ensure adequate hydration, monitor renal function, and adjust doses
Q50. What is the recommended pharmacist action when a patient with AKI has rising creatinine after starting an ACE inhibitor?
- Immediately increase ACE inhibitor dose
- Evaluate volume status, review other nephrotoxins, and consider holding the ACE inhibitor if indicated
- Ignore changes and continue current therapy
- Switch to another ACE inhibitor without assessment
Correct Answer: Evaluate volume status, review other nephrotoxins, and consider holding the ACE inhibitor if indicated
