Disorders of kidney MCQs With Answer

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Disorders of kidney MCQs With Answer are essential study tools for B. Pharm students preparing for pharmacology and clinical pharmacy exams. This focused collection covers renal physiology, acute kidney injury (AKI), chronic kidney disease (CKD), glomerular and tubular disorders, electrolyte and acid–base imbalances, nephrotoxicity, dose adjustment, dialysis, and transplant pharmacotherapy. Each MCQ emphasizes drug mechanisms, renal dosing, monitoring parameters, and clinical implications to build strong competence in renal therapeutics and patient safety. Keywords: kidney disorders, renal pharmacology, nephrotoxicity, dose adjustment, CKD, AKI, B. Pharm. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which parameter best estimates glomerular filtration rate for dose adjustment in adults?

  • Serum creatinine concentration alone
  • Estimated GFR (eGFR) using CKD-EPI or MDRD
  • Blood urea nitrogen (BUN)
  • Urine specific gravity

Correct Answer: Estimated GFR (eGFR) using CKD-EPI or MDRD

Q2. The most common cause of acute kidney injury in hospitalized patients is:

  • Glomerulonephritis
  • Prerenal azotemia due to hypovolemia
  • Urinary tract obstruction
  • Drug-induced interstitial nephritis

Correct Answer: Prerenal azotemia due to hypovolemia

Q3. Which drug class is most commonly associated with acute interstitial nephritis?

  • ACE inhibitors
  • Beta-lactam antibiotics (e.g., penicillins)
  • Loop diuretics
  • Statins

Correct Answer: Beta-lactam antibiotics (e.g., penicillins)

Q4. In chronic kidney disease, which electrolyte abnormality is most life-threatening?

  • Hyperphosphatemia
  • Hypokalemia
  • Hyperkalemia
  • Hypocalcemia

Correct Answer: Hyperkalemia

Q5. Which of the following medications requires dose adjustment in reduced renal function due to predominant renal excretion?

  • Warfarin
  • Metformin
  • Atorvastatin
  • Omeprazole

Correct Answer: Metformin

Q6. Which laboratory marker rises earliest in acute kidney injury?

  • Serum creatinine
  • Blood urea nitrogen (BUN)
  • Urine output decline
  • Serum cystatin C

Correct Answer: Urine output decline

Q7. Nephrotic syndrome is characterized by which hallmark finding?

  • Hematuria
  • Proteinuria >3.5 g/day
  • Pyuria
  • Elevated urinary sodium

Correct Answer: Proteinuria >3.5 g/day

Q8. Aminoglycoside nephrotoxicity primarily affects which part of the nephron?

  • Glomerulus
  • Proximal tubule
  • Loop of Henle
  • Collecting duct

Correct Answer: Proximal tubule

Q9. Which diuretic is preferred for treating hypercalciuria and calcium kidney stones?

  • Furosemide
  • Hydrochlorothiazide
  • Spironolactone
  • Acetazolamide

Correct Answer: Hydrochlorothiazide

Q10. ACE inhibitors in renal disease commonly cause an initial rise in serum creatinine due to:

  • Direct nephrotoxicity
  • Decreased glomerular efferent arteriolar tone causing reduced GFR
  • Immune-mediated injury
  • Volume depletion

Correct Answer: Decreased glomerular efferent arteriolar tone causing reduced GFR

Q11. Which acid–base disturbance is most often seen in advanced CKD?

  • Respiratory acidosis
  • Metabolic alkalosis
  • Metabolic acidosis with normal anion gap
  • Metabolic acidosis with high anion gap

Correct Answer: Metabolic acidosis with high anion gap

Q12. The best pharmacologic strategy to reduce proteinuria in diabetic nephropathy is:

  • Loop diuretics
  • ACE inhibitors or ARBs
  • Calcium channel blockers only
  • Beta-blockers

Correct Answer: ACE inhibitors or ARBs

Q13. Which urinary finding suggests glomerulonephritis rather than tubular disease?

  • Fatty casts
  • White blood cell casts
  • Red blood cell casts
  • Hyaline casts

Correct Answer: Red blood cell casts

Q14. For estimating creatinine clearance in drug dosing, the Cockcroft-Gault equation requires:

  • Serum urea and age
  • Serum creatinine, age, weight, and sex
  • Serum cystatin C only
  • Urine sodium

Correct Answer: Serum creatinine, age, weight, and sex

Q15. Contrast-induced nephropathy prevention includes which measure?

  • High dose NSAIDs before imaging
  • Hydration with isotonic saline
  • Withholding ACE inhibitors on the day of contrast only
  • Administering aminoglycosides prophylactically

Correct Answer: Hydration with isotonic saline

Q16. Which electrolyte abnormality is characteristic of nephrotic syndrome?

  • Hypoalbuminemia leading to edema
  • Hypernatremia without edema
  • Severe hyperkalemia early in disease
  • Hypophosphatemia with polyuria

Correct Answer: Hypoalbuminemia leading to edema

Q17. A rise in BUN disproportionate to creatinine suggests which origin of AKI?

  • Intrinsic renal parenchymal disease
  • Prerenal azotemia
  • Postrenal obstruction
  • Glomerulonephritis

Correct Answer: Prerenal azotemia

Q18. Loop diuretics act primarily by inhibiting which transporter?

  • Na+/Cl− cotransporter in DCT
  • Na+/K+/2Cl− cotransporter in thick ascending limb
  • ENaC in collecting duct
  • Carbonic anhydrase in proximal tubule

Correct Answer: Na+/K+/2Cl− cotransporter in thick ascending limb

Q19. Which drug can cause hyperkalemia by blocking aldosterone effect at the receptor?

  • Spironolactone
  • Furosemide
  • Chlorthalidone
  • Mannitol

Correct Answer: Spironolactone

Q20. Best initial test to detect urinary tract infection is:

  • Urine culture only
  • Urine dipstick for leukocyte esterase and nitrite
  • Serum WBC count
  • Renal ultrasound

Correct Answer: Urine dipstick for leukocyte esterase and nitrite

Q21. Which kidney disease presents with facial swelling, oliguria, and cola-colored urine?

  • Nephrotic syndrome
  • Acute poststreptococcal glomerulonephritis
  • Diabetic nephropathy
  • Interstitial nephritis

Correct Answer: Acute poststreptococcal glomerulonephritis

Q22. In dialysis patients, which drug dosing consideration is critical?

  • All drugs are removed by dialysis equally
  • Hydrophilic, low-protein-bound, low-volume drugs are dialyzable
  • High lipophilicity increases dialysis removal
  • Only orally administered drugs require adjustment

Correct Answer: Hydrophilic, low-protein-bound, low-volume drugs are dialyzable

Q23. Chronic use of which analgesic class is strongly linked to analgesic nephropathy?

  • Acetaminophen alone
  • Combination analgesics containing NSAIDs and phenacetin-like agents
  • Topical analgesics
  • Opioids

Correct Answer: Combination analgesics containing NSAIDs and phenacetin-like agents

Q24. Erythropoietin therapy in CKD primarily corrects:

  • Hyperkalemia
  • Anemia due to decreased erythropoietin production

Correct Answer: Anemia due to decreased erythropoietin production

Q25. Which lab result indicates nephrotic-range proteinuria on a spot urine sample?

  • Urine albumin-to-creatinine ratio (ACR) >300 mg/g
  • Urine sodium >40 mmol/L
  • Urine specific gravity >1.030
  • Urine pH <5.5

Correct Answer: Urine albumin-to-creatinine ratio (ACR) >300 mg/g

Q26. Which immunosuppressant used in transplant patients is notably nephrotoxic?

  • Azathioprine
  • Ciclosporin (cyclosporine)
  • Mycophenolate mofetil
  • Prednisolone

Correct Answer: Ciclosporin (cyclosporine)

Q27. A B. Pharm student should monitor which parameter when dispensing vancomycin to renal-impaired patients?

  • Peak and trough serum concentrations
  • Blood glucose
  • Liver function only
  • Serum magnesium

Correct Answer: Peak and trough serum concentrations

Q28. Which kidney stone type is radiolucent on X-ray and often associated with urease-producing bacteria?

  • Calcium oxalate
  • Uric acid
  • Struvite (magnesium ammonium phosphate)
  • Cystine

Correct Answer: Struvite (magnesium ammonium phosphate)

Q29. Digitalis (digoxin) dosing in renal failure requires adjustment because:

  • It is hepatically cleared only
  • It is primarily renally excreted
  • It is inactivated by gastric acid
  • Renal failure increases protein binding

Correct Answer: It is primarily renally excreted

Q30. Treatment of hyperkalemia with insulin works by:

  • Increasing urinary excretion of potassium
  • Driving potassium into cells via stimulation of Na+/K+ ATPase
  • Binding potassium in gut
  • Blocking potassium channels in heart

Correct Answer: Driving potassium into cells via stimulation of Na+/K+ ATPase

Q31. Which antibiotic requires therapeutic drug monitoring due to nephrotoxicity and renal clearance?

  • Azithromycin
  • Gentamicin
  • Ciprofloxacin
  • Doxycycline

Correct Answer: Gentamicin

Q32. In metabolic acidosis of CKD, which oral medication is commonly used to correct bicarbonate deficit?

  • Sodium bicarbonate
  • Calcium carbonate only
  • Hydrochlorothiazide
  • Amiloride

Correct Answer: Sodium bicarbonate

Q33. The presence of granular (muddy brown) casts in urine suggests:

  • Prerenal azotemia
  • Acute tubular necrosis (ATN)
  • Postrenal obstruction
  • Nephrotic syndrome

Correct Answer: Acute tubular necrosis (ATN)

Q34. Which antihypertensive may worsen renal function in bilateral renal artery stenosis?

  • Calcium channel blockers
  • ACE inhibitors
  • Alpha blockers
  • Hydralazine

Correct Answer: ACE inhibitors

Q35. For a B. Pharm student, which monitoring parameter is most relevant when dispensing NSAIDs to elderly with CKD?

  • Liver enzymes only
  • Serum creatinine and urine output
  • Serum amylase
  • Serum bilirubin

Correct Answer: Serum creatinine and urine output

Q36. Which hereditary kidney disease often leads to bilateral enlarged kidneys and progressive CKD?

  • Alport syndrome
  • Autosomal dominant polycystic kidney disease (ADPKD)
  • Minimal change disease
  • IgA nephropathy

Correct Answer: Autosomal dominant polycystic kidney disease (ADPKD)

Q37. Which diagnostic marker indicates tubular proteinuria rather than glomerular proteinuria?

  • Selective albuminuria
  • Low-molecular-weight proteins in urine (e.g., beta-2 microglobulin)
  • High-molecular-weight proteins only
  • Absence of protein on dipstick

Correct Answer: Low-molecular-weight proteins in urine (e.g., beta-2 microglobulin)

Q38. In hypertensive patients with CKD and proteinuria, which antihypertensive is most renoprotective?

  • ACE inhibitors
  • Beta-blockers
  • Loop diuretics
  • Peripheral alpha blockers

Correct Answer: ACE inhibitors

Q39. Which condition increases the risk of contrast-induced nephropathy most?

  • Well-controlled diabetes with normal GFR
  • Preexisting CKD with eGFR <60 mL/min/1.73 m2
  • Young age and hydration
  • Use of low-osmolar contrast only

Correct Answer: Preexisting CKD with eGFR <60 mL/min/1.73 m2

Q40. A B. Pharm graduate should counsel CKD patients to restrict which dietary nutrient to manage hyperphosphatemia?

  • Potassium
  • Phosphorus
  • Protein entirely
  • Vitamin C

Correct Answer: Phosphorus

Q41. Which urinary calculus is most likely in patients with gout and acidic urine?

  • Calcium phosphate stones
  • Uric acid stones
  • Struvite stones
  • Cystine stones

Correct Answer: Uric acid stones

Q42. Which measurement is preferred for drug dosing in obese patients with renal impairment?

  • Use actual body weight without adjustment
  • Use ideal body weight only for all drugs
  • Use adjusted body weight and appropriate creatinine clearance estimation
  • Ignore weight and use serum creatinine only

Correct Answer: Use adjusted body weight and appropriate creatinine clearance estimation

Q43. Which therapy is first-line for severe hyperphosphatemia in CKD when diet alone is insufficient?

  • Oral phosphate binders (e.g., sevelamer, calcium acetate)
  • Loop diuretics
  • Sodium bicarbonate
  • Oral potassium supplements

Correct Answer: Oral phosphate binders (e.g., sevelamer, calcium acetate)

Q44. In acute tubular necrosis, fractional excretion of sodium (FENa) is typically:

  • Less than 1%
  • Greater than 2%
  • Exactly 0%
  • Unreliable in all settings

Correct Answer: Greater than 2%

Q45. Which feature differentiates nephritic syndrome from nephrotic syndrome?

  • Massive proteinuria (>3.5 g/day)
  • Hypoalbuminemia is absent in nephritic
  • Hematuria and hypertension in nephritic syndrome
  • Generalized hyperlipidemia only in nephritic

Correct Answer: Hematuria and hypertension in nephritic syndrome

Q46. Which medication class can reduce progression of diabetic nephropathy beyond blood pressure lowering?

  • ACE inhibitors and ARBs
  • Central alpha agonists
  • Non-selective beta-blockers only
  • Peripheral vasodilators like hydralazine

Correct Answer: ACE inhibitors and ARBs

Q47. For prevention of hyperuricemia-associated kidney injury, which drug lowers uric acid production?

  • Probenecid
  • Allopurinol
  • Colchicine
  • Furosemide

Correct Answer: Allopurinol

Q48. Which renal replacement therapy is preferred for hemodynamically unstable ICU patients?

  • Intermittent hemodialysis
  • Continuous renal replacement therapy (CRRT)
  • Peritoneal dialysis only
  • Oral bicarbonate therapy

Correct Answer: Continuous renal replacement therapy (CRRT)

Q49. Which antigen is classically associated with IgA nephropathy flare-ups following infections?

  • Hepatitis B surface antigen
  • Respiratory mucosal antigen triggers with IgA deposition
  • HLA-B27 antigen
  • ANA positivity

Correct Answer: Respiratory mucosal antigen triggers with IgA deposition

Q50. A key counseling point for B. Pharm students when advising CKD patients on herbal supplements is:

  • All herbal supplements are safe in CKD
  • Some herbs may be nephrotoxic or contain heavy metals and should be avoided
  • Herbal supplements never interact with prescription drugs
  • Dosage does not need adjustment in kidney disease

Correct Answer: Some herbs may be nephrotoxic or contain heavy metals and should be avoided

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