Nephrotic Syndrome: Causes, Mechanisms, and Complications

Question 1

In children, what is the most prevalent cause of nephrotic syndrome?

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Membranous nephropathy

Question 2

Which mechanism is primarily responsible for proteinuria in nephrotic syndrome?

Accepted Answer

Increased glomerular permeability

Answer

Reduced tubular reabsorption

Answer

Impaired lymphatic drainage

Answer

Reduced glomerular filtration rate

Question 3

Which intervention is the cornerstone of treatment for nephrotic syndrome?

Accepted Answer

Immunosuppressants

Answer

Diuretics

Answer

Antiplatelet therapy

Answer

Anticoagulation

Question 4

Which dietary recommendation is applicable for patients with nephrotic syndrome?

Accepted Answer

Restrict sodium intake

Answer

Increase protein intake

Answer

Increase potassium intake

Answer

Limit processed foods

Question 5

A common cause of nephrotic syndrome in children is:

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Membranous nephropathy

Answer

IgA nephropathy

Question 6

The primary mechanism of proteinuria in nephrotic syndrome involves damage to which glomerular component?

Accepted Answer

Podocytes

Answer

Basement membrane

Answer

Endothelium

Answer

Mesangium

Question 7

Podocytes play a crucial role in the glomerular filtration barrier by:

Accepted Answer

Preventing protein filtration

Answer

Regulating filtrate flow

Answer

Secreting renin

Answer

Clearing immune complexes

Question 8

The primary treatment goal for a patient with nephrotic syndrome is to:

Accepted Answer

Reduce proteinuria

Answer

Improve renal function

Answer

Resolve edema

Answer

Correct hypoalbuminemia

Question 9

The first-line treatment for nephrotic syndrome caused by minimal change disease is:

Accepted Answer

Corticosteroids

Answer

ACE inhibitors

Answer

Diuretics

Answer

Immunosuppressants

Question 10

The predominant immunoglobulin class involved in immune complex-mediated nephrotic syndrome is:

Accepted Answer

IgG

Answer

IgA

Answer

IgM

Answer

IgE

Question 11

Which pathophysiological feature is a hallmark of nephrotic syndrome?

Accepted Answer

Increased permeability of the glomerular filtration barrier to proteins

Answer

Elevated glomerular filtration rate

Answer

Diminished albumin production by the liver

Question 12

Which of the following mechanisms is the primary cause of proteinuria in nephrotic syndrome?

Accepted Answer

Defective glomerular basement membrane

Answer

Increased glomerular filtration rate

Answer

Tubular reabsorption defects

Answer

Increased renal blood flow

Question 13

Which protein type is predominantly lost in nephrotic syndrome?

Accepted Answer

Albumin

Answer

Hemoglobin

Answer

Globulin

Answer

Fibrinogen

Question 14

Select the most common cause of primary nephrotic syndrome in children.

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Membranous nephropathy

Answer

IgA nephropathy

Question 15

Which medication is typically used as first-line treatment for nephrotic syndrome due to minimal change disease?

Accepted Answer

Prednisone

Answer

Cyclosporine

Answer

Tacrolimus

Answer

Rituximab

Question 16

In a patient with nephrotic syndrome, what does a urine protein-to-creatinine ratio of 3.5 g/g indicate?

Accepted Answer

Heavy proteinuria

Answer

Tubular reabsorption defect

Answer

Normal protein levels

Answer

Slight proteinuria

Question 17

What is the main function of podocytes in relation to nephrotic syndrome?

Accepted Answer

Maintaining the integrity of the glomerular filtration barrier

Answer

Regulating renal blood flow

Answer

Producing renin

Answer

Synthesizing erythropoietin

Question 18

Which of the following is a consequence of renin-angiotensin-aldosterone system (RAAS) activation in nephrotic syndrome?

Accepted Answer

Hypertension

Answer

Increased glomerular filtration rate

Answer

Reduced edema

Answer

Decreased proteinuria

Question 19

Which laboratory finding is most indicative of nephrotic syndrome?

Accepted Answer

Proteinuria > 3.5 g/24 hours

Answer

Hematuria

Answer

Pyuria

Answer

Elevated serum creatinine

Question 20

The pathophysiology of nephrotic syndrome is mainly attributed to a defect in:

Accepted Answer

Glomerular filtration barrier

Answer

Tubular reabsorption

Answer

Hormonal regulation

Answer

Renal blood flow

Question 21

What is the initial treatment of choice for minimal change disease, a common cause of nephrotic syndrome in children?

Accepted Answer

Prednisone

Answer

ACE inhibitors

Answer

Cyclosporine

Answer

Plasmapheresis

Question 22

Which factors influence the long-term outlook for patients with nephrotic syndrome?

Accepted Answer

Age at onset

Accepted Answer

Duration of protein loss

Accepted Answer

Underlying disease type

Answer

Severity of swelling

Question 23

In children, what is the most common cause of nephrotic syndrome?

Accepted Answer

Minimal change disease

Answer

Membranous nephropathy

Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Question 24

In children, what is the most prevalent cause of nephrotic syndrome?

Accepted Answer

Minimal change disease

Answer

Systemic lupus erythematosus

Answer

Diabetes mellitus

Answer

Sickle cell disease

Question 25

In the pathogenesis of nephrotic syndrome, podocyte injury is a critical event leading to proteinuria. Which of the following is NOT a recognized mechanism of podocyte injury?

Accepted Answer

Hypertension

Answer

Immune-mediated injury

Answer

Circulating factors (e.g., VEGF)

Answer

Genetic mutations

Question 26

Minimal change disease (MCD) is a form of nephrotic syndrome characterized by:

Accepted Answer

Complete effacement of podocyte foot processes

Answer

Mesangial proliferation

Answer

Basement membrane thickening

Answer

Normal glomerular histology

Question 27

The selective permeability of the glomerular filtration barrier is primarily maintained by:

Accepted Answer

Podocytes

Answer

Glomerular endothelium

Answer

Glomerular basement membrane

Answer

Mesangial cells

Question 28

A characteristic sign of nephrotic-range proteinuria is a:

Accepted Answer

Urine protein-to-creatinine ratio exceeding 3.5 g/g

Answer

Positive urine dipstick for protein

Answer

Presence of casts in the urine

Answer

Low serum albumin

Question 29

Nephrotic syndrome is more prevalent in:

Accepted Answer

Children

Answer

Adults

Answer

Females

Answer

Males

Question 30

What type of microscopic changes are characteristic of minimal change disease, a common cause of nephrotic syndrome in children?

Accepted Answer

Normal appearance

Answer

Mesangial proliferation

Answer

Crescentic formation

Answer

Basement membrane thickening

Question 31

Which of the following treatments is typically used as first-line therapy for nephrotic syndrome caused by minimal change disease in children?

Accepted Answer

Prednisone

Answer

Cyclosporine

Answer

Rituximab

Answer

Plasmapheresis

Question 32

What is the role of podocytes in maintaining normal glomerular function?

Accepted Answer

Prevention of proteinuria

Answer

Filtration of waste products

Answer

Reabsorption of sodium

Answer

Regulation of blood flow

Question 33

Which of the following tests is most useful in the initial evaluation of a person suspected of having nephrotic syndrome?

Accepted Answer

Urinalysis

Answer

Blood urea nitrogen (BUN) level

Answer

Creatinine clearance

Answer

Renal biopsy

Question 34

What is the prognosis for a patient with nephrotic syndrome caused by minimal change disease?

Accepted Answer

Excellent with complete remission in most cases

Answer

Good with frequent relapses

Answer

Poor with progression to end-stage renal disease

Answer

Variable depending on the underlying cause

Question 35

What is the most frequent mechanism leading to proteinuria in nephrotic syndrome?

Accepted Answer

Increased glomerular permeability

Answer

Decreased tubular reabsorption

Answer

Increased renal blood flow

Answer

Glomerular inflammation

Question 36

Which type of nephrotic syndrome is characterized by the absence of any detectable underlying cause?

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Membranous nephropathy

Answer

IgA nephropathy

Question 37

What is typically the most prominent laboratory finding in nephrotic syndrome?

Accepted Answer

Proteinuria

Answer

Hematuria

Answer

Pyuria

Answer

Bacteriuria

Question 38

What is widely regarded as the definitive diagnostic procedure for nephrotic syndrome?

Accepted Answer

Renal biopsy

Answer

Urine dipstick analysis

Answer

Blood urea nitrogen (BUN) level

Answer

Serum creatinine level

Question 39

In the pathophysiology of nephrotic syndrome, what is the primary defect leading to proteinuria?

Accepted Answer

Defects in the glomerular filtration barrier allowing albumin to leak into the urine

Answer

Activation of the renin-angiotensin-aldosterone system causing fluid retention

Answer

Increased renal blood flow leading to glomerular hyperfiltration

Question 40

Which treatment option is most commonly employed for nephrotic syndrome caused by minimal change disease?

Accepted Answer

Corticosteroids, such as prednisone, to reduce inflammation and proteinuria

Answer

Immunosuppressive agents, such as cyclosporine, to suppress the immune system

Answer

Nephrectomy, the surgical removal of a kidney, which is rarely indicated in nephrotic syndrome

Answer

Diuretics, such as furosemide, to increase urine output and reduce edema

Question 41

Which laboratory finding is a defining characteristic of nephrotic syndrome?

Accepted Answer

Proteinuria exceeding 3.5 grams per 24 hours, indicating excessive protein loss in the urine

Answer

Blood urea nitrogen exceeding 20 mg/dL, indicating impaired kidney function

Answer

Serum creatinine exceeding 1.5 mg/dL, suggesting advanced kidney disease

Answer

Hematuria exceeding 5 red blood cells per high-power field, suggesting glomerular damage

Question 42

In the histological examination of a kidney biopsy from a patient with nephrotic syndrome, which morphological change is commonly observed?

Accepted Answer

Foot process effacement, characterized by the flattening and loss of podocyte foot processes

Answer

Tubular atrophy, characterized by the shrinkage and loss of renal tubules

Answer

Glomerular sclerosis, marked by the scarring and hardening of glomeruli

Answer

Mesangial proliferation, characterized by the thickening and expansion of mesangial cells

Question 43

Which type of nephrotic syndrome is characterized by an abrupt onset, often in children, and typically responds well to corticosteroid therapy?

Accepted Answer

Minimal change disease, an idiopathic form of nephrotic syndrome with no apparent underlying cause

Answer

Membranous nephropathy, characterized by the formation of immune complexes on the glomerular basement membrane

Answer

Focal segmental glomerulosclerosis, characterized by scarring of specific segments of glomeruli

Answer

IgA nephropathy, characterized by the deposition of IgA antibodies in the glomeruli

Question 44

Which laboratory test is primarily used to assess the amount of protein in the urine for the diagnosis of nephrotic syndrome?

Accepted Answer

Urinalysis with protein-to-creatinine ratio, which measures the concentration of protein relative to creatinine to account for variations in urine volume

Answer

Liver function tests, which assess the health and function of the liver

Answer

Serum electrolytes, which measure the levels of electrolytes in the blood

Answer

Complete blood count, which evaluates the cellular components of the blood

Question 45

A 25-year-old patient presents with edema, hypoalbuminemia, and proteinuria. Which of the following is the MOST likely underlying mechanism of proteinuria in nephrotic syndrome?

Accepted Answer

Increased glomerular permeability to protein

Answer

Increased glomerular filtration rate (GFR)

Answer

Decreased tubular reabsorption of protein

Answer

Overproduction of plasma proteins by the liver

Question 46

Which of the following laboratory findings is MOST characteristic of nephrotic syndrome?

Accepted Answer

Urine protein excretion exceeding 3.5 g/day

Answer

Urine specific gravity of 1.005

Answer

Serum creatinine level of 2.5 mg/dL

Question 47

A patient with nephrotic syndrome is at increased risk for developing thromboembolic complications. Which of the following alterations in blood components contributes MOST to this risk?

Accepted Answer

Loss of antithrombin III in urine

Answer

Increased platelet aggregation

Answer

Elevated serum potassium levels

Question 48

Which of the following dietary modifications is MOST appropriate for a patient with nephrotic syndrome?

Accepted Answer

Reduced sodium intake

Answer

Increased potassium intake

Answer

High protein intake

Answer

Fluid restriction is unnecessary

Question 49

Which of the following is a common clinical manifestation of nephrotic syndrome related to hypoalbuminemia?

Accepted Answer

Peripheral edema

Answer

Oliguria

Answer

Hematuria

Answer

Hypertension

Question 50

Minimal change disease is a common cause of nephrotic syndrome, particularly in children. Which of the following histological findings is characteristic of minimal change disease on electron microscopy?

Accepted Answer

Effacement of podocyte foot processes

Answer

Mesangial cell proliferation

Answer

Thickening of the glomerular basement membrane

Question 51

Which of the following medications is a first-line treatment option for idiopathic nephrotic syndrome and acts by reducing proteinuria?

Accepted Answer

Corticosteroids

Answer

Diuretics

Answer

Angiotensin-converting enzyme (ACE) inhibitors

Answer

Antibiotics

Question 52

Which one of the following is NOT a potential complication of nephrotic syndrome?

Accepted Answer

Hyperkalemia

Answer

Thromboembolic events

Answer

Acute kidney injury

Answer

Infections

Question 53

A patient with a history of nephrotic syndrome presents with sudden onset flank pain and hematuria. Which of the following complications should be considered?

Accepted Answer

Renal vein thrombosis

Answer

Urinary tract infection

Answer

Acute glomerulonephritis

Answer

Nephrolithiasis

Question 54

What is the primary goal of nursing care for a patient with nephrotic syndrome?

Accepted Answer

Manage edema, prevent infection, and educate the patient on medication and dietary management

Answer

Encourage strenuous physical activity to promote fluid shifts

Answer

Administer high-protein diets to compensate for urinary protein loss