✅ Acute Renal Failure (ARF) / Acute Kidney Injury (AKI) – MCQs
1. Which of the following is a common cause of pre-renal acute renal failure?
A. Hypovolemia
B. Acute tubular necrosis
C. Glomerulonephritis
D. Obstructive uropathy
➡️ Answer: A. Hypovolemia
2. What is the hallmark laboratory finding in pre-renal AKI?
A. Urine sodium <20 mEq/L
B. Urine sodium >40 mEq/L
C. Elevated urine osmolality <300 mOsm/kg
D. Low BUN to creatinine ratio
➡️ Answer: A. Urine sodium <20 mEq/L
3. Which of the following is NOT a common cause of intrinsic renal failure?
A. Acute tubular necrosis
B. Acute interstitial nephritis
C. Post-renal obstruction
D. Glomerulonephritis
➡️ Answer: C. Post-renal obstruction
4. What is the typical cause of post-renal acute renal failure?
A. Urinary tract obstruction
B. Dehydration
C. Sepsis
D. Nephrotoxic drugs
➡️ Answer: A. Urinary tract obstruction
5. Which of the following drugs is a known nephrotoxin causing acute tubular necrosis?
A. Aminoglycosides
B. Acetaminophen
C. Metformin
D. Penicillin
➡️ Answer: A. Aminoglycosides
6. Which electrolyte abnormality is commonly seen in acute renal failure?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
➡️ Answer: A. Hyperkalemia
7. What is the definition of acute kidney injury based on serum creatinine?
A. Increase in serum creatinine by ≥0.3 mg/dL within 48 hours or ≥50% increase within 7 days
B. Decrease in serum creatinine by 0.3 mg/dL
C. Stable creatinine for 3 days
D. None of the above
➡️ Answer: A. Increase in serum creatinine by ≥0.3 mg/dL within 48 hours or ≥50% increase within 7 days
8. Which of the following is the best initial diagnostic test in suspected post-renal AKI?
A. Renal ultrasound
B. Kidney biopsy
C. Serum complement levels
D. CT scan without contrast
➡️ Answer: A. Renal ultrasound
9. What urine sediment finding is characteristic of acute tubular necrosis?
A. Muddy brown granular casts
B. Red blood cell casts
C. White blood cell casts
D. Eosinophils
➡️ Answer: A. Muddy brown granular casts
10. Which of the following is NOT a typical feature of acute interstitial nephritis?
A. Fever and rash
B. Eosinophiluria
C. Muddy brown casts
D. Recent exposure to antibiotics or NSAIDs
➡️ Answer: C. Muddy brown casts
11. Which of the following is the most common cause of intrinsic acute kidney injury?
A. Acute tubular necrosis (ATN)
B. Acute glomerulonephritis
C. Acute interstitial nephritis
D. Renal artery stenosis
➡️ Answer: A. Acute tubular necrosis (ATN)
12. Which laboratory test helps differentiate pre-renal from intrinsic AKI?
A. Fractional excretion of sodium (FENa)
B. Serum glucose
C. Urine protein electrophoresis
D. Serum albumin
➡️ Answer: A. Fractional excretion of sodium (FENa)
13. What FENa value is typically seen in pre-renal AKI?
A. <1%
B. >2%
C. 5-10%
D. >10%
➡️ Answer: A. <1%
14. What is the typical clinical presentation of acute renal failure?
A. Oliguria or anuria, fluid overload, and electrolyte disturbances
B. Polyuria with dehydration
C. Asymptomatic with normal urine output
D. Only hypertension
➡️ Answer: A. Oliguria or anuria, fluid overload, and electrolyte disturbances
15. Which of the following is NOT an indication for urgent dialysis in acute renal failure?
A. Severe hyperkalemia refractory to medical therapy
B. Volume overload unresponsive to diuretics
C. Symptomatic uremia
D. Mild azotemia with stable electrolytes
➡️ Answer: D. Mild azotemia with stable electrolytes
16. Which of the following physical findings is commonly associated with volume overload in AKI?
A. Peripheral edema
B. Dry mucous membranes
C. Hypotension
D. Decreased jugular venous pressure
➡️ Answer: A. Peripheral edema
17. Which acid-base disorder is most commonly associated with acute renal failure?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
➡️ Answer: A. Metabolic acidosis
18. Which of the following is true about the recovery phase of ATN?
A. Polyuric phase with risk of volume depletion and electrolyte losses
B. Oliguric phase with fluid overload
C. No changes in urine output
D. Always requires lifelong dialysis
➡️ Answer: A. Polyuric phase with risk of volume depletion and electrolyte losses
19. Which of the following conditions can cause post-renal acute renal failure?
A. Bilateral ureteral obstruction due to stones
B. Hypovolemia
C. Septic shock
D. Rhabdomyolysis
➡️ Answer: A. Bilateral ureteral obstruction due to stones
20. Which imaging modality is preferred for evaluating obstructive causes of acute renal failure?
A. Renal ultrasound
B. Non-contrast CT
C. MRI
D. Nuclear renal scan
➡️ Answer: A. Renal ultrasound
21. Which of the following is a common cause of acute tubular necrosis (ATN)?
A. Ischemia due to prolonged hypotension
B. Diabetes mellitus
C. Chronic hypertension
D. Polycystic kidney disease
➡️ Answer: A. Ischemia due to prolonged hypotension
22. What urine output characterizes oliguria in AKI?
A. Less than 400 mL/day
B. More than 2 liters/day
C. 1–2 liters/day
D. More than 4 liters/day
➡️ Answer: A. Less than 400 mL/day
23. Which electrolyte abnormality in AKI can cause peaked T waves on ECG?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypocalcemia
➡️ Answer: A. Hyperkalemia
24. Which of the following is the initial management priority in a patient with acute renal failure?
A. Correct volume status
B. Start dialysis immediately
C. Give high-dose steroids
D. Restrict all fluids
➡️ Answer: A. Correct volume status
25. Which of the following medications should be avoided or used cautiously in patients with AKI?
A. NSAIDs
B. Acetaminophen
C. Vitamin C
D. Metformin
➡️ Answer: A. NSAIDs
26. What is the typical change in blood urea nitrogen (BUN) to creatinine ratio in pre-renal AKI?
A. Increased (>20:1)
B. Decreased (<10:1)
C. Normal (10-15:1)
D. No change
➡️ Answer: A. Increased (>20:1)
27. What is the pathophysiologic mechanism in acute interstitial nephritis?
A. Hypersensitivity reaction causing inflammation of the renal interstitium
B. Obstruction of renal tubules
C. Ischemic injury to tubular cells
D. Glomerular basement membrane damage
➡️ Answer: A. Hypersensitivity reaction causing inflammation of the renal interstitium
28. Which of the following findings suggests intrinsic renal AKI rather than pre-renal AKI?
A. Urine sodium >40 mEq/L
B. BUN/creatinine ratio >20
C. Urine specific gravity >1.020
D. Low urine sodium (<20 mEq/L)
➡️ Answer: A. Urine sodium >40 mEq/L
29. Which of the following is a hallmark of recovery phase in acute tubular necrosis?
A. High urine output with risk of electrolyte loss
B. Persistent oliguria
C. Rising creatinine levels
D. Severe acidosis
➡️ Answer: A. High urine output with risk of electrolyte loss
30. What is the main goal of renal replacement therapy in ARF?
A. Manage fluid overload, correct electrolyte imbalances, and remove toxins
B. Cure underlying cause
C. Replace kidney permanently
D. Only treat hyperkalemia
➡️ Answer: A. Manage fluid overload, correct electrolyte imbalances, and remove toxins
31. Which of the following drugs can cause acute interstitial nephritis?
A. Penicillins and NSAIDs
B. Metformin
C. ACE inhibitors
D. Beta blockers
➡️ Answer: A. Penicillins and NSAIDs
32. In the management of AKI, which of the following fluid types is generally preferred for volume resuscitation?
A. Isotonic saline (0.9% NaCl)
B. Dextrose 5% in water
C. Half-normal saline (0.45% NaCl)
D. Lactated Ringer’s solution (use cautiously in renal failure)
➡️ Answer: A. Isotonic saline (0.9% NaCl)
33. What urine microscopy finding is characteristic of acute glomerulonephritis?
A. Red blood cell casts
B. White blood cell casts
C. Granular casts
D. Fatty casts
➡️ Answer: A. Red blood cell casts
34. Which of the following is the best marker of renal tubular damage?
A. Urinary neutrophil gelatinase-associated lipocalin (NGAL)
B. Serum creatinine
C. BUN
D. Urine protein
➡️ Answer: A. Urinary neutrophil gelatinase-associated lipocalin (NGAL)
35. What is a common cause of rhabdomyolysis-induced acute kidney injury?
A. Trauma or prolonged immobilization
B. Diabetes
C. Hypertension
D. Urinary tract infection
➡️ Answer: A. Trauma or prolonged immobilization
36. Which acid-base disorder is frequently seen in AKI patients?
A. Metabolic acidosis with an increased anion gap
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
➡️ Answer: A. Metabolic acidosis with an increased anion gap
37. Which of the following is NOT typically elevated in acute kidney injury?
A. Serum creatinine
B. Blood urea nitrogen (BUN)
C. Serum albumin
D. Potassium
➡️ Answer: C. Serum albumin
38. What is the urine output definition of anuria?
A. Less than 50 mL/day
B. Less than 400 mL/day
C. More than 1000 mL/day
D. 500 mL/day
➡️ Answer: A. Less than 50 mL/day
39. Which of the following is the most common cause of death in patients with acute renal failure?
A. Infection
B. Hyperkalemia
C. Pulmonary edema
D. Bleeding
➡️ Answer: A. Infection
40. Which diagnostic test is most definitive in diagnosing acute glomerulonephritis?
A. Kidney biopsy
B. Urinalysis
C. Renal ultrasound
D. Serum creatinine
➡️ Answer: A. Kidney biopsy
41. Which of the following laboratory findings suggests intrinsic renal failure?
A. Urine osmolality ~300 mOsm/kg (isosthenuria)
B. Urine sodium <20 mEq/L
C. BUN/Creatinine ratio >20:1
D. High urine specific gravity (>1.020)
➡️ Answer: A. Urine osmolality ~300 mOsm/kg (isosthenuria)
42. Which is the most common type of acute kidney injury in hospitalized patients?
A. Acute tubular necrosis (ATN)
B. Pre-renal azotemia
C. Post-renal obstruction
D. Acute interstitial nephritis
➡️ Answer: A. Acute tubular necrosis (ATN)
43. What is the mechanism of acute tubular necrosis?
A. Ischemic or nephrotoxic injury to tubular epithelial cells
B. Immune complex deposition in glomeruli
C. Obstruction of ureters
D. Autoimmune interstitial inflammation
➡️ Answer: A. Ischemic or nephrotoxic injury to tubular epithelial cells
44. What is the typical time course for recovery from ATN?
A. 1 to 3 weeks
B. Several hours
C. 6 months
D. Years
➡️ Answer: A. 1 to 3 weeks
45. Which of the following is a risk factor for contrast-induced nephropathy?
A. Pre-existing chronic kidney disease
B. Young age
C. Adequate hydration
D. Low contrast volume
➡️ Answer: A. Pre-existing chronic kidney disease
46. Which urine sediment finding is most consistent with acute interstitial nephritis?
A. White blood cell casts and eosinophils
B. Red blood cell casts
C. Fatty casts
D. Granular casts
➡️ Answer: A. White blood cell casts and eosinophils
47. Which of the following conditions can cause post-renal acute renal failure?
A. Prostatic hypertrophy
B. Hypovolemia
C. Sepsis
D. Hypotension
➡️ Answer: A. Prostatic hypertrophy
48. Which of the following is the most sensitive early marker of acute kidney injury?
A. Serum creatinine
B. Blood urea nitrogen (BUN)
C. Urinary NGAL
D. Urine specific gravity
➡️ Answer: C. Urinary NGAL
49. Which electrolyte abnormality in AKI can lead to cardiac arrhythmias?
A. Hyperkalemia
B. Hypocalcemia
C. Hypokalemia
D. Hypernatremia
➡️ Answer: A. Hyperkalemia
50. What is the best initial step in managing hyperkalemia in AKI?
A. Stabilize the myocardium with calcium gluconate
B. Immediate dialysis
C. Administer sodium bicarbonate only
D. Restrict potassium intake only
➡️ Answer: A. Stabilize the myocardium with calcium gluconate
51. Which of the following conditions is associated with pigment-induced acute tubular necrosis?
A. Rhabdomyolysis
B. Diabetes mellitus
C. Hypertension
D. Urinary tract infection
➡️ Answer: A. Rhabdomyolysis
52. Which medication class should be avoided or used cautiously in AKI due to nephrotoxicity risk?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Beta blockers
C. Calcium channel blockers
D. Diuretics
➡️ Answer: A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
53. Which of the following is a common cause of pre-renal AKI?
A. Dehydration
B. Acute glomerulonephritis
C. Kidney stones
D. Pyelonephritis
➡️ Answer: A. Dehydration
54. What is the most useful imaging modality for detecting urinary tract obstruction causing post-renal AKI?
A. Renal ultrasound
B. MRI of the abdomen
C. Contrast-enhanced CT scan
D. X-ray KUB
➡️ Answer: A. Renal ultrasound
55. Which of the following is the hallmark of recovery phase in ATN?
A. Polyuria with risk of electrolyte losses
B. Persistent oliguria
C. Worsening azotemia
D. Persistent hyperkalemia
➡️ Answer: A. Polyuria with risk of electrolyte losses
56. What electrolyte disturbance is commonly seen in AKI and can cause muscle weakness and arrhythmias?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypocalcemia
➡️ Answer: A. Hyperkalemia
57. What urine output defines oliguria?
A. Less than 400 mL/day
B. More than 2 liters/day
C. 1-2 liters/day
D. More than 4 liters/day
➡️ Answer: A. Less than 400 mL/day
58. Which of the following best describes the pathophysiology of pre-renal AKI?
A. Decreased renal perfusion without parenchymal damage
B. Intrinsic damage to renal tubules
C. Obstruction of urinary outflow
D. Immune-mediated glomerular injury
➡️ Answer: A. Decreased renal perfusion without parenchymal damage
59. Which of the following is the preferred initial treatment for volume depletion causing pre-renal AKI?
A. Intravenous isotonic saline
B. Oral water restriction
C. Diuretics
D. Dialysis
➡️ Answer: A. Intravenous isotonic saline
60. Which of the following is the typical urine sodium concentration in intrinsic renal failure?
A. Greater than 40 mEq/L
B. Less than 20 mEq/L
C. Variable
D. Zero
➡️ Answer: A. Greater than 40 mEq/L
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