WorksheetsNefro
Total questions: 15
Worksheet time: 15mins
A 7-month-old has 2 days of 39°C fever, irritability, vomiting, and reduced intake. No other infectious focus is found. Urinalysis from a catheterized sample shows positive leukocyte esterase, positive nitrites, and 20–30 WBC/HPF. Urine culture grows Escherichia coli. Chest radiograph is normal. What is the posible diagnosis?
Acute cystitis without parenchymal involvement
Acute pyelonephritis
Asymptomatic bacteriuria
Contamination during urine collection
Sterile pyuria due to viral infection
A 10-month-old with a first febrile UTI improves clinically after parenteral antibiotics. Physical exam is unremarkable at early follow-up. What is the appropriate next step?
Routine VCUG immediately during the acute phase for all infants
DMSA scan at 48–72 hours to assess scarring
Renal and bladder ultrasound 1–2 weeks after the acute phase resolves
No imaging if clinical response before 48 hours
Contrast CT urography immediately after completing antibiotics
A 2-month-old with febrile UTI appears toxic with mildly decreased peripheral perfusion; urinalysis supports a UTI. Initial therapy ?
Oral nitrofurantoin monotherapy
High-dose oral amoxicillin
Intravenous third-generation cephalosporin (e.g., cefotaxime/ceftriaxone)
Oral cefixime from the outset
Intravenous gentamicin alone without combination
A 5-year-old develops morning periorbital edema progressing to anasarca over several days. Blood pressure and GFR are normal. Urinalysis shows +4 proteinuria without significant hematuria; serum albumin is 2.0 g/dL. No history of severe infection, systemic disease, or nephrotoxic drugs. What is the posible diagnosis?
Acute post-streptococcal glomerulonephritis
Lupus nephritis (class III/IV)
Idiopathic Nephrotic syndrome
Non minimal change nephrotic syndrome
Atypical HUS
For the case above, remission induction follows national consensus. The appropriate treatment?Prednisone 1 mg/kg/day for 2 weeks then stop
Prednisone 2 mg/kg/day (max 80 mg) for 4–6 weeks → 1.5 mg/kg alternate days for 4–6 weeks
Three-day methylprednisolone pulses for all initial cases
Dexamethasone 0.6 mg/kg/day for 10 days
No steroids; salt restriction only
An 13-year-old presents with generalized edema and massive proteinuria. Blood pressure 140/90 mmHg, persistent microscopic hematuria, low C3, and mildly increased creatinine. No notable atopic history. What is the appropriate next step before definitive therapy ?
Delay biopsy; give full-course steroids for 8 weeks first
Add diuretics and observe; biopsy only if relapse
Kidney biopsy before definitive treatment
Start cyclophosphamide as initial induction
Multivitamins and high-protein diet, no biopsy
A 7-year-old, two weeks after sore throat, has periorbital edema, cola-colored gross hematuria, hypertension, and +/++ proteinuria. Complement testing shows low C3. Creatinine is slightly elevated, no other systemic features. The posible diagnosis?
IgA nephropathy with concurrent URI
Acute post-streptococcal glomerulonephritis (APSGN)
Minimal Change Nephrotic Syndrome
Typical post-diarrheal HUS
Post-staphylococcal GN
A typical APSGN case shows good clinical follow-up: edema decreases, blood pressure approaches normal, and hematuria gradually declines. A lab test is considered to assess resolution and exclude alternative etiologies.
Weekly anti-dsDNA for all cases
Repeat C3 at 6–8 weeks
ANA every 2 weeks
Routine kidney biopsy for all APSGN
Repeat throat culture
A 9-year-old with recurrent diarrhea and low fluid intake has urine output 0.3 mL/kg/hour for 8 hours. Serum creatinine rises to 1.6× previous value within 48 hours. Blood pressure is stable; no pulmonary edema. The posible diagnosis?
Prerenal AKI, AKI KDIGO stage 1
Prerenal AKI, AKI KDIGO stage 2
Renal AKI, AKI KDIGO stage 1
Renal AKI, AKI KDIGO stage 2
Prerenal AKI, AKI KDIGO stage 3
A 3-year-old with acute diarrhea has decreased skin turgor, prolonged capillary refill, tachycardia, hypotension, and scant urine. Findings suggest prerenal AKI from hypovolemia. Choose the initial step to restore renal perfusion with close monitoring.
Carefully titrated isotonic fluid boluses with urine output/hemodynamic monitoring
Withhold fluids; trial of furosemide first
Rapid hypotonic fluids to “catch up” the deficit
Low-dose “renal” dopamine as first-line
Immediate dialysis for all prerenal AKI
A 6-year-old with intrinsic AKI has persistent hyperkalemia 6.5 mmol/L despite medical therapy, pulmonary edema, metabolic acidosis pH 7.12, and uremic features. Urine output is minimal. Choose the next step to address life-threatening issues.
Increase loop diuretics to high dose
Potassium-binding resin only
Initiate renal replacement therapy (dialysis)
Insulin–glucose alone without an RRT plan
Close observation for 24 hours first
A 14-year-old has repeated clinic measurements at ≥3 visits averaging 140/92 mmHg. No severe headache or visual complaints. Physical exam otherwise normal. Determine the blood pressure category per national guidance.
Elevated blood pressure
Stage 1 hypertension
Stage 2 hypertension
White-coat hypertension
Definite secondary hypertension
A 9-year-old shows clinic blood pressures persistently between the percentil 95 + 5 mmHg over multiple visits, asymptomatic, with no cardiomegaly on ECG. An evaluation is needed to distinguish white-coat from sustained hypertension.
Home blood pressure monitoring (HBPM) only
Ambulatory blood pressure monitoring (ABPM)
Renal ultrasound as the determinant of white-coat
ECG alone
Repeat clinic measurements without other tools
A 12-year-old with obesity has stage 1 hypertension persisting after 6 months of comprehensive lifestyle modification. No target-organ damage, normal renal function, and no proteinuria. Pharmacologic therapy ?
Beta-blocker as first-line
ACE inhibitor or ARB/CCB/thiazide as first-line options
Long-term loop diuretic for all patients
Initial combination ACE inhibitor + potassium-sparing diuretic
Transdermal clonidine as first-line choice
An 8-year-old with APSGN one year ago is now normotensive with no proteinuria on recent testing. Activity is normal, no complaints. What is long-term follow-up plan to avoid missing progression to chronic kidney disease?
No follow-up; APSGN always fully resolves
Periodic monitoring (BP, urinalysis, renal function) due to CKD risk
Only if edema recurs
Only if urine culture is positive
Only if BP exceeds the 95th percentile
