KIDNEY 25 March 2010

1. A 42 years old male comes to the Siloam hospital with muscular weakness, mild
headache after eating salted fish. Usually he drinks only small amount of water. He said
that usually his blood pressure is 100/70 mmHg. His blood pressure 140/90 mmHg. The
doctor sends him to the laboratory. The result shows serum sodium is 150 mEq/L (N: 135
- 155), potassium is 3.5 mEq/L (N: 3.5 – 5.0), random blood glucose 150 mg/dl (N <140).
In this condition, what will the kidney do?
A. Increase glomerular filtration rate
B. Increase obligatory water reabsorption (dgn PCT)
C. Increase facultative water reabsorption ( dgn ADH)
D. Increase renin secretion
E. Increase aldosteron secretion

2. To cover the above function, what mechanism is used?

A. Increase cardiac output
B. Increase frequency of the heart
C. Increase secretion of renin
D. Increase secretion of antidiuretic hormone
E. Increase secretion of aldosteron

3. Which factor support the above mechanism?

A. Filtration rate of the glomeruli
B. Active transport of the tubular cell
C. High osmolality of the interstitium of medulla
D. Obligatory water reabsortion
E. Osmolality of the filtrate in distal convoluted tubule

4. If the urinalysis is also done, what will you see about the glucose in urine?
A. positive ++++
B. positive +++
C. positive ++
D. positive+
E. negative

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5. In a kidney laboratory, using a micropipette, we can measure the hemodynamic pressure
of afferent arteriole, pressure in Bowman capsule, and osmotic pressure in glomerular
lumen. If the pressure in afferent arteriole is 40 mmHg, in Bowman capsule 1 mmHg, the
osmotic pressure of glomerulus is 30 mmHg, the effective filtration pressure in
glomerulus is:
A. 71 mmHg
B. 69 mmHg
C. 11 mmHg
D. 9 mmHg
E. – 9 mmHg

6. A 63-year-old-man, with a history of heart failure and edema fails to respond adequately
to maximum recommended dosages of chlorthalidone. (diuretic)
Which of the following is the most likely appropriate for restoring the diuretic response?
A. add with hydrochlorothiazide
B. add with metolazone
C. replace with furosemide
D. replace with hydrochlorothiazide
E. increasing the dose of chlorthalidone

7. A 75-year-old woman with hypertension is being treated with thiazide. Her blood
pressure is decrease to 120/76 mm Hg. After several months on the medication, she
complains of being tired and weak. Which of the following substance in analysis of blood
indicates low values? Thiazide efek samping nyaaaa low potassium
A. calcium
B. uric acid
C. potassium
D. sodium
E. glucose

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8. A jaundiced 1-week premature infant with elevated free bilirubin is seen in the premature
baby nursery. The mother had received antibiotic combination for a urinary tract infection
(UTI) 1 week before delivery.
Which of the following is the most likely cause of the baby’s kernicterus? ( bilirubin naik)
A. cefixime
B. amoxicillin
C. azithromycin
D. erythromycin
E. cotrimoxazole - Sulofamide

9. A 4-year-old-boy was brought to hospital with puffiness around the eyes, especially in the
morning and swelling over the legs. His mother also complaint he has foamy urine. Urine
sample shows protein ++++ (>3.5 per 1.73 m2 per 24 hour), albumin level 1.5g/dL
(normal=3.5-5g/dL).
What is the principal management in this patient?
Nephrotic syndrome –dgn symptom di soal- obat nyaaaa diberikan steroid
Steroid contohnya prednisone
A. Albumin
B. Furosemide
C. Prednisone
D. Thiazide
E. Cyclosporin

10. A 13 year-old-girl was brought to emergency unit with seizure. Her mother complaint she
had fever 2 weeks ago, but has recovered. Now she has swelling around the eyes and legs
and she has dark urine. From physical exam, she is unconscious. Her blood pressure is
180/120 mmHg. Urine sample shows erythrocytes 20/hpf and protein +. Albumin level
within normal limit.
What other laboratory findings to confirm the diagnosis in this patient?
(ASTO naik penanda pernah kena streptococcocal – glomerulonephritis (nephritic
syndrome ditandai dgn increase DnaseB) - antibodi terbentuk complex trap di mesangilal
cell dan terbentuk matrix di glomerulus – complemen ke sana- dan complemen decrease
di darah)
A. Decreased anti streptolisin O (ASO), increased DNase-B, decreased C3
B. Increased anti streptolisin O (ASO), decreased DNase-B, decreased C3
C. Decreased anti streptolisin O (ASO), increased DNase-B, increased C3
D. Increased anti streptolisin O (ASO), decreased DNase-B, increased C3
E. Increased anti streptolisin O (ASO), increased DNase-B, decreased C3

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11. A 70-year-old male with tuberculosis, he was treated with daily streptomycin for 1 week.
After the last injection, his urine output diminished and the laboratory test revealed ureum
80 (20 – 40) mg/dL, creatinine 3.0 (0.5 - 1.5) mg/dL.
What is the most likely diagnosis in this patient?
A. Urinary tract infection
B. Sepsis
C. Glomerulonephritis
D. Chronic renal failure
E. Acute tubular nephritis

12. What is the most possible cause in this patient?

A. Renal ischemia
B. Direct toxic injury (nephrotoxic karena obat)
C. Complex immune response
D. Urinary obstruction
E. Drug hypersensitivity

13. A 3 year old boy was brought to emergency unit with severe diarrhea since three days
ago. On arrival he is not fully alert. His vital sign are as follows: blood pressure is 80/60
mmHg, pulse is not palpable, respiratory rate was 36 breaths per minute, and body
temperature was 38.4oC. On physical exam there is sunken anterior fontanel, dry mucous
membranes, sunken eyes, lack of tears, poor skin turgor, and the capillary refill more then
2 seconds. The laboratory test in this patient reveal haemoglobin 13 g/dL(11.5-15.5 g/dL),
hematocrit 46% (35-45%), WBC 7,000/mm3(5,500-15,500/mm3), platelets count
260,000/mm3 (150,000-400,000 mm3), urea nitrogen 40 mg/dL (5-18 mg/dL), and
creatinine 1.7 mg/dL (0.3-0.7 mg/dL). Urine specific gravity is 1.040 (N: 1.003 – 1.030)
What is the most likely diagnosis in this patient?
Pre renal – diare,
A. Acute tubular nephritis
B. Prerenal acute kidney injury
C. Intrinsic acute kidney injury
D. Postrenal acute kidney injury
E. Chonic renal failure

14. A 10 year old girl was brought to your clinic with dysuria since 5 days ago. On physical
exam she is healthy with no significant findings. From urine culture is found Eschericia
coli wih CFU ≥ 100,000.
What is the most likely diagnosis in this patient?
UTI- complicated –cowo, menyerang fungsi ,
uncomplicated-cewe, asymptomatic

A. Acute pyelonephritic

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 B. Reflux nephropathy
C. Uncomplicated urinary tract infection
D. Complicated urinary tract infection
E. Chronic urinary tract infection

A 55-year-old man refers to ICU after the procedure open reduction of femur fracture and
bleeding intra operative. At the third day he became apatis, fever 38,5 C with blood pressure
110/60 mmHg, pulse 55 x/min, respiratory 20x/min, and urine output decreased to 10 cc/hour
in 24 hours. At laboratory examination findings creatinine 4 mg/dL (N: 0.5-1.5), ureum 100
mg/dL (N: 20-40), sodium 130 mEq/L (N: 135-155), potassium serum 7.5 mEq/L (N: 3.5-
5.5), blood sugar 200 mg/dL (N: <140).
From blood gas analysis finding pH 7.1, pCO2 30 mmHg, pO2 90 mmHg,
HCO3 18 mEq/L. ECG examination finds widening of QRS wave. - Hyperkalemia

Community –PCE (proteus, candida, e coli)

HAP- SKP (strep, klebsiella, pseudomonas)

15. What is the most critical condition can cause life threatening the patient?
A. nothing for awareness
B. ureum and creatinine at very high level
C. hyperkalemia
D. metabolic acidosis
E. severe hyponatremia

16. What is the treatment for the critical condition above?

A. Waiting for the general condition of the patient became more better
B. Give diuretic until the urine output will be normally
C. Hemodialysis immediately (karena ureum yg tinggi)
D. Give sodium bicarbonate until pH of blood became normal
E. Intubation and ventilator to maintain the respiratory

17. A 36-year-old male truck driver is referred to you for evaluation of recurrent urolithiasis.
The patient has passed more than 20 calcium oxalate stones since age 18. Previous
therapy with hydrochlorothiazide and cellulose phosphate has been ineffective. Physical
examination is normal. Laboratory finding: Serum creatinine 1.0 mg/dL, Serum uric acid
8.9 mg/dL, Urine pH 5.0
Radiographs of the abdomen show smooth renal silhouettes measuring 13.6 cm on the
right and 14.2 cm on the left, and no radioopaque at kidney region
(radioopaque- ca phosphate, Ca oxalate), radiolucent- uric acid,
struvite?.
From sonography findings multiple hyperechoic shadow from both kidney with measure
about 2 – 5 mm.
Which of the following treatment is the most effective for this patient?

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 A. Dietary sodium restriction
B. Dietary calcium supplementation
C. High fluid intake and long-term urine acidification
D. High fluid intake and allopurinol
E. Shock wave lithotripsy

18. A 75 year old man had urine incontinence since 3 months ago. He had been diagnosed
dementia by the doctor since 6 months ago. On examination he had no prostate problems.
What is the cause of his urination’s problem?
Incontinence - neurogenic(parasympatis-untk mempecepat urine-pipis putus),
stress(tekanna abodomen naik, operasi prostate, terlalu byk melahirkan),
overflow(obstruksi prostate, striktur urethra), urge
A. Impaired frontal inhibition
B. Impaired pontine inhibition
C. Sympathetic system dysfunction
D. Parasympathetic system dysfunction
E. Sensoric system dysfunction

19. A 44 year old man was hospitalized for systemic fungal infection. He was on Amfoterisin
B (ATN) treatment for 7 days. On examination, he is conscious, BP 120/80 mmHg, pulse
80 x/min, RR 16 x/min, temperature 36,7 C. Lab: Hb 13 gr%, HT 37%, WBC 8600,
Platelet 340.000. Ureum 91, creatinin 2, 0. Volume urine 800 cc/24 jam
What is the patognomonic laboratory finding in this case?
A. Increased osmolality
B. Leucocyturia
C. Muddy brown cast karena ATN
D. Erythrocyte cast
E. Haemoglobinuria

AIN – eosinophilia di urine, WBC cast(lebih jarang)

CKD( Waxy cast)
GN (hyaline cast)
ATN (muddy brown)
Acute GN (RBC cast)

20. A 24-year-old woman went to a physician because pain during urination and frequency.
On examination, she had has suprapubic pain, but no fever. Her urine was cloudy and
shows microscopic evidence of erythrocytes, pyuria, and gram-positive bacteria. In the

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 past medical history, she never had any symptoms like this one. Which organism is most
likely responsible for this patient’s illness?
A. Klebsiella pneumonia
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Proteus mirabilis
E. Staphylococcus saprophyticus (gram positive)

21. A 55-year-old male complains hematuria at the physician’s office for 2 weeks. A
cystoscopic examinations showed a 2 cm,exophytic,friable mass on the right bladder
dome.
A biopsy of this lesion show findings most consistent with a/an
A. Papilloma
B. Verrucous carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Adenocarcinoma

22. A 50-year-old male presents with a month long history of flank pain and hematuria.An
USG abdominal results a 3 cm bosselated mass, protrudes from cortical are in the right
kidney.Cytologic examination reveals malignant cells.
What is most likely biopsy finding for this patient?
A. Wilms tumor
B. Renal Cell Carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Undifferentited carcinoma

23. A 60-year-old male experiences the onzet of headache, naussea ,vomitting fo 1 month.
Physical examination reveals hypertention, subfebril. Pyelogram showed the affected
kidney assymmetrically contracted with deformity of the calyceal system. Gross of the
affected kidney showed contracted and has irregular granular surface.The parenchyma is
atrophic and replace by fibrosis. Microscopic showed glomerular sclerosis, hyalinization
and atrophi in cortical area. Another areas showed fibrosis, chronic inflammatory cells
with limpocytes agregation.
What is the most likely lesions occur in this kidney?
A. Renal cell carcinoma
B. Chronic pyelonephritis
C. Acute nephritis
D. Nephrotic syndrome
E. Diabetic nephropathy

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24. A 5-year-old boy child who had a palpable abdominal mass brought to hospital by his
mother. The child later had abdominal distention from bowel obstruction. An USG reveals
a 6 cm left renal mass with necrosis and hemorrhage. Microscopic showed embryonal
tissue with abortive of tubular and glomerular structures.
What is the diagnosis ot this patient?
A. Teratoma
B. Retinoblastoma
C. Wilms’tumor
D. Hanarthoma
E. Hemangioma

25. A 62-year-old woman presents with hematuria and left flank pain. Physical examination
reveals costovertebral angle tenderness. Renal ultrasound shows marked left
hydronephrosis. Serum creatinine and CBC are normal.
Which of the following diagnostic test is the most relevant?
A. Renal biopsy
B. Renal arteriogram (arteri renal stenosis)
C. Palpation for inguinal lymph nodes
D. Antinuclear antibody test (lupus)
E. IVP (first line hematuria )

USG batu kecil, batu ureter tidak terdeteksi – kelemahan

26. A 34-year-old man comes with 3-day history of low back pain, urinary hesitancy, and
pain with urination. He has not had any urethral discharge or recent sexual contacts. His
temperature is 38.2C, and blood pressure is 120/70 mm Hg. Pulse 96x/min, RR 20x/min.
There is no costovertebral angle tenderness. Abdominal examination shows no tenderness
or masses. Rectal examination shows no tender prostate and no masses.
Specific gravity 1.030; Blood negative; Glucose negative; Ketones negative;
Leukocyte esterase positive
What is the most likely diagnosis?
A. Benign prostatic hypertrophy
B. Cystitis
C. Prostatitis
D. Pyelonephritis
E. Urolithiasis

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27. A 55-year-old man is brought to the emergency due to acute onset of severe right-sided
flank pain. He has a 10-year history of gout. His blood pressure is 110/80 mm Hg, pulse
is 78x/min, and RR 16x/min. Examination shows normal bowel sounds and no abdominal
tenderness or masses. Urinalysis shows 40 erythrocytes/hpf. Intravenous pyelography
confirms a right ureteral calculus.
Which of the following underlying mechanism is responsible for this patient's condition?
A. An increase in urinary pH
B. Damage to the epithelial lining of the ureters
C. Lack of inhibitors of crystal formation
D. Presence of urease-splitting bacteria
E. Urinary supersaturation with uric acid

A 66-year-old man came to Emergency Department with shortness of breath as his chief
complaint. He also got nausea, vomiting and loss of appetite since 3 days ago. No diarrhea
was occurred prior to the symptoms. He was taking irregularly anti hypertension drugs for 20
years. Physical exam: weight 70 kg, blood pressure 190/110 mmHg, Pulse 120 x/min, and
Respiratory rate 46 x/min. Pale conjunctiva, fine crackles +/+ were heard on the both side of
the lung. Heart, liver and spleen were normal.
Lab results: Hb 7.2 g/dl, WBC 7000/mm3, trombosit 225000/mm3, random glucose 135
mg/dl, Ureum 150 mg/dl, Creatinin 5.2 mg/dl. Proteinuria +3

28. What is the most possible electrolyte level show?

A. Phosphate decreased
B. Calcium increased
C. Potassium decreased
D. Phosphate increased

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 E. Normal Calcium

29. A 25-year-old man has been crashed by a truck. The doctor suspects that his kidney is
rupture, and then he sent the patient to have IVP.
What is the most likely the appearance of renal parenchymal rupture in IVP?
A. The kidney shows non function
B. Ekstravasation
C. Hydronephrosis
D. Normal nephrogram
E. Dilatation of calyx

30. A 50-year-old man comes to the clinic with complain of abdominal colic. The result of
IVP demonstrates ureteric dilatation.
What is the most likely problem?
A. Stone in the pelvicureter junction
B. Kidney cyst
C. Stone in the vesicoureter junction
D. Renal cell Ca stage I
E. Acute inflammation

31. A 24-year-old woman went to a physician because of pain during urination. On

examination, she had has left flank tenderness and low-grade fever. Her urine was cloudy
and shows microscopic evidence of erythrocytes, pyuria, and gram-positive bacteria. In
the past medical history, she never had any symptoms like this one.
Which organism is most likely responsible for this patient’s illness?
A. Klebsiella pneumonia
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Proteus mirabilis
E. Staphylococcus saprophyticus

32. Which urine specimen is most appropriate for the culture examination?
A. Suprapubic aspiration
B. Mid stream
C. Straight catheter
D. Indwelling catheter
E. 24 hours urine collection

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33. A 30-year-pregnant woman was complaining fever, pain when urinating, blood in her
urine, and severe lower back pain. The physician submits her urine for culture; the next
day, the laboratory reports an organisms growth count of greater than 10 5/ml of urine. The
organism grew well on the blood agar and producing β–hemolytic colonies.
Which important virulence factor for the organism is most likely responsible for this
patient’s illness?
A. Capsule
B. P-fimbriae
C. Endotoxin
D. Phospolipase C
E. Lipooligopolysaccharide

34. A 30-year-old man patient complained of a sharp pain in his loin radiating down to his
perineum, accompanied by hematuria. He reported that he had a few days of urinary
urgency, frequency, and burning when urinating. On examination, his temperature was
37.5ºC; other vital sign were normal; and he appears to be in pain. A urinalysis shows
erythrocytes, leukocytes esterase and a high pH.
Which antigenic composition is most likely responsible for this illness?
A. Hemolysin
B. Catalase
C. Fibronectin
D. Opa protein
E. Cord factor

35. A 67-year-old man with an episode of acute urine retention was catheterized. Three days
later, he developed fever and suprapubic pain. Culture of urine revealed a thin film of
bacterial growth over the entire blood agar plate, and urease test was positive.
Which of the following is most likely organism to cause this infection?
A. Escherichia coli
B. Staphylococcus sapropyticus
C. Proteus mirabilis (urease)
D. Enterococcus faecalis
E. Morganella morgagni

36. A 34-year-old woman presents with pain during urination and frequency. On examination,
she had has suprapubic pain, but no fever. Her urine was cloudy and shows microscopic

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 evidence of erythrocytes, pyuria, and bacteria. The urine has a high pH. Which of the
following bacteria’s strategy is responsible for this condition?
A. Destroy blood vessel in the kidney
B. Exhibits “swarming” motility
C. Ferments many sugars
D. Produce a potent urease (high PH)
E. Secretes many exotoxins

37. IVP image of a new born baby shows that left kidney tremendously enlarged and clearly
demonstrates intra-parenchyma mass. What abnormality could possibly occur?
A. horseshoe kidney
B. pelvic kidney
C. unilateral renal agenesis
D. polycystic kidney (karena enlarge kidney)
E. pancake kidney
Congenital kidney:
Renal agenesis – fetus tidak bisa pipis, amniotic fluid deficient (dibawah 400ml)
Congenital polistik- ada kista di kidney
Horseshoe kidney – inferior jadi satu
Pelvic kidney- kedua kidney turun
Cross ectopia- satu turun
Hypospadia – urethra di bawah
Epispadia - urethra di atas
Hydrocele – akumulasi air di scrotum (transiluminasi test)
Varicocele- akumulasi darah (transilumination test)
Cryohidism - Testis tidak turun

38. Oligohydramnios can be related to malformation in kidney. Why can the amount of
amniotic fluid determine such malformation?
A. baby drinks the amniotic fluid
B. baby cannot drink amniotic fluid
C. amniotic fluid mostly contains urine
D. little amount of amniotic fluid causes the pelvic malformation
E. little amount of amniotic fluid disturbs the kidney development

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39. A new born baby boy has a malformation in genitourinary appearance. When he urinates,
the urine comes out from large area below the urethra opening. What process could
possible failed during the development of genitourinary process?
A. closure of genital fold
B. closure of genital opening
C. closure of genital tubercle
D. closure of urogenital sinus
E. closure of Wollfian duct

40. Cryptorchid condition results in germ cells failed to multiply, and then die and only in
Sertoli cells exist in seminferous tubules. What is the development process the main cause
of cryptorchid?
A. inguinal hernia
B. failure of testicular decent
C. failure of gubernaculums regression
D. fusion of the tunica albuginea and peritoneum
E. guevedoces

41. A 30-year-old man had nausea, vomiting, and severe colicky right flank pain radiating
into the thigh for 4 hours. He is afebrile. There is right costovertebral angle tenderness.
Urinalysis shows numerous RBCs and no bacteria.
Which of the following is the most likely diagnosis?
A. Acute glomerulonephritis
B. Bacterial cystitis
C. Benign prostatic hyperplasia
D. Urolithiasis
E. Renal cell carcinoma

42. A previously healthy 72-year-old man comes to the physician because of decreased
urinary output during the past 2 days; he has had no urinary output for 8 hours.
Examination shows suprapubic fullness and enlarged prostate.
Which of the following is the most appropriate next step in management?
A. PSA examination
B. Ultrasonography of the kidneys
C. CT scan of the abdomen

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 D. Bladder catheterization
E. Intravenous pyelography

43. An otherwise healthy 20-year-old woman is given sulfamethoxazole to treat a bladder

infection. Three days after beginning the antibiotic regimen, the patient has moderately
severe jaundice and dark urine. Pain with urination and a low-grade fever have resolved.
Her hematocrit is 20%. Substantial numbers of erythrocytes contain Heinz bodies. Her
condition worsens until day 6 of antibiotic therapy, when it begins to resolve. Symptoms
are completely gone by day 9 of continued antibiotic therapy.
Which of the following conditions is the most likely explanation for these findings?
A. Aplastic anemia
B. Generalized cytochrome-b5 reductase deficiency
C. Glucose-6-phosphate dehydrogenase deficiency
D. Pyruvate kinase deficiency
E. Steven Johnson Syndrome

44. A 61-year-old man comes to the physician because of a 3-month history of episodes of
headache, palpitation, and excessive sweating. He has had a 10-kg (22-lb) weight loss
during this period. While being examined, during an episode his blood pressure is
210/110 mm Hg. Physical examination shows no other abnormalities. Urine studies show
increased catecholamine concentrations. A CT scan of the abdomen is most likely to show
a mass in which of the following locations?
A. Adrenal glands
B. Ureter
C. Urethral
D. Bladder
E. Right kidney

45. A 6-year-old boy has a large intra-abdominal mass in the midline just above the
symphysis pubis. During an operation, a cystic mass is found attached to the umbilicus
and the apex of the bladder. Which of the following is the most likely diagnosis?
A. Hydrocele
B. Meckel cyst
C. Meckel diverticulum
D. Omphalocele

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 E. Urachal cyst (stenosis dibagian ke umbilical)
bau pesing (patent ductus urachus)

46. A 69-year-old man with 82 kg is referred to you with fatigue and laboratory result shows
Hb 7 g/dL, ureum 55 mg/dL, and creatinin 5.4 mg/dL. He has not seen a physician for
several years.
Which finding would help you decide that this condition is chronic?
A. Low serum calcium
B. Low serum bicarbonate
C. Protein detected in urinalysis
D. Broad waxy casts in urinalysis - CKD
E. Elevated serum phosphorus

47. A 52-year-old woman with longstanding type II diabetes is referred with

microalbuminuria and normal serum creatinine. Her weight is 85 kg and height is 160 cm.
Blood pressure is 150/100 mmHg.
Which of the following measures should you advise to prevent progression to overt
nephropathy?
A. Tight glucose control
B. High-protein and low carbohydrate diet
C. Blood pressure control
D. Regular diuretic
E. Increased water intake

48. A 20-year-old man presents with malaise, nausea, and decreased urine output. He was
previously well and his physical examination is normal except for an elevated jugular
venous pressure (JVP) and pericardia rub. His electrolytes reveal acute renal failure
(ARF).
Which of the following findings on the urinalysis is most likely in keeping with acute
glomerulonephritis?
A. Granular casts (ATN )
B. Erythrocyte casts (glomerulonephritis)
C. Proteinuria
D. Hyaline casts
E. White blood cell casts (AIN)

49. A 35-year-old women presents with nausea and vomiting of 2 days duration. She is not on
any medications and was previously well until now. Her physical examination is normal
except for postural drop in her blood pressure from 110/80 mmHg supine to 90/80 mmHg

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 standing. Her serum electrolytes are Sodium 130 mEq/L, Potassium 3 mEq/L, Chloride
90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL.
Which of the following electrolytes in the case above is most likely to be filtered through
the glomerulus but unaffected by tubular secretion?
Urea naik

A. Potassium
B. Urea
C. Creatinine
D. Bicarbonate
E. Sodium

50. A 68-year-old man came seeing a general practitioner with a swelling throughout the
body. He also felt urine volume decreases and the urine color was red. He denied any pain
on urination or in any part of his body, on physical examination costovertebrae angular
test negative. Blood test results obtained ureum 55 mg/dL (normal 20-40 mg/dL) and
creatinine 1.7 mg/dL (normal <1.1 mg/dL). Obtained urine lab protein 2 + and 50-60 red
blood cells.
Which of the following diuretics is the most appropriate for treating the patient above?
.A Acetazolamide
.B Furosemide (loop of henle) – MOST POWERFUL DIURETIC
.C Hidrochlorothiazid (distal)
.D Spironolactone (hyperkalemia) - NaK ATP ase tidak berbentuk
.E Triamteren / amiloride (NaK blocker- potassium sparing)

51. A 10 month pregnant woman complained lower abdominal pain, and suffering from
dysuria for 48 hours. Patient has mild fever, urine analysis showed 1+ protein, but did not
find any glucose, and blood. Gram stain shows a gram negative bacteria.
Which of the following drugs is the most appropriate for this patient condition?
Nitroflorantoin
Beta lactam – cephalosporin -
A. Chloramphenicol
B. Cefixime
C. Cephadroxil
D. Cotrimoxazole
E. Tetracycline

52. A 6-year-old girl, brought by her mother to the clinic with complaints of swelling that
begins from both of eyelid throughout her body. Blood tests obtained: albumin 2 g / dL,
total cholesterol 250 mg / dL. On examination of urine obtained protein +3. Which of the
following is the most likely diagnosis for the case above?
A. Nephritic syndrome

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 B. Nephrotic syndrome
C. Acute renal failure
D. Chronic renal failure
E. Glomerulonefritis
53. According to the case above, which of the following is the most likely pathophysiology
that caused of swelling?
A. Infection
B. Hypercholesterolemia
C. Hypoalbuminemia
D. Proteinuria
E. Water retention

54. A 39-year-old woman with a history of recurrent urinary tract infections and now
suffering that infection. Culture examination of urine samples showed Escherichia colli as
the cause of infection. Patients were given doses of ciprofloxacin in the treatment and
symptoms of infection disappear. Which of the following is the most correct process or
enzyme that inhibited by the drug?
A. Cell membrane synthesis
B. Cell protein synthesis
C. Dehidrofolate sintetase
D. DNA gyrase
E. DNA polimerase

55. A 74 years old man was admitted to the hospital for swollen ankle, hands and eyelids. Her
skin was pale, damp and cool. The patient’s vital signs were: blood pressure 170/90
mmHg, heart rate 100 beats/min, deep respiration 18 breath/min, and temperature 37.8°C.
The patient had no urine output and the laboratory report showed that the patient’s blood
urea nitrogen [BUN], creatinine, potassium and phosphate level s was all higher than
normal. A chest x-ray showed white, fluffy patches that spread outward from the hilar
areas to the peripheral border of both lungs. Her left ventricle appeared moderately
enlarged. Which of the following is the most likely caused of an altered renal function in
this case?
A. Elevated BUN level
B. No urine output
C. Heart failure
D. Pulmonary disease
E. Infection

56. A 50-year-old woman went to a Puskesmas complaining of edema in both legs which
became worse along the day. Her Blood pressure is 160/95 mmHg, pulse rate 70/min. She

17
 also had a history of an ischemic stroke. Laboratory test are,fasting blood sugar 150
mg/dL (N: <121 mg/dL), serum creatine 2.1mg/dL (N: <1.1 mg/dL), ureum 100mg%,
urinary protein ++.
Which of the following is the most appropriate drug should be given to the patient in
order to prevent secondary stroke attack?
A. Propranolol
B. Captopril (ACEI)
C. Reserpin
D. Hydrochlorothiazide
E. Furosemid

57. A 63-year-old man, came to a clinic with of pain on her knees, there are also looked
swelling and redness at her both of knees. She said that she also suffering edema in both
legs which became worse along the day. Her Blood pressure is 180/100 mmHg, pulse rate
90/min. Laboratory test result: Hb: 10.8 gram%, serum creatine 2.7mg/dL (N: <1.1
mg/dL), ureum 80mg%, urinary protein ++. You are suggesting giving an aspirin 3X500
mg with caution.
Which of the following is the most reason that you give the drug with caution?
A. It is ineffective
B. It causes hypokalemia
C. It worsen anemia
D. its metabolite is nephrotoxic
E. It decrease kidney filtration

58. A 55-year-old male complained at the physician’s office of his hematuria for 2 weeks
now. Urine cytologic examination showed malignancy cells. A cystoscopic examination
found a 2 cm, exophytic, friable mass on the right bladder dome.
A biopsy of this lesion will likely to show findings that mostly consistent with,
A. Papilloma
B. Verrucous carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Adenocarcinoma
59. Which of the following risk factors is most likely to have led to development of this
lesion?
A. Diabetes mellitus
B. Recurrent urinary tract infection

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 C. Therapy with methicillin
D. Cigarette smoking, aniline dye
E. Tuberous sclerosis

60. A 50-year old male was present with a month-long history of flank pain and hematuria.
An USG abdominal imaged a 3-cm bosselated mass which protruded from cortical in the
right kidney. The cytologic examination revealed malignant cells.
A biopsy of this mass will likely to show findings that mostly consistent with,
A. Wilms tumor
B. Renal Cell Carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Undifferentited carcinoma

61. On physical examination to a 60-year old male revealed hypertension and subfebril. He
has had history of nausea, vomit and right lateral abdominal pain for 2 months.
Pyelogram showed that the right kidney smaller than of the left, asymmetrically
contracted with deformity of the calyceal system. The right nephrectomy was performed
which showed contraction and it has irregular granular surface. The parenchyma is
atrophic and replaced by fibrosis. The microscopic showed glomerular sclerosis,
hyalinization and atrophy in cortical area. Another area showed fibrosis, with
lymphocytes aggregation.
Which of the following lesions could likely to happen in this kidney?
A. Renal cell carcinoma
B. Chronic pyelonephritis
C. Acute nephritis
D. Nephrotic syndrome
E. Diabetic nephropathy

62. A 5-year-old boy child who had a palpable abdominal mass was brought to hospital by his
mother. The child later had abdominal distention from bowel obstruction. An USG
revealed a 6cm left renal mass with necrosis and hemorrhage. The microscopic showed
embryonal tissue with abortive of tubular and glomerular structures.
The depicted lesion will most likely be,
A. Teratoma
B. Retinoblastoma
C. Wilms’tumor
D. Hanarthoma

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 E. Hemangioma

63. A 45 years old man, came to the hospital. And told the doctor that he had episodic severe
pain in the left abdomen and radiated into his flank and sometimes into his testical
(ipsilateral). From USG the doctor found 6 mm stone in his urinary tract.
What location is the most possible for the obstruction?
A. Upper ureter
B. Middle ureter
C. Lower ureter -
D. Vesicae urinariae
E. Urethra
Flank T10
Loin L2-L4
Groin S2-S3

64. If the patient felt the pain radiated from left abdomen to the testicle cause of a stone in his
ureter, what level of sympathetic fibers is the most responsible for ureter?
A. T 7-8
B. S 2-4
C. T 11-12
D. L1-3
E. L4-5

65. A 50-year-old man came to his doctor and told the doctor that for the last 2 months, he
felt burning on urination and the color was dark. The doctor told him to check his urine.
And the result:
pH :7 (N : 4.5 – 8) , WBC: 15-20/HPF (N : 0-2/HPF) ; RBC : 5-10/HPF (N: 0/HPF ).
Urine sediments show crystals with cuboid shape. – Calcium Oxalat
What is the most likely metabolic abnormality?
A. Hyperoxaluria
B. Hypercalciuria
C. Hypercitraturia
D. Hyperuricuria
E. Renal tubular acidosis
Pecah- Amorf
Rabut/bintang – calcium phosphat

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66. A 42-year-old man came to the hospital and said that his urine’s color is red and he saw
vermiform (bertentuk seperti cacing-panjang) clot. From his statement, could you tell the
possible source of his problem?
A. Ureter
B. Urethra
C. Bladder
D. Prostate
Blood Clot – gross hematuria, panjang/ bentuk cacing di ureter/tubulus, bulat di
bladder,. Gross hematuria bisa membentuk clotting. Clotting membentuk bentuk”.

67. A 50-year-old man is hospitalized for acute myocardial infarction. He has decreased
cardiac output with hypotension requiring multiple pressor agents. His urine output drops
over the next 3 days. His serum urea nitrogen increases to 59 mg/dL, with creatinine of
2.9 mg/dL. Urinalysis reveals no protein or glucose, a trace blood, and numerous hyaline
casts. Five days later, he develops polyuria and his serum urea nitrogen declines.
Which of the following pathologic findings in his kidneys is most likely to have caused
his azotemia?
A. Patchy tubular necrosis
B. Fusion of podocyte foot processes
C. Glomerular crescents
D. Hyperplastic arteriolosclerosis
E. Mesangial immune complex deposition

68. A 26-year-old diabetic woman is seen in the ER for sore throat. Rapid strep test is positive
for streptococcal pharyngitis and she was started on ampicillin 500 mg four times a day.
Three days later, she develops hematuria associated with a low grade fever. On physical
examination, she has a maculopapular rash and a temperature of 38 C. Laboratory studies
show: serum creatinine 3.6 mg/dl, WBC 8,700 with 56% PMN, 25% lymphs, 3% monos
and 15% eosinophils. Urinalysis: pH 6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30
WBCs/HPF, 3-4 WBC casts/HPF. ASTO value is increased.
What is the most likely diagnosis?
A. Diabetic nephropathy
B. IgA nephropathy
C. Acute interstitial nephritis
D. Acute pyelonephritis

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69. A 40-year old man with arthritis has been using ibuprofen (nonsteroidal anti-
inflammatory) every 6 hours. He developed renal failure associated with nephrotic range
proteinuria.
What is the most likely glomerular lesion in this patient?
A. Membranoproliferative glomerulonephritis (nephritic/nephrotic)
B. Minimal change disease – anak” (nephrotic)
C. IgA nephropathy (nephritic)
D. Diabetic nephropathy(nephrotic)
E. Focal segmental glomerulosclerosis (nephritic)

70. A 4-year-old-boy was brought to hospital with puffiness around the eyes, especially in the
morning and swelling over the legs. His mother also complaint he has foamy urine. Urine
sample shows protein ++++ (>3.5 per 1.73 m2 per 24 hour), albumin level 1.5g/dL
(normal=3.5-5g/dL). What is the most likely underlying mechanism in this patient?
What is the principal management in this patient?
A. Albumin 0,5-1 g/kg, iv, follow with furosemide 1-2 mg/kgBB/iv
B. Prednisone 40 mg/m2/day
C. Prednisone 60 mg/m2/day
D. Reduce sodium intake
E. Alkylating agent

71. A 5 day old baby was hospitalized due to indirect hyperbilirubinemia. On the third day
hospitalization he had fever and then he was given amoxicillin and gentamycin
intravenously. Three days later his urine output diminished and the laboratory test
revealed urea nitrogen 25 (3-12) mg/dL, creatinine 0.9 (0.2-0.4) mg/dL.
What is the most likely diagnosis in this patient?
A. Urinary tract infection
B. Sepsis
C. Acute renal failure
D. Chronic renal failure
E. Acute tubular nephritis

A 3 year old boy was brought to emergency unit Karawaci Hospital with severe diarrhea
since three days ago. On arrival he is not fully alert. His vital sign are as follows: blood
pressure is 80/60 mmHg, pulse is not palpable, respiratory rate was 36 breaths per minute,
and body temperature was 38.4oC. On physical exam there is sunken anterior fontanel, dry
mucous membranes, sunken eyes, lack of tears, poor skin turgor, and the capillary refill more
then 2 seconds. The daily urine volume is less than 400 mL.
72. In this patient, the tubular epithelial cells are particular susceptible to ischaemic injury
due to:
A. Little charged surface for reabsorption

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 B. Low metabolic rate and oxygen consumption
C. Decreased levels of salt reaching the distal tubules
D. Loss of polarity that cause redistribution of membrane proteins
E. Passive transport systems for ions and organic acids

73. The laboratory test in this patient reveal haemoglobin 15 g/dL( 11.5-15.5 g/dL),
hematocrit 46% (35-45%), WBC 7,000/mm3 (5,500-15,500/mm3), platelets count
260,000/mm3 (150,000-400,000 mm3), urea nitrogen 40 mg/dL (5-18 mg/dL), and
creatinine 1.7 mg/dL (0.3-0.7 mg/dL).
The most likely diagnosis in this patient is:
A. Acute tubular nephritis
B. Prerenal acute kidney injury
C. Intrinsic acute kidney injury
D. Postrenal acute kidney injury
E. Chonic renal failure

A 10 year old girl was brought to your clinic with disuria since 5 days ago. On physical exam
she is healthy with no significant findings. From urine culture is found Eschericia coli with
CFU ≥ 100,000.
74. What is the most likely diagnosis in this patient?
A. Acute pyelonephritic
B. Reflux nephropathy
C. Uncomplicated urinary tract infection
D. Complicated urinary tract infection
E. Chronic urinary tract infection

75. Factors unfavorable to bacterial growth in this patient’s urine is:

A. A low pH
B. A low concentration of urea
C. The absence of organic acids from a diet
D. A low osmolality
E. The presence of normal microorganism

76. An 8 years old boy presents with decreased urine output, hematuria, high blood pressure,
proteinuria add rising creatinine. One week ago he had a fever and sore throat. A renal
biopsy is carried out reveals diffuse proliferative glomerulonephritis. Electron microscope
will show abnormal deposits in what location?
A. Between basement membrane and endothelial cells of the glomeruli
B. Between the basement membrane and epithelial cells of the proximal tubule
C. Between the basement membrane and epithelial cells of the glomeruli
D. Within the juxtaglomerular apparatus

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77. A 45 years old female has a long history of poorly controlled diabetes. She presents now
with edema, hypertension and massive proteinuria, hematuria and hyperlipidemia. Renal
biopsy shows hyaline arteriosclerosis of the arterioles. What changes will be present in
the glomeruli?
A. Diffuse proliferative glomerulonephritis
B. Membranous proliferative gomerulonephritis
C. Membranous glomerulosclerosis
D. Focal segmental glomerulosclerosis
E. Nodular glomerulosclerosis
78. A 64-year-old male presents with hematuria. Examination shows a flank mass and he has
elevated hemoglobin. Pathology of the surgical specimen shows a clear cell renal cell
carcinoma. What is the cell of origin of this tumor?
A. Glomerulocyte
B. Glomerular endothelium
C. Glomerular epithelium
D. Proximal tubular epithelium
E. Histiocyte

79. A 32-year-old female presents with headaches. Investigation reveals hypertension

(180/110 mmHg) and very high level of aldosterone presumed due to a tumor. What of
the following is characteristic of this condition?
A. Elevated serum sodium levels
B. Elevated serum potassium levels
C. Elevated urinary cortisols
D. Elevated urinary bicarbonate

80. An 18-year-old male presents to emergency following a motorcycle accident. There is

significant blood loss. In the ER, his BP is 90/60 mmHg and his pulse is 120 x/min. What
physiological response occurs in the kidney?
A. Decreased urine osmolality
B. Reduced release and action of ADH
C. Beta adrenergic stimulation of the vasculature
D. Vasoconstriction of the renal arterioles
E. Reduced aldosterone production and sodium loss

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