LATEST PEDIATRIC NEPHROLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 5-year-old child presents with periorbital edema
and frothy urine. Urinalysis shows 3+ protein. Serum
albumin is 2.0 g/dL (normal 3.5-5.0). Cholesterol is
300 mg/dL (elevated). What is the most likely
diagnosis?
A) Minimal change disease (nephrotic syndrome)
B) Post-streptococcal glomerulonephritis (PSGN)
C) IgA nephropathy
D) Hemolytic uremic syndrome (HUS)
Correct answer: A
Rationale: Nephrotic syndrome is defined by
proteinuria (>40 mg/m²/hr or urine protein/creatinine
ratio >2 mg/mg), hypoalbuminemia (<2.5 g/dL),
edema, and hyperlipidemia. Minimal change disease
is the most common cause in children (75-80%).
2. A 7-year-old child presents with gross hematuria
(cola-colored urine), edema, and hypertension. He
,had a sore throat 2 weeks ago. Serum C3
complement is low. What is the most likely diagnosis?
A) Post-streptococcal glomerulonephritis (PSGN)
B) IgA nephropathy (normal C3)
C) Membranoproliferative glomerulonephritis (MPGN)
(low C3)
D) Alport syndrome (hereditary nephritis)
Correct answer: A
Rationale: PSGN (post-infectious) presents with
acute nephritic syndrome (hematuria, edema,
hypertension, oliguria) 1-2 weeks after Group A Strep
infection. Low C3 is characteristic (normalizes in 6-8
weeks). ASO titer elevated.
3. A 10-year-old child presents with painless, gross
hematuria (tea-colored) after an upper respiratory
infection. Serum C3 is normal. Renal biopsy shows
mesangial IgA deposits. What is the most likely
diagnosis?
A) IgA nephropathy (Berger disease)
B) Post-streptococcal glomerulonephritis (low C3)
C) Alport syndrome (hereditary, sensorineural
hearing loss)
,D) Thin basement membrane disease (benign familial
hematuria)
Correct answer: A
Rationale: IgA nephropathy is the most common
glomerulonephritis worldwide, presenting with
episodic gross hematuria (often after URI or GI
infection). C3 is normal. IgA deposits on
immunofluorescence.
4. A 3-year-old child with nephrotic syndrome
(minimal change disease) is started on prednisone
(60 mg/m²/day). After 4 weeks, the urine protein is
still 3+ (steroid-resistant). What is the most
appropriate next step?
A) Renal biopsy (to rule out focal segmental
glomerulosclerosis, FSGS)
B) Continue prednisone for another 4 weeks (some
respond later)
C) Add cyclophosphamide (alkylating agent)
D) Start tacrolimus (calcineurin inhibitor)
Correct answer: A
Rationale: Steroid-resistant nephrotic syndrome (no
remission after 4-6 weeks of high-dose prednisone)
requires renal biopsy to determine histology (FSGS,
, membranoproliferative, membranous). Minimal
change disease is usually steroid-sensitive.
5. A 6-year-old child with a history of hematuria and
sensorineural hearing loss. His mother has end-stage
renal disease (ESRD). What is the most likely
diagnosis?
A) Alport syndrome (X-linked, COL4A5 mutation)
(hereditary nephritis)
B) Thin basement membrane disease (benign, normal
hearing)
C) IgA nephropathy (no hearing loss)
D) Post-streptococcal glomerulonephritis (acute,
self-limited)
Correct answer: A
Rationale: Alport syndrome (X-linked dominant)
presents with hematuria, progressive renal failure,
sensorineural hearing loss, and ocular findings
(anterior lenticonus). COL4A5 mutation (type IV
collagen).
6. A 4-year-old child presents with acute kidney injury
(AKI) (creatinine 2.0 mg/dL) following a diarrheal
illness (bloody diarrhea). Platelets are 50,000/μL,
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 5-year-old child presents with periorbital edema
and frothy urine. Urinalysis shows 3+ protein. Serum
albumin is 2.0 g/dL (normal 3.5-5.0). Cholesterol is
300 mg/dL (elevated). What is the most likely
diagnosis?
A) Minimal change disease (nephrotic syndrome)
B) Post-streptococcal glomerulonephritis (PSGN)
C) IgA nephropathy
D) Hemolytic uremic syndrome (HUS)
Correct answer: A
Rationale: Nephrotic syndrome is defined by
proteinuria (>40 mg/m²/hr or urine protein/creatinine
ratio >2 mg/mg), hypoalbuminemia (<2.5 g/dL),
edema, and hyperlipidemia. Minimal change disease
is the most common cause in children (75-80%).
2. A 7-year-old child presents with gross hematuria
(cola-colored urine), edema, and hypertension. He
,had a sore throat 2 weeks ago. Serum C3
complement is low. What is the most likely diagnosis?
A) Post-streptococcal glomerulonephritis (PSGN)
B) IgA nephropathy (normal C3)
C) Membranoproliferative glomerulonephritis (MPGN)
(low C3)
D) Alport syndrome (hereditary nephritis)
Correct answer: A
Rationale: PSGN (post-infectious) presents with
acute nephritic syndrome (hematuria, edema,
hypertension, oliguria) 1-2 weeks after Group A Strep
infection. Low C3 is characteristic (normalizes in 6-8
weeks). ASO titer elevated.
3. A 10-year-old child presents with painless, gross
hematuria (tea-colored) after an upper respiratory
infection. Serum C3 is normal. Renal biopsy shows
mesangial IgA deposits. What is the most likely
diagnosis?
A) IgA nephropathy (Berger disease)
B) Post-streptococcal glomerulonephritis (low C3)
C) Alport syndrome (hereditary, sensorineural
hearing loss)
,D) Thin basement membrane disease (benign familial
hematuria)
Correct answer: A
Rationale: IgA nephropathy is the most common
glomerulonephritis worldwide, presenting with
episodic gross hematuria (often after URI or GI
infection). C3 is normal. IgA deposits on
immunofluorescence.
4. A 3-year-old child with nephrotic syndrome
(minimal change disease) is started on prednisone
(60 mg/m²/day). After 4 weeks, the urine protein is
still 3+ (steroid-resistant). What is the most
appropriate next step?
A) Renal biopsy (to rule out focal segmental
glomerulosclerosis, FSGS)
B) Continue prednisone for another 4 weeks (some
respond later)
C) Add cyclophosphamide (alkylating agent)
D) Start tacrolimus (calcineurin inhibitor)
Correct answer: A
Rationale: Steroid-resistant nephrotic syndrome (no
remission after 4-6 weeks of high-dose prednisone)
requires renal biopsy to determine histology (FSGS,
, membranoproliferative, membranous). Minimal
change disease is usually steroid-sensitive.
5. A 6-year-old child with a history of hematuria and
sensorineural hearing loss. His mother has end-stage
renal disease (ESRD). What is the most likely
diagnosis?
A) Alport syndrome (X-linked, COL4A5 mutation)
(hereditary nephritis)
B) Thin basement membrane disease (benign, normal
hearing)
C) IgA nephropathy (no hearing loss)
D) Post-streptococcal glomerulonephritis (acute,
self-limited)
Correct answer: A
Rationale: Alport syndrome (X-linked dominant)
presents with hematuria, progressive renal failure,
sensorineural hearing loss, and ocular findings
(anterior lenticonus). COL4A5 mutation (type IV
collagen).
6. A 4-year-old child presents with acute kidney injury
(AKI) (creatinine 2.0 mg/dL) following a diarrheal
illness (bloody diarrhea). Platelets are 50,000/μL,
