MEDICINE NEPHROLOGY COMPREHENSIVE
STUDY GUIDE QUESTIONS AND
SOLUTIONS 2026 MASTER CLINICAL
REVIEW PACK
◉ Afferent Arteriole
Answer: The small artery that carries blood toward the capillaries of
the glomerulus.
◉ Glomerulus
Answer: A ball of capillaries surrounded by Bowman's capsule in the
nephron and serving as the site of filtration in the vertebrate kidney.
◉ Efferent Arteriole
Answer: The small artery that carries blood away from the
capillaries of the glomerulus.
◉ Peritubular Capillaries
Answer: The network of tiny blood vessels that surrounds the
proximal and distal tubules in the kidney, allowing reabsorption and
secretion between blood and the inner lumen of the nephron.
,◉ Urinary Casts
Answer: Gelatinous structures that take the shape of the renal
tubules. *If you see these in urinalysis, then this indicates an
intrinsic problem within the kidney tubules (NOT a problem
OUTSIDE the kidneys!).*
◉ Urinary Casts
Answer: *Urinary Casts*
• Broad/Waxy Cast = CKD; chronic kidney failure
• WBC Cast = Interstitial nephritis or pyelonephritis
• RBC Cast = Glomerulonephritis
• Fatty Cast = Nephrotic Syndrome
• Renal Tubular Epithelial Cast = Acute tubular necrosis (ATN)
• Granular Cast = Chronic kidney failure; muddle brown means ATN
• Hyaline Cast = Exercise, diuretics, and increase in urine
concentration
◉ Broad/Waxy Cast
Answer: Chronic kidney disease or chronic kidney failure will result
in which kind of cast:
◉ WBC Cast
,Answer: Interstitial nephritis or pyelonephritis will result in which
kind of cast:
◉ RBC Cast
Answer: Glomerulonephritis will result in which kind of cast:
◉ Fatty Cast
Answer: Nephrotic syndrome will result in which kind of cast:
◉ Renal Tubular Epithelial (Muddy Brown) Cast
Answer: Acute tubular necrosis will result in which kind of cast:
◉ Granular Cast
Answer: Chronic kidney failure and acute tubular necrosis will result
in which kind of cast:
◉ Hyaline Cast
Answer: Exercise, diuretics, and an increase in urine concentration
will result in which kind of cast: This cast is composed of Tamm-
Horsfall mucoprotein.
◉ Nephrotic Syndrome
, Answer: A disease process characterized by massive proteinuria
(greater than 3.5 grams/day), hypoalbuminemia (caused by loss of
protein), hyperlipidemia (loss of protein causes hepatic protein
synthesis - cholesterol is produced in the liver), and edema (d/t loss
of oncotic pressure). Primary causes include: minimal change
disease, focal segmental glomerulosclerosis, and membranous
neuropathy. Secondary causes include: DM, SLE, infections,
amyloidosis, sarcoidosis. Clinical presentation: edema in legs, scrotal
area, periorbital region, pleural effusions. Hypercoagulability (b/c
liver tries to make more of everything [including clotting factors]
because everything is getting lost in the urine). Urine is frothy. To
diagnose, greater than 3.5 g/day of protein in urine. On CMP, observe
hypoalbuminemia and elevated BUN/Creatinine. Oval fat bodies on
microscopy. Hyperlipidemia. Treatment: prednisone (first-line). If
refractory, use immunomodulating agents like cyclophosphamide.
Use thiazide (HCTZ) or loop (furosemide) diuretics. To reduce
proteinuria and protect kidneys, give ACE inhibitors (works to dilate
the efferent arteriole, thus decreasing direct pressure of fluid on the
glomerulus).
◉ • Minimal Change Disease
• Focal Segmental Glomerulosclerosis (FSGS)
• Membranous Nephropathy
Answer: What are some causes of nephrotic syndrome?
◉ • Kidney disease characterized by proteinuria (greater than 3.5
g/day), hypoalbuminemia, hyperlipidemia, and edema.
STUDY GUIDE QUESTIONS AND
SOLUTIONS 2026 MASTER CLINICAL
REVIEW PACK
◉ Afferent Arteriole
Answer: The small artery that carries blood toward the capillaries of
the glomerulus.
◉ Glomerulus
Answer: A ball of capillaries surrounded by Bowman's capsule in the
nephron and serving as the site of filtration in the vertebrate kidney.
◉ Efferent Arteriole
Answer: The small artery that carries blood away from the
capillaries of the glomerulus.
◉ Peritubular Capillaries
Answer: The network of tiny blood vessels that surrounds the
proximal and distal tubules in the kidney, allowing reabsorption and
secretion between blood and the inner lumen of the nephron.
,◉ Urinary Casts
Answer: Gelatinous structures that take the shape of the renal
tubules. *If you see these in urinalysis, then this indicates an
intrinsic problem within the kidney tubules (NOT a problem
OUTSIDE the kidneys!).*
◉ Urinary Casts
Answer: *Urinary Casts*
• Broad/Waxy Cast = CKD; chronic kidney failure
• WBC Cast = Interstitial nephritis or pyelonephritis
• RBC Cast = Glomerulonephritis
• Fatty Cast = Nephrotic Syndrome
• Renal Tubular Epithelial Cast = Acute tubular necrosis (ATN)
• Granular Cast = Chronic kidney failure; muddle brown means ATN
• Hyaline Cast = Exercise, diuretics, and increase in urine
concentration
◉ Broad/Waxy Cast
Answer: Chronic kidney disease or chronic kidney failure will result
in which kind of cast:
◉ WBC Cast
,Answer: Interstitial nephritis or pyelonephritis will result in which
kind of cast:
◉ RBC Cast
Answer: Glomerulonephritis will result in which kind of cast:
◉ Fatty Cast
Answer: Nephrotic syndrome will result in which kind of cast:
◉ Renal Tubular Epithelial (Muddy Brown) Cast
Answer: Acute tubular necrosis will result in which kind of cast:
◉ Granular Cast
Answer: Chronic kidney failure and acute tubular necrosis will result
in which kind of cast:
◉ Hyaline Cast
Answer: Exercise, diuretics, and an increase in urine concentration
will result in which kind of cast: This cast is composed of Tamm-
Horsfall mucoprotein.
◉ Nephrotic Syndrome
, Answer: A disease process characterized by massive proteinuria
(greater than 3.5 grams/day), hypoalbuminemia (caused by loss of
protein), hyperlipidemia (loss of protein causes hepatic protein
synthesis - cholesterol is produced in the liver), and edema (d/t loss
of oncotic pressure). Primary causes include: minimal change
disease, focal segmental glomerulosclerosis, and membranous
neuropathy. Secondary causes include: DM, SLE, infections,
amyloidosis, sarcoidosis. Clinical presentation: edema in legs, scrotal
area, periorbital region, pleural effusions. Hypercoagulability (b/c
liver tries to make more of everything [including clotting factors]
because everything is getting lost in the urine). Urine is frothy. To
diagnose, greater than 3.5 g/day of protein in urine. On CMP, observe
hypoalbuminemia and elevated BUN/Creatinine. Oval fat bodies on
microscopy. Hyperlipidemia. Treatment: prednisone (first-line). If
refractory, use immunomodulating agents like cyclophosphamide.
Use thiazide (HCTZ) or loop (furosemide) diuretics. To reduce
proteinuria and protect kidneys, give ACE inhibitors (works to dilate
the efferent arteriole, thus decreasing direct pressure of fluid on the
glomerulus).
◉ • Minimal Change Disease
• Focal Segmental Glomerulosclerosis (FSGS)
• Membranous Nephropathy
Answer: What are some causes of nephrotic syndrome?
◉ • Kidney disease characterized by proteinuria (greater than 3.5
g/day), hypoalbuminemia, hyperlipidemia, and edema.
