Nephrology: acute tubular necrosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: acute tubular necrosis

Sample item

A patient with septic shock develops oliguria. Urine microscopy shows muddy brown granular casts and FENa is 3 percent. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Acute tubular necrosis

Muddy brown granular casts and FENa above 2 percent point to ischaemic or toxic acute tubular necrosis. Urine is isosthenuric because tubular concentrating ability is lost. Management is supportive, and recovery often follows a diuretic phase.

Option by option

  • A. Prerenal azotaemia

    Prerenal AKI has bland sediment and low FENa.

  • B. Acute tubular necrosis (correct)

    Correct. These findings are typical of ATN.

  • C. Post-streptococcal glomerulonephritis

    PSGN shows red cell casts.

  • D. Renal artery stenosis

    Renal artery stenosis does not give muddy brown casts.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Acute tubular necrosis. Muddy brown granular casts and FENa above 2 percent point to ischaemic or toxic acute tubular necrosis.

Why is "Prerenal azotaemia" not the answer?

Prerenal AKI has bland sediment and low FENa.

Why is "Post-streptococcal glomerulonephritis" not the answer?

PSGN shows red cell casts.

Why is "Renal artery stenosis" not the answer?

Renal artery stenosis does not give muddy brown casts.

What concept does this question test?

It tests Nephrology: acute tubular necrosis in General Medicine. Urine is isosthenuric because tubular concentrating ability is lost. Management is supportive, and recovery often follows a diuretic phase.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: acute tubular necrosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.