PANCE, Medical exams, 5%

Renal System

Renal questions test acute kidney injury categories, chronic kidney disease staging, glomerular disease patterns, stones, and the fluid, electrolyte, and acid-base problems that accompany them. Urinalysis interpretation is the recurring skill.

Position: 13 of 15 content areas
Published weighting: 5% in the official framework
Topics covered: 6 topics in this guide

What is covered

Topics inside this content area.

These topics describe the scope students most often review for this part of PANCE. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Acute kidney injury: Prerenal, intrinsic, and postrenal patterns with the urine studies that separate them.
Chronic kidney disease: Staging, progression control, and complication management.
Glomerular disease: Nephritic versus nephrotic presentations and their classic associations.
Nephrolithiasis: Stone types, imaging choice, and size-based management thresholds.
Fluid, electrolyte, and acid-base disorders: Sodium and potassium emergencies plus a reliable blood-gas method.
Cystic and hereditary kidney disease: Polycystic kidney disease features and screening implications.

Study tips

How to practice Renal.

Section-specific guidance that follows from how this material is usually tested.

Adopt one acid-base algorithm and apply it to every practice gas without shortcuts.
Sort AKI cases with the fractional excretion of sodium and the clinical story together.
Summarize nephritic versus nephrotic findings in a two-column table you rebuild from memory.

Where this fits

Renal System is 13 of 15 content areas in the PANCE guide, and it carries a published weighting of 5% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the PANCE guide Official exam information

Sample Renal questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Which urine microscopy finding is characteristic of acute tubular necrosis?
1. AMuddy brown granular casts
2. BRed blood cell casts
3. CWhite blood cell casts
4. DBroad waxy casts
Show answer
Answer: A. Muddy brown granular casts
Sloughed tubular epithelial cells and their debris form the pigmented granular casts that define acute tubular necrosis on urinalysis. Red blood cell casts are the tempting distractor because they also signal intrinsic kidney injury, but they indicate glomerular inflammation rather than tubular damage.
Key insight: Cast type localizes intrinsic kidney injury: granular means tubules, red cell means glomeruli, white cell means interstitium.
Question 2Foundational
Which kidney syndrome is defined by proteinuria above 3.5 grams per day together with hypoalbuminemia, edema, and hyperlipidemia?
1. ANephrotic syndrome
2. BNephritic syndrome
3. CAcute interstitial nephritis
4. DAcute tubular necrosis
Show answer
Answer: A. Nephrotic syndrome
Nephrotic syndrome reflects a leaky glomerular filtration barrier, so massive protein loss drives low albumin, edema, and compensatory hyperlipidemia. Nephritic syndrome is the tempting distractor, but that inflammatory picture leads with hematuria, red blood cell casts, and hypertension, and its proteinuria is usually subnephrotic.
Key insight: Nephrotic leaks protein; nephritic leaks blood and raises the blood pressure.
Question 3Intermediate
True or false: in prerenal acute kidney injury the fractional excretion of sodium is typically less than 1 percent.
1. ATrue
2. BFalse
Show answer
Answer: A. True
Reduced kidney perfusion triggers avid tubular sodium and water reabsorption, so the fraction of filtered sodium that reaches the urine falls below 1 percent while the urine stays concentrated. In acute tubular necrosis the damaged tubules cannot reabsorb sodium, so the fractional excretion typically rises above 2 percent, which is what makes the test useful.
Key insight: Thirsty but intact tubules hold on to sodium; injured tubules cannot, which is why the fractional excretion of sodium separates the two.
Question 4Intermediate
Which imaging study is the most sensitive for detecting kidney stones in an adult with acute flank pain?
1. ANoncontrast helical CT of the abdomen and pelvis
2. BRenal ultrasonography
3. CPlain abdominal radiography
4. DIntravenous pyelography
Show answer
Answer: A. Noncontrast helical CT of the abdomen and pelvis
Noncontrast CT detects stones of essentially any composition along with their size and location, and it also reveals alternative causes of flank pain. Ultrasonography is the tempting distractor and is preferred when radiation must be avoided, such as in pregnancy, but it misses small and mid-ureteral stones.
Key insight: Noncontrast CT is the most sensitive stone study; ultrasound is the radiation-sparing alternative, not the more accurate one.
Question 5Advanced
An arterial blood gas shows a pH of 7.28, a PaCO2 of 30 mm Hg, and a serum bicarbonate of 14 mEq/L. Which acid-base disturbance does this represent?
1. AMetabolic acidosis with appropriate respiratory compensation
2. BRespiratory acidosis with metabolic compensation
3. CMetabolic alkalosis with respiratory compensation
4. DRespiratory alkalosis with metabolic compensation
Show answer
Answer: A. Metabolic acidosis with appropriate respiratory compensation
The pH is acidemic and the bicarbonate is low, which identifies a metabolic acidosis, and the low PaCO2 shows that hyperventilation is compensating rather than causing the problem. Winter formula predicts a PaCO2 of about 29 mm Hg for a bicarbonate of 14, so the measured value of 30 confirms that compensation is appropriate and no second disorder is hiding.
Key insight: Compensation never overcorrects the pH, so the primary disorder is always the one that moves the pH in the direction it actually went.

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