患者男性，34岁，2年来反复镜下血尿，偶见红细胞管型。尿蛋白定量1.3g/d，血肌酐 102μmol/L，尿素氮5.4mmol/L，ALB 30g/L，IgA 0.6g/L，抗“O”600U。为了明确诊断，最有价值的进一步检查是

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• 1患者男性，13岁。上呼吸道感染后2周出现颜面水肿伴肉眼血尿，血压150/95mmHg，内生肌酐清除率下降，拟诊急性肾炎。实验室检查：血红蛋白95g/L，患者贫血的原因可能是

  A.水钠潴留，血液稀释

  B.骨髓抑制

  C.红细胞破坏增多

  D.失血

  E.促红细胞生成素生成减少

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• 2患者女性，29岁，间歇性颜面及下肢水肿4年。查体：血压150/95mmHg，Hb90g/L，尿蛋白（++)，RBC 15〜20个/HP，BUN 8.7mmol/L，Cr148μmol/L。可能的诊断是

  A.隐匿性肾炎

  B.肾病综合征

  C.急性肾炎

  D.慢性肾炎

  E.高血压肾损害

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• 3A 60-year-old previously healthy man has been feeling tired for the past 15 days. He goes to his physician when he passes dark-colored urine. On physical examination his blood pressure is 155/90mmHg. Laboratory studies show his serum creatinine is 390μmol/L, P-ANCA 1 ： 160( + ). A urinalysis reveals pH 6,specific gravity 1.011,4+ blood,2+ pro­tein, no glucose,and no ketones. Which of the following pathologic findings on renal biopsy is most likely to be present in this man

  A.大于50% glomerular crescents

  B.Widened proximal tubules

  C.Lymphocytes infiltration

  D.Severe interstitial fibrosis

  E.IgA deposited in glomerular capillaries

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• 4A 39-year-old male presents with a long-standing history of hypertension. Investigations show a urea of 9.2mmol/L and a Creatinine of 142μmol/L. Which one of the following would suggest a diagnosis of acute glomerulonephritis

  A.24 hour urinary protein excretion of 3.1g

  B.Unilaterally smaller kidney

  C.RBC casts in urinary sediment

  D.Dyslipidaemia

  E.Shrunken glomeruli on renal biopsy

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• 5患者男性，18岁。1周来尿少色红，伴眼睑和双下肢水肿，血压150/90mmHg，尿蛋白（++)，RBC10〜20个/HP，WBC5〜10个/HP，血红蛋白136g/L，肌酐 95μmol/L。追问病史，3周前有咽痛发热史。该患者最可能的诊断为

  A.急性肾炎

  B.急进性肾炎

  C.急性肾盂肾炎

  D.肾病综合征

  E.慢性肾炎急性发作

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• 6A 23 year-old female presents at 16 weeks into her first pregnancy with a blood pressure of 144/96mmHg. A 24 hour urine collection reveals a protein excretion of 1.7g/ d. What is the most likely explanation for these findings

  A.Normal changes of pregnancy

  B.Gestational hypertension

  C.Essential hypertension

  D.Pre-eclampsia

  E.Hypertension secondary to chronic glomerulonephritis

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• 7患者男性，16岁，上呼吸道感染后2周出现眼睑水肿、肉眼血尿。查体：血压145/90mmHg，血补体下降，血肌酐98μmol/L。其发生水肿的主要机制是

  A.全身毛细血管通透性增高

  B.低白蛋白血症

  C.抗利尿激素分泌增加

  D.肾小球滤过率下降

  E.淋巴回流受阻

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• 8急性肾小球肾炎的实验室检查改变包括

  A.血清补体C3下降

  B.血清抗链球菌溶血素“O”滴度升高

  C.早期血沉升高

  D.血清抗核抗体滴度升高

  E.血肌酐可一过性升高

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• 9与溶血性链球菌感染有关的疾病有

  A.风湿热

  B.狼疮性肾炎

  C.过敏性紫癜

  D.亚急性细菌性心内膜炎

  E.急性肾小球肾炎

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• 10在某些情况下，急性肾小球肾炎需肾活检以进一步明确诊断，如

  A.病情不典型者，如伴肾病综合征

  B.无补体C3持续下降

  C.少尿1周以上或进行性尿量减少伴肾功能进行性恶化

  D.镜下血尿3个月仍持续存在

  E.病情1〜2个月未恢复

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