American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition is associated with preceding upper respiratory tract infection symptoms followed by nephritic syndrome?

1. Poststreptococcal glomerulonephritis

2. Acute interstitial nephritis

3. Membranous nephropathy

4. IgA nephropathy

The correct answer is: Poststreptococcal glomerulonephritis

The association of preceding upper respiratory tract infection symptoms followed by nephritic syndrome is characteristic of poststreptococcal glomerulonephritis. This condition typically occurs after an infection, most commonly with group A beta-hemolytic streptococcus, leading to an immune-mediated response. In many cases, patients may present with symptoms of a sore throat or skin infection weeks before developing signs of nephritis, such as hematuria, proteinuria, and hypertension. The timing of the nephritic symptoms relative to the infection is crucial; it usually presents 1 to 3 weeks after the infection resolves, which helps differentiate it from other conditions. This specific sequence of events—upper respiratory illness followed by renal symptoms—highlights the post-infectious nature of this glomerular disease. Other conditions listed do not typically demonstrate this clear temporal relationship with upper respiratory infections. For instance, acute interstitial nephritis usually results from drug reactions or infections, but it doesn't follow a typical upper respiratory tract infection. Membranous nephropathy is more often idiopathic or associated with other processes, including malignancy or autoimmune diseases, without a clear preceding respiratory illness. IgA nephropathy can follow respiratory infections but more commonly manifests with episodes