Nephrotube Ckd Module End Exam
20 MCQs
60 min
Good Luck
Gawad
- 1.
A 58-yr-old white man was diagnosed 2 yr ago with type 2 diabetes. His 46-yr-old sister also has type 2 diabetes and has recently had a myocardial infarction. He was initially treated with oral hypoglycemic agents but was started on insulin 2 mo ago because of poor blood glucose control. He continues to smoke 1 package of cigarettes per day. On physical examination, he is obese with a body mass index of 32 kg/m2. Blood pressure (BP) is 120/75 mmHg, and pulse is 110 beats per minute. Funduscopic exam revealed background retinopathy. Laboratory studies included a serum creatinine of 1.1 mg/dl, an albumin/ creatinine ratio of 200 mg/g (normal 17 mg/g), hemoglobin A1C is 9.8%, and serum cholesterol is 298 mg/dl. Which ONE of the following treatment choices should be recommended to the patient?
- A.
Stop insulin treatment and begin a combination of oral hypoglycemic agents.
- B.
Perform angiotensin-converting enzyme (ACE) polymorphism studies and start treatment with an ACE inhibitor if his genotype is DD.
- C.
Start treatment with an angiotensin II receptor blocker (ARB).
- D.
Start treatment with a beta-blocker.
- E.
Monitor albumin/creatinine ratio every 6 mo and institute treatment with an ARB if he develops overt albuminuria (albumin/creatinine ratio 250 mg/g).
Correct Answer
C. Start treatment with an angiotensin II receptor blocker (ARB).Explanation
The patient in this case has type 2 diabetes and is at increased risk for cardiovascular complications due to his family history and smoking habit. His blood pressure is within the normal range, but his albumin/creatinine ratio is elevated, indicating early kidney damage. Starting treatment with an angiotensin II receptor blocker (ARB) is recommended in this case as ARBs have been shown to slow the progression of kidney disease in patients with diabetes. This treatment choice aims to protect the patient's kidneys and reduce the risk of further complications.Rate this question:
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- 2.
A 38-yr-old African-American woman is found to have microscopic hematuria on a routine physical examination. Her only significant history is a normal labor and delivery at age 22. Her mother and a maternal aunt are on hemodialysis for end-stage renal disease (ESRD) secondary to polycystic kidney disease (PKD). On physical examination, blood pressure (BP) is 145/95 mmHg, pulse is 80 beats/ min, and weight is 75 kg. Her serum creatinine is 1.2 mg/dl; her hemoglobin is 14.5 g/dl; urinalysis shows specific gravity of 1.017, no protein, trace blood, and 5 to 10 red blood cells/high power field. A spot urine protein/creatinine ratio is 150 mg/g (normal 200 mg/g), and urine sodium is 102 mEq/L. Renal ultrasound demonstrates multiple cysts in both kidneys. Which ONE of the following is true regarding her condition?
- A.
She does not have chronic kidney disease (CKD) because her serum creatinine and protein excretion are both normal.
- B.
Estimating glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) study equation is not accurate in PKD patients.
- C.
She has CKD on the basis of the microscopic hematuria and abnormal renal ultrasound.
- D.
On the basis of her current serum creatinine, she is unlikely to develop ESRD during her lifetime.
- E.
GFR should be measured by 125I-iothalamate clearance to appropriately stage her CKD.
Correct Answer
C. She has CKD on the basis of the microscopic hematuria and abnormal renal ultrasound.Explanation
The patient's history of microscopic hematuria and abnormal renal ultrasound findings indicate the presence of chronic kidney disease (CKD). CKD is defined by the presence of kidney damage or decreased kidney function for three months or longer. The presence of blood in the urine (hematuria) and the presence of multiple cysts in both kidneys on ultrasound are consistent with kidney damage. The normal serum creatinine and protein excretion do not exclude the diagnosis of CKD, as early stages of CKD can be asymptomatic and may not cause significant changes in these parameters.Rate this question:
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- 3.
Reagrding to the case in MCQ 3, Which ONE of the following should be recommended for therapy?
- A.
She should be advised to lower her salt intake with follow-up blood pressure (BP) and serum creatinine in 4 mo.
- B.
She should be referred for laparoscopic deroofing of her renal cysts.
- C.
Anti-hypertensive therapy should be started with a thiazide diuretic, and a beta-blocker could be added if needed.
- D.
She should be placed on dietary protein restriction (0.6 g/kg per d).
- E.
She should be treated with an angiotensinconverting enzyme (ACE) inhibitor to a target BP of 130/85 mmHg.
Correct Answer
E. She should be treated with an angiotensinconverting enzyme (ACE) inhibitor to a target BP of 130/85 mmHg.Explanation
The correct answer is to treat the patient with an angiotensin-converting enzyme (ACE) inhibitor to achieve a target blood pressure (BP) of 130/85 mmHg. This recommendation is based on the information provided in the case, which suggests that the patient has hypertension. ACE inhibitors are commonly used to treat hypertension and have been shown to be effective in reducing BP and preventing cardiovascular complications. The target BP of 130/85 mmHg is in line with current guidelines for the management of hypertension.Rate this question:
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- 4.
A 78-yr-old white man comes to your office for routine preventive care. He has a history of hypertension treated with a thiazide diuretic. He is currently asymptomatic. On physical examination, his blood pressure (BP) is 155/80 mmHg, his pulse is 80 beats/min and regular, and his weight is 75 kg. The remainder of his examination is unremarkable. Laboratory studies show the following: serum creatinine, 1.1 mg/dl; calculated glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation, 69 ml/min per 1.73 m2; urinalysis is normal; spot protein-to-creatinine ratio, 130 mg/g (normal 200 mg/g). A renal ultrasound shows the right kidney is 11 cm and the left kidney is 11.5 cm in length without evidence for hydronephrosis. Which ONE of the following is true regarding his condition?
- A.
The Cockcroft-Gault equation is more accurate than the MDRD equation for estimating GFR in patients 70-yr-old.
- B.
A kidney biopsy is indicated to define the underlying renal pathology.
- C.
On the basis of the urinary protein excretion rate and GFR, he has stage 3 chronic kidney disease (CKD).
- D.
The low GFR is a consequence of aging, and he should not be classified as having CKD.
- E.
The thiazide diuretic should be switched to a loop diuretic.
Correct Answer
D. The low GFR is a consequence of aging, and he should not be classified as having CKD.Explanation
The answer states that the low GFR in the 78-year-old man is a consequence of aging and he should not be classified as having chronic kidney disease (CKD). This is because as individuals age, there is a natural decline in kidney function, resulting in a lower GFR. In this case, the patient's GFR is 69 ml/min per 1.73 m2, which falls within the range for stage 2 CKD. However, it is important to note that the patient's urinary protein excretion rate is normal, indicating that there is no evidence of kidney damage. Therefore, the low GFR is attributed to aging rather than a pathological condition.Rate this question:
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- 5.
A 46-yr-old white woman is seen in your office for evaluation of elevated serum creatinine. She currently has hypertension. A kidney biopsy performed 2 yr ago showed membranous glomerulonephritis. There was severe tubulointerstitial disease, and 3 of 27 glomeruli were globally sclerosed. At that time, her serum creatinine was 2.1 mg/dl, her calculated glomerular filtration rate (GFR) by the abbreviated Modification of Diet in Renal Disease (MDRD) study equation was 27 ml/min per 1.73 m2, serum cholesterol was 320 mg/dl, and she had a 24-h urinary protein excretion of 8.6 g. Which ONE of the following is true regarding her risk of developing progressive kidney failure?
- A.
White patients have a higher risk of progression compared with patients from other ethnic groups.
- B.
Few glomeruli were globally sclerosed; therefore, her renal prognosis is good.
- C.
The severity of tubulointerstitial disease is a good predictor of kidney disease progression.
- D.
Proteinuria is not a risk factor for kidney disease progression.
- E.
On the basis of the amount of proteinuria, she is unlikely to respond to an angiotensinconverting enzyme (ACE) inhibitor.
Correct Answer
C. The severity of tubulointerstitial disease is a good predictor of kidney disease progression.Explanation
The severity of tubulointerstitial disease is a good predictor of kidney disease progression. This means that the extent of damage and inflammation in the tubules and interstitium of the kidney can help determine the likelihood of the disease progressing. In this case, the patient had severe tubulointerstitial disease on a previous kidney biopsy, suggesting a higher risk of kidney failure in the future. This information is important for managing the patient's condition and making decisions about treatment options.Rate this question:
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- 6.
A 58-yr-old Asian man is seen in your office for assessment and treatment of his elevated serum creatinine. He was diagnosed by renal biopsy with immunoglobulin A (IgA) nephropathy 2 yr ago. Laboratory studies show serum creatinine of 2.0 mg/dl, calculated glomerular filtration rate (GFR) of 37 ml/min per 1.73 m2 by the abbreviated Modification of Diet in Renal Disease (MDRD) study equation, hemoglobin of 10.0 g/dl, hematocrit of 30%; urine protein-tocreatinine ratio of 2400 mg/g (normal 200 mg/g). Which ONE of the following is true regarding assessment of his anemia?
- A.
Hematocrit is a more accurate way of defining anemia than hemoglobin.
- B.
Erythropoietin levels are useful in deciding treatment.
- C.
A bone marrow biopsy should be performed to rule out myelodysplastic syndrome.
- D.
Serum iron, transferrin saturation, and ferritin should be measured to assess iron stores.
- E.
Proteinuria is associated with a poor response to erythropoietin therapy.
Correct Answer
D. Serum iron, transferrin saturation, and ferritin should be measured to assess iron stores.Explanation
The correct answer is that serum iron, transferrin saturation, and ferritin should be measured to assess iron stores. In this case, the patient has anemia with a low hemoglobin level and hematocrit, which suggests a deficiency in iron. To confirm this, it is necessary to measure serum iron, transferrin saturation, and ferritin levels. These tests will provide information about the body's iron stores and help guide appropriate treatment for the anemia. The other options are not relevant to the assessment of anemia in this patient with IgA nephropathy.Rate this question:
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- 7.
Which ONE of the following is true regarding therapy?
- A.
Treatment of anemia is associated with higher rates of hospitalizations.
- B.
Treatment of anemia can prevent the development of left ventricular hypertrophy.
- C.
Erythropoietin can accelerate the progression of kidney disease.
- D.
Treatment with recombinant erythropoietin should only be initiated when the hemoglobin is 8 g/dl.
- E.
Target hemoglobin levels with recombinant erythropoietin should be 11 g/dl.
Correct Answer
B. Treatment of anemia can prevent the development of left ventricular hypertrophy.Explanation
Treatment of anemia can prevent the development of left ventricular hypertrophy. Left ventricular hypertrophy is a condition where the muscle wall of the left ventricle of the heart becomes thickened, which can lead to heart failure. Anemia is a condition characterized by a decrease in red blood cells or hemoglobin levels, which can result in decreased oxygen delivery to tissues, including the heart. By treating anemia and increasing the hemoglobin levels, the oxygen-carrying capacity of the blood is improved, reducing the risk of left ventricular hypertrophy.Rate this question:
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- 8.
A 62-yr-old white man with type 2 diabetes and chronic kidney disease (CKD) presents to your office for treatment recommendations. Coronary artery bypass surgery was performed 3 yr ago. He has hypertension that is being treated with furosemide, metoprolol, and lisinopril. His major complaint is fatigue. On physical examination, his blood pressure (BP) is 140/85 mmHg, and he has 1 peripheral edema. His serum creatinine is 2.2 mg/dl with a calculated glomerular filtration rate (GFR) of 32 ml/min per 1.73 m2 by the Modification of Diet in Renal Disease (MDRD) abbreviated formula. A spot protein-to-creatinine ratio is 4000 mg/g (normal 200 mg/g). His fasting blood glucose is 150 mg/dl. Which ONE of the following choices is most correct regarding this patient?
- A.
At this stage in his kidney disease, glycemic control is likely to be beneficial in slowing the progression.
- B.
He has a low risk of kidney disease progression.
- C.
His target BP should not be lowered because it would increase his risk of sudden cardiac death (J point phenomenon).
- D.
Addition of an angiotensin receptor blocker will further decrease the progression of his kidney disease.
- E.
Lowering his target BP can slow the progression of his kidney disease.
Correct Answer
E. Lowering his target BP can slow the progression of his kidney disease.Explanation
Lowering the target blood pressure (BP) can slow the progression of kidney disease in this patient. The patient has chronic kidney disease (CKD) with a calculated glomerular filtration rate (GFR) of 32 ml/min per 1.73 m2. Lowering the BP can help protect the kidneys by reducing the pressure on the blood vessels in the kidneys, thereby slowing the progression of kidney disease. This is especially important in patients with diabetes and hypertension, as they are at a higher risk for kidney disease progression. Therefore, lowering the target BP is the most correct choice for this patient.Rate this question:
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- 9.
Additional laboratory tests performed on the patient described in last MCQ case return and demonstrate a hemoglobin of 10.1 g/dl with a serum iron of 92 mg/dl, a transferrin saturation of 23%, and a ferritin of 130 ng/ml. Which ONE of the following should be done next?
- A.
Carefully follow his hemoglobin and start recombinant erythropoietin therapy if it decreased to 8 g/dl.
- B.
Check an echocardiogram and start recombinant erythropoietin therapy if left ventricular hypertrophy is present.
- C.
Start oral iron and recheck hemoglobin level in 1 mo.
- D.
Start recombinant erythropoietin 10,000 units subcutaneously once weekly along with oral iron.
- E.
Transfuse 2 units of packed red blood cells.
Correct Answer
D. Start recombinant erythropoietin 10,000 units subcutaneously once weekly along with oral iron.Explanation
Based on the laboratory test results, the patient has a low hemoglobin level (10.1 g/dl), indicating anemia. The serum iron level (92 mg/dl), transferrin saturation (23%), and ferritin level (130 ng/ml) suggest iron deficiency anemia. The appropriate next step would be to start recombinant erythropoietin therapy, which stimulates red blood cell production, along with oral iron supplementation to address the iron deficiency. This treatment approach aims to increase the patient's hemoglobin level and improve their anemia.Rate this question:
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- 10.
A 48-yr-old African-American man is seen in your office for elevated serum creatinine. He has polycystic kidney disease (PKD). His blood pressure (BP) is 135/90 mmHg, his weight is 85 kg, and his exam is remarkable for palpable kidneys. Laboratory studies include serum creatinine of 2 mg/dl, serum calcium of 7.6 mg/dl, serum phosphorus of 5.1 mg/dl, serum albumin of 4.0 g/dl, serum intact parathyroid hormone of 280 pg/ml (normal 12 to 72 pg/ml), and calculated glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation of 46 ml/min per 1.73 m2. Which ONE of the following is true regarding therapy?
- A.
Dietary phosphorus should be restricted to 2 g/d.
- B.
He should be treated with 0.25 g/d calcitriol.
- C.
Calcium-containing phosphate binders should be avoided.
- D.
Long-term therapy with aluminum hydroxide should be started at a dose of 15 ml orally with meals.
- E.
Sevelamer therapy would be associated with an increased risk of development of osteomalacia and bone fractures.
Correct Answer
B. He should be treated with 0.25 g/d calcitriol.Explanation
The patient has polycystic kidney disease (PKD) which can lead to decreased production of active vitamin D (calcitriol) by the kidneys. The low serum calcium level and high intact parathyroid hormone (PTH) level indicate secondary hyperparathyroidism, which is commonly seen in CKD. Treatment with calcitriol helps to increase serum calcium levels and suppress PTH secretion, thereby managing secondary hyperparathyroidism. Restricting dietary phosphorus, avoiding calcium-containing phosphate binders, and starting long-term therapy with aluminum hydroxide are not appropriate for this patient. Sevelamer therapy is actually associated with a decreased risk of osteomalacia and bone fractures.Rate this question:
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- 11.
A 23-yr-old white woman is seen in your office to discuss strategies to prevent the development of diabetic nephropathy. She was diagnosed as having type 1 diabetes at age 8 yr. Currently, she is normotensive and her glucose is well controlled on an insulin pump (HbA1C 5.0%). Her blood pressure (BP) is 120/70 mmHg. Laboratory studies include serum creatinine of 1.0 mg/dl and spot albumin-to-creatinine ratio of 200 mg/g (normal 25 mg/g). Which ONE of the following is true regarding therapy?
- A.
Anti-hypertensive therapy is not indicated because she is normotensive, but she should have BP monitored every 3 mo.
- B.
Therapy should be started with a dihydropyridine calcium channel blocker to prevent the development of diabetic nephropathy.
- C.
Anti-hypertensive therapy is not indicated at the present time, but an angiotensin-converting enzyme (ACE) inhibitor should be started if her urinary albumin-to-creatinine ratio increases to 355 mg/g.
- D.
ACE inhibitors have been demonstrated to reduce albuminuria and decrease the risk of progressing to overt diabetic nephropathy.
- E.
Angiotensin receptor blockers have been demonstrated to reduce albuminuria and reduce the risk of progressing to overt diabetic nephropathy.
Correct Answer
D. ACE inhibitors have been demonstrated to reduce albuminuria and decrease the risk of progressing to overt diabetic nephropathy. -
- 12.
A 31-yr-old white man is referred to you from his primary care physician for recommendations regarding the management of his chronic kidney disease (CKD). He has biopsy-proven immunoglobulin A (IgA) nephropathy. His main symptoms are fatigue. He is currently taking an angiotensin receptor blocker for control of his hypertension. His sister is bloodgroup compatible and is interested in being a kidney donor for him. On physical examination, his blood pressure (BP) is 125/70 mmHg. Laboratory studies include serum creatinine of 4.1 mg/dl and 24-h urinary protein excretion of 6.2 g. His calculated glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation is 18 ml/min per 1.73 m2. Which ONE of the following should you recommend for this patient?
- A.
Continue on his present treatment and return when his serum creatinine is 6 mg/ dl.
- B.
Once he starts on dialysis, he should be evaluated as a kidney transplant candidate.
- C.
Vascular access for dialysis should be placed in preparation for needed dialysis.
- D.
Preemptive living donor transplant if a donor is available.
- E.
Start on a low-protein diet of 0.3 g/kg per d to delay the need for dialysis.
Correct Answer
D. Preemptive living donor transplant if a donor is available.Explanation
The patient has biopsy-proven IgA nephropathy and is already experiencing symptoms of fatigue. His kidney function, as indicated by his serum creatinine and GFR, is significantly impaired. Given his young age and the availability of a blood-group compatible sister as a potential kidney donor, a preemptive living donor transplant would be the most appropriate recommendation. This would provide the patient with the best chance of long-term renal function and improved quality of life, compared to starting dialysis or delaying the need for dialysis with a low-protein diet.Rate this question:
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- 13.
A 79-yr-old Asian man is seen in your office for evaluation of chronic kidney disease (CKD) secondary to type 2 diabetes. Over the past 2 yr, his glomerular filtration rate (GFR) has decreased from 47 ml/min per 1.73 m2 to a current GFR of 19 ml/min per 1.73 m2, despite good blood pressure (BP) control with an angiotensin- converting enzyme (ACE) inhibitor. Laboratory studies include serum creatinine of 4.1 mg/dl, potassium of 5.0 mEq/L, and bicarbonate of 17 mEq/L. An arterial blood gas confirms he has a compensated metabolic acidosis. Which ONE of the following is true regarding his acidosis?
- A.
No adverse effects of acidosis are seen until the bicarbonate is 15 mEq/L.
- B.
Acidosis stimulates albumin synthesis by the liver.
- C.
Acidosis suppresses parathyroid hormone release.
- D.
Acidosis increases calcium loss from bone.
- E.
Acidosis stimulates skeletal muscle hypertrophy.
Correct Answer
D. Acidosis increases calcium loss from bone.Explanation
Acidosis increases calcium loss from bone. In metabolic acidosis, there is decreased pH in the blood, which leads to increased bone resorption and calcium release from the bones. This is due to the body's compensatory mechanism to maintain pH balance by releasing calcium ions from the bones. This can contribute to the development of osteoporosis and increased risk of fractures.Rate this question:
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- 14.
A 55-yr-old white woman has chronic kidney disease (CKD) from type 2 diabetes. Her current glomerular filtration rate (GFR) is 45 ml/ min per 1.73 m2. Which ONE of the following is true regarding alterations in bone and mineral metabolism in CKD?
- A.
The most sensitive marker of abnormal mineral metabolism is decreased calcitriol production.
- B.
Elevations in parathyroid hormone (PTH) secretion do not occur until GFR is 20 ml/min per 1.73 m2.
- C.
Elevated serum phosphorus inhibits the 1-alpha hydroxylase enzyme in the kidney, leading to decreased calcitriol synthesis.
- D.
An alteration in the set point for calcium occurs in the parathyroid glands, leading to increased PTH secretion for any increase in serum calcium.
- E.
The most common bone abnormality is osteomalacia.
Correct Answer
C. Elevated serum phosphorus inhibits the 1-alpha hydroxylase enzyme in the kidney, leading to decreased calcitriol synthesis.Explanation
In chronic kidney disease (CKD), there is a decrease in the glomerular filtration rate (GFR), which leads to alterations in bone and mineral metabolism. The correct answer states that elevated serum phosphorus inhibits the 1-alpha hydroxylase enzyme in the kidney, which is responsible for the synthesis of calcitriol (active form of vitamin D). This inhibition of calcitriol synthesis can lead to abnormal mineral metabolism. This answer is supported by the understanding that CKD can cause abnormalities in phosphate metabolism, leading to elevated serum phosphorus levels, which in turn can inhibit the production of calcitriol.Rate this question:
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- 15.
A 37-yr-old African-American woman presents with nephrotic syndrome. A kidney biopsy is diagnostic for focal and segmental glomerulosclerosis. Her current estimated glomerular filtration rate (GFR) by the abbreviated Modification of Diet in Renal Disease (MDRD) equation is 60 ml/min per 1.73 m2. Which ONE of the following is the BEST predictor of her risk of progressing to ESRD?
- A.
The percentage of glomeruli with focal changes on biopsy.
- B.
Angiotensin-converting enzyme (ACE) genotyping for polymorphisms.
- C.
The extent of tubulointerstitial disease on biopsy.
- D.
The level of plasma renin activity.
- E.
A family history of hypertension.
Correct Answer
C. The extent of tubulointerstitial disease on biopsy.Explanation
The extent of tubulointerstitial disease on biopsy is the best predictor of the patient's risk of progressing to end-stage renal disease (ESRD). Tubulointerstitial disease refers to damage and inflammation in the tubules and interstitial tissue of the kidneys, which can contribute to the progression of kidney disease. The presence and severity of tubulointerstitial disease on biopsy can help determine the extent of kidney damage and the likelihood of progression to ESRD.Rate this question:
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- 16.
Which ONE of the following is TRUE regarding cardiovascular disease in patients with CKD?
- A.
Microalbuminuria is not a risk factor for cardiovascular disease.
- B.
Most patients with chronic kidney disease will die of cardiovascular disease before they reach end stage renal disease.
- C.
CKD is a risk factor for coronary artery disease but not for stroke or peripheral vascular disease.
- D.
CKD is a risk factor for cardiovascular disease only when the serum creatinine is 3 mg/dl.
- E.
A higher prevalence of traditional risk factors such as hypertension and dyslipidemia account for the increased risk of cardiovascular disease in patients with CKD.
Correct Answer
B. Most patients with chronic kidney disease will die of cardiovascular disease before they reach end stage renal disease.Explanation
A higher prevalence of traditional risk factors such as hypertension and dyslipidemia account for the increased risk of cardiovascular disease in patients with CKD. This means that patients with CKD are more likely to have conditions like high blood pressure and high cholesterol, which are known risk factors for cardiovascular disease. As a result, they are at a higher risk of developing cardiovascular disease compared to the general population. Additionally, the statement suggests that cardiovascular disease may be a leading cause of death in patients with CKD before they progress to end-stage renal disease.Rate this question:
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- 17.
A 74-yr-old Asian woman was admitted to the hospital with failure-to-thrive. She has a past medical history of diabetes mellitus, heart failure, osteoporosis and Alzheimer’s disease. She has lost 20 pounds over the past half year and weighs 70 pounds currently. On physical examination, she is cachectic and has 2 lower extremity pitting edema. Her serum creatinine is 1.0 mg/dl. Her serum albumin is 2.5 g/dl. A random spot urine protein/creatinine ratio on admission is 3.6 g/gm. A complete 24-h urine collected via Foley during the second day of hospitalization revealed 1.6 g of protein and 453 mg of creatinine. Which ONE of the following statements is TRUE?
- A.
The patient has nephrotic range proteinuria.
- B.
There is contradictory information presented regarding whether or not patient has nephrotic range proteinuria.
- C.
There is insufficient information to determine whether or not the patient has nephrotic range proteinuria.
- D.
The random spot urine protein/creatinine ratio is misleading because of the low creatinine production.
- E.
It is not valid to use urine protein/creatinine ratio to assess proteinuria when the serum albumin level is low.
Correct Answer
D. The random spot urine protein/creatinine ratio is misleading because of the low creatinine production.Explanation
The random spot urine protein/creatinine ratio is misleading because of the low creatinine production. This is because the patient's serum creatinine level is normal, indicating that her kidney function is not impaired. However, the spot urine protein/creatinine ratio is high, suggesting significant proteinuria. This discrepancy can be explained by the low creatinine production, which leads to an artificially elevated protein/creatinine ratio. Therefore, the patient does not have nephrotic range proteinuria.Rate this question:
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- 18.
A 51-yr-old Caucasian male patient with autosomal dominant polycystic kidney disease developed renal failure requiring hemodialysis seven years ago. Two years ago, he received a cadaveric kidney transplant. He is currently maintained on cyclosporine, prednisone and mycophenolate mofetil. His stable estimated GFR is 70 ml/min/1.73m2. His dipstick urinalysis has trace protein that is persistent but no hemoglobin or other abnormalities. He has 300 mg of protein in a 24-h urine collection. According to the current National Kidney Foundation Chronic Kidney Disease classification, this patient has which ONE of the following stages of CKD?
- A.
Stage 1.
- B.
Stage 2.
- C.
Stage 3.
- D.
Stage 4.
- E.
Stage 5.
Correct Answer
B. Stage 2.Explanation
According to the current National Kidney Foundation Chronic Kidney Disease classification, Stage 2 is characterized by mild reduction in kidney function (GFR 60-89 ml/min/1.73m2) with evidence of kidney damage, such as persistent proteinuria. Since the patient has a stable estimated GFR of 70 ml/min/1.73m2 and persistent trace protein in the urine, he falls into Stage 2 of CKD.Rate this question:
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- 19.
A 59-yr-old Caucasian man with type 2 diabetes mellitus was admitted to the hospital with sepsis of unclear etiology. His baseline urine dipstick has 1 protein and his baseline serum creatinine is 1.2 mg/dl (MDRD equation estimated GFR 66 ml/min/1.73m2). Patient failed to improve with antibiotic therapy and was admitted to the intensive care unit when he developed hypotension requiring vasoconstrictors and hypoxia requiring mechanical ventilation. He received IV contrast for an abdominal CT scan. His serum creatinine was 1.2 mg/dl the morning he received the contrast and rose to 2.4 mg/dl the following morning. Which ONE of the following statements is MOST correct?
- A.
The patient’s baseline CKD is unrelated to his acute renal failure.
- B.
Intravenous contrast is not contraindicated in patients with CKD.
- C.
The patient’s diabetes is not a risk factor for his acute renal failure.
- D.
The patient’s GFR when his creatinine rose to 2.4 mg/dl is approximately 30 ml/ min/1.73m2.
- E.
To measure the patient’s current creatinine clearance, a 24-h urine collection should be started the morning when his serum creatinine rose to 2.4 mg/dl.
Correct Answer
B. Intravenous contrast is not contraindicated in patients with CKD.Explanation
The correct answer is that intravenous contrast is not contraindicated in patients with CKD. This is because the patient's acute renal failure, indicated by the rise in serum creatinine after receiving IV contrast, is likely due to acute tubular necrosis caused by sepsis and hypotension, rather than contrast-induced nephropathy. The patient's baseline CKD, as indicated by the proteinuria and slightly decreased estimated GFR, is unrelated to the acute renal failure. Therefore, the administration of IV contrast in this case is not contraindicated.Rate this question:
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- 20.
Which of the following is the most common cause of resistant anemia in CKD patients?
- A.
Iron deficiency
- B.
Malignancy
- C.
Trauma
- D.
Drugs
- E.
PRCA
Correct Answer
A. Iron deficiencyExplanation
Iron deficiency is the most common cause of resistant anemia in CKD patients. Chronic kidney disease (CKD) can lead to decreased production and release of erythropoietin, a hormone responsible for stimulating red blood cell production. This can result in anemia. Iron deficiency further exacerbates the anemia as iron is necessary for the production of hemoglobin, the protein in red blood cells that carries oxygen. Therefore, addressing iron deficiency is crucial in managing anemia in CKD patients.Rate this question:
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