Nephrotube Online Quiz - Anemia In Ckd - Quiz, Flashcards & Trivia

1. High Hb targets (>11.5 g/dl) may increase mortality and morbidity.

True

False

High hemoglobin (Hb) targets, specifically levels above 11.5 g/dl, have been associated with increased mortality and morbidity. This means that aiming for higher Hb levels can actually be harmful and lead to negative health outcomes. It is important to maintain Hb within a safe range to avoid these risks.

Explanation

High hemoglobin (Hb) targets, specifically levels above 11.5 g/dl, have been associated with increased mortality and morbidity. This means that aiming for higher Hb levels can actually be harmful and lead to negative health outcomes. It is important to maintain Hb within a safe range to avoid these risks.

2. History of Stroke & Malignancy is relative contraindications to ESAs.

True

False

A history of stroke and malignancy are considered relative contraindications to ESAs (erythropoiesis-stimulating agents). This means that while ESAs may still be used in these cases, caution should be exercised due to potential risks or complications. ESAs are commonly used to treat anemia in patients with chronic kidney disease, cancer, or other conditions. However, in patients with a history of stroke or malignancy, ESAs may increase the risk of adverse events such as thromboembolic events or tumor progression. Therefore, careful evaluation and monitoring are necessary when considering the use of ESAs in these patients.

Explanation

A history of stroke and malignancy are considered relative contraindications to ESAs (erythropoiesis-stimulating agents). This means that while ESAs may still be used in these cases, caution should be exercised due to potential risks or complications. ESAs are commonly used to treat anemia in patients with chronic kidney disease, cancer, or other conditions. However, in patients with a history of stroke or malignancy, ESAs may increase the risk of adverse events such as thromboembolic events or tumor progression. Therefore, careful evaluation and monitoring are necessary when considering the use of ESAs in these patients.

3. A 49-yr-old Asian woman with CKD resulting from IgA nephropathy has a serum creatinine of 5.7 mg/dl, blood urea nitrogen of 49 mg/dl, and hemoglobin (Hb) of 9.1 g/dl. She is found to have a serum ferritin of 30 ng/ml and transferrin saturation of 12%. A stool sample is positive for occult blood. She weighs 52 kg. Which ONE of the following is CORRECTregarding her anemia and its management?

You order intravenous administration of 500 mg of iron sucrose over 1 h.

You administer the antioxidant N-acetylcysteine along with iron.

You decide to order oral rather than intravenous iron.

You begin iron therapy but insist on colonoscopy.

You decide not to treat her anemia because recent trials have shown that Hb levels any higher than her current level are associated with increased mortality.

The correct answer is "You begin iron therapy but insist on colonoscopy." This is the correct management for the patient's anemia because her low hemoglobin level (9.1 g/dl) indicates iron deficiency anemia. However, since her stool sample is positive for occult blood, further investigation with a colonoscopy is necessary to rule out any gastrointestinal bleeding as the cause of her anemia.

Explanation

The correct answer is "You begin iron therapy but insist on colonoscopy." This is the correct management for the patient's anemia because her low hemoglobin level (9.1 g/dl) indicates iron deficiency anemia. However, since her stool sample is positive for occult blood, further investigation with a colonoscopy is necessary to rule out any gastrointestinal bleeding as the cause of her anemia.

4. High Hb targets (>11.5 g/dl) may improve QOL of life in some patients.

True

False

High hemoglobin (Hb) targets, specifically levels above 11.5 g/dl, have the potential to enhance the quality of life (QOL) for certain patients. This suggests that maintaining higher Hb levels can lead to improved well-being and overall satisfaction in these individuals.

Explanation

High hemoglobin (Hb) targets, specifically levels above 11.5 g/dl, have the potential to enhance the quality of life (QOL) for certain patients. This suggests that maintaining higher Hb levels can lead to improved well-being and overall satisfaction in these individuals.

5. One of most causes of Fe deficiency in CKD is ESAs therapy itself.

True

False

The statement is true because ESAs therapy, which stands for erythropoiesis-stimulating agents, can lead to iron deficiency in patients with chronic kidney disease (CKD). ESAs are commonly used to treat anemia in CKD patients by stimulating the production of red blood cells. However, this therapy can increase the demand for iron in the body, leading to a depletion of iron stores and ultimately causing iron deficiency. Therefore, ESAs therapy itself can be one of the main causes of iron deficiency in CKD patients.

Explanation

The statement is true because ESAs therapy, which stands for erythropoiesis-stimulating agents, can lead to iron deficiency in patients with chronic kidney disease (CKD). ESAs are commonly used to treat anemia in CKD patients by stimulating the production of red blood cells. However, this therapy can increase the demand for iron in the body, leading to a depletion of iron stores and ultimately causing iron deficiency. Therefore, ESAs therapy itself can be one of the main causes of iron deficiency in CKD patients.

6. Anemia of CKD is a microcytic hypochromic anemia.

True

False

Anemia of CKD is not a microcytic hypochromic anemia. In fact, it is usually a normocytic normochromic anemia. In chronic kidney disease (CKD), the kidneys are unable to produce enough erythropoietin, which is a hormone responsible for stimulating red blood cell production. This leads to a decrease in the number of red blood cells, resulting in anemia. However, the red blood cells that are produced are typically of normal size and color, rather than being smaller (microcytic) and paler (hypochromic).

Explanation

Anemia of CKD is not a microcytic hypochromic anemia. In fact, it is usually a normocytic normochromic anemia. In chronic kidney disease (CKD), the kidneys are unable to produce enough erythropoietin, which is a hormone responsible for stimulating red blood cell production. This leads to a decrease in the number of red blood cells, resulting in anemia. However, the red blood cells that are produced are typically of normal size and color, rather than being smaller (microcytic) and paler (hypochromic).

7. A 63-yr-old African American man has an eGFR of 26 ml/min per 1.73 m2 and an Hb of9.8 g/dl. Serum ferritin is 160 ng/ml, transferrin saturation is 28%, vitamin B12 and folate levels are normal, and stool sample for occult blood was negative. Mean red cell volume and mean corpuscular hemoglobin concentration are within normal limits.Which ONE of the following is CORRECT regarding his anemia and its management?

Treatment with 100 mg of topical testosterone gel will significantly reduce the amount of epoetin needed on a weekly basis to achieve an Hb level of 11 g/dl.

Mild anemia, such as with Hb levels in the range of 9.0 to 10.0 g/dl, as in this patient, should not be treated with epoetin.

He should be treated with epoetin therapy to achieve an Hb level of at least 13.0 g/dl.

He should be treated with darbepoetin rather than erythropoietin.

Treatment with subcutaneous epoetin therapy in conjugation with iron therapy improves some quality-of-life measures in this patient

The correct answer states that treatment with subcutaneous epoetin therapy in conjunction with iron therapy improves some quality-of-life measures in this patient. This suggests that the patient's anemia may be due to chronic kidney disease, as indicated by the low eGFR. Epoetin is a medication that stimulates red blood cell production and can be used to treat anemia associated with chronic kidney disease. Iron therapy is often used in conjunction with epoetin to optimize its effectiveness. By improving the patient's anemia, this treatment can potentially improve their quality of life.

Explanation

The correct answer states that treatment with subcutaneous epoetin therapy in conjunction with iron therapy improves some quality-of-life measures in this patient. This suggests that the patient's anemia may be due to chronic kidney disease, as indicated by the low eGFR. Epoetin is a medication that stimulates red blood cell production and can be used to treat anemia associated with chronic kidney disease. Iron therapy is often used in conjunction with epoetin to optimize its effectiveness. By improving the patient's anemia, this treatment can potentially improve their quality of life.

8. During ESAs initiation, the target Hb increase is > 2g/dl/month

True

False

During ESA initiation, the target Hb increase is typically not greater than 2g/dl per month. This is because a rapid increase in hemoglobin levels can lead to adverse effects such as increased risk of cardiovascular events. Therefore, a gradual increase is recommended to ensure patient safety and optimal outcomes.

Explanation

During ESA initiation, the target Hb increase is typically not greater than 2g/dl per month. This is because a rapid increase in hemoglobin levels can lead to adverse effects such as increased risk of cardiovascular events. Therefore, a gradual increase is recommended to ensure patient safety and optimal outcomes.

9. KDIGO 2012 target S.TSAT <30% & S.Ferritin <500 ng/ml.

True

False

The correct answer is False because the statement is not accurate. The KDIGO 2012 guidelines recommend a target S.TSAT (transferrin saturation) of 30-40% and a target S.Ferritin (serum ferritin) of 500-800 ng/ml for patients with chronic kidney disease. Therefore, the statement in the question is incorrect.

Explanation

The correct answer is False because the statement is not accurate. The KDIGO 2012 guidelines recommend a target S.TSAT (transferrin saturation) of 30-40% and a target S.Ferritin (serum ferritin) of 500-800 ng/ml for patients with chronic kidney disease. Therefore, the statement in the question is incorrect.

10. The gold standard test used for the assessment of body iron stores is :

Serum ferritin.

The content of Hb in reticulocytes (CHr).

Serum hepcidin assay.

Bone marrow iron staining.

The percentage of hypochromic red blood cells (PHRC).

Bone marrow iron staining is the gold standard test used for the assessment of body iron stores. This test directly measures the amount of iron stored in the bone marrow, providing an accurate assessment of iron levels in the body. Serum ferritin, CHr, serum hepcidin assay, and PHRC are other tests that can provide information about iron stores, but they are not as reliable or accurate as bone marrow iron staining.

Explanation

Bone marrow iron staining is the gold standard test used for the assessment of body iron stores. This test directly measures the amount of iron stored in the bone marrow, providing an accurate assessment of iron levels in the body. Serum ferritin, CHr, serum hepcidin assay, and PHRC are other tests that can provide information about iron stores, but they are not as reliable or accurate as bone marrow iron staining.