Chronic Kidney Disease Part 1

Question 1

Hallmark of DM nephropathy

Answer 1

persistent albuminuria > 300 mg/24 hours

Question 2

DM nephropathy diagnosed clinically if the following are fulfilled

Answer 2

dm retinopathy + absence of clinical or laboratory evidence of other kidney or renal tract disease

Question 3

urinary albumin excretion of > 30 mg/24 hours and less than 300 mg/24 hours in 2 of 3 samples

Answer 3

microalbuminuria

Question 4

first pathologic sign in dm nephropathy type 1 dm and proteinuria

Answer 4

glomerular basement membrane thickening

Question 5

arteriolar hyalinosis usually seen within

Answer 5

3 to 5 years

Question 6

exudative lesions in type 1 DM nephropathy pathology

Answer 6

arteriolar hyalinosis, bowmans capsular drops, hyaline caps

Question 7

45-59 ml/min GFR

Answer 7

stage 3a

Question 8

GFR 30-44

Answer 8

stage 3b

Question 9

GFR 15-29

Answer 9

stage 4

Question 10

GFR less than 15

Answer 10

stage 5

Question 11

BP target in CKD with proteinuria

Answer 11

less than 130/80

Question 12

BP target if no proteinuria

Answer 12

less than 140/80

Question 13

education on RRT and hepatitis B vaccination

Answer 13

Stage 4

Question 14

AVF creation

Answer 14

stage 5

Question 15

Goal for Acei or ARB treatment

Answer 15

urine protein level < 0.5 g/day

Question 16

target for weight loss in obese patients

Answer 16

5%

Question 17

dietary salt restriction

Answer 17

<5 g (90 meqs sodium per day)

Question 18

protein requirement for normal adults or those with uncomplicated CKD

Answer 18

0.8 g protein/kg/day

Question 19

CKD patients with complications

Answer 19

0.6 g protein/kg/day or 0.3 g/kg + ketoacids or a mixture of aminoacid

Question 20

CKD patients with loss of muscle mass

Answer 20

0.8 g protein/kg/day

Question 21

CKD with proteinuria

Answer 21

< 0.8 g protein/kg/day + 1 g protein/g proteinuria

Question 22

at least 3 episodes of itch in a 2 week period that causes difficulty for the patient or as itch that occurs over a 6 month period in a regular pattern

Answer 22

pruritus

Question 23

associated with hyperparathyroidism or elevated Ca x Phos

Answer 23

calciphylaxis

Question 24

main regulator of systemic iron hoemostasis

Answer 24

hepcidin

Question 25

increase in PTH secretion immediate effects

Answer 25

increase in 1a hydroxylase activity, bone turnover, ca reabsoprtion decrease in renal po4 reabsorption

Question 26

more than 3 rbc/hpf in atleast 2 of 3 freshly voioded midstream clean catch urine

Answer 26

asymptomatic hematuria

Question 27

most common cause of hematuria in young women

Answer 27

UTI

Question 28

most common cause of hematuria in older patients

Answer 28

malignancy

Question 29

gross hematuria more pronounced on initiation

Answer 29

urethral source

Question 30

gross hematuria more pronounced on termination

Answer 30

bladder neck/prostatic urethra

Question 31

preferred initial imaging modality

Answer 31

computed tomography

Question 32

next best initial imaging test

Answer 32

renal ultrasonography

Question 33

imaging to localize and control source of bleeding

Answer 33

cystoscopy

Question 34

diagnostic when there is any suspicion of upper tract disease

Answer 34

retrograde pyelography

Question 35

glomerular hematuria + active urine sediment + wbcs/casts

Answer 35

nephritic syndrome

Question 36

hallmark of nephritic syndrome

Answer 36

glomerular hematuria

Question 37

definitive finding in nephritic syndrome

Answer 37

rbc casts

Question 38

principal underlying abnormality in nephrotic syndrome

Answer 38

increased permeability of the glomerular capillaries

Question 39

most common underlying systemic disease causing nephrotic syndrome

Answer 39

Diabetes Mellitus

Question 40

1+ urine dipstick protein is equivalent

Answer 40

30-100 mg/dL

Question 41

most common urine lipid

Answer 41

esterified cholesterol

Question 42

birefingent birght cross like appearance in polarizing microscope

Answer 42

lipiduria

Question 43

type of RTA associated in obstructive uropathy

Answer 43

type 4

Question 44

test of choice to diagnose obstructive uropathy

Answer 44

renal ultrasonography

Question 45

stage 1 hypertension

Answer 45

140-159/90-99

Question 46

benzene ring-shaped cysteine crustals

Answer 46

cystinuria

Question 47

coffin lid crystals

Answer 47

struvite

Question 48

imaging procedure of choice for stones

Answer 48

noncontrast helical CT scan

Question 49

radioopaque stones

Answer 49

calcium, cysteine

Question 50

radiolucent stones

Answer 50

uric acid, indinavir or triamterene stones

Question 51

size of stones that will pass spontaneously

Answer 51

4 mm

Question 52

most important vascular complication in patients with CKD

Answer 52

CAD

Question 53

strongest indicator of possible renal underpefusion

Answer 53

overt hypotension

Question 54

normal blood glucose in OGTT

Answer 54

less than 140 mg/dL

Question 55

impaired glucose tolerance or preDM

Answer 55

OGTT 140-199 mg/dL

Question 56

primary cause of insulin resistance in uremia

Answer 56

impaired tissue sensitivity

Question 57

independent risk factors for cardiovascular complication in patients with ESKD

Answer 57

insulin resistance and hyperinsulinemia

Question 58

uremic dyslipidemia

Answer 58

increased triglycerides, ldl and vldl, decreased hdl cholesterol

Question 59

metformin should be used with caution when eGFR is

Answer 59

less than 60 ml/min

Question 60

when to discontinue metformin

Answer 60

less than 30 ml/min

Question 61

insulin sensitizer, causes lactic acidosis in CKD

Answer 61

metformin

Question 62

T3 levels in CKD

Answer 62

low due to low conversion of T4

Question 63

strong inhibitors of protein binding of T4

Answer 63

urea, creatinine, indoles, phenols ,heparin

Question 64

Increase in GH secretion

Answer 64

fasting, insulin induced hypoglycemia, increase of protein

Question 65

glucose load in growth hormone secretion

Answer 65

decrease GH secretion

Question 66

reason for reduced linear bone growth in CKD

Answer 66

reduced effectiveness of GF and IGF-1

Question 67

primary mediator of effects of GH

Answer 67

IGF-1

Question 68

GH deficiency in GFR and renal plasma flow

Answer 68

decrease GFR and plasma flow

Question 69

reason for GH resistance

Answer 69

decreased GH receptors and post GH receptor defects, decreased IGF-1 synthesis

Question 70

stimulates protein synthesis, decreases urea generation and improves nitrogen balance

Answer 70

recombinant human GH

Question 71

adverse reaction to GH treatment

Answer 71

benign intracranial hypertension, hyperglycemia, fluid retention

Question 72

most abundant steroid hormone

Answer 72

DHEA

Question 73

antifibrotic and antiapoptotic effects in kidney

Answer 73

estrogen

Question 74

responsible for decreased libido, erectile dysfunction, oliospermia and infertility, osteopenia in adults with ESKD

Answer 74

hypogonadism, low testoteron and hyperprolactinemia

Question 75

development of lipid enriched plaques in the intimal layer of the artery

Answer 75

atherosclerosis

Question 76

phenomenon of noncalcified nonatheromatous stiffening of smaller muscular arteries

Answer 76

arteriolosclerosis

Question 77

characterized by medial thickening and heavy calcification without the presence of atheroma

Answer 77

monckerberg's medial calcific sclerosis

Question 78

LV remodeling occurs as early as

Answer 78

stage 2

Question 79

indirect risk factors of CVD/CKD

Answer 79

DM, obesity

Question 80

partially treated uremia and side effects of dialysis

Answer 80

residual syndrome

Question 81

most abundant solute excreted by kidney

Answer 81

urea

Question 82

uremic toxin that impairs platelet function

Answer 82

guanidosuccinic acid

Question 83

aromatic waste compound normally excreted in the largest quantity

Answer 83

hippurate

Question 84

uremic solute associated with cardiovascular death in patients undergoing hd

Answer 84

p-cresol sulfate

Question 85

Fractional excretion of calcium remains unchanged until gfr

Answer 85

<25 ml/min

Question 86

As GFR decrease Na and Phosphate is maintained by

Answer 86

Decreased reabsorption

Question 87

absence of cellular (osteoblast and osteoclast) activity, osteoid formation and endosteal fibrosis

Answer 87

low turn over (adynamic bone disease)

Question 88

bone biopsies that features secondary hpt and mineralization defect, extensive osteoclastic and osteoblastic activity and increased endosteal peritrabecular fibrosis with more osteoid

Answer 88

mixed uremic osteodystrophy

Question 89

rate of skeletal remodeling: bone resoprtion + formation

Answer 89

turn over

Question 90

how well bone collagen calcified during the formation phase of skeletal remodeling

Answer 90

mineralization

Question 91

amount of bone per unit volume of tissue

Answer 91

volume

Question 92

Dxa to assess fracture risk is recommended/not recommended in

Answer 92

stage 1-3/stage 3b-5

Question 93

LV remodeling occurs

Answer 93

Stage 2-3 CKD

Question 94

primary disease of cardiac muscle assoc with ckd causing systolic dysfunction; interstitial myocardial fibrosis

Answer 94

Uremic cardiomyopathy

Question 95

when is statins recommended in ckd

Answer 95

Stage 3-5 in older than 50 years or less than 50 yo with additional risk factors

Question 96

screening of anemia starts at stage

Answer 96

G3

Question 97

tx of aluminum toxicity

Answer 97

deionized water or chelation with desferrioxamine

Question 98

most effective tx of posttransplantation erythrocytosis

Answer 98

Raas blocker

Question 99

gold standard in assesing iron stores

Answer 99

Bone marrow iron

Question 100

if hit is established, what should be considered

Answer 100

Direct thrombin inhibitors or factor Xa

Question 101

Other tx for uremic bleeding

Answer 101

Ddvap cryoprecipitate estrogen

Question 102

primary prevention of stroke

Answer 102

aspirin