CKD

Question 1

Which of the following is considered a newly recognized risk factor for chronic kidney disease (CKD)?

A. Diabetes mellitus
B. Hypertension
C. A past episode of recovered acute kidney injury (AKI)
D. Obesity

Answer 1

C

Most recently identified risk factors for which there is now a consensus include a past episode of apparently recovered acute kidney injury (AKI), tobacco use, and many forms of apparently resolved childhood and adolescent kidney disease.

Question 2

Which genetic factor is linked to a higher incidence of nondiabetic CKD in individuals of West African ancestry?

A. HLA-B27
B. APOL1 gene
C. BRCA1 gene
D. GFR1 mutation

Answer 2

B

Question 3

Which of the following methods is currently recommended for measuring albuminuria in patients at risk for CKD?

A. 24-hour urine collection
B. Serum albumin concentration
C. Urinary albumin-to-creatinine ratio (UACR) from spot first-morning urine samples
D. Dipstick test for proteinuria

Answer 3

C

Question 4

Which of the following statements about CKD staging using estimated glomerular filtration rate (eGFR) is correct?

A. Serum creatinine levels are sufficient for staging CKD.
B. eGFR is only calculated in patients with proteinuria.
C. eGFR equations are only valid when serum creatinine is stable.
D. Race adjustment in eGFR equations has no societal implications.

Answer 4

C

Question 5

Which GFR level corresponds to stage 5 CKD?

A. >90 mL/min per 1.73 m²
B. 60-89 mL/min per 1.73 m²
C. 30-59 mL/min per 1.73 m²
D. <15 mL/min per 1.73 m²

Answer 5

D

Question 6

Which of the following statements best describes the recommended screening for CKD in the general population?

A. Screen all adults regardless of risk factors.
B. Screen only patients with a family history of CKD.
C. Screen individuals with recognized CKD risk factors every 2 years.
D. Screen only elderly patients over the age of 70.

Answer 6

C

Question 7

The most frequent cause of CKD in North America and Europe is ____

Answer 7

diabetic nephropathy, most often secondary to type 2 diabetes mellitus.

Question 8

The benefits of the RAS inhibitors in ameliorating hyperfiltration and progression of CKD often favor their cautious and judicious use with very close monitoring of plasma potassium concentration.

Answer 8

T

Question 9

Diuretic resistance with intractable edema and hypertension in advanced CKD may serve as an indication to initiate dialysis.

Answer 9

T

Question 9

decline in GFR is not necessarily accompanied by a parallel decline in urinary potassium excretion

Answer 9

T

Question 10

Type of acidosis seen in early stages of CKD

Answer 10

Non anion gap metabolic acidosis

Question 11

_____promote urinary potassium excretion, whereas potassium-binding resins, such as calcium resonium, sodium polystyrene, or patiromer, can promote potassium loss through the _____

Answer 11

Kaliuretic diuretics

GI tract

Question 12

Which of the following is a major driver of secondary hyperparathyroidism in CKD?

A) Increased renal calcitriol production
B) Phosphate retention
C) Elevated ionized calcium levels
D) Increased urinary calcium excretion

Answer 12

B

Question 13

What type of bone disease is primarily associated with secondary hyperparathyroidism in CKD?

A) Osteomalacia
B) Osteitis fibrosa cystica
C) Adynamic bone disease
D) Brown tumors

Answer 13

B

Secondary hyperparathyroidism causes high-turnover bone disease, characterized by osteitis fibrosa cystica with abnormal osteoid and marrow fibrosis.

C. Low. bone turnover

Question 14

Which laboratory abnormality is typically seen early in CKD and contributes to the development of secondary hyperparathyroidism?

A) Hypercalcemia
B) Hypophosphatemia
C) Elevated FGF-23 levels
D) Increased calcitriol levels

Answer 14

C

Question 15

Which bone disease in CKD is associated with low or normal PTH levels and reduced bone turnover?

A) Osteitis fibrosa cystica
B) Adynamic bone disease
C) Osteomalacia
D) Paget’s disease

Answer 15

B

Question 16

What is the primary cause of osteomalacia in CKD?

A) Hypocalcemia due to hyperphosphatemia
B) Reduced production of 1,25(OH)2D3 (calcitriol)
C) Elevated PTH levels
D) Use of calcimimetic agents

Answer 16

B

Question 17

____ is a devastating condition seen almost exclusively in patients with advanced CKD.

Answer 17

Calciphylaxis

Question 18

Medication considered as a risk factor for calciphylaxis

Answer 18

Warfarin

Question 19

The optimal management of secondary hyperparathyroidism and osteitis fibrosa is _____.

Answer 19

prevention

Question 20

Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommend a target PTH level between _____ times the upper limit of normal,

Answer 20

2 and 9

Question 21

This class of drug, which includes _____ produces a dose-dependent reduction in PTH and plasma calcium concentration in some patients.

Answer 21

cinacalcet and etecalcetide

Question 22

_____are the most common complications of CKD.

Answer 22

Hypertension and left ventricular hypertroph

Question 23

______should be the first line of therapy

Answer 23

Salt restriction

Question 24

______ is an absolute indication for the urgent initiation of dialysis or for intensification of the dialysis prescription in those already receiving dialysis.

Answer 24

Uremic pericarditis

Question 25

A normocytic, normochromic anemia is observed as early as stage ___CKD and is almost universal by stage ____

Answer 25

3 4.

Question 26

ECG monitoring studies have s gested that _____are the principal causes of sudden cardiac death in dialysis patients.

Answer 26

asystole and bradyarrhythmias

Question 27

[HF] A form of “low-pressure” pulmonary edema can also occur in advanced CKD, manifesting as shortness of breath and a _____distribution

Answer 27

“bat wing”

Question 28

____ are the most common complications of CKD.

Answer 28

Hypertension and left ventricular hypertrophy

Question 29

_____ are among the strongest risk factors for cardiovascular morbidity and mortality in patients with CKD and are thought to be related primarily, but not exclusively, to prolonged hypertension and ECFV overload.

Answer 29

Left ventricular hypertrophy and dilated cardiomyopathy

Question 30

In addition, anemia and the _____for hemodialysis can generate a high cardiac output state and consequent high-output heart failure.

Answer 30

placement of an a venous fistula

Question 31

In CKD patients with diabetes or proteinuria >1 g per 24 h, blood pressure should be reduced to _______ mmHg, if achievable without prohibitive adverse effects.

Answer 31

<130/80

Question 32

[HTN] _____should be the first line of therapy.

Answer 32

Salt restriction

Question 33

[HTN] _____ appear to slow the rate of decline of kidney function in a manner that extends beyond reduction of systemic arterial pressure and that involves reduction in the intraglomerular hyperfiltration and hypertension.

Answer 33

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)

Question 34

[HTN] The use of ACE inhibitors and ARBs may also be c cated by the development of ____.

Answer 34

hyperkalemia

Question 35

The use of the ____ in patients with diabetes mellitus has recently been associated with kidney protection and a reduction in cardiovascular events, including heart failure.

Answer 35

gliflozins (SGLT2 inhibitors)

Question 36

Chest pain with respiratory accentuation, accompanied by a friction rub, is diagnostic of ____.

Answer 36

pericarditis

Question 37

It is now more often observed in underdialyzed, nonadherent patients than in those starting dialysis.

Answer 37

Pericarditis

Question 38

A normocytic, normochromic anemia is observed as early as stage _____ CKD and is almost universal by stage ____

Answer 38

3 4

Question 39

The primary cause of anemia is insufficient production of ____ by the diseased kidneys.

Answer 39

erythropoietin (EPO)

Question 40

For the CKD patient not yet on dialysis or the patient treated with peritoneal dialysis, oral ____supplementation should be attempted

Answer 40

iron

Question 41

[Anemia] . Current practice is to target a hemoglobin concentration of ______

Answer 41

100–115 g/L.

Question 42

[Treatment Abnormal Hemostasis] It is often more prudent to use conventional ____, titrated to the measured partial thromboplastin time, in hospitalized patients requiring an alternative to warfarin anticoagulation.

Answer 42

unfractionated heparin

Question 43

Subtle clinical manifestations of uremic neuromuscular disease usually become evident at stage____CKD.

Answer 43

3

Question 44

Peripheral neuropathy usually becomes clinically evident after the patient reaches stage ____CKD

Answer 44

4

Question 44

Evidence of peripheral neuropathy without another cause (e.g., diabetes mellitus or iron deficiency) is an indication for starting renal replacement therapy. T/F

Answer 44

T

Question 45

These patients are also prone to constipation, which can be worsened by the administration of ____ supplements.

Answer 45

calcium and iron

Question 46

Weight loss and protein-energy malnutrition, consequences of low protein and caloric intake, are common in advanced CKD and are often an indication for initiation of renal replacement therapy T/F

Answer 46

T

Question 47

When the GFR has declined to ~___mL/min, pregnancy is associated with a high rate of spontaneous abortion, with only ~20% of pregnancies leading to live births, and pregnancy may hasten the progression of the kidney disease itself.

Answer 47

40

Question 48

A skin condition unique to CKD patients called ____ consists of progressive subcutaneous induration, especially on the arms and legs.

Answer 48

nephrogenic fibrosing dermopathy

Question 48

Patients with CKD stage 3 (GFR 30–59 mL/min) should minimize exposure to ____ and those with CKD stages 4–5 (GFR <30 mL/min) should avoid the use of ____ unless it is medically necessary.

Answer 48

gadolinium

Question 49

What is the primary cardiovascular risk associated with an arteriovenous (AV) fistula in dialysis patients? A) Coronary artery disease B) High-output heart failure C) Systemic hypertension D) Pulmonary hypertension

Answer 49

B

Question 49

Sudden cardiac death in CKD patients is most commonly associated with which of the following? A) Myocardial infarction B) Bradyarrhythmias and asystole C) Ventricular tachycardia D) Pulmonary embolism

Answer 49

B

Question 50

Which of the following is a distinct feature of "low-pressure" pulmonary edema in CKD? A) High pulmonary capillary wedge pressure B) "Bat wing" distribution of alveolar edema on chest X-ray C) Pulmonary hypertension D) Hypernatremia

Answer 50

B

Question 51

What is a common risk factor for high-output heart failure in CKD patients on hemodialysis? A) Arteriovenous (AV) fistula B) Chronic hypertension C) Volume depletion D) Hyperkalemia

Answer 51

A

Question 52

How does the presence of low blood pressure in late-stage CKD patients affect prognosis? A) It reflects good volume control B) It is associated with better cardiovascular outcomes C) It indicates poor left ventricular function and worse prognosis D) It reduces the risk of high-output heart failure

Answer 52

C

Question 53

What contributes to "reverse causation" in CKD-related heart failure studies? A) Patients with higher blood pressure often fare better B) Hyperlipidemia is associated with increased mortality C) Obesity reduces cardiovascular risk in CKD patients D) Low blood pressure, BMI, and hypolipidemia often reflect malnutrition-inflammation

Answer 53

D

Question 54

What is the primary goal of hypertension management in CKD? A) Prevent end-stage renal disease B) Reduce proteinuria C) Prevent cardiovascular and cerebrovascular complications D) Avoid use of antihypertensive medications

Answer 54

A

Question 55

What is the recommended blood pressure target for CKD patients with proteinuria >1 g per 24 hours? A) <140/90 mmHg B) <130/80 mmHg C) <120/70 mmHg D) <150/90 mmHg

Answer 55

B

Question 56

Which first-line intervention is recommended in the management of hypertension in CKD? A) Beta-blocker therapy B) Sodium restriction C) Loop diuretics D) Calcium supplementation

Answer 56

B

Question 57

What is a potential side effect of ACE inhibitor or ARB use in CKD that requires close monitoring? A) Hypercalcemia B) Hypokalemia C) Hyperkalemia D) Hypotension

Answer 57

C

Question 58

The most useful imaging study is a ____, which can verify the presence of two kidneys, determine if they are symmetric, provide an estimate of kidney size, and rule out renal masses and evidence of obstruction.

Answer 58

renal ultrasound

Question 59

Kidney biopsy contraindications

Answer 59

Bilaterally small kidneys Uncontrolled hypertension Active urinary tract infection Bleeding diathesis (including ongoing anticoagulation) Severe obesity

Question 60

Kidney biopsy indications

Answer 60

suspicion of a concomitant or s imposed active process such as interstitial nephritis or in the face of accelerated loss of GFR)

Question 61

The most important initial diagnostic step is to_____

Answer 61

distinguish newly diagnosed CKD from acute or subacute renal failure, because the latter two conditions may respond to targeted therapy.

Question 62

Kidney biopsy can usually be performed in early CKD stage______

Answer 62

(stages 1–3)

Question 63

Which two factors are most closely linked to CKD progression risk? A) Age and gender B) GFR and albuminuria C) Blood pressure and serum creatinine D) Calcium and phosphate levels

Answer 63

B