CKD Flashcards
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
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.
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
B
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
C
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.
C
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
D
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.
C
The most frequent cause of CKD in North America and Europe is ____
diabetic nephropathy, most often secondary to type 2 diabetes mellitus.
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.
T
Diuretic resistance with intractable edema and hypertension in advanced CKD may serve as an indication to initiate dialysis.
T
decline in GFR is not necessarily accompanied by a parallel decline in urinary potassium excretion
T
Type of acidosis seen in early stages of CKD
Non anion gap metabolic acidosis
_____promote urinary potassium excretion, whereas potassium-binding resins, such as calcium resonium, sodium polystyrene, or patiromer, can promote potassium loss through the _____
Kaliuretic diuretics
GI tract
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
B
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
B
Secondary hyperparathyroidism causes high-turnover bone disease, characterized by osteitis fibrosa cystica with abnormal osteoid and marrow fibrosis.
C. Low. bone turnover
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
C
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
B
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
B
____ is a devastating condition seen almost exclusively in patients with advanced CKD.
Calciphylaxis
Medication considered as a risk factor for calciphylaxis
Warfarin
The optimal management of secondary hyperparathyroidism and osteitis fibrosa is _____.
prevention
Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommend a target PTH level between _____ times the upper limit of normal,
2 and 9
This class of drug, which includes _____ produces a dose-dependent reduction in PTH and plasma calcium concentration in some patients.
cinacalcet and etecalcetide
_____are the most common complications of CKD.
Hypertension and left ventricular hypertroph
______should be the first line of therapy
Salt restriction
______ is an absolute indication for the urgent initiation of dialysis or for intensification of the dialysis prescription in those already receiving dialysis.
Uremic pericarditis
A normocytic, normochromic anemia is observed as early as stage ___CKD and is almost universal by stage ____
3
4.
ECG monitoring studies have s gested that _____are the principal causes of sudden cardiac death in dialysis patients.
asystole and bradyarrhythmias
[HF] A form of “low-pressure” pulmonary edema can also occur in advanced CKD, manifesting as shortness of breath and a _____distribution
“bat wing”
____ are the most common complications of CKD.
Hypertension and left ventricular hypertrophy
_____ 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.
Left ventricular hypertrophy and dilated cardiomyopathy
In addition, anemia and the _____for hemodialysis can generate a high cardiac output state and consequent high-output heart failure.
placement of an a venous fistula
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.
<130/80
[HTN] _____should be the first line of therapy.
Salt restriction
[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.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
[HTN] The use of ACE inhibitors and ARBs may also be c cated by the development of ____.
hyperkalemia
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.
gliflozins (SGLT2 inhibitors)
Chest pain with respiratory accentuation, accompanied by a friction rub, is diagnostic of ____.
pericarditis
It is now more often observed in underdialyzed, nonadherent patients than in those starting dialysis.
Pericarditis
A normocytic, normochromic anemia is observed as early as stage _____ CKD and is almost universal by stage ____
3
4
The primary cause of anemia is insufficient production of ____ by the diseased kidneys.
erythropoietin (EPO)
For the CKD patient not yet on dialysis or the patient treated with peritoneal dialysis, oral ____supplementation should be attempted
iron
[Anemia] . Current practice is to target a hemoglobin concentration of ______
100–115 g/L.
[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.
unfractionated heparin
Subtle clinical manifestations of uremic neuromuscular disease usually become evident at stage____CKD.
3
Peripheral neuropathy usually becomes clinically evident after the patient reaches stage ____CKD
4
Evidence of peripheral neuropathy without another cause (e.g., diabetes mellitus or iron deficiency) is an indication for starting renal replacement therapy. T/F
T
These patients are also prone to constipation, which can be worsened by the administration of ____ supplements.
calcium and iron
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
T
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.
40
A skin condition unique to CKD patients called ____ consists of progressive subcutaneous induration, especially on the arms and legs.
nephrogenic fibrosing dermopathy
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.
gadolinium
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
B
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
B
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
B
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
A
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
C
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
D
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
A
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
B
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
B
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
C
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.
renal ultrasound
Kidney biopsy contraindications
Bilaterally small kidneys
Uncontrolled hypertension
Active urinary tract infection
Bleeding diathesis (including ongoing anticoagulation) Severe obesity
Kidney biopsy indications
suspicion of a concomitant or s imposed active process such as interstitial nephritis or in the face of accelerated loss of GFR)
The most important initial diagnostic step is to_____
distinguish newly diagnosed CKD from acute or subacute renal failure, because the latter two conditions may respond to targeted therapy.
Kidney biopsy can usually be performed in early CKD stage______
(stages 1–3)
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
B
