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NEPHRO > CKD > Flashcards

CKD Flashcards

1
Q

What is the primary nondiabetic kidney disease associated with allelic variations in the APOL1 gene?
A. Membranous nephropathy
B. Focal segmental glomerulosclerosis
C. Minimal change disease
D. IgA nephropathy

A

B. Focal segmental glomerulosclerosis

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2
Q

Which population group has a higher frequency of certain nondiabetic CKD etiologies due to allelic variations in the APOL1 gene?

A. East Asian population
B. European ancestry population
C. West African population ancestry
D. Native American population

A

C. West African population ancestry

Rationale: Allelic variations in the APOL1 gene, common in individuals of West African population ancestry, are associated with an increased risk of certain nondiabetic CKD etiologies, such as focal segmental glomerulosclerosis. This genetic predisposition contributes to the higher prevalence of CKD among African and Hispanic Americans, as well as in major regions of Africa and the African diaspora globally.

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3
Q

What is the normal rate of annual decline in GFR after the third decade of life?
A. ~0.5 mL/min per year per 1.73 m²
B. ~1 mL/min per year per 1.73 m²
C. ~2 mL/min per year per 1.73 m²
D. ~3 mL/min per year per 1.73 m²

A

B. ~1 mL/min per year per 1.73 m²

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4
Q

What is the primary treatment for ECFV expansion in CKD patients?
A. Sodium supplementation
B. Increased water intake
C. Salt restriction and diuretics
D. Initiating dialysis immediately

A

C. Salt restriction and diuretics

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5
Q

What is the primary function of FGF-23 in phosphate metabolism?
A. To promote phosphate retention
B. To stimulate intestinal phosphate absorption
C. To enhance renal phosphate excretion
D. To inhibit renal calcium excretion

A

C. To enhance renal phosphate excretion

Rationale: FGF-23, part of the phosphatonin family, promotes phosphate excretion by reducing phosphate reabsorption in the renal tubules.

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6
Q

Which of the following conditions is FGF-23 an independent risk factor for in CKD patients?
A. Pulmonary hypertension
B. Left ventricular hypertrophy
C. Hypercalcemia
D. Peripheral neuropathy

A

B. Left ventricular hypertrophy

Rationale: High levels of FGF-23 in CKD patients are strongly associated with the development of left ventricular hypertrophy, contributing to cardiovascular complications.

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7
Q

In CKD patients, what is the relationship between elevated FGF-23 levels and patient mortality?
A. FGF-23 has no significant effect on mortality.
B. Elevated FGF-23 levels reduce the risk of mortality.
C. Elevated FGF-23 levels are associated with increased mortality.
D. FGF-23 levels only affect mortality in non-dialysis patients.

A

C. Elevated FGF-23 levels are associated with increased mortality.

Rationale: Elevated FGF-23 levels are linked to higher mortality rates in CKD, dialysis, and kidney transplant patients due to cardiovascular and other systemic complications.

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8
Q

What is the hallmark histological finding in osteitis fibrosa cystica caused by severe hyperparathyroidism?
A. Woven bone without fibrosis
B. Bone marrow fibrosis and abnormal osteoid
C. Osteoblastic activity without bone resorption
D. Fatty infiltration of bone marrow

A

B. Bone marrow fibrosis and abnormal osteoid

Rationale: Osteitis fibrosa cystica is characterized by abnormal osteoid formation, bone marrow fibrosis, and in advanced stages, the formation of bone cysts.

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9
Q

In patients with severe hyperparathyroidism, what condition is indicated by bone pain, fragility, and compression syndromes?
A. Osteomalacia
B. Osteitis fibrosa cystica
C. Paget’s disease of bone
D. Osteogenesis imperfecta

A

B. Osteitis fibrosa cystica

Rationale: These clinical features are characteristic of osteitis fibrosa cystica, a high-turnover bone disease caused by severe hyperparathyroidism.

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10
Q

What is the primary characteristic of adynamic bone disease?
A. Increased bone turnover with osteoclastic activity
B. Reduced bone volume and mineralization
C. Formation of brown tumors in bone
D. Excessive osteoblast proliferation

A

B. Reduced bone volume and mineralization

Rationale: Adynamic bone disease is characterized by decreased bone turnover, leading to reduced bone volume and impaired mineralization.

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11
Q

Which population is most at risk for developing adynamic bone disease?
A. Patients with early-stage CKD
B. Young patients on dialysis
C. Diabetic and older patients
D. Patients with untreated hyperparathyroidism

A

C. Diabetic and older patients

Rationale: Adynamic bone disease is increasingly prevalent in diabetic and older individuals, partly due to factors such as chronic inflammation and the use of calcium-based therapies.

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12
Q

What is a key pathological difference between adynamic bone disease and osteitis fibrosa cystica?
A. Adynamic bone disease has high bone turnover, while osteitis fibrosa cystica has low bone turnover.
B. Adynamic bone disease results in reduced bone turnover, while osteitis fibrosa cystica involves high bone turnover.
C. Both are caused by excessive PTH secretion.
D. Adynamic bone disease primarily affects young patients, while osteitis fibrosa cystica is more common in older individuals.

A

B. Adynamic bone disease results in reduced bone turnover, while osteitis fibrosa cystica involves high bone turnover.

Rationale: Adynamic bone disease is a low-turnover bone disease, whereas osteitis fibrosa cystica is a high-turnover bone disease caused by hyperparathyroidism.

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13
Q

What is the hallmark clinical presentation of calciphylaxis in patients with advanced CKD?
A. Painless erythematous plaques
B. Painful livedo reticularis and subcutaneous nodules
C. Blistering skin lesions with pruritus
D. Diffuse petechial rash

A

B. Painful livedo reticularis and subcutaneous nodules

Rationale: Calciphylaxis typically presents with painful livedo reticularis and subcutaneous nodules that can progress to ischemic necrosis, especially in the lower extremities, abdomen, and breasts.

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14
Q

Which medication is considered a significant risk factor for calciphylaxis in dialysis patients?
A. Heparin
B. Warfarin
C. Aspirin
D. Clopidogrel

A

B. Warfarin

Rationale: Warfarin inhibits vitamin K–dependent activation of matrix GLA protein, a key inhibitor of vascular calcification, making it a risk factor for calciphylaxis.

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15
Q

In a patient with calciphylaxis, what is the most appropriate next step regarding warfarin therapy?
A. Continue warfarin therapy at a lower dose.
B. Switch to direct oral anticoagulants (DOACs).
C. Discontinue warfarin and select an alternative anticoagulation strategy based on the indication.
D. Replace warfarin with low-dose aspirin.

A

C. Discontinue warfarin and select an alternative anticoagulation strategy based on the indication.

Rationale: Warfarin should be stopped in calciphylaxis patients due to its role in promoting vascular calcification, and alternative anticoagulants should be considered based on the underlying need for anticoagulation.

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16
Q

Which of the following mechanisms underlies the pathophysiology of calciphylaxis?
A. Immune-mediated vasculitis
B. Microvascular calcification and thrombosis
C. Direct infectious invasion of the skin
D. Impaired protein metabolism

A

B. Microvascular calcification and thrombosis

Rationale: Calciphylaxis results from vascular calcification and thrombosis in the microvasculature, leading to ischemia and necrosis.

17
Q

What is the recommended blood pressure goal for CKD patients with diabetes or proteinuria >1 g per 24 hours?
A. <140/90 mmHg
B. <130/80 mmHg
C. <120/70 mmHg
D. <135/85 mmHg

A

B. <130/80 mmHg

Rationale: Blood pressure in CKD patients with diabetes or significant proteinuria (>1 g/day) should be reduced to <130/80 mmHg to slow the progression of kidney disease and reduce cardiovascular risk, provided it is achievable without adverse effects.

18
Q

What is the first-line non-pharmacologic therapy for managing hypertension in CKD patients?
A. Regular exercise
B. Weight loss
C. Salt restriction
D. Smoking cessation

A

C. Salt restriction

Rationale: Salt restriction is the first-line non-pharmacologic therapy in CKD patients for managing blood pressure by reducing extracellular fluid volume and helping control hypertension.

19
Q

Which class of antihypertensive medications has been shown to slow CKD progression beyond their effect on systemic blood pressure?
A. Beta-blockers
B. Calcium channel blockers
C. ACE inhibitors and ARBs
D. Diuretics

A

C. ACE inhibitors and ARBs

Rationale: ACE inhibitors and ARBs slow CKD progression by reducing intraglomerular hypertension and hyperfiltration in addition to lowering systemic blood pressure.

20
Q

Why should ACE inhibitors and ARBs generally not be used in combination in CKD patients?
A. Increased risk of hyperkalemia
B. Increased risk of hypocalcemia
C. Increased risk of hyperglycemia
D. Increased risk of thrombocytopenia

A

A. Increased risk of hyperkalemia

Rationale: Using ACE inhibitors and ARBs together increases the risk of hyperkalemia and AKI, as both medications inhibit the renin-angiotensin-aldosterone system, leading to a greater reduction in potassium excretion.

21
Q

Which electrocardiographic (ECG) finding is most specific for pericarditis?
A. ST-segment elevation in V1–V3
B. PR-interval depression and diffuse ST-segment elevation
C. T-wave inversion in lateral leads
D. Q waves in inferior leads

A

B. PR-interval depression and diffuse ST-segment elevation

Rationale: The classic ECG findings of pericarditis are diffuse ST-segment elevation and PR-interval depression, reflecting widespread inflammation of the pericardium.

22
Q

What is the most appropriate management for uremic pericarditis in a patient with advanced CKD?
A. Immediate initiation or intensification of dialysis
B. High-dose corticosteroids
C. Intravenous antibiotics
D. High-dose NSAIDs

A

A. Immediate initiation or intensification of dialysis

Rationale: Uremic pericarditis is an absolute indication for urgent dialysis initiation or intensification to address the underlying cause.

23
Q

Why should dialysis for uremic pericarditis be performed without heparin?
A. Heparin increases the risk of electrolyte imbalance
B. Heparin may cause hyperkalemia
C. Heparin increases the risk of hemorrhage in the pericardial fluid
D. Heparin prolongs the duration of pericarditis symptoms

A

C. Heparin increases the risk of hemorrhage in the pericardial fluid

Rationale: Patients with uremic pericarditis are prone to bleeding, and the use of heparin during dialysis can exacerbate hemorrhage into the pericardial space.

24
Q

In a patient with pericardial effusion and echocardiographic signs of tamponade, what is the next best step in management?
A. Increase dialysis sessions
B. Administer high-dose NSAIDs and colchicine
C. Perform urgent pericardiocentesis
D. Start high-dose corticosteroids

A

C. Perform urgent pericardiocentesis

Rationale: Pericardiocentesis is indicated in patients with pericardial effusion and echocardiographic evidence of tamponade to relieve life-threatening pressure on the heart.

25
Q

What is the primary cause of anemia in chronic kidney disease (CKD)?
A. Hemolysis due to uremia
B. Iron deficiency
C. Insufficient erythropoietin (EPO) production by the kidneys
D. Gastrointestinal blood loss

A

Insufficient erythropoietin (EPO) production by the kidneys

Rationale: The primary cause of anemia in CKD is reduced production of erythropoietin by the diseased kidneys, which impairs red blood cell production

26
Q

At what stage of CKD is normocytic, normochromic anemia commonly observed?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 5

A

C. Stage 3

Rationale: Normocytic, normochromic anemia is commonly observed as early as stage 3 CKD and becomes almost universal by stage 4.

27
Q

What is a significant challenge in treating anemia with erythropoiesis-stimulating agents (ESAs) in CKD patients?
A. ESA-induced hyperkalemia
B. Resistance to ESAs caused by inflammation
C. Increased risk of infection due to ESAs
D. ESA-induced thrombocytopenia

A

B. Resistance to ESAs caused by inflammation

Rationale: Inflammation in CKD patients can lead to resistance to exogenous erythropoiesis-stimulating agents (ESAs), complicating anemia management.

28
Q

What is the recommended target hemoglobin concentration in patients with anemia of CKD?
A. 80–90 g/L
B. 90–100 g/L
C. 100–115 g/L
D. 120–130 g/L

A

C. 100–115 g/L

Rationale: Current practice guidelines recommend targeting a hemoglobin concentration of 100–115 g/L in CKD patients to balance the benefits of anemia correction with the risks of adverse effects, such as cardiovascular events.

29
Q

Which of the following symptoms is an indication to initiate renal replacement therapy in a CKD patient?
A. Restless leg syndrome
B. Evidence of peripheral neuropathy without another identifiable cause
C. Mild disturbances in memory and concentration
D. Muscle cramps

A

B. Evidence of peripheral neuropathy without another identifiable cause

Rationale: Peripheral neuropathy in the absence of another cause, such as diabetes or iron deficiency, is a recognized indication for starting renal replacement therapy in CKD patients.

30
Q

What is the characteristic presentation of peripheral neuropathy in CKD patients?
A. Proximal motor nerve involvement before sensory nerves
B. Distal sensory nerve involvement before motor nerves
C. Upper extremities affected more than lower extremities
D. Generalized symmetrical motor weakness

A

B. Distal sensory nerve involvement before motor nerves

Rationale: In CKD-associated peripheral neuropathy, sensory nerves are affected earlier and more than motor nerves, with distal regions (e.g., feet and legs) being affected before proximal regions.

31
Q

Which of the following symptoms is most characteristic of restless leg syndrome in CKD patients?
A. Severe muscle cramps
B. Ill-defined discomfort in the legs relieved by movement
C. Twitching of proximal muscles
D. Numbness and tingling in the hands

A

B. Ill-defined discomfort in the legs relieved by movement

Rationale: Restless leg syndrome is characterized by uncomfortable sensations in the legs and feet, which are relieved by frequent leg movements.

32
Q

What is the primary reproductive complication observed in women with chronic kidney disease (CKD) with a GFR of ~40 mL/min?
A. Polycystic ovary syndrome
B. Hyperprolactinemia
C. High rate of spontaneous abortion
D. Premature ovarian failure

A

C. High rate of spontaneous abortion

Rationale: In women with CKD, when the GFR declines to ~40 mL/min, pregnancy is associated with a high risk of spontaneous abortion, and only about 20% of pregnancies result in live births.

33
Q

What is a common sexual health complication in men with CKD?
A. Hypersexuality
B. Reduced plasma testosterone levels
C. Early-onset androgenic alopecia
D. Increased sperm motility

A

B. Reduced plasma testosterone levels

Rationale: Men with CKD often experience reduced plasma testosterone levels, leading to sexual dysfunction and oligospermia.

34
Q

What is the primary characteristic of nephrogenic fibrosing dermopathy (NFD)?
A. Psoriatic plaques on the scalp and elbows
B. Progressive subcutaneous induration, especially on the arms and legs
C. Vesicular rash involving mucous membranes
D. Petechial rash confined to the trunk

A

B. Progressive subcutaneous induration, especially on the arms and legs

Rationale: NFD is characterized by progressive subcutaneous thickening and induration, particularly in the arms and legs, and is linked to gadolinium exposure in CKD patients.

35
Q

What is the recommended approach for using gadolinium-based contrast agents in patients with CKD stage 4–5 (GFR <30 mL/min)?
A. Administer gadolinium only during emergencies, followed by immediate hemodialysis.
B. Avoid gadolinium-based contrast agents entirely, regardless of circumstances.
C. Use gadolinium liberally, as it is safe in CKD stages 4–5.
D. Recommend alternative contrast agents for all imaging needs.

A

A. Administer gadolinium only during emergencies, followed by immediate hemodialysis.

Rationale: Gadolinium-based contrast agents should generally be avoided in CKD stages 4–5 unless absolutely necessary. If used, rapid removal by hemodialysis is recommended to reduce the risk of NFD.

36
Q

Why is renal biopsy generally not advised in patients with bilaterally small kidneys?
A. Small kidneys are more susceptible to infection after biopsy.
B. There is usually no diagnostic or therapeutic benefit.
C. The procedure cannot be performed using ultrasound guidance.
D. Patients with small kidneys are not at risk of complications from biopsy.

A

B. There is usually no diagnostic or therapeutic benefit.

Rationale: In patients with bilaterally small kidneys, the extensive scarring makes it unlikely to identify the underlying disease, and the opportunity for effective disease-specific therapy has usually passed.

In the patient with bilaterally small kidneys,
renal biopsy is not advised because (1) it is technically difficult and
has a greater likelihood of causing bleeding and other adverse consequences,
(2) there is usually so much scarring that the underlying
disease may not be apparent, and (3) the window of opportunity to
render disease-specific therapy has passed

37
Q

Which of the following is a contraindication for performing a renal biopsy?
A. Controlled hypertension
B. Active urinary tract infection
C. Mild obesity
D. Normal bleeding time

A

B. Active urinary tract infection

Rationale: Active urinary tract infections increase the risk of sepsis and complications during a renal biopsy. Other contraindications include uncontrolled hypertension, severe obesity, and bleeding diathesis.

38
Q

Which approach is preferred for performing a renal biopsy in most patients?
A. Open surgical biopsy
B. Laparoscopic biopsy
C. Ultrasound-guided percutaneous biopsy
D. Fluoroscopic-guided percutaneous biopsy

A

C. Ultrasound-guided percutaneous biopsy

Rationale: Ultrasound-guided percutaneous biopsy is the favored approach because it is minimally invasive and allows for precise targeting while reducing the risk of complications.

NEPHRO (9 decks)

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