CKD

Question 1

Macroalbuminuria

Answer 1

Random urine albumin/creatinine ratio > 300mg/g

Question 2

Microalbuminuria

Answer 2

Random urine albumin/creatinine ratio 30-300mg/g

Question 3

Early markers of renal injury

Answer 3

Albuminuria

Question 4

Stages of CKD

Answer 4

Stage 1: GFR >/= 90
Stage 2: GFR >/= 60
Stage 3a: GFR >/= 45
Stage 3b: GFR >/= 30
Stage 4: GFR >/= 15
Stage 5: GFR < 15

A1: Albuminuria < 30mg/g
A2: Albuminuria 30-300mg/g
A3: Albuminuria > 300mg/g

Question 5

Peak GFR

Answer 5

3rd decade of life ~120ml/min

Question 6

Annual GFR decline rate

Answer 6

1ml/min/yr

Question 7

Gold standard for measurement of albuminuria

Answer 7

24-hour urine collection

Question 8

Marker for the presence of microvascular disease

Answer 8

Microalbuminuria

Question 9

Five most frequent causes of CKD

Answer 9

1. DM nephropathy
2. Glomerulonephritis
3. Hypertension-associated CKD
4. Autosomal dominant polycystic kidney disease
5. Tubulointerstitial nephropathy

Question 10

Most frequent cause of CKD in Western countries

Answer 10

DM nephropathy

Question 11

Electrolyte imbalance not commonly seen in CKD

Answer 11

Hyponatremia and hypokalemia

Question 12

When to consider alkali supplementation

Answer 12

Serum HCO3 < 20mmol/l

Question 13

Osteitis fibrosa cystica

Answer 13

Classic lesion of hyperparathyroidism which results from high-turnover bone disease in CKD (secondary hyperparathyroidism)

“Brown tumor”

Question 14

What maintains normal serum phosphorus

Answer 14

FGF-23

Question 15

Independent risk factor for LVH and mortality in CKD, HD, and transplant patients

Answer 15

High level of FGF-23

Question 16

Manifestations, pathology and risk factor for calciphylaxis (calcific uremic arteriolopathy)

Answer 16

Manifests as livedo reticularis
Occurs due to vascular occlusion and calcification
Risk factor is warfarin use

Question 17

Goal PTH level

Answer 17

150-300 pg/ml

Question 18

Leading cause of mortality and morbidity in every stage of CKD

Answer 18

Cardiovascular disease

Question 19

Low levels of what leads to more rapid vascular calcification especially with hyperphosphatemia

Answer 19

Fetuin

Question 20

What stage of CKD is anemia seen

Answer 20

As early as stage 3, universal at stage 4

Question 21

BP goal in CKD with DM or proteinuria > 1 g/24h

Answer 21

130/80

Question 22

Goal hemoglobin level with EPO

Answer 22

10-11.5 mg/dl

Question 23

Preferred anticoagulant in CKD

Answer 23

Conventional unfractionated heparin

Question 24

What stage of CKD is uremic neuromuscular disease seen

Answer 24

Stage 3

Question 25

What stage of CKD is peripheral neuropathy seen

Answer 25

Stage 4

Question 26

Unique dermatologic abnormality in CKD

Answer 26

Nephrogenic fibrosing dermopathy - progressive subcutaneous induration

Question 27

Indication for use of ACE-i and ARBs

Answer 27

Proteinuria > 300mg

Question 28

Diseases with normal or enlarged kidneys

Answer 28

1. DM nephropathy
2. HIV nephropathy
3. Amyloidosis
4. Polycystic kidney disease

Question 29

Contraindications to kidney biopsy

Answer 29

1. Bilaterally small kidneys
2. Uncontrolled hypertension
3. Active UTI
4. Bleeding diathesis
5. Morbid obesity

Question 30

Clear indications for RRT

Answer 30

1. Uremic pericarditis
2. Encephalopathy
3. Intractable muscle cramping/hyperkalemia
4. Anorexia and nausea not attributable to other causes
5. Malnutrition
6. Fluid overload
7. Toxic ingestion