MKSAP Nephro IV

Question 1

CKD goals for iron target levels:

1. transferrin saturation level >___%
2. serum ferritin level > ____ ng/mL

Answer 1

> 30%

>500

Question 2

How do you calculate urine AG?

Answer 2

Na + K - Cl (urine)

Question 3

Urine chloride of _____ indicates surreptitious vomiting/nasogastric suction, diuretic use as a cause of metabolic alkalosis.

Answer 3

< 15

Question 4

_____ is the most common kidney manifestation of IgG4-related disease and typically presents with pyuria, proteinuria, and elevated serum IgG and IgE levels; kidney imaging may show enlarged kidneys or renal masses.

Answer 4

Tubulointerstitial nephritis

Other manifestations of IgG4-related disease can include autoimmune pancreatitis, allergic rhinitis, submandibular gland swelling, an elevated antinuclear antibody (ANA) titer, low serum complement levels, elevated serum IgG, elevated serum IgE, and peripheral eosinophilia.

Question 5

What are examples of calcineurin inhibitors?

Answer 5

tacrolimus or cyclosporine

Question 6

What is the best way to treat calcineurin inhibitor-induced HTN and hyperkalemia in kidney transplant recipients?

Answer 6

thiazide diuretics

Question 7

How do you treat hypermagnesemia toxicity?

Answer 7

NS, lasix, IV calcium

Calcium is a direct antagonist of magnesium and will target the effects of hypermagnesemia.

Question 8

Hypermagnesemia is usually not associated with significant symptoms until the level is >____.

Answer 8

> 7.2

Question 9

Chronic hypertension in a pregnant patient is defined as a systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg starting before ___ weeks of gestation or persists longer than ___ weeks postpartum.

Answer 9

20 weeks; 12 weeks

Question 10

Type 4 (hyperkalemic distal) renal tubular acidosis is characterized by: (4)

Answer 10

1. hyperkalemia,
2. a normal anion gap metabolic acidosis
3. impaired urine acidification (positive urine anion gap),
4. urine pH <5.5

Question 11

A ____ should be performed in patients with known systemic lupus erythematosus with suspected significant kidney involvement to establish the diagnosis and to identify the class, which will guide treatment decisions.

Answer 11

kidney biopsy (determine if proliferative v mesangial proliferative v membranous lupus nephritis)

Commonly cited indications for kidney biopsy include increasing serum creatinine without explanation, proteinuria >500 mg/24 h, or active urine sediment (dysmorphic erythrocytes, erythrocyte casts).

Question 12

Some medications (such as cimetidine, trimethoprim, some HIV medications ___, ____, ___, and ___) reduce proximal tubule secretion of creatinine, resulting in increases in serum creatinine that are nonprogressive; repeat serum creatinine measurement is required to confirm stable levels.

Answer 12

cobicistat, dolutegravir, bictegravir, and rilpivirine

Question 13

____, a carbonic anhydrase inhibitor, causes a decrease in urinary citrate excretion and formation of alkaline urine that favor the creation of calcium phosphate stones.

Answer 13

Topiramate

Question 14

Nonspecific symptoms of tubulointerstitial disease include ___, ___, ___ as well as progressive kidney dysfunction.

Answer 14

polyuria, malaise, and anorexia

Question 15

____ can be caused by proton pump inhibitors, and the median time from drug initiation to diagnosis may exceed 6 to 9 months.

Answer 15

Chronic tubulointerstitial nephritis