Nephrology

Question 1

In a patient with syncope & recently increased HCTZ, what’s the next step in management?

Answer 1

Decrease HCTZ dose & obtain ambulatory blood pressure monitoring

Question 2

Is required to make the diagnosis of glomerulopathy associated with the nephrotic syndrome in adult patients?

Answer 2

A kidney biopsy

Question 3

The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend treatment of metabolic acidosis with

Answer 3

Sodium Bicarbonate (alkali therapy) in patients with CKD when the serum bicarbonate is chronically <22 .

Question 4

Treatment minimal change glomerulopathy?

Answer 4

Glucocorticoids are first-line

Standard treatment of the nephrotic syndrome (ACEI or ARBs, diuretics for edema, and cholesterol-lowering medication if total cholesterol >200 mg/dL is also indicated as needed.

Question 5

Monoclonal gammopathy of renal significance is diagnosed in patients who would otherwise meet the criteria for monoclonal gammopathy of undetermined significance but have an abnormal urinalysis and kidney insufficiency. How do you diagnosed

Answer 5

Kidney biopsy

Question 6

Treatment for IgA nephropathy?

Answer 6

ACEI or ARBs, is the hallmark & most validated treatment strategy for IgA nephropathy, do not discontinue for mild decrease in renal function.

Question 7

Isovolemic hypotonic hyponatremia associated with urine osmolality <100 mOsm/kg H₂O indicates?

Answer 7

Excessive water intake, as seen with psychogenic polydipsia or poor solute intake

Note: Although lithium can cause nephrogenic diabetes insipidus, the fact that she is hyponatremic rules out this diagnosis. Serum sodium is typically normal but may be elevated in patients who do not have access to water & low urine osmolality will be noted.

Question 8

In patients with chronic diarrhea & malabsorption with calcium oxalate stones, what an be used for prevention?

Answer 8

Potassium citrate

Question 9

The best predictors for the presence of diabetic nephropathy are duration of diabetes mellitus for more than 8 years followed by the presence of the nephrotic syndrome. How do you treat diabetic nephropathy?

Answer 9

ACEI or ARBs

Question 10

Initial management of rhabdomyolysis-induced acute kidney injury includes

Answer 10

Aggressive fluid resuscitation with normal saline aimed at maintaining a urine output of 200 to 300 mL/h.

Question 11

How do you prevent contrast-induced nephropathy?

Answer 11

IV volume expansion with isotonic crystalloids has been shown to decrease the incidence of contrast-induced nephropathy in patients at risk.

Question 12

Is suggested by the constellation of anemia, hypercalcemia, normal anion gap metabolic acidosis, and acute kidney injury?

Answer 12

Multiple Myeloma

Classic symptoms of polyuria, polydipsia, and nocturia sometimes occur with elevated serum calcium levels of 11 mg/dL (2.8 mmol/L) or less. Other symptoms such as anorexia, nausea, abdominal pain, constipation, increased serum creatinine levels, & mild mental status changes are more likely to occur with levels >11 mg/dL.

Question 13

Three strategies can be used for antihypertensive dose adjustment in the treatment of hypertension:

Answer 13

(1) maximize the medication dose before adding another; (2) add another class of medication before reaching the maximum dose of the first; and (3) start with two medication classes separately or as fixed-dose combinations.

Question 14

Treatment ethylene glycol toxicity?

Note: typical findings of ethylene glycol toxicity, including central nervous system depression, an increased anion gap metabolic acidosis, & an increased osmolal gap.

Answer 14

Aggressive fluid resuscitation, fomepizole, and hemodialysis.

Question 15

The initial step in the management of newly diagnosed membranous glomerulopathy is to evaluate for

Answer 15

secondary forms of the disease, which account for approximately 25% of cases, with age & sex appropriate cancer screening.

Question 16

How do diagnose transitional cell (urothelial) cancer in a patient with Balkan endemic nephropathy (BEN)?

Answer 16

Endoscopic urological evaluation

Note: BEN has a high prevalence rate in southeastern Europe (Serbia, Bulgaria, Romania, Bosnia and Herzegovina, and Croatia) and is the cause of kidney disease in up to 70% of patients receiving dialysis in some of the most heavily affected regions

Question 17

Diabetes insipidus (DI) is diagnosed with simultaneous laboratory evidence of inability to concentrate urine in the face of hypernatremia & osmolality; a water deprivation test can confirm the diagnosis & treatment is with?

Answer 17

Desmopressin acetate

Note: This patient most likely has central nervous system sarcoidosis & central DI. Nearly half of hypothalamic-pituitary sarcoidosis cases occur in the course of previously treated sarcoidosis. Central DI results from inadequate release of ADH from the posterior pituitary gland.

Question 18

Hypoaldosteronism caused by _______, inhibitors of the renin-angiotensin system, type 4 renal tubular acidosis, or primary adrenal disease can cause hyperkalemia, especially in patients with chronic kidney disease or diabetes mellitus, or in those taking an ACE inhibitor or angiotensin receptor blocker.

Answer 18

Heparin

Question 19

In properly selected individuals, peritoneal dialysis allows patients to preserve

Answer 19

their independence and offers outcomes similar to those seen with hemodialysis.

Question 20

Treatment of stage 2 hypertension and an average BP of 20/10 mm Hg above BP target?

Answer 20

Combination therapy with two first-line antihypertensive drugs of different classes (separately or as a single-dose pill)

Question 21

Is typically characterized by a vasculitic prodrome of malaise, arthralgia, myalgia, and skin findings; hematuria, proteinuria, and acute kidney injury are present, and kidney biopsy will confirm diagnosis?

Answer 21

ANCA-associated glomerulonephritis

Question 22

Occurs in patients receiving therapeutic doses of acetaminophen on a chronic basis in the setting of critical illness, poor nutrition, liver disease, chronic kidney disease, or a strict vegetarian diet;

Answer 22

Pyroglutamic acidosis

Diagnosis can be confirmed by measuring urine levels of pyroglutamic acid.

Question 23

How do you diagnose abdominal compartment syndrome?

Answer 23

Measure intra-abdominal pressure.

a sustained intra-abdominal pressure >20 mm Hg associated with at least one organ dysfunction; management includes supportive therapy, abdominal compartment decompression, and correction of positive fluid balance.

Question 24

Patients with nonglomerular hematuria should be stratified as high, intermediate, or low risk for urothelial cancer using factors that include age, gender, tobacco use, extent of hematuria, exposure to urothelial carcinogens, or chronic irritative voiding symptoms; intermediate- or high-risk patients require imaging of the genitourinary tract and

Answer 24

Cystoscopy

Question 25

Glomerular macroscopic hematuria typically features brown- or tea-colored urine with dysmorphic erythrocytes (or acanthocytes) and/or erythrocyte casts on urine sediment examination.

Answer 25

Glomerulonephritis

Question 26

Risk factors associated with __________________ include chronic kidney disease, prolonged therapy, doses ≥4 g/d, trough concentrations >15 mg/L, and concomitant use of loop diuretics.

Answer 26

Vancomycin-induced acute tubular necrosis.

Question 27

Treat acute hyponatremia in a symptomatic patient with?

Answer 27

100-mL bolus of 3% saline to increase the serum sodium level by 2 to 3 mEq/L (2-3 mmol/L).

Question 28

Is the most appropriate diagnostic test to evaluate for fibromuscular dysplasia in a young woman with new-onset hypertension?

Answer 28

Renal artery imaging

Question 29

Management of a patient with with chronic kidney disease & acute MI ?

Answer 29

Cardiac catheterization

Question 30

In a patient with kidney stone of 11 mm, the next step in management

Answer 30

Extracorporeal shock wave lithotripsy

Only 50% of stones >6 mm will pass spontaneously, whereas stones >10 mm are extremely unlikely to pass spontaneously. Urologic intervention is required in all patients with evidence of infection, acute kidney injury, intractable nausea or pain, and stones that fail to pass or are unlikely to pass.

Question 31

Kidney involvement in ____________ can manifest as nephrocalcinosis from hypercalcemia and hypercalciuria, and as tubulointerstitial nephritis with granuloma formation.

Answer 31

Sarcoidosis

Question 32

___________________ is common in normal pregnancy due to plasma volume increases with water retention greater than sodium retention; no treatment is necessary.

Answer 32

Mild hyponatremia

Question 33

The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend treatment of dyslipidemia with a statin in patients?

Answer 33

aged ≥50 years with an GFR <60 mL/min/1.73 m², but not treated with chronic dialysis or kidney transplantation.

Question 34

What is the gold standard for diagnosis of nephrolithiasis?

Answer 34

Noncontrast helical CT abdomen

Question 35

Increased muscle mass can result in an increase in serum creatinine level in the absence of change in kidney function & the most appropriate management is to measure?

Answer 35

Serum cystatin C level

Note: Because serum creatinine is derived from the metabolism of creatinine produced by muscle, a significant increase in muscle mass would be expected to increase serum creatinine. An elevation in serum creatinine could also occur with creatine supplements. Cystatin C, which is cleared by the kidney, is produced by all nucleated cells; therefore, levels are less dependent on muscle mass.

Question 36

In patients with hypercalciuria & recurrent kidney stones, calcium excretion & stone formation can be decreased by the use of?

Answer 36

Thiazides, which are used to treat hypercalciuria (urine calcium which is 320 or greater)

Question 37

Is recommended for patients with autosomal dominant polycystic kidney disease?

Answer 37

Screening for intracranial cerebral aneurysms using CT or MR angiography.

In 2018, the FDA approved the use of Tolvaptan in pts. with ADPKD who met certain criteria indicating high risk of rapid progressive loss of kidney function & likely benefit of treatment.

Question 38

Patients with newly diagnosed primary membranous glomerulopathy are usually observed for?

Answer 38

6 to 12 months while on conservative therapy (renin-angiotensin blockade, cholesterol-lowering medication & edema management) to allow time for possible spontaneous remission before initiating immunosuppression.

Question 39

In most patients with renal artery stenosis, the primary therapeutic intervention is

Answer 39

ACEI or ARBs, not surgery

Note: ACEI or ARB can be continued if there is not a >25% rise in the serum creatinine from baseline.

Question 40

Prevent contrast-induced nephropathy in a patient with CKD?

Answer 40

IV isotonic fluids are the mainstay in preventing contrast-induced nephropathy.

Question 41

Associated with Sjogrens syndrome* & is due to a defect in urine acidification in the distal nephron & is characterized by a normal anion gap metabolic acidosis, *positive urine anion gap, inability to acidify urine below a pH of 6.0, and hypokalemia?

Answer 41

Type 1 (hypokalemic distal)

Note: Type 2 (proximal) RTA, defect in reclaiming bicarbonate, normal AG metabolic acidosis, hypokalemia, glycosuria (without hyperglycemia), low-molecular-weight proteinuria, & renal phosphate wasting (known as Fanconi syndrome when all features are present), urine pH is <5.5

Type 4 (hyperkalemic distal) RTA due to aldosterone deficiency or resistance, hyperkalemia and a urine pH <5.5.

Question 42

Treat alcoholic ketoacidosis with?

Answer 42

5% dextrose in 0.9% saline

Dextrose will increase insulin and decrease glucagon secretion, while saline will repair any volume deficit; the combination will correct ketoacidosis.

Question 43

Edema management in a patient with newly diagnosed nephrotic syndrome starts with a salt-restricted diet and an oral loop diuretic; when loop diuretics have been maximally uptitrated and weight loss/edema control is insufficient, it is often necessary to add a?

Answer 43

Thiazide e.g Metolazone and/or potassium-sparing diuretic

Question 44

A type of nephrotic syndrome, that is classically seen in patients with obesity but also can manifest in those with a history of premature birth or solitary kidney.

Answer 44

Secondary focal segmental glomerulosclerosis (FSGS)

The pathogenesis of FSGS stems from podocyte injury due to immunologic, genetic, and/or hyperfiltration causes.

Question 45

In membranous glomerulopathy & in general nephrotic syndrome, what are patients at greatest risk of developing?

Answer 45

Renal vein thrombosis, due to a secondary hypercoagulable state & risk is related to the degree of hypoalbuminemia.

Question 46

Treatment for hypertension in a patient with CKD?

Answer 46

ACEI or ARBs

Question 47

Is defined by new-onset hypertension and proteinuria that occurs after 20 weeks of pregnancy; new-onset hypertension with new-onset end-organ damage (such as liver or kidney injury, pulmonary edema, cerebral or visual symptoms, or thrombocytopenia) are also diagnostic?

Answer 47

Preeclampsia

Note: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a life-threatening state that complicates 10% to 20% of cases of preeclampsia. The diagnosis requires the presence of microangiopathic hemolytic anemia, which is excluded by the normal bilirubin & peripheral blood smear.

Question 48

Should be considered as a cause of CKD of unknown etiology in young adulthood, who presents with pain & burning sensations in the hands & feet precipitated by exercise, fever, fatigue, or other stressors. Also, angiokeratomas (violaceous papules with overlying scale), decreased perspiration & corneal and lens opacities of the eyes can be noted?

Answer 48

Fabry disease, x-linked recessive

Question 49

Manage a patient with a struvite stone?

Answer 49

Stone removal

Question 50

Can occur in patients with chronic kidney disease or those on dialysis and is associated with fracture or bone pain; parathyroid hormone and alkaline phosphatase levels are typically normal?

Answer 50

Adynamic bone disease

Note: Osteitis fibrosa cystica is the classic pathology associated with kidney disease. This disorder is associated with increased bone turnover and elevated PTH and alkaline phosphatase levels.

Question 51

In cardiorenal syndrome type 1, _______________ are first-line therapy for managing volume overload in patients with decompensated heart failure with evidence of peripheral and/or pulmonary edema.

Answer 51

Loop diuretics e.g. Furosemide

Question 52

All patients with chronic kidney disease and anemia should have iron profiles assessed, including transferrin saturation and ferritin levels; treatment target levels are a transferrin saturation level >30% and a serum ferritin level >500 ng/mL (500 µg/L) using either?

Answer 52

Oral or IV iron supplementation

Question 53

In patients with resistant hypertension, hypokalemia, metabolic alkalosis, evaluate for?

Answer 53

Primary hyperaldosteronism, Calculation of the plasma aldosterone concentration/plasma renin activity ratio

A positive screening test: reveal a reduced or undetectable PRA or concentration & an inappropriately high (usually >15 ng/dL) PAC, which results in a high PAC/PRA ratio of >20. Confirmatory testing is performed except when initial testing is diagnostic, as in cases of spontaneous hypokalemia with undetectable PRA and PAC (>30 ng/dL [828 pmol/L]). Confirmatory tests include oral & IV salt loading and the fludrocortisone suppression & captopril challenge tests.

Question 54

Saline-responsive metabolic alkalosis typically presents with hypovolemia and a low urine chloride of <15 mEq; the most common causes are?

Answer 54

Surreptitious vomiting, nasogastric suction, and diuretic use.

Conditions that contribute to the maintenance of metabolic alkalosis include volume contraction, ineffective arterial blood volume, hypokalemia, chloride depletion, & decreased glomerular filtration. Laboratory evaluation of metabolic alkalosis is based on urine chloride concentration.

Question 55

Typically presents with pyuria, proteinuria, peripheral eosinophilia & elevated serum IgG and IgE levels; kidney imaging may show enlarged kidneys or renal masses in a patient with autoimmune pancreatitis?

Answer 55

IgG4-related disease

Tubulointerstitial nephritis is the most common kidney manifestation of IgG4-related disease

Definitive diagnosis of IgG4-related disease requires a tissue biopsy to demonstrate an infiltrate with IgG4-positive plasma cells. IgG4-related disease is readily treatable with glucocorticoids.

Question 56

In patients with chronic kidney disease, _______ are potentially nephrotoxic and a frequent cause of acute kidney injury and should be avoided.

Answer 56

NSAIDs

Question 57

Treatment for calcineurin inhibitor–induced hypertension and hyperkalemia in a kidney transplant recipient?

Answer 57

Thiazide or thiazide-like diuretic such as chlorthalidone.

Question 58

Management of hypermagnesemia includes discontinuation of magnesium-containing medications, administration of saline diuresis to enhance magnesium excretion, & administration of?

Answer 58

IV calcium to treat severe symptoms

Question 59

Use for diagnosis of oliguric AKI?

Answer 59

Examination of urine sediment

The presence of granular casts and/or renal epithelial cells on urine microscopy has strong predictive value for acute tubular necrosis.

In the setting of diuretics, the fractional excretion of urea (FE_Urea) is more accurate than the fractional excretion of sodium because urea excretion is not promoted by diuretics & is still retained in volume-depleted states.

Question 60

Suspected masked hypertension (defined as blood pressure that is normal in the office but elevated in the ambulatory setting) should be confirmed with

Answer 60

Ambulatory blood pressure monitoring or home blood pressure monitoring

Question 61

Initial antihypertensive treatment in black patients without chronic kidney disease should include

Answer 61

a thiazide diuretic or calcium channel blocker or ACEI/ARB or the combination of a thiazide & a ACEI/ARB or CCB.

Question 62

Diagnose chronic hypertension in a pregnant patient?

Answer 62

a SBP ≥140 mm Hg or DBP ≥90 mm Hg starting before pregnancy or before 20 weeks of gestation or persists longer than 12 weeks’ postpartum.

Note: Gestational HTN first manifests after 20 weeks of pregnancy without proteinuria or other end-organ damage and resolves within 12 weeks of delivery.

Question 63

Acute & steep rise in creatinine accompanied by hematuria & proteinuria w/positive antimyeloperoxidase (MPO) antibodies

Answer 63

Serologic testing for anti–glomerular basement membrane antibodies and kidney biopsy can confirm the diagnosis of anti–glomerular basement membrane antibody disease as the cause of rapidly progressive glomerulonephritis.

Question 64

White coat hypertension refers to elevated blood pressure measured in the office, but normal out-of-office blood pressure averages; diagnosis requires confirmation using

Answer 64

24-hour ambulatory blood pressure monitoring (gold standard) or home blood pressure monitoring.

Question 65

Treatment for hyperkalemia of 7.1 with EKG changes in a patient with acute kidney injury using?

Answer 65

Hemodialysis

Question 66

Characterized by hyperkalemia, a normal anion gap metabolic acidosis, impaired urine acidification (positive urine anion gap), and a urine pH <5.5?

Answer 66

Type 4 (hyperkalemic distal) renal tubular acidosis

Seen in diabetics, HIV & obstruction

Question 67

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 67

Kidney biopsy

Question 68

Treatment for hypertension associated with volume expansion in CKD?

Answer 68

Loop diuretics are a cornerstone of blood pressure management in patients with advanced CKD

Question 69

PICC placement before or after hemodialysis initiation is associated with adverse vascular access outcomes in patients with CKD. What’s the most appropriate venous access strategy?

Answer 69

Tunneled IJ central venous catheter

Note: PICC (Peripherally inserted central catheter)

Question 70

What is the treatment of choice for hypertension in patients with diabetes mellitus and albuminuria?

Answer 70

ACEI or ARB

Question 71

Some medications 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. Name such medications?

Answer 71

Such as cimetidine, trimethoprim, cobicistat, dolutegravir, bictegravir, and rilpivirine

Question 72

Topiramate, a carbonic anhydrase inhibitor, causes a decrease in urinary citrate excretion and formation of alkaline urine that favor the creation of

Answer 72

Calcium phosphate stones

Note: The most common crystal formations of calcium oxalate in the urine are the dumbbell-shaped calcium oxalate monohydrate crystals* and *envelope-shaped calcium oxalate dihydrate crystals*. She has *amorphous crystals in alkaline urine, which are usually calcium phosphate crystals.

Question 73

Chronic tubulointerstitial nephritis can be caused by

Answer 73

PPIs & the median time from drug initiation to diagnosis may exceed 6 to 9 months.

Question 74

Pseudohyperkalemia may occur in serum specimens when there are extreme elevations of leukocytes or platelets; therefore what should be done next?

Answer 74

repeat plasma potassium measurements

Question 75

treat anemia in patients with CKD & adequate iron stores who have hemoglobin concentrations <10 g/dL (100 g/L)?

Answer 75

Erythropoiesis-stimulating agents, the dose should be titrated to avoid hemoglobin concentrations increasing above 11.5 g/dL (115 g/L).

Question 76

________________ can cause symptomatic hypokalemia via renal losses of potassium; importantly, the hypokalemia will be refractory to therapy until this is repleted.

Answer 76

Hypomagnesemia

Question 77

Patient w/ AKI & cellulitis, with active urine sediment & low serum complement levels. The biopsy shows a proliferative glomerulonephritis on light microscopy with immunofluorescence of C3 and IgA & subepithelial hump-like deposits on electron microscopy, confirming a diagnosis of infection-related glomerulonephritis (IRGN). Which bacteria most likely cause this patient’s kidney disease?

Answer 77

Staphylococcus aureus

Question 78

The American College of Physicians and American Academy of Family Physicians recommend that antihypertensive drugs be initiated in patients ≥60 years old if blood pressure is

Answer 78

>150/90 mm Hg, with a goal of reducing systolic blood pressure to <150 mm Hg

The American College of Cardiology/American Heart Association recommends a systolic blood pressure target of <130 mm Hg in patients ≥65 years old.

Question 79

Initial treatment of secondary hyperparathyroidism in chronic kidney disease stages G3 through G5 is correction of?

Answer 79

Serum calcium, phosphorus, and vitamin D levels.

Treat hyperphosphatemia with Sevelamer

Question 80

Many medications, such as _______, can result in reversible elevations in blood pressure; discontinuation of the drug and a reassessment of blood pressure 1 month later are necessary to confirm a return to normal blood pressure measurement.

Answer 80

NSAIDS

Question 81

An immune-complex membranoproliferative glomerulonephritis with low C4 is the classic form of kidney involvement seen in patients with?

Answer 81

Hepatitis C

Question 82

Can occur in patients with occupational exposure to lead or exposure to lead in water, soil, paint, or food products; it is frequently associated with hyperuricemia, hypertension, and recurrent gouty attacks?

Answer 82

Lead nephropathy

This patient’s lead exposure is likely due to lead-contaminated moonshine. Contamination occurs when lead-containing car radiators are used to condense the alcohol during the distilling process.

Question 83

Normal anion gap metabolic acidosis can be caused by:

Answer 83

Gastrointestinal bicarbonate loss e.g. laxative abuse, renal loss of bicarbonate, or the inability of the kidney to excrete acid.

Question 84

___________ should be considered in patients with acute kidney injury from no apparent or unclear cause, suspected glomerulonephritis, or unexplained systemic disease.

Answer 84

Kidney biopsy

Question 85

The diagnosis of hereditary nephritis is confirmed with kidney biopsy, skin biopsy, or molecular genetic analysis. Patients should undergo what before biopsy?

Answer 85

Genetic Counseling

Question 86

Identify the type of a kidney stone in a patient with Crohn disease?

Answer 86

Calcium oxalate

Patients with diarrhea who are volume depleted and have a metabolic acidosis are at increased risk for developing kidney stones, particularly calcium oxalate stones and, less commonly, uric acid stones.

Question 87

Is characterized by an high anion gap metabolic acidosis in patients with short-bowel syndrome* or other forms of malabsorption; *diagnosis is confirmed by measuring the D-lactate level rather than the conventional L-lactate level.

Answer 87

D-lactic acidosis

Characteristic symptoms include intermittent confusion, slurred speech & ataxia. The diagnosis should therefore be considered in a patient with characteristic neurologic findings who presents with an increased anion gap metabolic acidosis, normal lactate level, negative ketones

Question 88

When managing chronic hypertension prior to conception, which meds should be discontinued?

Answer 88

ACEI, ARBs &** **direct renin inhibitors

Question 89

The presence of HTN, microhematuria & a positive family history of CKD requiring dialysis, as well as a brain aneurysm, raises clinical suspicion for autosomal dominant polycystic kidney disease (ADPKD), what’s the next diagnostic step?

Answer 89

Renal US

Question 90

In kidney transplant recipients who are planning pregnancy, which meds should be switched?

Answer 90

Mycophenolate mofetil, sirolimus, and everolimus must be discontinued 3 to 6 months prior to conception and replaced with azathioprine, which is generally safer and well tolerated in pregnancy.

Kidney transplant recipients should wait 1 to 2 years with a stable allograft before attempting conception. Also Cr should be <1.5.

Question 91

A clinical clue to the diagnosis is the presence of an elevated urine protein-creatinine ratio, w? minimal proteinuria detected by dipstick urinalysis (dipstick urinalysis detects albumin but not light chains). Other supporting findings are the presence of anemia & hypercalcemia (when calcium measurement is corrected for albumin)?

Answer 91

Light chain cast nephropathy from multiple myeloma

Question 92

Is recurrent gross hematuria that occurs concomitantly or within days after an upper respiratory infection or physical exertion, normal complements and usually follows a benign course?

Answer 92

IgA nephropathy

Question 93

Diagnose a complex mixed acid-base disorder

Answer 93

Because the blood pH is 7.56, the patient’s dominant acid-base disorder is an alkalosis. The low PCO₂ indicates a respiratory component to the alkalosis. The expected metabolic compensation for chronic respiratory alkalosis is a reduction in the serum bicarbonate of 4 to 5 mEq/L (4-5 mmol/L) for each 10 mm Hg (1.3 kPa) decrease in the PCO₂(in this case, the decrease in PCO₂ is 20 mm Hg [2.7 kPa]). The expected serum bicarbonate concentration in this patient is calculated as follows:

Normal Bicarbonate − Expected Compensation

24 − (8-10) mEq/L (mmol/L) = 14-16 mEq/L (14-16 mmol/L)

Because the measured bicarbonate of 20 mEq/L (20 mmol/L) is higher than expected, this suggests coexistence of a metabolic alkalosis.

An elevated anion gap is also present, indicating the presence of an increased anion gap metabolic acidosis. Assessing the ratio of the change in the anion gap (Δ anion gap) to the change in bicarbonate level (Δ bicarbonate), or the “delta-delta (Δ-Δ) ratio,” may indicate the presence of a coexistent acid-base disturbance. A ratio of <0.5 to 1 may reflect the presence of concurrent normal anion gap metabolic acidosis, whereas a ratio >2 may indicate the presence of metabolic alkalosis. This patient’s Δ-Δ ratio is 2.5 [Δ anion gap/Δ bicarbonate = (22 − 12)/(24 − 20) = 2.5], confirming the coexistence of the metabolic alkalosis.

Question 94

The presence of significant measured proteinuria in the context of minimal proteinuria on urine dipstick suggests the presence of Bence-Jones (light chain) proteinuria, which can be confirmed by a?

Answer 94

Urine protein electrophoresis

Question 95

Is indicated when the estimated glomerular filtration rate is <30 mL/min/1.73 m² to allow for adequate time to identify suitable living donors or to be put on an early listing if no living donor is available?

Answer 95

Referral for kidney transplant evaluation

Question 96

General management of type 1 hepatorenal syndrome includes?

Answer 96

Discontinuing diuretics, volume replacement with albumin, and use of vasoconstrictors with octreotide and oral midodrine.

Question 97

Hypernatremia may be caused by _____________, in which the urine osmolality is usually between 300 and 600 mOsm/kg H₂O.

Answer 97

Osmotic diuresis

Question 98

A decline in kidney function to include glomerular hematuria, severely increased albuminuria, acute or chronic kidney disease of unclear cause, and kidney transplant dysfunction or for just monitoring, should be managed with?

Answer 98

A kidney biopsy

Question 99

Manage end-stage kidney disease in an elderly patient with multiple comorbidities and poor prognosis with?

Answer 99

Non-dialytic therapy is a reasonable treatment option for elderly patients with end-stage kidney disease and multiple comorbidities; treatment focuses on symptom management.

Question 100

Management for difficult-to-control HTN in a CKD patient with the addition of a?

Answer 100

Loop diuretic

Question 101

is characterized by polyuria, tubular injury, hypomagnesemia, & proximal renal tubular acidosis with Fanconi syndrome in a patient receiving chemotherapy for non-small cell lung cancer?

Answer 101

Cisplatin

Question 102

In a patient with CKD & hypervolemia, HTN should be treated to a target of?

Answer 102

<130/80 with BP meds & dietary sodium restriction to <2000 mg/d combined with appropriate use of diuretics is recommended.

Question 103

The kidney failure risk equation uses four variables:

Answer 103

Age, sex, estimated GFR, and albuminuria (urine albumin-creatinine ratio) to predict 2-year & 5-year risk of end-stage kidney disease in patients with stages G3 to G5 chronic kidney disease.

Question 104

AA amyloid is formed by serum amyloid A protein, an acute phase reactant produced in various inflammatory diseases such as rheumatoid arthritis; confirmation of _________________ requires a kidney biopsy.

Answer 104

AA renal amyloidosis

Question 105

Treatment for mildly elevated BP at 128/78?

Answer 105

Lifestyle modification

Question 106

Patients with end-stage kidney disease have a markedly increased risk for renal cell carcinoma, and a high level of suspicion is warranted in patients with symptoms such as new-onset gross hematuria or unexplained flank pain. What’s the most appropriatenext step in management?

Answer 106

B/L radical nephrectomy

Question 107

The American College of Cardiology/American Heart Association recommend that adults not receiving hypertensive therapy with an elevated BP (120–129 mm Hg and <80 mm Hg) or stage 1 hypertension (130–139 mm Hg or 80–89 mm Hg) and who have an estimated 10-year ASCVD risk less than 10% should have a repeat BP evaluation within

Answer 107

3 to 6 months

Question 108

Management of stage G5 chronic kidney disease in a patient who will imminently require renal replacement therapy?

Answer 108

The most appropriate management for this patient with stage G5 chronic kidney disease (CKD) is to delay dialysis until she has uremic symptoms.