Quiz Questions

Question 1

1. Over the 4 days a 72 yo man started feeling worse and worse. He has fatigue, ascites with an audible succussion splash and bilateral pitting edema on both ankles. He presents late in the afternoon to your office. His oral temp is 99.4, BP is 180/100 mmhg and his pulse is 80 bpm. An in-office spot urinalysis reveals he has 1+ blood and 2+ protein w/no other abnormalities. Whats his clinical Dx?

Acute glomerulonephritis
Nephrotic S/d
Goodpasture’s s/d
Acute Kidney dz

Answer 1

Acute glomerulonephritis

Question 2

2. A 50 yo woman presents w. abdominal pain, gross hematuria and fatigue. She has been urinating blood since last night; it started as just a little blood in her urine at bedtime, mostly near the end of her urine stream, but this morning she urinated mostly blood. About 2 weeks ago, she had an episode of severe chest pain and dyspnea; she went to the ER at the time and they ruled out myocardial infarction and pulmonary embolism and sent her home without treatment when the pain subsided spontaneously. An in office urinalysis shows brick red urine that is 4+ positive for blood and 3+ for protein. What is her clinical dx?

Acute Glomerulonephritis
Nephrotic s/d
Goodpasture’s s/d
Acute kidney injury

Answer 2

Goodpasture’s s/d

Question 3

3. Which of the following is the most appropriate course of action for the 50yo woman just described?

a. The ER already R/O anything serious; it is ok to send her home w/dietary advice alone.
b. Give her 2 aspirins and monitor her in office after performing an ECG.
c. Send her back to the ER.
d. Prepare an individual herbal formula for her to start taking at high doses right away.

Answer 3

c. Send her back to the ER.

Question 4

4. A 9yo boy present w/smokey urine, fatigue, nausea, edema causing puffy eyes and pitting edema in both ankles and decreased urine production. His oral temp. is 101 F, his BP is 164/98 mmhg. The urine dipstick is positive for blood (3+) and protein is (1+). What is his clinical dx?

Acute Glomerulonephritis
Nephrotic S/d
Goodpasture’s S/d
Acute Kidney injury

Answer 4

Acute Glomerulonephritis

Question 5

5. A 40yo man w/a 40yr pack hx of smoking and mild emphysema but no other major health problems present w/Severe right flank pain and an episode of vomiting. He is pale and also notes he is tired and a dull HA which is unusual for him. The pain came on suddenly about 4 hrs ago, is deep and burning in nature, and the intensity is a 10/10. It is continues. He is not restless. Abdominal exam reveals only mild tenderness on palpation of the right lower quadrant. He cannot tolerate attempted kidney punch. His serum creatinine was 2.8 mg/dl. What is his clinical Dx?

Ureteral colic
Acute kidney injury
Goodpasture’s S/d
Nephrotic s/d

Answer 5

Ureteral colic

Acute kidney injury

Question 6

6. A 30 yo woman w/severe edema affecting his face, hands, legs and everywhere else. Her BP is 130/75 mmhg. Her urine protein is quantified at 4 g/d. Her serum creatinine is 1.0 mg/dl. What is her clinical dx?

Nephrotic s/d
Isolated Proteinuria
Chronic kidney dz
Renal HTN

Answer 6

Nephrotic s/d

Question 7

7. An 81yo asymptomatic woman present w/serum creatinine of 2.4 mg/dl and eGFR of 18 ml/min. These numbers have been progressively worsening oner the past several years. She has a 20+ year history of mild HTN and is taking lisinopril which keeps it under 140/90. In office her blood pressure is 130/80. She is very petite (5’2” tall & 110 lbs). An in office urine dipstick shows no abnormal results. What is her clinical dx?

Nephrotic S/d
Isolated proteinuria
Chronic Kidney dz
Renal HTN

Answer 7

Chronic Kidney dz

Question 8

8. A 59yo asymptomatic woman presents for routine check up. During her visit a routing screening urine microalbumin is positive at 81mg/g. Follow up testing shows her eGFR is 55 ml/min. Her oral temp is 98.2 deg. F, BP is 120/70 mm/hg and pulse 72. What is her clinical dx?

Nephrotic S/d
Isolated proteinuria
Chronic Kidney Dz
Renal HTN

Answer 8

Chronic Kidney Dz

Question 9

9. A 67yo man with painful bilateral hip osteoarthritis and no other sx’s is noted to have urine albumin/creatinine ratio of 45 mg/g on his routine annual screening test. His eGFR is >60 ml/min and a confirmatory creatinine clearance test shows his GFR is 90 ml/min. His BP is normal. What is his clinical dx?

Nephrotic s/d
Isolated proteinuria
Chronic kidney dz
Renal HTN

Answer 9

Chronic kidney dz

Question 10

10. A long time pt. of yours calls alarmed as she has noted that her 8 mo. old daughter developed a very puffy face over the past 3 days. She also noted an oily film in her diaper associated with urine each time she changed it. You have her come into the office on an urgent basis and note also that her hands are swollen. An in office urinalysis showed only 4+ protein. What is her most likely clinical dx?

Nephrotic s/d
Isolated proteinuria
Chronic kidney dz
Renal HTN

Answer 10

Nephrotic s/d

Question 11

55-yr-old man, long history of cigarette smoking with a chronic smoker’s cough,
otherwise healthy. Noted pitting edema in his legs this morning. No other symptoms.
SCr 1.6 mg/dl, BUN 31 mg/dl, eGFR (by CKD-EPI equation) 48 ml/min/1.73 m2, no
proteinuria.

What is his clinical syndrome?

Answer 11

Patient 1: early CKD (stage G3aA1a by the way)

Question 12

Patient 2: 
14-year-old girl, previously healthy. Awoke with painful purpura on her legs. First morning urine dark. Mother noted her face was puffy and she felt feverish. What is her clinical syndrome?

Answer 12

Patient 2: AGN (r/o Henoch-Schönlein purpura nephritis)

Question 13

Patient 3:

64-year-old man, history of coronary artery disease and hip osteoarthritis, on chronic NSAIDs. Over 1 wk, developed a persistent cough and started noticing intermittent bright red blood in his urine with back pain. In office, BP is 175/120 mmHg, urine dipstick is positive for blood and protein (both 3+), and he has bilateral 2+ pitting edema of his ankles. What is his clinical diagnosis? What is your response?

Answer 13

Patient 3: AGN w/ likely anti-GBM disease; send to hospital

Question 14

Patient 4:

42-year-old woman, history of irregular menstrual periods and dysmenorrhea, fatigue, currently taking levothyroxine. Found out her mother had aggressive breast cancer and started having to help take care of her (became very busy, not eating well). She herself tested positive for BRCA1; extremely stressed. Started getting severe nausea, abdominal pain, restlessness not relieved by any position, but helped by taking ibuprofen. What is her clinical syndrome?

Answer 14

Patient 4: ureteral colic

Question 15

Patient 5:

71-year-old man, type I diabetes mellitus since age 17 yr, using insulin (basal and short-acting), refuses statins (highly skeptical of conventional medicine). Diagnosed one year ago with retinopathy in left eye. Over the past month has become extremely fatigued, dyspneic, confused, anorexic, and has gained weight (~15 lb in 1 mon). In office, BP is 160/105 mmHg, he has 3+ bilateral pitting edema of legs, has a positive fluid wave in abdomen, urine dipstick positive for glucose (4+), protein (1+), and blood (1+). What is his clinical syndrome?

Answer 15

Patient 5: late CKD (stage cannot be determined)

Question 16

Patient 6:

37-year-old man, history of scoliosis and back pain. Recent onset of fatigue and swollen face and ankles. Also noted oily sheen in toilet after urinating. In office BP 120/74 mmHg, urine dipstick 3+ protein, 3+ pitting edema of both lower legs almost to the knees and dorsa of his hands. BUN 24 mg/dl, SCr 1.0 mg/dl, eGFR >60 ml/min/1.73 m2. What is his clinical syndrome? What tests would confirm this?

Answer 16

Patient 6: nephrotic syndrome; serum lipids, 24 h urine protein, serum albumin

Question 17

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

What is his clinical s/d?

a. Chronic Kidney dz
b. Nephrotic s/d
c. Acute glomerulonephritis
d. Acute kidney injury

Answer 17

a. Chronic Kidney dz

Question 18

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

2. Which of the following best explains his clinical symptoms?
   a. Goodpature’s s/d
   b. Autonomic neuropathy
   c. Increased intestinal permeability
   d. Gymnema toxicity

Answer 18

b. Autonomic neuropathy

Question 19

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

3. His son recently read that he should adopt a Paleolithic-style diet to help reverse his diabetic nephropathy. Which of the following are most likely to be problems with this approach?

a. Low sodium, low calcium and low carb level in the diet.
b. High sodium, high calcium and high carb level diet
c. Low protein, low phosphorus and low potassium
d. High protein, high phosphorus and high potassium level diet.

Answer 19

d. High protein, high phosphorus and high potassium level diet.

Question 20

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

4. In contrast to a Paleolithic diet, which of the following diets has been shown to reduce mortality and delay progression in the patients with diabetic nephropathy, even at his stage?

a. A complete raw and strict vegan diet
b. Avoid fish and fowl (in favor of beef and fork), decrease legumes and whole grains, eat only sprouted nuts/seeds, eliminate all alcohol and caffeine
c. Avoid beef and pork (in favor and fowl) , increased legumes, whole grains and nuts/seeds and drink moderate red wine and black tea.
d. No diet has been shown to do this.

Answer 20

c. Avoid beef and pork (in favor and fowl) , increased legumes, whole grains and nuts/seeds and drink moderate red wine and black tea.

Question 21

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

5. Which of the following herbs would be most indicated to protect remaining nephrons, support regeneration of damage nephrons and potentially lower blood pressure.

a. Apium graveolens fruit
b. Rheum palmatum cooked root
c. Urtica dioica seed
d. Lespedeza capitata leaf/flower

Answer 21

d. Lespedeza capitata leaf/flower

Question 22

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

6. You consider recommending a folic acid supplement to this patient. Which of the following is most true about folic acid and renal failure?

a. Folic acid as part of a tx for high homocysteine is associated w/increased rate of kidney deterioration in diabetic patients.
b. Folic acid minimally affects renal failure, but by reducing homocysteine levels it improves CV outcomes.
c. Folic acid usually slows progression of renal failure.
d. There is no research about folic acid and renal failure.

Answer 22

a. Folic acid as part of a tx for high homocysteine is associated w/increased rate of kidney deterioration in diabetic patients.

Question 23

7. Which of the following foods is most likely to be high in phosphorus?
   a. Corn Tortilla
   b. Glass of cow’s milk
   c. An apple
   d. Pretzels

Answer 23

b. Glass of cow’s milk

Question 24

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

8. Which of the following is a low sodium food and why would the a low sodium diet be beneficial for this patient?

a. A hard boiled egg to reduce blood pressure (and hence need for medication) and edema.
b. Potato chips, to lower his serum sodium to just below the normal range.
c. A slice of cheese pizza; to raise his serum calcium level (and hence avoid the need for calcium or vit. D supplements).
d. Conventional frozen dinner, to halt progression of his diabetic nephropathy.

Answer 24

a. A hard boiled egg to reduce blood pressure (and hence need for medication) and edema.

Question 25

9. Which of the following is true about calcium supplements, in general?

a. When given w/vit. D concurrent, absorption of calcium citrate can approach 90% of the total dose.
b. They are more effective than biophosphonate medication in fracture prevention in osteoporosis patients.
c. Calcium overdose would likely lead to HTN, diarrhea and urinary retention.
d. Calcium supplementation has been linked to increase in CV mortality in some, but not all, research.

Answer 25

d. Calcium supplementation has been linked to increase in CV mortality in some, but not all, research.

Question 26

PATIENT: 70 yo hispanic male, 5’7”, wt. 198 lb, BMI 31 kg/m2
PRESENTATION: He has been having diff. w/HTN, erectile dysfxn and sensation of food sitting like a brick in his stomach for a long time after he eats coupled w/heartburn or uncomfortable bloating secondary to long standing diabetes mellitus type 2. He was told he has kidney problem a few yrs ago and it has been mentioned he will probably end up on dialysis which he is starting to become afraid of and would like to avoid. He also notes he has moderate ankle edema by the end of the day.
MEDICAL HISTORY: He was dx’d w/diabetes almost 22 yrs ago. He has not worked very hard to keep his blood glucose under control. He has 2 brothers and 1 sister, all of whom are obese and also have type 2 diabetes. He has both knees replaced in the past 3 yrs.
PSYCHOSOCIAL: He lives with his wife and 1 of their grown children who lost his job and fell on hard times. He is a retired postal worker.
HEALTH HABITS: He does not smoke or drink alcohol and never has drank. He has a sedentary lifestyle now.
MEDS: Glyburide, Lisinopril
SUPPLEMENTS: Vit. D3, multivitamin, Gymnema
VITALS: T: 98.7, BP: 155/90, Pulse: 76, RR: 16/min
PHYSICAL EXAM: The only pertinent positive were diminished bowel sounds and all 4 quadrants, Lack of fine touch discrimination in both feet and ankles (Shins were sensitive) and 1+ pitting edema BL.
PRELIMINARY LAB RESULTS: HgA1C 8.2%, eGFR 20 ml/min, serum K+ 6.0 mEq/L (nl 3.5-5.5), Phosphorus 5.1 mg/dl (nl 3-4.5), Ca2+ 8.8 mg/dl (nl 8.5-10.6), NA+ 146 mEq/L (nl 135-147)

10. Which of the following accurately reflects his stage and what does this say about the likelihood of progression if he doesn’t make any changes?

a. G2 unknown, urine protein testing would be necessary to know if he would progress
b. G3b A1b, he is actually pretty likely to improve
c. G4 A unknown, progression is highly likely
d. G5 A2, he should get ready for imminent dialysis

Answer 26

c. G4 A unknown, progression is highly likely