Nephrology (CKD, glomerular diseases) Practice Questions

Question 1

A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disease, hypertension, and diabetic polyneuropathy. Her current medications include insulin, torasemide, lisinopril, and synthetic erythropoietin. Her temperature is 36.7°C (98°F), pulse is 87/min, and blood pressure is 138/89 mm Hg. She appears pale. There is 2+ pitting edema in the lower extremities. Sensation to pinprick and light touch is decreased over the feet and legs bilaterally. Laboratory studies show:
Hemoglobin 11.4 g/dL
Leukocyte count 6000/mm3
Platelet count 280,000/mm3
Serum
Na+ 137 mEq/L
K+ 5.3 mEq/L
Cl− 100 mEq/L
HCO3− 20 mEq/L
Urea nitrogen 85 mg/dL
Creatinine 8 mg/dL
pH 7.25
Which of the following long-term treatments would best improve quality of life and maximize survival in this patient?

Accepted Answer

Living donor kidney transplant

Answer

Peritoneal dialysis

Answer

Cadaveric kidney transplant

Answer

Hemofiltration

Answer

Fluid restriction

Question 2

A 64-year-old African American female comes to the physician's office for a routine check-up. The patient's past medical history is significant for hypertension, diabetes, and osteoarthritis in her right knee. Her medications include metformin, glimepiride, lisinopril, metoprolol, hydrochlorothiazide, and ibuprofen as needed. Her only complaint is an unremitting cough that started about 3 weeks ago and she has noticed some swelling around her mouth. The drug most likely responsible for her recent symptoms causes its primary renal hemodynamic effect on which part of the kidney?

Accepted Answer

Efferent arteriole

Answer

Collecting duct

Answer

Distal convoluted tubule

Answer

Juxtaglomerular cells

Answer

Afferent arteriole

Question 3

A 45-year-old man presents with a 3-day history of right-sided flank pain due to a lodged ureteral stone. What changes would be expected to be seen at the level of glomerular filtration?

Accepted Answer

Increase in Bowman's space hydrostatic pressure

Answer

Increase in glomerular capillary oncotic pressure

Answer

Increase in Bowman's space oncotic pressure

Answer

Increase in filtration fraction

Answer

No change in filtration fraction

Question 4

Activation of the renin-angiotensin-aldosterone system yields a significant physiological effect on renal blood flow and filtration. Which of the following is most likely to occur in response to increased levels of Angiotensin-II?

Accepted Answer

Decreased renal plasma flow, increased filtration fraction

Answer

Decreased renal plasma flow, decreased filtration fraction

Answer

Decreased renal plasma flow, increased glomerular capillary oncotic pressure

Answer

Increased renal plasma flow, decreased filtration fraction

Answer

Increased renal plasma flow, increased filtration fraction

Question 5

A 58-year-old man presents to the Emergency Department after 3 hours of intense suprapubic pain associated with inability to urinate for the past day or two. His medical history is relevant for benign prostatic hyperplasia (BPH) that has been under treatment with prazosin and tadalafil. Upon admission, he is found to have a blood pressure of 180/100 mm Hg, a pulse of 80/min, a respiratory rate of 23/min, and a temperature of 36.5°C (97.7°F). He weighs 84 kg (185.1 lb) and is 175 cm (5 ft 7 in) tall. Physical exam, he has suprapubic tenderness. A bladder scan reveals 700 ml of urine. A Foley catheter is inserted and the urine is drained.  Initial laboratory tests and their follow up 8 hours after admission are shown below.
Admission 8 hours after admission
Serum potassium 4.2 mmol/L Serum potassium 4.0 mmol/L
Serum sodium 140 mmol/L Serum sodium 142 mmol/L
Serum chloride 102 mmol/L Serum chloride 110 mmol/L
Serum creatinine 1.4 mg/dL Serum creatinine 1.6 mg/dL
Serum blood urea nitrogen 64 mg/dL Serum blood urea nitrogen 62 mg/dL
Urine output 250 mL Urine output 260 mL
A senior attending suggests a consultation with Nephrology. Which of the following best justifies this suggestion?

Accepted Answer

Urine output

Answer

Estimated glomerular filtration rate (eGFR)

Answer

Serum creatinine (SCr)

Answer

Serum blood urea nitrogen (BUN)

Answer

Serum potassium

Question 6

A 72-year-old woman with a medical history significant for chronic kidney disease stage 4, hypertension, and type 2 diabetes mellitus, presents to the office for a scheduled visit. During her last visit, the physician started discussing with her the possibility of starting her on dialysis for her chronic kidney disease. The patient has no complaints about her health and enjoys spending time with her family. At presentation, she is afebrile; the blood pressure is 139/89 mm Hg and the heart rate is 80/min. On physical examination, her pulses are bounding, the complexion is pale, she has a grade ⅙ holosystolic murmur, breath sounds remain clear, and 2+ pedal edema to the knee. The measurement of which of the following laboratory values is most appropriate to screen for renal osteodystrophy in this patient?

Accepted Answer

Serum intact parathyroid hormone level

Answer

Erythrocyte sedimentation rate

Answer

Serum vitamin B-12 level

Answer

Serum C-reactive protein level

Answer

Serum thyroid-stimulating hormone level

Question 7

A 55-year-old man presents to his primary care physician with a complaint of fatigue for a couple of months. He was feeling well during his last visit 6 months ago. He has a history of hypertension for the past 8 years, diabetes mellitus for the past 5 years, and chronic kidney disease (CKD) for a year. The vital signs include: blood pressure 138/84 mm Hg, pulse 81/min, temperature 36.8°C (98.2°F), and respiratory rate 9/min. On physical examination, moderate pallor is noted on the palpebral conjunctiva and nail bed.

Complete blood count results are as follows:
Hemoglobin 8.5 g/dL
RBC 4.2 million cells/µL
Hematocrit 39%
Total leukocyte count 6,500 cells/µL
Neutrophils 61%
Lymphocytes 34%
Monocytes 4%
Eosinophils 1%
Basophils 0%
Platelets 240,000 cells/µL

A basic metabolic panel shows:
Sodium 133 mEq/L
Potassium 5.8 mEq/L
Chloride 101 mEq/L
Bicarbonate 21 mEq/L
Albumin 3.1 mg/dL
Urea nitrogen 31 mg/dL
Creatinine 2.8 mg/dL
Uric acid 6.4 mg/dL
Calcium 8.1 mg/dL
Glucose 111 mg/dL

Which of the following explanations best explains the mechanism for his decreased hemoglobin?

Accepted Answer

Failure of adequate erythropoietin production

Answer

Progressive metabolic acidosis

Answer

Side effect of his medication

Answer

Failure of 1-alpha-hydroxylation of 25-hydroxycholecalciferol

Answer

Increased retention of uremic products

Question 8

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Question 9

A 43-year-old man is referred by his family physician because his urine dipstick reveals 3+ protein and urinalysis reveals 1-2 red cells/high power field, but is otherwise negative. He does not have any current complaints. His family history is irrelevant. He denies smoking and alcohol use. His temperature is 36.7°C (98.06°F), blood pressure is 130/82 mm Hg, and pulse is 78/min. Physical examination is unremarkable. Which of the following is the best next step in the management of this patient’s condition?

Accepted Answer

24-hour urine collection

Answer

Reassurance

Answer

Repeat the urine dipstick test

Answer

Start captopril

Answer

Urine culture

Question 10

A 55-year-old Caucasian woman visits her family physician for a checkup and to discuss her laboratory results from a previous visit. The medical history is significant for obesity, hypothyroidism, and chronic venous insufficiency. The medications include thyroxine and a multivitamin. In her previous visit, she complained about being hungry all the time, urinating multiple times a day, and craving water for most of the day. Blood and urine samples were obtained. Today her blood pressure is 120/70 mm Hg, the pulse is 80/min, the respiratory rate is 18/min, and the body temperature is 36.4°C (97.5°F). The physical examination reveals clear lungs with regular heart sounds and no abdominal tenderness. There is mild pitting edema of the bilateral lower extremities. The laboratory results are as follows:
Elevated SCr for an eGFR of 60 mL/min/1.73 m²
Spot urine albumin-to-creatinine ratio 250 mg/g
Urinalysis
Specific gravity 1.070
Proteins  (++)
Glucose (+++)
Nitrites  (-)
Microscopy
Red blood cells none
White blood cells none
Hyaline casts few
A bedside renal ultrasound revealed enlarged kidneys bilaterally without hydronephrosis. Which of the following kidney-related test should be ordered next?

Accepted Answer

Urine protein electrophoresis

Answer

Renal computed tomography

Answer

No further renal tests are required

Answer

Renal arteriography

Answer

Renal biopsy

Nephrology (CKD, glomerular diseases)

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CKD classification and staging

CKD etiology and pathophysiology

CKD complications management

Diabetic nephropathy

Hypertensive nephrosclerosis

Glomerulonephritis classification

Primary glomerular diseases

Secondary glomerular diseases

Nephrotic syndrome

Nephritic syndrome

Acute kidney injury

Renal replacement therapy

Kidney transplantation

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About Nephrology (CKD, glomerular diseases) for USMLE

Lessons in Nephrology (CKD, glomerular diseases)

Master Nephrology (CKD, glomerular diseases)