WorksheetsNeph Exam 3 - Heeter - CKD
Total questions: 53
Worksheet time: 27mins
Name
Class
Date
1.
What is defined as the progressive loss of renal function occuring over the course of several months to years
a)
chronic kidney disease
b)
progressive kidney disease
c)
chronic renal insufficiency
d)
kidney failure
2.
CKD is categorized from stages 1 - 5. Which stage indicates the most advanced disease
a)
1
b)
2
c)
3
d)
4
e)
5
3.
Which risk factor category for CKD is not proven to directly cause kidney damage but is useful for identifying patients at high risk for CKD
a)
susceptibility factors
b)
initiation factors
c)
progression factors
4.
Which risk factor category for CKD directly results in kidney disease and is modifiable by pharmacologic therapy
a)
susceptibility factors
b)
initiation factors
c)
progression factors
5.
Which risk factor category for CKD is associated with further kidney damage (progression of CKD and decline in renal function)
a)
susceptibility factors
b)
initiation factors
c)
progression factors
6.
What are susceptibility risk factors of CKD
a)
advanced age, low birth weight, reduced kidney mass
b)
racial/ethnic minority, FHx
c)
low income, low education
d)
systemic inflammation, dyslipidemia
e)
smoking, obesity
7.
What are initiation risk factors of CKD
a)
diabetes, HTN
b)
glomerulonephritis
c)
drug toxicity
d)
UTI, urinary stones
e)
hyperglycemia
8.
What are progression risk factors of CKD
a)
hyperglycemia
b)
uncontrolled HTN
c)
proteinuria
d)
smoking,obesity
e)
drug toxicity
9.
What causes the loss of nephrons in the kidney
a)
exposure to susceptibility factors
b)
exposure to initiation factors
c)
exposure to progression factors
10.
What is happening when there is hypertrophy of remaining nephrons
a)
compensation
b)
proteinuria
c)
progressive loss of nephrons
11.
Glomerular capillary hypertension is mediated by which hormone
a)
angiotensin II
b)
renin
c)
ADH
d)
erythropoietin
12.
What causes the promotion of progressive loss of nephrons and proteinuria
a)
cell damage due to upregulation of inflammatory cytokines
b)
cell damage due to downregulation of inflammatory cytokines
c)
scarring of interstitium
13.
If a patient has a GFR of greater than or equal to 90 mL/min, what stage of CKD are they at
a)
I
b)
II
c)
III
d)
IV
e)
V
14.
If a patient has a GFR of 60-89 mL/min, what stage of CKD are they at
a)
I
b)
II
c)
III
d)
IV
e)
V
15.
If a patient has a GFR of 30-59 mL/min, what stage of CKD are they at
a)
I
b)
II
c)
III
d)
IV
e)
V
16.
If a patient has a GFR of 15-29 mL/min, what stage of CKD are they at
a)
I
b)
II
c)
III
d)
IV
e)
V
17.
If a patient has a GFR of <15 mL/min (including dialysis), what stage of CKD are they at
a)
I
b)
II
c)
III
d)
IV
e)
V
18.
If a patient has normal renal function, they can NOT have CKD even if there is evidence of structual damage to the kidney (the presence of proteinuria)
a)
true
b)
false
19.
What is a normal level of proteinuria in a 24-hour collection
a)
<300 mg/day protein
b)
<30 mg/day albumin
c)
30-299 mg/day albumin
d)
greater than or equal to 300 mg/day protein or albumin
e)
N/A
20.
What is the microalbuminuria level of proteinuria during a 24-hour collection
a)
<300 mg/day protein
b)
<30 mg/day albumin
c)
30-299 mg/day albumin
d)
greater than or equal to 300 mg/day protein or albumin
e)
N/A
21.
What is the clinical proteinuria level during a 24-hour collection
a)
<300 mg/day protein
b)
<30 mg/day albumin
c)
30-299 mg/day albumin
d)
greater than or equal to 300 mg/day protein or albumin
e)
N/A
22.
What is the normal level of proteinuria in a spot collection when looking at albumin:creatinine
a)
<200 mg/g
b)
>200 mg/g
c)
30-299 mcg/mg
d)
<30 mcg/mg
e)
greater than or equal to 300 mcg/mg
23.
What is the microalbuminuria level of proteinuria in a spot collection when looking at albumin:creatinine
a)
<200 mg/g
b)
>200 mg/g
c)
30-299 mcg/mg
d)
<30 mcg/mg
e)
greater than or equal to 300 mcg/mg
24.
What is the clinical proteinuria level of proteinuria in a spot collection when looking at albumin:creatinine
a)
<200 mg/g
b)
>200 mg/g
c)
30-299 mcg/mg
d)
<30 mcg/mg
e)
greater than or equal to 300 mcg/mg
25.
What stages of CKD are often asymptomatic
a)
I
b)
II
c)
III
d)
IV
e)
V
26.
What stages of CKD have minimal symptoms
a)
I
b)
II
c)
III
d)
IV
e)
V
27.
Screening for CKD should be considered for what patients
a)
PMHx: DM, HTN
b)
PMHx: autoimmune diseases
c)
GU abnormalities
d)
family history
e)
advanced age
28.
What is the recommended screening for CKD
a)
SCr and GFR/CrCl estimation
b)
urinalysis
c)
imaging studies of kidney
d)
kidney biopsy
29.
What are some symptoms of CKD
a)
edema
b)
cold intolerance
c)
SOB
d)
palpitation
e)
cramping
30.
What are some signs of CKD
a)
decreased vitamin D activation
b)
secondary hyperparathyroidism
c)
hypernatremia
d)
hyponatremia
e)
hyperkalemia
31.
What medications contribute to fluid retention/edema
a)
corticosteroids
b)
androgens/estrogens
c)
TZDs<br />
d)
calcium channel blockers
e)
NSAIDs
32.
What is a non-pharmacologic therapy for CKD
a)
modest dietary protein restriction in selected patients
b)
complete protein restriction in all patients
c)
increase dietary protein in selected patients
d)
increase sodium intake in all patients
33.
What group of patients saw a benefit in decreasing dietary protein by 0.2g/kg/day
a)
patients with a GFR < 25 mL/min
b)
patients with a GFR < 60 mL/min
c)
patients with a GFR <40 mL/min
d)
patients with a GFR < 30 mL/min
34.
There is a clear correlation between dietary protein restriction in patients with CKD and improving their kidney function<br />
a)
true
b)
false
35.
KDIGO recommends that patients restrict their dietary protein intake if their GFR is <30 mL/min by<br />
a)
0.8 g/kg/day
b)
1.3 g/kg/day
c)
if at risk for progression
36.
KDIGO recommends that patients avoid high protein intake if GFR is >30 mL/min by<br />
a)
0.8 g/kg/day
b)
1.3 g/kg/day
c)
if at risk for progression
37.
If a patient with diabetes also has CKD, Metformin should be discontinued when
a)
eGFR < 45
b)
eGFR < 30
c)
pt is on dialysis
38.
If a patient with diabetes also has CKD, Metformin should be reduced when
a)
eGFR < 45
b)
eGFR < 30
c)
pt is on dialysis
39.
What is the first line therapy for patients with diabetic CKD
a)
metformin
b)
SGLT2 inhibitor
c)
GLP-1 receptor
d)
DPP-4
e)
insulin
40.
If a patient with diabetes also has CKD, SGLT2 inhibitors should not be inidiated or should be discontinued when
a)
eGFR < 45
b)
eGFR < 30
c)
pt is on dialysis
41.
The 2021 KDIGO guidelines state that the BP goal for HTN in CKD should be <120/80 mmHg for all patients with CKD if tolerated<br />
a)
true
b)
false
42.
What are characteristics of the DASH diet that is recommended for HTN goals in CKD
a)
<2 g sodium/day
b)
<10 g sodium/day
c)
fruits and vegetables
d)
<1 g sodium/day
e)
elevated protein intake
43.
For patients with HTN and CKD, moderate intensity physical activity is recommended for cumulative duration for at least
a)
100 min/wk
b)
150 min/wk
c)
200 min/wk
d)
250 min/wk
44.
Who recommends for a patient's blood pressure to be <120/80 if they have HTN and CKD
a)
KDIGO
b)
American Heart Association
c)
American Kidney Association
45.
What is the first line treatment for patients with abnormal albumin in the urine
a)
ACE-I
b)
ARB
c)
Nondihydropyridine CCB
d)
Aldosterone antagonists
e)
thiazide diuretic<br />
46.
After beginning a patient on first line treatment for abnormal albumin in the urine, what is the goal based on their baseline value
a)
urine albumin <30 mg/24h
b)
decrease by 30-50%
c)
decrease by 50-70%
d)
urine albumin <45 mg/24h
47.
When beginning treatment for a patient with abnormal albumin in urine, you may stop titrating the patient's medication (ACEI or ARB) if you reach the BP target of <120/80 OR when urine albumin excretion is <30 mg/24h
a)
true
b)
false
48.
When initiating ACEi or ARB therapy for CKD and HTN, what lab values should be monitored
a)
serum creatinine
b)
potassium
c)
albumin
d)
calcium
49.
When initiating ACEi or ARB therapy for CKD and HTN, when should lab values be taken
a)
within 1 week of starting or changing dose
b)
within 2-4 weeks of starting or changing dose
c)
within 6-9 weeks of starting or changing dose
d)
within 1 year of starting or changing dose
50.
When a patient is on ACE-I or ARB drugs, we expect to see an increase in creatinine. As long as the creatinine level stays under ___ we can continue therapy
a)
<10%
b)
<20%
c)
<15%
d)
<30%
51.
When a patient is on ACE-I or ARB drugs, the dose should be reduced or stopped if the patient is experiencing
a)
normokalemia
b)
hypokalemia
c)
hyperkalemia
d)
>30% increase in creatinine
e)
<30% increase in creatinine
52.
If a patient still has proteinuria while on max dose of ACEI/ARB therapy or if they are unable to tolerate ACEI/ARB, what drugs can be used
a)
thiazide diuretics
b)
aldosterone antagonists
c)
Nondihydropyridine CCB
53.
KDIGO guidelines include patients who are on hemodialysis
a)
true
b)
false
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