Which of these functions as the tubular sensor for tubuloglomerular feedback (TGF) and tubular regulation of renin?

Which among the following stimulates sodium reabsorption in the thick ascending limb?

Which segment of the nephron is primarily responsible for the fine-tuning of sodium and water reabsorption and is largely influenced by aldosterone?

Which of the following will likely stimulate the secretion of renin from the juxtaglomerular cells?

As the glomerular filtration rate (GFR) decreases, decreased tubular reabsorption is the dominant mechanism that allows the nephron to maintain equilibrium for which of the following solutes?

Which osmotically active electrolyte is the main determinant of extracellular fluid volume partitioning according to the traditional two-compartment model?

A 67-year-old man with acute decompensated heart failure presented with hyponatremia and volume overload. What is your expected urine sodium value?

A 34-year-old woman is admitted with severe anasarca from nephrotic syndrome secondary to minimal change disease. Despite oral furosemide 40 mg once a day, she is still anasarcous. What diuretic strategy can be done next?

Which is the best example of osmotic thirst?

A 36-year-old woman with bipolar disorder is presenting with weakness and headaches. She was recently started on lithium and clonazepam. Laboratories are as follows: Serum creatinine 1.3 mg/dL; BUN 10 mmol/L (2.1–8.5 mmol/L); Serum sodium 159 mmol/L; Serum potassium 3.0 mmol/L; Serum ionized calcium 1.3 mg/dL (1.16–1.31 mg/dL); Urinalysis: pH 7.0, specific gravity 1.006, CHO (-), CHON (-), hyaline casts 2–3/HPF; ABG: pH 7.36, pCO2 44, pO2 89, HCO3 24, SpO2 96%. What is the most appropriate next step in management?

A 55-year-old man with non-small cell lung cancer was referred for hyponatremia. Laboratories are as follows: Serum creatinine 1.0 mg/dL; Serum BUN 8 mmol/L (2.1–8.5 mmol/L); Serum sodium 120 mmol/L; Serum ALT 250 U/L (4–36 U/L); Plasma osmolality 270 mOsm/kg H2O (275–295 mOsm/kg H2O); Urine osmolality 600 mOsm/kg H2O (500–850 mOsm/kg H2O); 24-hour urine studies: volume 1000 mL, sodium 10 mmol/L, creatinine 1.8 g. What is the next best step?

Which of the following statements about sodium reabsorption is/are true? I. The proximal tubule reabsorbs approximately 60–70% of filtered NaCl. II. The thick ascending limb reabsorbs about 10% of filtered NaCl. III. Na+-Cl- absorption in the distal nephron is energy independent. IV. The kidney filters around 25,000 mmol of Na+ daily.

Glomerulotubular balance is the phenomenon wherein changes in the GFR are offset by changes in tubular reabsorption. Which of the following are true? I. Fluid reabsorption in the proximal tubule increases linearly with GFR. II. This balance is dependent on aldosterone. III. Peritubular oncotic pressure influences reabsorption. IV. Proximal tubular reabsorption is not adjusted to changes in tubular flow.

What ion is primarily reabsorbed through paracellular transport in the proximal tubule under high flow conditions?

Which channel is stimulated by vasopressin in the thin ascending limb?

Diuretics act at transporters across the renal tubule. Which of the following correctly matches the diuretic with its action on the renal tubule? I. Furosemide inhibits NKCC2. II. Thiazides block ENaC channels. III. Amiloride inhibits ENaC in the collecting duct. IV. Loop diuretics act at the thick ascending limb.

Which of the following is true regarding ENaC and aldosterone? I. ENaC activity is stimulated by aldosterone. II. ENaC is primarily found in the proximal tubule. III. Liddle syndrome is due to ENaC overactivity. IV. Aldosterone increases expression of Na+-K+-ATPase.

What channel is critical for apical K+ recycling in the thick ascending limb (TAL)?

Which structure has the highest capacity for amiloride-sensitive Na+ reabsorption?

What syndrome is associated with ENaC gain-of-function mutations?

Various hormones control the transport of sodium, chloride, and potassium across the renal tubule. Which of the following is/are true regarding neurohormonal control of Na+, Cl−, and K+ transport? I. Angiotensin II stimulates Na+ transport at low concentrations. II. Dopamine inhibits Na+-Cl− reabsorption. III. ANP and dopamine act synergistically to increase Na+ reabsorption. IV. Parasympathetic stimulation increases Na+-K+-ATPase activity.

What is the mechanism of the development of renal injury in chronic hypokalemia?

What type of Bartter Syndrome features a loss-of-function mutation in the chloride channels of the basolateral CLC-NKB channels?

What composes the management of Bartter Syndrome?

What is the most common cause of distal RTA in adults?

Which drug acts as an ENaC inhibitor eventually leading to hyperkalemia?

What is the maximum dose of spironolactone to avoid hyperkalemia when it is used in combination with an ACEI or ARB?

A 60-year-old diabetic male with CKD Stage 4 was referred for hyperkalemia (5.8). Patient claims to be compliant with a low-potassium and low-protein diet and medications include insulin glargine, aspirin, amlodipine, and ketoanalogues of amino acids all of which he takes religiously. Which laboratory parameter is characteristic of this cause of hyperkalemia?

Which is true regarding hemodialysis in hyperkalemia?

Which pathophysiologic mechanism explains the increased fractional excretion of sodium (FeNa) in ischemic acute tubular necrosis (ATN)?

Which patient would benefit most from the use of balanced crystalloids versus isotonic saline according to the SMART Trial (Isotonic Solution and Major Adverse Renal Events)?

24-year-old female post emergency cesarean section presented with elevated liver enzymes, thrombocytopenia, and elevated LDH. She is referred for oliguria and hypertensive episodes (highest 190/100 mmHg). Which urinalysis finding is most consistent with the cause of her AKI?

Which of the following statements best describe vigorous diuresis during the recovery phase of AKI?

Post-renal AKI would usually present with hydronephrosis on imaging. Hydronephrosis may not be apparent in which of the following patients?

45-year-old male with a history of congestive heart failure presents with signs of fluid overload and oliguria. Laboratory findings showed elevated creatinine and FeNa of 0.4%. Which of the following interventions is most appropriate?

RL, 38-year-old male, was referred due to 2+ proteinuria on his routine urinalysis. He told you that for the past 3 months he had been experiencing bubbly urine, on and off swelling of his lower extremities, and episodes of elevated blood pressure. What will be your target blood pressure for him based on the KDIGO guidelines?

Which of the following statements is true regarding the clinical manifestations of cardiovascular disease in CKD patients?

What is the characteristic lipid profile in patients with at least CKD stage G3? (MK, recall, 0.8)

What ultrasound finding has been shown to be a strong predictor of death from cardiovascular causes in patients with CKD, independent of other risk factors? (MK, recall, 0.7)

Which of the following factors is/are associated with vascular calcification in CKD patients? (GK, recall, 0.5)

Which of the following statements is TRUE as to the experimental models of CKD? (GK, comprehension, 0.8)

Which indicates chronic changes in the fundoscopic exam in a hypertensive patient? (MK, recall, 0.8)

Which clinical findings are better correlated with home blood pressure reading? GK, comprehension, 0.4)

Which is true of ambulatory BP monitoring? (GK, comprehension, 0.6)

Which of the following would cause a false positive aldosterone-renin ratio (ARR)? (MK, comprehension, 0.6)

Which clinical scenario would warrant rapid lowering of blood pressure within 20 minutes? (MK, problem-solving, 0.8)

Which patient would you suspect renovascular hypertension? (MK, problem-solving, 0.8)

What SBP and DBP levels in preeclampsia will make one start antihypertensives? (MK, recall, 0.8)

Beta-blockers have been used in pregnancy without known teratogenic or adverse effects to the fetus. Which beta-blocker can cause teratogenic effects? (MK, recall, 0.6)

A 30-year-old pregnant patient was admitted for abnormal uterine bleeding and decreased fetal movements at 32 weeks AOG by LMP. The assessment is placental abruption. An emergency C-section was performed with massive intraoperative blood transfusion. The patient presented post-op with progressing oliguria, weakness, edema, and new-onset hypertension. Which of the following findings is consistent with this form of AKI post-partum? (MK, comprehension, 0.6)

Systolic blood pressure (SBP) variability has been associated with stroke and MI’s. Which classes of antihypertensives have been shown to produce the least variability in SBP? (MK, recall, 0.6)

Recommended treatment for aortic dissection in the setting of hypertensive emergency: (recall, MK, 0.7)

Recommended treatment for eclampsia or preeclampsia in the setting of hypertensive emergency: (recall, MK, 0.7)

Recommended treatment for heart failure (or pulmonary edema) in the setting of hypertensive emergency: (recall, MK, 0.7)

Recommended treatment for hypertensive encephalopathy: (recall, MK, 0.7)

Which is most strongly associated with recurrent acute cystitis in post-menopausal women? (Recall.MK.E.0.8)

Which of the following statement regarding the diagnosis of cystitis is TRUE? (Compre.MK.MD.0.7)

What is the optimal diagnostic imaging for acute, severe pyelonephritis that is non-responsive or those who develop early post-treatment recurrent infection? (Compre.MK.E.0.8)

What is an appropriate starting fluid to use for replacement in patients with post-obstructive diuresis? (Recall.MK.E.0.8)

What fluoroquinolone could precipitate in the tubular fluid, resulting in crystalluria with stone formation and urinary tract obstruction? (Recall.GK.MD.0.5)

What is the most prevalent kidney stone accounting for 70 to 80% of kidney stones? (Recall. MK.E.0.8)

The rule of 6 in AVF cannulation pertains to readiness of an AVF for first cannulation provided the AVF is… (Recall. MK, 0.8) I. At least 6 mm in diameter II. At least 6 cm overall needle accessible length III. No more than 6 mm from the skin surface IV. At least 6 weeks old from creation

What are the factors that affect clearance of substances in a flowing system? (Comprehension. MK, 0.7) I. Blood flow II. Dialysate flow III. Membrane permeability IV. Substance molecular weight

Which substance is highly sequestered in the body such that the rate of removal via dialysis is faster than its rate of shift outside the cells? (recall. MK, 0.8)

What can cause low arterial pressure alarms during HD? (Comprehension. MK, 0.7) I. Kink in the arterial line II. Hypotension III. Access arterial outflow stenosis IV. Access venous outflow stenosis

Which is true of high flux dialyzers? (Comprehension. MK, 0.7) I. Most effective with blood flow rates of up to 250 mL/min II. Greater clearance of vitamin B12 III. Greater clearance of beta-2 microglobulin IV. Higher ultrafiltration coefficient

What clinical condition warrants an anticoagulation-free hemodialysis? (Comprehension. MK, 0.8)

What is the definition of patient dry weight? (Comprehension. MK, 0.8)

What is the recommended weekly Kt/V signifying adequate HD? (recall. MK, 0.8)

Interventions to consider in recurrent intradialytic hypotension… (Comprehension. MK, 0.8) I. Increase dialysis time II. Reduce intradialytic sodium gain III. Increase dialysate temperature IV. Feed patient during dialysis to prevent hypoglycemia

What mechanism is responsible for the clearance of larger solutes during PD? (recall. MK, 0.8)

The correct sequence of the standard peritoneal equilibration test (PET)... (Comprehension. MK, 0.8) I. Instill 2L of 2.5% dextrose over 10 minutes II. Dwell for 240 minutes (4 hours) III. 8–12 hours overnight exchange drained in sitting over 20 minutes IV. Collect dialysate creatinine at 0–30–60–120–180–240-minute marks and plasma creatinine at 120-minute mark

What is the most common buffer of peritoneal dialysis solutions? (recall MK, 0.8)

What PD prescription will best benefit slow transporters? (Comprehension. MK, 0.7)

What modification in PD prescription is recommended for patients with volume overload? (problem-solving. MK, 0.7)

What practice will increase the yield of a positive culture in a patient suspected with peritonitis? (Comprehension. MK, 0.8)

When is PD catheter removal indicated? (problem-solving. MK, 0.8)

Which metabolic complication is more common among patients on PD? (Comprehension. MK, 0.7)

67/M, ESKD from DM nephropathy on PD for 10 years gradually develops persistent constipation, malaise, recurrent low-grade fever, and poor PD catheter outflow over the course of 3 months. What diagnostic will you order next? (problem-solving. MK, 0.8)

What test defines the functional effect of upper urinary tract dilation by measuring the hydrostatic pressures in the renal pelvis and bladder during infusion of a saline and contrast mixture into the renal pelvis via a catheter? (recall, GK, 0.5)

What is the gold standard for the diagnosis of renal artery thromboembolism? (recall, MK, 0.8)

What is the characteristic radiographic finding of renal vein thrombosis?

Which of the following causes a false positive leukocyte esterase test in urinalysis in struvite stones?

60/F referred for elevated creatinine and edema. Patient has heart failure on bumetanide and sacubitril + valsartan. Laboratories are as follows: Serum BUN 15 mmol/L; Serum Crea 1.7 mg/dL; Serum sodium 140 meq/L; Serum potassium 3.7 mmol/L; Urine sodium 40 meq/L; Urine creatinine 30 mmol/L; Urine BUN 10 mmol/L; Urinalysis: CHON trace, CHO negative, specific gravity 1.015. Which of the following will best determine if AKI is prerenal?

Which condition might lead to an underestimation of GFR when using EDTA as a filtration marker?

What is a limitation of using creatinine clearance (CrCl) for estimating GFR?

Which of the following is an advantage of cystatin C over creatinine as a GFR marker?

What is the main disadvantage of using the Jaffe method for measuring serum creatinine?

Which equation is preferred for estimating GFR in elderly populations?

Match the urine crystal to its proper name: image labeled 89.1 shows an envelope-shaped crystal viewed under microscopy. Identify the crystal.

Match the urine crystal to its proper name: image labeled 89.2 shows a square crystal with an X-shaped internal pattern. Identify the crystal.

Match the urine crystal to its proper name: image labeled 90.1 shows a colorless hexagonal plate-like crystal. Identify the crystal.

Match the urine crystal to its proper name: image labeled 90.2 shows clusters of slender needle-like crystals. Identify the crystal.

45/F in the ICU post-percutaneous biliary drainage (PTBD) insertion for acute cholangitis due to an obstructing cholelithiasis. Latest serum creatinine is 2.9 mg/dL with urine output of 0.8 cc/kg/hour. Medications being given are meropenem and metronidazole. What is the most appropriate supportive therapeutic strategy?

What is the preferred route of nutritional administration in patients with acute kidney injury?

What is the recommended protein intake in patients with hypercatabolic acute kidney injury on continuous veno-veno hemodiafiltration (CVVH)?

A 45/M with CKD G3B A2 has a kidney failure risk equation (KFRE) score of 10% risk of kidney failure in the next 2 years (high-risk). What is your recommended daily protein intake?

Which is correct about sodium restriction in CKD patients?

45/M with CKD G3A A3 from diabetes (insulin-requiring, uncontrolled) has a KFRE score of 10% risk of kidney failure in the next 2 years (high-risk). Which is true?

A 70-year-old woman on thrice-weekly hemodialysis is prescribed digoxin for atrial fibrillation. What pharmacokinetic alteration is most relevant?

A patient with advanced CKD is given morphine postoperatively. Hours later, he develops excessive sedation and hypoventilation. What is the mechanism behind this toxicity?

A patient with ESKD on hemodialysis is treated with ceftriaxone. What pharmacokinetic property explains the altered dosing?

A 78-year-old man with CKD is being considered for dose adjustment of an antibiotic. The pharmacist notes that body weight is missing from the record. Which equation is most appropriate to estimate kidney function in this case?

A patient with AKI needs antibiotics for high-risk pneumonia (meropenem). Her GFR is 18 via CG equation. Urine output is 800 cc in 24 hours and patient has clinical signs of volume overload. What is your recommendation regarding meropenem dosing?

A CKD patient is prescribed ciprofloxacin for UTI and takes it with phosphate binders and omeprazole. What is the expected drug interaction?

You started dapagliflozin in your patient with CKD 3B A3 from diabetes. Her eGFR dropped from 40 to 30 mL/min per 1.73 m^2 (CKD EPI) in a span of 6 weeks of use. There is no intercurrent illness between follow-up visits. What is the next best step?

Diagnosis of CKD in older adults has remained controversial due to the normal ageing process of the kidneys. What is the threshold GFR for the diagnosis of CKD in older adults according to KDIGO 2024 CKD Guidelines?

When is the eGFRcr-cys preferred over eGFRcr in determining GFR in patients with CKD?

What is the general frequency of hemoglobin monitoring in CKD Stage 4 patients without anemia?

Your hemodialysis patient’s monthly hemoglobin is at 14.5 g/dL on erythropoietin (EPO) alfa 18,000 units subcutaneous per week. What is the next best step?

What CKD stage should one start monitoring for calcium, phosphate, PTH, and alkaline phosphatase levels?

A 50-year-old female patient with CKD stage 4 has a serum 25-hydroxyvitamin D level of 15 ng/mL (NV: 20–40 ng/mL) and a parathyroid hormone (PTH) level of 120 pg/mL (NV: 10–65 pg/mL). She has no history of hypercalcemia or vitamin D hypersensitivity and is currently not taking any vitamin D supplements. What is the appropriate approach to vitamin D supplementation for this patient?

A 65-year-old patient with CKD stage G3a is complaining of back pain and weakness. Recent lab results indicate low serum calcium and elevated phosphate levels. The patient has a history of vitamin D deficiency and is currently on supplementation. Based on KDIGO guidelines for CKD-MBD, which step should be prioritized to manage the patient's condition effectively?

A 70-year-old patient with type 2 diabetes and CKD stage G4 has persistent albuminuria despite being on losartan, linagliptin, and empagliflozin. Sugars are not controlled. According to KDIGO guidelines, which treatment can be added?

A 65-year-old patient with type 2 diabetes and CKD stage G3 is on metformin and an SGLT2 inhibitor but has not achieved optimal glycemic control. What is the recommended individualized HbA1c target range for this patient?

Which statement is true about blood pressure measurement in CKD?

A 37-year-old woman with CKD 5 after a living-related kidney transplant has a BP of 140/90 mmHg while on amlodipine. Urine albumin-to-creatinine ratio (UACR) is 31 mg/g. What is the recommended add-on antihypertensive?

What is the recommended target single-pool Kt/V (spKt/V) per hemodialysis session in patients receiving thrice-weekly HD?

The safety and tolerability of hemodialysis are dictated in part by the ultrafiltration rate (UFR). Which clinical parameters determine the UFR?

A 78-year-old man with CKD G3A A2 from diabetes is referred for renal risk stratification prior to angioplasty. His steady-state eGFR is 50 (CKD-EPI). He is taking metformin, perindopril, bisoprolol, and rosuvastatin and uses insulin degludec once a day. Which pre-procedural order is appropriate?

A 55-year-old man with traumatic brain injury from a vehicular accident develops acute renal failure due to rhabdomyolysis. What is your preferred form of renal replacement therapy?

A 58-year-old woman with CKD G3B A3 from diabetes has recurrent urinary tract infection. Which medications can be given as continuous prophylaxis for 6–12 months? (Select all that apply.)

A 19-year-old patient without comorbidities presents with chills, fever, vomiting, and flank pain associated with painful urination. What is your first-choice antibiotic?