Chronic Kidney Disease

A patient with CKD stage 3 has a persistent eGFR of 48 mL/min/1.73m². Which management strategy is most appropriate?

• A. Begin dialysis
  

• B. Prescribe high-protein diet
  

• C. Start ACE inhibitor
  

• D. Refer for renal transplant

A urinalysis reveals proteinuria and microscopic haematuria. What is the most likely implication?

• A. Acute cystitis
  

• B. Prerenal AKI
  

• C. Glomerular pathology
  

• D. Obstructive uropathy

A CKD patient develops secondary hyperparathyroidism. What is the most appropriate intervention?

• A. Increase dietary phosphate
  

• B. Administer vitamin D analog
  

• C. Prescribe loop diuretic
  

• D. Limit calcium intake

A patient’s renal ultrasound shows small, shrunken kidneys bilaterally. What does this suggest?

• A. Acute renal failure
  

• B. Autosomal dominant polycystic kidney disease
  

• C. Chronic irreversible kidney damage
  

• D. Renal vein thrombosis

What is the significance of a persistently elevated albumin-to-creatinine ratio (ACR) in a diabetic patient?

• A. It confirms urinary tract infection
  

• B. Indicates early diabetic nephropathy
  

• C. Requires immediate dialysis
  

• D. Suggests glomerulonephritis

A patient on ACE inhibitors develops hyperkalemia. What is the next best step?

• A. Stop all antihypertensives
  

• B. Initiate sodium bicarbonate
  

• C. Review potassium intake and consider dose adjustment
  

• D. Add spironolactone

A CKD patient is found to have normocytic normochromic anemia. What is the best treatment approach?

• A. Iron infusion
  

• B. Blood transfusion
  

• C. Erythropoiesis-stimulating agent (ESA)
  

• D. Oral B12 supplement

What is the primary mechanism behind decreased GFR in progressive CKD?

• A. Tubular obstruction
  

• B. Increased renal perfusion
  

• C. Nephron loss and glomerular sclerosis
  

• D. Immune complex deposition

A patient’s eGFR drops from 60 to 50 in 6 months. What should the clinician do first?

• A. Begin dialysis
  

• B. Reassess for reversible causes (e.g., medications, hydration)
  

• C. Increase protein intake
  

• D. Refer to surgery

Which of the following would be least helpful in assessing CKD progression?

• A. Serial serum creatinine
  

• B. Renal ultrasound
  

• C. Serum amylase
  

• D. Urine albumin/creatinine ratio