Clinical Management of Chronic Kidney Disease

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. CKD is defined as which of the following for 3 months or greater:
  1. an elevated albumin to creatinine ratio
  2. kidney damage and/or structural abnormalities
  3. micralbuminuria
  4. an estimated glomerular filtration rate less than or equal to 60 mL/hour/1.73 squared

a) 1 and 4
b) 2 only
c) 2 and 4
d) 4 only

2. In this stage, clinical management must include detection and management of anemia and early renal bone disease, and dietary modification of sodium and protein consumption.

a) Stage 1
b) Stage 2
c) Stage 3
d) Stage 4

3. The glomerular filtration rate(GFR) measures the volume of plasma filtered at the glomerulus per unit of time.

a) true
b) false

4. Factors that influence the relationship of serum creatinine and glomerular filtration rates are:
  1. age, sex and race
  2. disease
  3. body muscle mass
  4. medications

a) 1 and 4
b) 2 and 3
c) 1, 3, and 4
d) 1, 2, and 3

5. The Modification Diet in Renal Disease was a clinical trial that examined the impact of blood pressure control and dietary ________ restriction on the rate of loss of GFR in 1,074 participants.

a) protein
b) carbohydrate
c) fat
d) fluid

6. Which of the following factors can cause a low estimated GFR that is not CKD:
  1. vegetarian diet
  2. cirrhosis
  3. volume depletion
  4. hypotension
  5. pregnancy

a) 3 only
b) 3, 4, and 5
c) 1 and 2
d) 1, 4, and 5
e) 1, 2, and 3

7. Two important trends that will increase the number of end stage renal disease patients in the future is aging of the population and:

a) cardiovascular disease
b) increasing obesity
c) a high fat and high sodium diet
d) lack of exercise

8. The National Health and Nutrition Examination Survey lll found that stage 3 and 4 CKD is higher in _______ compared with ________.

a) blacks, whites
b) Eskimos, blacks
c) Latinos, blacks
d) whites, blacks

9. Which of the following groups are at high risk for CKD:
  1. obese
  2. hypertensive
  3. diabetic
  4. cardiovascular disease
  5. vegetarians

a) 2 and 4
b) 2, 3, and 4
c) 1 and 3
d) 2 and 5
e) 2, 4, and 5

10. Smoking is a(n) ________ factor.

a) predisposing
b) initiating
c) progression

11. A feature of the type ______ diabetic is that microalbuminuria develops in 25% of the patients by 10 years.

a) 1
b) 2

12. The microalbuminuria test can also be positive due to:

a) cirrhosis
b) uncontrolled hypertension
c) pregnancy
d) cancer

13. One of the recommendations for those at high risk for diabetes mellitus is to:

a) have a yearly glucose tolerance test
b) be screened for neuropathy
c) use sugar substitutes
d) follow the DASH diet

14. One of the important points from the United Kingdom Prospective Diabetes Study was:

a) randomized individuals with intensive therapy had a 37% reduction in microvascular complications
b) intensive glucose control was associated with a lower HbA1C over 10 years
c) kidney protection was evident with 12 months of the trial
d) differences were seen between captopril and atenolol regarding microvascular end points

15. Which of the following are reduced in the DASH diet for individuals in stage 3 and 4 CKD:

a) sugar, protein, and sodium
b) fats, sugar, and potassium
c) protein, phosphorous and potassium
d) sodium, calcium and fluids

16. Malignant hypertension is severely elevated blood pressure.

a) true
b) false

17. One of the important points regarding the African American Study of Kidney Disease and Hypertension was:

a) combined therapy decreased proteinuria
b) diuretics are effective antihypertensives
c) there was no difference in the glomerular filtration rate among the antihypertensive treatments
d) risk reduction was greatest among patients with baseline proteinuria > 1 gram/day

18. Mortality is ____ to ____ times higher in dialysis patients than in the general population.

a) 5, 10
b) 8, 15
c) 10, 30
d) 15, 25

19. Nicotine does accumulate in renal failure which must be taken into consideration when nicotine-replacement therapy is used.

a) true
b) false

20. Which of the following are diagnostic traits of the metabolic syndrome:
  1. fasting triglycerides _> 150 mg/dL
  2. a BMI greater than 30 Kg/m squared
  3. blood pressure _> 130/85 mm Hg
  4. an elevated c-reactive protein
  5. fasting glucose _> 110 mg/dL

a) 2, 4, and 5
b) 1, 2, and 3
c) 3, 4, and 5
d) 1, 3, and 5

21. An example of nontraditional risk factors for CVD have also been found to be high in individuals with CKD such as:

a) obesity and smoking
b) malnutrition and sleep disturbances
c) elevating clotting factors and hypertension
d) high fat diet and oxidative stress

22. This agent is the preferred first-line therapy for hypertension in patients with either diabetic or nondiabetic CKD:

a) alpha-adrenergic blockers
b) beta-adrenergic blockers
c) calcium channel blockers
d) angiostatin-converting enzyme inhibitors
e) diuretics

23. When hyperkalemia is reported, a 60% reduction in prevalence occurs when which of the following is used concurrently:

a) thiazide or loop diuretics
b) potassium-sparing diuretics
c) osmotic diuretics

24. One factor that contributes to hyperkalemia is the use of salt substitute.

a) true
b) false

25. An albumin level of > 300 mg/g creatinine is the definition of:

a) micralbuminuria
b) macroalbuminuria

26. A patient with proteinuria > 1 g/day would benefit from consultation with a nephrologist to aid in management decisions.

a) true
b) false

27. Most patients have anemia related to insufficient production of:

a) albumin
b) circulating iron
c) endogenous erythropoietin
d) folate and B 12

28. Both Procrit and Aransep are given via the intravenous route.

a) true
b) false

29. Iron deficiency is common in patients with CKD due to:
  1. poor iron intake
  2. reduced gastrointestinal iron absorption
  3. hypoaldosteronism
  4. increased losses of iron

a) 1 only
b) 2, 3, and 4
c) 2 and 4
d) 1, 2, and 4

30. The normal serum calcium is maintained at a constant level between _______ and ______ mg/dL , ______% of which is bound to protein, principally albumin.

a) 8.0, 12.2, 60
b) 9.0, 10.4, 40
c) 6.6, 8.2, 30
d) 10.6, 12.8, 20

31. As CKD progresses, there is a decrease in GI absorption of calcium and phosphorous due to the lack of:

a) parathyroid hormone
b) iron
c) dietary protein
d) vitamin D

32. Which of the high phosphorous foods should be restricted, especially during stage 3 of CKD:

a) dark cola, pancake mix, pizza
b) chicken, dried peas , popcorn
c) milk, pasta, nuts

33. Paricalcitrol is an active drug, whereas doxercalciferol is a prodrug and activated in the:

a) small intestine
b) liver
c) kidney
d) stomach

34. The central nervous system is commonly affected by acidosis. Which of the following is often exacerbated:

a) hypertension
b) itching
c) a headache
d) seizure activity

35. With rapid growth and aging of the end-stage renal disease population, creation of ______ have actually declined, replaced by the creation of ______ and central catheters.

a) AVGs, AVFs
b) AVFs, AVGs

36. This is the leading cause of death in the CKD patient:

a) infection
b) respiratory failure
c) blood dyscrasias
d) cardiovascular disease

37. The final step in dosing is:

a) choosing an appropriate maintenance dose based on kidney function
b) evaluating the excretion rate of the drug
c) lowering the dose to prevent acidosis
d) assessing the absorption rates

38. In order to be eligibile for Medicare coverage due to end-stage renal disease, it must be defined by the:

a) primary medical physician
b) nephrologist
c) Federal Register
d) Department of Health and Human Services

39. In general, primary care physicians should be responsible for:

a) identifying and screening individuals at risk for CKD
b) discussing CKD progression
c) treating nutritional disorders
d) recommending treatment for diabetes and hypertension