ABIM Nephrology 3

Question 1

A 28-year-old man presents with episodic gross hematuria following upper respiratory infections. Renal biopsy shows mesangial IgA deposits. What is the diagnosis?

Accepted Answer

IgA nephropathy (Berger disease)

Answer

IgA nephropathy (Berger disease) presents with episodic gross hematuria coinciding with mucosal infections and is defined by mesangial IgA deposits on immunofluorescence.

Question 2

A patient on hemodialysis has persistent hypertension despite ultrafiltration. The most common cause is:

Accepted Answer

Volume overload between sessions

Answer

Volume overload from interdialytic fluid and salt intake is the most common cause of hypertension in dialysis patients.

Question 3

Which medication is the first-line treatment for hypertension in a patient with CKD and proteinuria >300 mg/day?

Accepted Answer

ACE inhibitor or ARB

Answer

ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria through efferent arteriolar dilation, slowing CKD progression and are first-line in proteinuric CKD.

Question 4

A patient with CKD stage 3b has a hemoglobin of 9.5 g/dL with low reticulocyte count and low iron stores. What is the correct sequence of treatment?

Accepted Answer

Replete iron first, then reassess for ESA therapy

Answer

Iron deficiency must be corrected before initiating ESA therapy in CKD-related anemia, as functional iron deficiency blunts ESA response.

Question 5

A patient presents with fever, flank pain, and dysuria. Blood cultures grow E. coli. CT scan shows a gas-forming infection within the renal parenchyma. What is the diagnosis?

Accepted Answer

Emphysematous pyelonephritis

Answer

Emphysematous pyelonephritis is a life-threatening necrotizing infection of the renal parenchyma with gas formation, occurring predominantly in diabetic patients.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Nephrology 3