BCACP Renal Disease and Chronic Kidney Disease Management

Question 1

A pharmacist is reviewing the medication list of a patient with CKD Stage 3b (eGFR 35 mL/min/1.73 m²).
The patient is taking metformin 1000 mg twice daily for type 2 diabetes.
What action should the pharmacist recommend?

Accepted Answer

Reduce metformin dose and continue with more frequent monitoring of renal function

Answer

Continue metformin at the current dose without any modifications

Answer

Discontinue metformin immediately as it is absolutely contraindicated below eGFR 60

Answer

Switch to a sulfonylurea such as glibenclamide (glyburide) as the safer alternative

Question 2

A patient with type 2 diabetes has an eGFR of 38 mL/min/1.73 m² and a urine albumin-to-creatinine ratio (UACR) of 350 mg/g. Which pharmacological intervention has demonstrated slowing of CKD progression specifically in patients with diabetic kidney disease at this stage?

Accepted Answer

Initiating a SGLT-2 inhibitor (e.g., empagliflozin or dapagliflozin) in addition to RAAS blockade

Answer

Adding a calcium channel blocker (amlodipine) as the primary kidney-protective agent

Answer

Starting high-dose loop diuretic therapy to reduce proteinuria

Answer

Discontinuing all antihypertensive medications to avoid renal hypoperfusion

Question 3

A patient with Stage 4 CKD (eGFR 22 mL/min/1.73 m²) develops anemia with a hemoglobin of 9.8 g/dL. Iron studies show ferritin of 85 ng/mL and transferrin saturation (TSAT) of 18%. What is the most appropriate initial treatment for this patient's anemia of CKD?

Accepted Answer

Initiate IV iron supplementation to optimize iron stores before or alongside ESA therapy

Answer

Start erythropoiesis-stimulating agent (ESA) immediately without iron repletion

Answer

Transfuse packed red blood cells as the first-line intervention

Answer

No treatment is needed until hemoglobin falls below 8 g/dL

Question 4

A patient with CKD Stage 4 develops hyperphosphatemia (serum phosphorus 6.8 mg/dL) despite dietary phosphate restriction. Which phosphate binder is most appropriate for a patient who also has hypercalcemia (serum calcium 10.8 mg/dL)?

Accepted Answer

Sevelamer carbonate

Answer

Calcium carbonate

Answer

Calcium acetate

Answer

Either calcium carbonate or calcium acetate, as calcium binders are preferred in CKD

Question 5

A patient with CKD Stage 3a starts lisinopril 10 mg daily for proteinuria reduction. At a follow-up visit 2 weeks later, creatinine has increased from 1.4 to 1.7 mg/dL (eGFR decreased from 52 to 43 mL/min/1.73 m²). What is the most appropriate clinical response?

Accepted Answer

Continue lisinopril if the creatinine rise is less than 30% from baseline — this hemodynamic effect is expected

Answer

Immediately discontinue lisinopril permanently as it is causing kidney damage

Answer

Switch to a calcium channel blocker instead, as ACE inhibitors are contraindicated in proteinuric CKD

Answer

Add an ARB to the ACE inhibitor to provide additive kidney protection

Question 6

Which of the following correctly describes CKD Stage G3b A3 according to the KDIGO 2012 classification?

Accepted Answer

eGFR 30–44 mL/min/1.73 m² with urine albumin-to-creatinine ratio ≥ 300 mg/g (severely increased albuminuria)

Answer

eGFR 45–59 mL/min/1.73 m² with urine albumin-to-creatinine ratio < 30 mg/g (normal albuminuria)

Answer

eGFR 15–29 mL/min/1.73 m² with urine albumin-to-creatinine ratio 30–300 mg/g (moderately increased albuminuria)

Answer

eGFR < 15 mL/min/1.73 m² with any level of albuminuria