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Nephrology and Hypertension Flashcards

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  1. A 55-year-old woman with IgA nephropathy has a urine protein-to-creatinine ratio of 1.8 g/g and eGFR of 52 mL/min/1.73m². Which additional therapy beyond RAS blockade has demonstrated benefit in slowing CKD progression in this condition?

    Answer: Sparsentan

    Sparsentan, a dual endothelin-angiotensin receptor antagonist, has demonstrated significant proteinuria reduction and renal protective effects in IgA nephropathy.

  2. A 40-year-old man presents with hematuria, flank pain, and a palpable abdominal mass. Imaging shows bilateral enlarged kidneys with multiple cysts. His father had the same condition and died from a ruptured intracranial aneurysm. Which gene mutation is most likely responsible?

    Answer: PKD1

    PKD1 mutations account for approximately 85% of autosomal dominant polycystic kidney disease cases and are associated with more severe disease and earlier ESRD.

  3. A 30-year-old pregnant woman at 32 weeks develops BP of 158/102 mmHg, 3+ proteinuria, and a platelet count of 82,000/µL with elevated LDH. What is the most appropriate next step?

    Answer: Emergent delivery after maternal stabilization

    HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) at ≥32 weeks warrants delivery after maternal stabilization with magnesium and antihypertensives.

  4. A patient with nephrotic syndrome develops sudden flank pain and gross hematuria. Doppler ultrasound reveals absent flow in the left renal vein. Which underlying condition most predisposes to this complication?

    Answer: Membranous nephropathy

    Membranous nephropathy carries the highest risk of renal vein thrombosis among nephrotic syndromes due to urinary loss of anticoagulant proteins like protein C, S, and antithrombin III.

  5. A 62-year-old man with type 2 diabetes and CKD stage 3b (eGFR 38) is on maximally tolerated ACEI. His most recent urine albumin-to-creatinine ratio is 420 mg/g. Which agent should be added to further reduce cardiorenal risk?

    Answer: Finerenone

    Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has demonstrated reduction in CKD progression and cardiovascular events in diabetic CKD when added to RAS blockade.

  6. A 45-year-old man presents with acute oliguric kidney injury, hemoptysis, and pANCA positivity. Kidney biopsy shows pauci-immune crescentic glomerulonephritis. What is the most appropriate induction therapy?

    Answer: High-dose glucocorticoids plus cyclophosphamide or rituximab

    ANCA-associated vasculitis with rapidly progressive GN requires induction with high-dose glucocorticoids combined with either cyclophosphamide or rituximab.

  7. A 70-year-old man with hypertension, CKD stage 3 (eGFR 42), and recent MI is found to have serum potassium of 5.9 mEq/L on lisinopril and spironolactone. What is the most appropriate management?

    Answer: Add patiromer and continue both medications

    Patiromer (or sodium zirconium cyclosilicate) can lower serum potassium sufficiently to allow continuation of both cardiorenal protective agents in patients with hyperkalemia.