ITE Nephrology and Hypertension 2

Question 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?

Accepted Answer

Sparsentan

Answer

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

Question 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?

Accepted Answer

PKD1

Answer

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

Question 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?

Accepted Answer

Emergent delivery after maternal stabilization

Answer

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

Question 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?

Accepted Answer

Membranous nephropathy

Answer

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.

Question 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?

Accepted Answer

Finerenone

Answer

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

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Nephrology and Hypertension 2