PANRE PANRE Nephrology 2 — Questions and Answers
Question 1: A patient on an ACE inhibitor is found to have bilateral renal artery stenosis. Which lab change is most expected after starting the ACE inhibitor?
- Decreased serum creatinine
- Increased serum creatinine (Correct answer)
- Decreased serum potassium
- Decreased urine protein
Correct answer: Increased serum creatinine
ACE inhibitors block efferent arteriolar vasoconstriction, causing a significant drop in GFR and a rise in creatinine in bilateral renal artery stenosis.
Question 2: A patient with ESRD develops pruritis, pericarditis, and encephalopathy. These findings are best explained by which condition?
- Hypervolemia
- Uremic syndrome (Correct answer)
- Hyponatremia
- Hyperphosphatemia
Correct answer: Uremic syndrome
Uremic syndrome encompasses pruritis, pericardial inflammation, neurologic changes, and bleeding tendency due to accumulated uremic toxins in ESRD.
Question 3: Impaired 1-alpha hydroxylation of vitamin D in CKD leads to which electrolyte abnormality?
- Hypokalemia
- Hypocalcemia (Correct answer)
- Hyponatremia
- Hypomagnesemia
Correct answer: Hypocalcemia
CKD impairs renal 1-alpha hydroxylation of vitamin D, reducing intestinal calcium absorption and causing hypocalcemia with secondary hyperparathyroidism.
Question 4: At what GFR level is hemodialysis typically initiated in symptomatic CKD patients?
- 30 mL/min/1.73m²
- 20 mL/min/1.73m²
- 10-15 mL/min/1.73m² (Correct answer)
- 5 mL/min/1.73m²
Correct answer: 10-15 mL/min/1.73m²
Dialysis is generally initiated when GFR falls to 10-15 mL/min/1.73m² in patients with uremic symptoms or complications.
Question 5: A child presents with cola-colored urine, periorbital edema, and hypertension 2 weeks after strep throat. What is the most likely diagnosis?
- Nephrotic syndrome
- Post-streptococcal glomerulonephritis (Correct answer)
- IgA nephropathy
- Lupus nephritis
Correct answer: Post-streptococcal glomerulonephritis
Post-streptococcal glomerulonephritis classically presents 1-3 weeks after Group A Strep pharyngitis with hematuria, edema, and hypertension.
Question 6: A patient with polycystic kidney disease (PKD) develops a sudden severe 'thunderclap' headache and nuchal rigidity. What complication must be immediately considered?
- Urinary tract infection
- Intracranial berry aneurysm rupture (Correct answer)
- Renal stone passage
- Hypertensive urgency
Correct answer: Intracranial berry aneurysm rupture
PKD is associated with intracranial berry aneurysms; rupture causing subarachnoid hemorrhage presents with sudden severe headache and meningismus.
PANRE PANRE Nephrology 2
A patient on an ACE inhibitor is found to have bilateral renal artery stenosis.
Which lab change is most expected after starting the ACE inhibitor?