PANRE PANRE Nephrology 1 — Questions and Answers
Question 1: A patient with CKD has a serum potassium of 6.4 mEq/L with peaked T-waves on EKG. What is the FIRST priority treatment?
- Sodium bicarbonate IV
- Calcium gluconate IV (Correct answer)
- Insulin with dextrose
- Sodium polystyrene sulfonate (Kayexalate)
Correct answer: Calcium gluconate IV
IV calcium gluconate is given first in hyperkalemia with EKG changes to stabilize the cardiac membrane and prevent fatal arrhythmias.
Question 2: Which formula is currently recommended for estimating GFR in clinical practice?
- Cockcroft-Gault equation
- CKD-EPI equation (Correct answer)
- Henderson-Hasselbalch equation
- MDRD equation
Correct answer: CKD-EPI equation
The CKD-EPI equation is the currently recommended formula for estimating GFR in adults and has replaced MDRD as the standard.
Question 3: Which is the most common cause of primary nephrotic syndrome in adults in the United States?
- Minimal change disease
- Membranous nephropathy (Correct answer)
- Focal segmental glomerulosclerosis
- IgA nephropathy
Correct answer: Membranous nephropathy
Membranous nephropathy is the most common cause of primary nephrotic syndrome in adults, often associated with PLA2R antibodies.
Question 4: Which medication class is first-line for reducing proteinuria and slowing progression of diabetic nephropathy?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, providing renoprotection in diabetic nephropathy.
Question 5: A patient presents with flank pain, hematuria, and nausea. CT shows a 4 mm ureteral stone. What is the most appropriate initial management?
- Immediate urologic surgical intervention
- Hydration, analgesia, and alpha-blocker (tamsulosin) (Correct answer)
- Extracorporeal shock wave lithotripsy
- Nephrostomy tube placement
Correct answer: Hydration, analgesia, and alpha-blocker (tamsulosin)
Stones ≤5 mm have a high rate of spontaneous passage; conservative management with hydration, analgesia, and medical expulsive therapy is first-line.
Question 6: Which urinalysis finding is pathognomonic for acute tubular necrosis (ATN)?
- Red blood cell casts
- White blood cell casts
- Granular (muddy brown) casts (Correct answer)
- Fatty casts
Correct answer: Granular (muddy brown) casts
Granular 'muddy brown' casts result from sloughed tubular epithelial cells and are pathognomonic for acute tubular necrosis.
PANRE PANRE Nephrology 1
A patient with CKD has a serum potassium of 6.4 mEq/L with peaked T-waves on EKG.
What is the FIRST priority treatment?