Nephrology Module 4

A 54-year-old male with end-stage renal disease (ESRD) secondary to diabetes mellitus presents for his first session of hemodialysis.

During the session, approximately one hour into the treatment, he begins to complain of a headache and nausea. Shortly thereafter, he experiences confusion and visual disturbances.

His blood pressure is 140/90 mmHg, heart rate is 76 beats per minute, and there are no signs of infection. Laboratory results show a significant decrease in blood urea nitrogen (BUN) levels.

Which of the following is the most likely diagnosis?

Which of the following is the most common buffer used in peritoneal dialysis (PD) fluid?

A 65-year-old female with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) presents for her routine follow-up. She has been on CAPD for the past six months. Recently, she has been experiencing increased fatigue and mild swelling in her lower extremities. Her blood pressure is 130/85 mmHg, and she has no signs of infection.

Laboratory results reveal a plasma urea concentration of 80 mg/dL and a plasma creatinine concentration of 8 mg/dL. The total weekly urea removal is measured at 150 grams, and the total weekly creatinine removal is 6000 mg. Her total body water is estimated to be 35 liters, and her body surface area is 1.7 m².

Which of the following statements best describes the adequacy of her peritoneal dialysis based on her weekly Kt/V and weekly creatinine clearance?

What is the primary mechanism by which SGLT-2 inhibitors help improve renal outcomes in patients with IgA nephropathy?

In a 45-year-old male patient recently diagnosed with IgA nephropathy and presenting with mild proteinuria of less than 1g/day, which of the following management options should NOT be part of the standard treatment plan?

Anti-GBM disease is an autoimmune disorder characterized by the production of autoantibodies targeting a specific component of the glomerular basement membrane.

Which of the following best describes the target and the mechanism involved in the pathogenesis of this disease?

What is the immunological mechanism by which Avacopan exerts its therapeutic effect in the treatment of ANCA-associated vasculitis?

A 60-year-old female presents to the clinic with a 2-month history of generalized weakness, unintentional weight loss, and low-grade fever. She reports having shortness of breath and hemoptysis over the past few weeks.

On examination, she has bilateral crackles on lung auscultation and mild ankle edema. Laboratory tests reveal elevated creatinine, hematuria, and proteinuria.

A chest CT scan shows diffuse ground-glass opacities without nodules.

Further serologic testing reveals the following:

• Positive anti-neutrophil cytoplasmic antibodies (ANCA) with a high titer of myeloperoxidase (MPO-ANCA).
• Negative ANA and ENA
• Negative Anti-GBM antibody

What is the most likely diagnosis for this patient based on the clinical presentation and serologic findings?

What is the primary mechanism of action of belimumab in the treatment of lupus nephritis?

A 25-year-old woman presents to the nephrology clinic with a 3-month history of swelling in her legs and frothy urine. She has no significant past medical history and is not on any medications. On physical examination, she has bilateral pitting edema up to her knees. Laboratory findings reveal the following:

• Urinalysis: 3+ protein, 2+ blood
• Serum creatinine: 1.2 mg/dL (normal: 0.6-1.1 mg/dL)
• Serum albumin: 2.5 g/dL (normal: 3.5-5.0 g/dL)
• Complement levels: C3 low, C4 normal
• Renal biopsy shows dense deposits within the glomerular basement membrane on electron microscopy.

Based on the clinical presentation and lab findings, what is the most likely diagnosis?

With regards to renal transplant, which of the following immunosuppressive drugs is correctly matched with its mechanism of action?

What is the role of Chronic antibody-mediated rejection (cAbMR) in causing graft loss in renal transplant recipients?

Which of the following Alloantigen-dependent factors significantly affects long-term graft survival in renal transplant patients?