Nephrology Module 3

A 65-year-old patient with chronic kidney disease (CKD) stage 4 is prescribed veverimer for the management of metabolic acidosis.

How does veverimer primarily help in correcting acid-base balance in this patient?

A 72-year-old male with end-stage renal disease on hemodialysis has been prescribed tenapanor to manage his refractory hyperphosphatemia.

Which of the following best describes the primary mechanism by which tenapanor reduces serum phosphate levels in this patient?

A 67-year-old female with chronic kidney disease on hemodialysis is being considered for Denosumab to treat her osteoporosis.

What is the primary reason for her increased risk of severe hypocalcemia following Denosumab administration?

A 31-year-old female Cambodian refugee is found to have nephrotic syndrome. Investigations reveal:

• urinary protein 7.00 g/day [<0.25]
• serum albumin 23 g/L [35-50]
• serum creatinine 0.07 mmol/L [0.03-0.11]
• A renal biopsy shows membranous nephropathy.

Which one of the following test is least likely to explain her presentation?

A 16-year-old presents with haemoptysis and consolidation of the right upper lobe and left lower lobe. His renal function is abnormal with elevated creatinine and proteinuria. He has had bloody rhinorrhea over a three-week period. His cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) test is positive.

What is the most likely diagnosis?

A patient presents with the following electrolyte findings:

• serum sodium 117 mmol/L [134-145]
• serum potassium 3.5 mmol/L [3.5-5.0]
• serum chloride 85 mmol/L [97-109]
• serum bicarbonate 30 mmol/L [24-33]
• serum creatinine 0.07 mmol/L [0.07-0.12]
• serum glucose 10.0 mmol/L [3.6-6.6]
• urinary sodium 100 mmol/L
• urinary potassium 20 mmol/L
• urinary osmolality 580 mosmol/kg [500-1200]

What is the most likely cause of these findings?

A 38-year-old man with abdominal pain has the following results:

• sodium 142 mmol/L [138-145]
• potassium 2.9 mmol/L [3.5-5.2]
• chloride 112 mmol/L [96-109]
• corrected calcium 2.40 mmol/L [2.15-2.57]
• creatinine 0.11 mmol/L [0.5-0.12]
• bicarbonate 15 mmol/L [24-28]
• albumin 42 g/L [38-48]

What is the best explanation for these results?

A 30-year-old woman has known Sjogren’s syndrome and a past history of a single renal calculus. She presents with a metabolic acidosis, with hyperchloraemia. The plasma anion gap is normal. There is no bicarbonate in the urine and the urine pH is 5.7.

What is the most likely cause of her presentation?

Which of the following is the most common autoimmune disorder associated with Type 1 Renal Tubular Acidosis?

Chronic kidney disease (CKD) can be categorized into 5 stages depending on their eGFR status. Which one has the highest prevalence in Australia?

A renal transplant patient develops hyperglycaemia three months post transplant.

Which therapy is least likely to contribute to hyperglycaemia?

Cardiovascular disease is frequently associated with chronic kidney disease (CKD). Which of the following risk factor is an independent predictor of cardiovascular disease in CKD?

In patients with autosomal dominant polycystic kidney disease (PKD) due to a mutation in the PKD1 gene, which one of the following processes best accounts for the formation of renal cysts?

Which of the following syndrome has a similar effect to thiazide diuretic?

What is the mechanism of action of mycophenolate mofetil?

A 45-year-old male receives a kidney transplant from his brother. Ten days after the operation, the transplant function appears to worsen, with serum creatinine rising from 140 μmol/L to 190 μmol/L [60 – 120 μmol/L].

What is the most likely cause of the rise in creatinine?

Baxdrostat is a novel agent used in patients with treatment resistant hypertension.

What is the mechanism of action of this drug?

In patients who have undergone renal transplantation, which of the following is the most sensitive and reliable indicator of possible rejection?

What is the most likely mechanism for hypokalemia in a patient who develops metabolic alkalosis secondary to prolonged vomiting?

A 68-year-old man with 3-month history of peripheral edema. Has exertional dyspnea but denies chest pain. No history of liver or kidney disease or deep venous thrombosis. Does not smoke or drink.Only takes multivitamin.

On physical examination,afebrile,BP 132/77 mm Hg, pulse 80/min, and respiration rate is 18/min. BMI is 29. Funduscopic examination is normal. Cardiac examination reveals an S3 and a grade 2/6 holosystolic murmur at the left sternal border that radiates to the cardiac apex. Pulmonary examination reveals bilateral basilar crackles.
There is macroglossia and ecchymoses on the arms and legs. Hepatomegaly is present. There is 2+ bilateral peripheral edema and normal sensation in the extremities.

Investigation results:

• Hemoglobin 110 g/L (110 g/L)
• Prothrombin time 15s
• INR 3.5
• Serum creatinine 2.3 mg/dL (203.3 mmol/L)
• Urinalysis Normal
• Urine protein-creatinine ratio 5 mg/mg
• Urine immunoelectrophoresis shows a paraprotein λ spike.
• Chest radiograph shows an enlarged cardiac silhouette. On kidney ultrasound, the kidneys are 12.5 cm bilaterally.

Which of the following diagnostic study should be performed next?

Which of the following metabolic situation is most likely to result in hyperkalaemia?

A 25-year-old woman is evaluated for a 5-year history of difficult-to-treat hypertension. Medical history is unremarkable. Her only medication is diltiazem. There is no family history of hypertension.

On physical examination, blood pressure is 180/115 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Cardiopulmonary examination reveals a prominent precordial heave and an abdominal bruit. Funduscopic examination reveals grade 2 hypertensive retinopathy.

Laboratory studies:

• Sodium 140 mmol/L
• Potassium 3.7 mmol/L
• Chloride 100 mmol/L
• Bicarbonate 28 mmol/L
• Blood urea nitrogen 6.4 mmol/L
• Serum creatinine 88.4 mmol/L
• Plasma renin activity 10 ng/mL/h (normal 0.6-4.3 ng/mL/h)

Which of the following diagnostic studies of the renal arteries should be performed next?

What is the best test to differentiate the syndrome of renovascular hypertension from anatomic presence of renal artery stenosis alone in a patient with normal renal function?

Loss of renal function five years after renal transplantation is most likely due to:

What is the most common histologic feature seen in chronic allograft nephropathy following 5 years of transplant?

Following kidney transplantation, which of the following is the most likely manifestation of BK virus infection?

Which of the following agents induces T cell lysis?

Which of the following agent is least likely to be effective in the treatment of acute renal allograft rejection?

A patient presents with a rising serum creatinine from 100 to 130 mmol/l from day 7 to day 8 post renal transplant.

All of the following are possible causes except?

A patient develops fever, abnormal liver function tests and diarrhea on day 60 post renal transplant.

What is the most likely diagnosis?

Which of the following agent is least likely to contribute to the development of diabetes after transplantation?

The use of Sirolimus in renal transplant recipient may actually reduce the progression of the following malignancy:

Which of the following immunosuppressant is safe for use in pregnancy?

Which of the following is the most important risk factor for cardiovascular events after kidney transplantation?