A 54-year-old man presents to his primary care provider for an annual wellness examination. He takes NSAIDS as needed for a recent knee replacement. Vital signs and physical examination are within normal limits, with the exception of trace edema in the lower extremities.  Laboratory studies are significant for serum creatinine of 2.4 mg/dl, and urinalysis reveals albuminuria of 101 mg/g. Estimated GFR is 52 mL/min/1.73 m2. At two previous visits, serum creatinine was < 2.0 mg/dl. 16. Which of the following is the most likely stage of the disease?

32. Which of the following parameters best characterizes overt diabetic nephropathy?

True or False:   A sonicator separates samples based on density.

14. Which of the following is the most common cause for the development of chronic kidney disease in adults?

A 28-year old woman with a history of anorexia is admitted to the hospital with lethargy and cognitive impairment.  BMI is 18.5. Serum creatinine is 3.1 mg/dl.  FENa is 0.1%, and urine sediment is bland.  She is diagnosed with pre-renal AKI secondary to diuretic abuse.   On hospital day 3 her symptoms worsen. Serum creatinine is  5.1 mg/dl.  FENa is 3.1%.  Repeat urinalysis reveals brownish pigment and granular casts with epithelial cells, but no white blood cells. 10. Which of the following is the most likely diagnosis on hospital day 3?

22. Which of the following is the best definition of a hypertensive urgency/emergency? Systolic BP (mmHg) Diastolic BP (mmHg) A. < 120 < 80 B. 120 - 139 80 - 89 C. 140 - 159 90 - 99 D. ≥ 180 ≥ 120  

3. Which of the following findings is most commonly present in a patient with prerenal acute kidney injury?

Use the following vignette to answer questions 29 – 31. A 26 y.o woman is visiting your office with complaints of back pain and headaches. These symptoms have affected her for several months and have worsened significantly. She has been taking various over-the-counter analgesics with some relief of the back pain but not of the headache. The patient also reports that more recently, she is experiencing some episodes of dyspnea.  During the office visit her pressure is 148/102 mmHg, and two subsequent measurements do not diverge significantly from these numbers. Her body Temperature is 100.2°F, HR is 78 bpm, with RR 24 breaths per minute, labored, and shallow at times. At the physical examination, heart sounds are normal and lung fields are clear although the tympanic sound at the lung bases is lost in both posterior quadrants. The abdomen appears to be slightly distended, and abdominal palpation reveals a liver border protruding below the rib cage, and the presence of bilateral masses in the right and left lower quadrants. Assessment of occult blood in the feces is negative. 30. Which additional laboratory test or procedure would you want to order?

A 48-year-old man with a 10-year history of poorly-controlled blood pressure and type 2 diabetes and is referred for evaluation of albuminuria and renal function. Blood pressure is 158/103 mm Hg sitting and standing. Urinalysis reveals albuminuria = 328.2 mg/g, and eGFR = 60 mL/min/1.73 m2. 12. Which of the following changes in the glomerulus is most likely responsible for this patient’s albuminuria?

A 65-year-old woman with type 2 diabetes and essential hypertension is admitted to the hospital with acute decompensated heart failure and edema. Serum creatinine at admission was 4.1 mg/dL; 10 hours later serum creatinine is 5.7 mg/dL. BUN/Cr ratio is 28:1. Urinary sediment is bland and unremarkable. Past medical history is significant for one episode of kidney stones 3 years ago. 9. Which of the following changes in extracellular fluid volume (EFV) and effective circulating volume (ECV) are the most likely causes of elevated serum creatinine in this patient? Extracellular Fluid Volume Effective Circulating Volume A. Increased Decreased B. Increased Increased C. Decreased Decreased D. Decreased Increased