2025 exam

Which statement best reflects current evidence regarding dietary potassium?

A. All CKD stage 3 patients must restrict potassium below 2 g/day regardless of serum levels

B. Higher dietary potassium from plant sources may be tolerated and is associated with lower mortality, provided serum potassium remains in a safe range

C. Dietary potassium from fruits and vegetables is fully to partially absorbed and may lead to hyperkalemia in CKD

D. Potassium intake should match magnesium intake to prevent hypertension.

Correct Answer: B Page 1983

A 52-year-old man with stage 3 CKD (eGFR 48 mL/min/1.73 m²), obesity, and newly diagnosed type 2 diabetes has microalbuminuria and borderline hypertension. He consumes a diet high in red meat, processed foods, and refined carbohydrates. His clinician recommends a dietary overhaul aimed at reducing CKD progression risk, improving glycemic control, and lowering blood pressure. Which dietary pattern would most comprehensively address the shared pathophysiologic mechanisms driving his diabetes, hypertension, and CKD progression?

A. Low–animal protein, low-carbohydrate diet emphasizing avoidance of red meat and cheese

B. Calorie-restricted diet, Low in simple sugars but low in saturated fat

C. Predominantly plant-based diet emphasizing fruits, vegetables, whole grains, reduced NaCl, and limited red meat

D. Moderate-protein diet (1 g/kg/day) with sodium restriction

Correct Answer: C Page 1980

A 52-year-old man with stage 3 CKD (eGFR 48 mL/min/1.73 m²), obesity, and newly diagnosed type 2 diabetes has microalbuminuria and borderline hypertension. He consumes a diet high in red meat, processed foods, and refined carbohydrates. His clinician recommends a dietary overhaul aimed at reducing CKD progression risk, improving glycemic control, and lowering blood pressure. Which dietary pattern would most comprehensively address the shared pathophysiologic mechanisms driving his diabetes, hypertension, and CKD progression?

A. Low–animal protein, low-carbohydrate diet emphasizing avoidance of red meat and cheese

B. Calorie-restricted diet, Low in simple sugars but low in saturated fat

C. Predominantly plant-based diet emphasizing fruits, vegetables, whole grains, reduced NaCl, and limited red meat

D. Moderate-protein diet (1 g/kg/day) with sodium restriction

Correct Answer: C Page 1980

64-year-old woman with stage 4 CKD (eGFR 24 mL/min/1.73 m²) has metabolic acidosis and progressive eGFR decline. She consumes a typical Western diet high in animal protein and processed foods. Her nephrologist recommends increasing fruits and vegetables instead of initiating alkali therapy. Which combination of mechanisms best explains how this intervention may slow CKD progression?

A. Decereased phosphorus absorption and stimulation of FGF-23

B. Reduced dietary acid load, decreased ET-1 and AT II activity, and lower tubulointerstitial fibrosis

C. Decrease sodium intake leading to natriuresis and kaliuresis

D. Decrease urea generation with no change in nitrogen excretion

Correct Answer: B Page 1982 /

In the ELAIN trial, what was the main finding regarding early RRT initiation?

A. Early RRT increased mortality

B. Early RRT significantly reduced mortality

C. Early RRT had no effect on outcomes

D. Early RRT worsened kidney recovery

Correct Answer: B
Page 2124

A patient undergoing dialysis develops hypotension during ultrafiltration. The physician notes impaired vascular tone due to underlying illness. Which factor may also contribute to dialysis- associated hypotension?

A. Dialysis-induced decrease in body temperature

B. Dialysis-induced increase in body temperature

C. Decreased blood volume monitoring

D. Increased renal perfusion

Correct Answer: B
Page 2127

A 64-year-old man with septic shock develops acute kidney injury and is started on continuous renal replacement therapy (CRRT). After several hours, the dialysis circuit repeatedly clots. What is the most likely reason anticoagulation is needed in the extracorporeal circuit?

A. Blood tends to clot when exposed to artificial membranes

B. Dialysis tubing activates fibrinolysis

C. Dialysis filters decrease platelet activity

D. Dialysis circuits increase calcium concentration

Answer: A
Page 2127/

What is a major concern with preemptive dialysis initiation or early KRT for patients in ICU?

A. Dialysis usually worsens renal function

B. Many patients may recover kidney function spontaneously

C. Dialysis disrupts fluid removal and urine output

D. Dialysis may often lead to electrolyte imbalances

Answer: B
page 2125

A critically ill patient with AKI is hemodynamically stable and requires rapid removal of potassium. Which RRT modality is most appropriate?

A. Continuous renal replacement therapy

B. Intermittent hemodialysis

C. Peritoneal dialysis

D. Slow ultrafiltration only

Answer: B
page 2124

A patient with acute liver failure sec to HCC receives multiple infusions including Dextrose containing IVF, Minophagen, vasopressors, and fresh frozen plasma. The physician decides to initiate continuous renal replacement therapy (CRRT). What is the main reason CRRT is used in this situation?

A. Careful toxin removal

B. Careful control of volume status

C. Correction of hypoglycemia

D. Prevention of coagulopathy

Answer: B
Page 2120

A 65-year-old man in the ICU develops acute kidney injury after septic shock. Laboratory results show potassium 6.8 mmol/L with ECG changes. He is oliguric and receiving vasopressors. What is the most appropriate next step in management?

A. Continue medical management and monitor

B. Initiate renal replacement therapy immediately

C. Start diuretics

D. Restrict fluids only

Answer: B
Page 2124

A 66-year-old woman is admitted to the ICU with septic shock from intra-abdominal sepsis. She develops acute kidney injury with oliguria and severe metabolic acidosis, and continuous renal replacement therapy (CRRT) is initiated. BP: 90/55 mmHg (on norepinephrine) Urine output: <0.3 mL/kg/hr Creatinine: 4.2 mg/dL Platelets: 72,000/mm³ INR: 2.4 Hemoglobin: 8.7 g/dL The patient also had gastrointestinal bleeding 24 hours earlier. What is the most appropriate anticoagulation strategy?

A. Start systemic unfractionated heparin at a renal adjusted dose

B. Increase dialysate sodium concentration to prevent clotting heparin infusion

C. Use heparin rinse on tubing and use saline flushing only using CVVHD.

D. Use regional citrate anticoagulation for the CRRT circuit

Answer: D
Page 2124

A 56-year-old man is in the ICU with severe ARDS from pneumonia. He is on lung-protective ventilation with permissive hypercapnia. He also has acute kidney injury with minimal urine output. Despite optimized ventilator settings, his gas exchange remains poor and CO₂ clearance is limited (high dead space physiology). The team considers giving IV sodium bicarbonate boluses for acidemia. ABG shows: pH 7.14 PaCO₂ 78 mmHg PaO₂ 62 mmHg (FiO₂ 0.80) HCO₃⁻ 26 mEq/L Chemistry: K 5.1 mmol/L, Lactate 1.8 mmol/L, Creatinine 2.4 mg/dL, anuric Which is the best next step?

A. Give repeated IV sodium bicarbonate boluses to rapidly raise HCO₃⁻

B. Hyperventilate aggressively by increasing tidal volume to normalize PaCO₂

C. Initiate CRRT to allow slow pH correction and support

D. No intervention is needed because the bicarbonate is already normal

Correct Answer: C
page 2125

A 68-year-old man is admitted to the ICU with septic shock complicated by acute kidney injury (AKI). His serum creatinine has increased from 1.0 mg/dL to 4.2 mg/dL, and his urine output has declined significantly over the past 24 hours. The patient complains of severe abdominal pain and is given intravenous morphine for analgesia. Several hours later, the nursing staff notes that the patient has become progressively drowsy and difficult to arouse. His respiratory rate decreases from 18 breaths/min to 10 breaths/min, and his pupils are mildly constricted. ABG showed: pH: 7.32 PaCO₂: 48 mmHg HCO₃⁻: 24 mEq/L What is the most likely explanation for the patient’s excessive sedation?

A. Active morphine metabolites accumulate due to reduced renal clearance

B. Morphine metabolism is increased in acute kidney injury

C. Morphine causes metabolic acidosis leading to sedation

D. Hemodialysis rapidly removes morphine from circulation

Answer: A
Page 2128

A 45-year-old man is brought to the emergency department with acute liver failure after ingesting a large amount of acetaminophen. Over the next 48 hours, he develops worsening jaundice and progressive hepatic encephalopathy. Laboratory Findings showed: AST: 4,800 U/L ALT: 5,200 U/L Total bilirubin: 12 mg/dL INR: 3.0 Creatinine: 3.1 mg/dL (baseline 0.9 mg/dL) BUN: 45 mg/dL Urine sodium is very low, and the fractional excretion of sodium is <1%. What is the appropriate management for this case?

A. Aggressive intravenous fluid resuscitation with isotonic saline

B. Appropriate-dose loop diuretics with normal saline

C. Immediate hemodialysis

D. Intravenous albumin with vasoconstrictor therapy like terlipressin

Correct Answer: A
page 2120

A 62-year-old man is admitted to the ICU with AKI and septic shock secondary to pneumonia. He requires mechanical ventilation and vasopressor support. Labs showed: Creatinine: 3.9 mg/dL (baseline 1.0 mg/dL), BUN: 56 mg/dL, Urine output: <0.3 mL/kg/hr, Potassium: 5.2 mmol/L CRRT was done. He was on NPO for the last 48 hours. What is the most appropriate nutritional management strategy for this patient?

A. Restrict protein intake to 0.8g/kg only to prevent uremia

B. Initiate early enteral nutrition with adequate protein intake

C. Provides parenteral nutrition until kidney function improves

D. Delay nutrition until there is hemodynamic instability then reintroduce higher protein 1.2g/kg/day

Answer: B page 1982