CPGS

Question 1

Start of monitoring of Ca, phosphate, PTH, Alkphos

Answer 1

CKD G3a

Question 2

interval of monitoring of Ca and Phos

Answer 2

G3: q6-12
G4 q3-6
G5 Q1-3

Question 3

PTH interval monitoring

Answer 3

G3 baseline
G4: q6-12 months
G5 - q3-6 months

Question 4

gold standard for the diagnosis and classification of renal osteodystrophy

Answer 4

bone biopsy

Question 5

when to do bone biopsy

Answer 5

unexplained fractures, refractory hypercalcemia, suspicion of osteomalacia, atypical response to standard therapies for elevated PTH, progressive decreases in BMD despite standard therapy

Question 6

dialysate calcium should be

Answer 6

1.25-1.50 mmol/L

Question 7

PTH should be maintained in

Answer 7

2-9x of upper normal limit for the assay

Question 8

severe hyperparathyroidism failing to respond to medical

Answer 8

parathyroidectomy

Question 9

immediate post KT Ca and phos monitoring

Answer 9

weekly until stable

Question 10

when to reduce dose or discontinue ACEi/ARBs

Answer 10

symptomatic hypotension or uncontrolled hyperkalemia

Question 11

Physical activity for DM

Answer 11

moderate intensity for at least 150 mins per week

Question 12

First line therapy for Type 2 DM and CKD

Answer 12

Metformin and SGLT2

Question 13

Weight loss, HF, high risk ASCVD

Answer 13

GL1P-RA

Question 14

Potent glucose lowering

Answer 14

GL1P-RA, insulin

Question 15

avoid hypoglycemia

Answer 15

GL1P
DPP4
TZD
AGI

Question 16

Low cost

Answer 16

SU, TZD, aGI

Question 17

EGFR < 15 or with HD

Answer 17

DPP4, insulin TZD

Question 18

When to adjust dose of Metformin

Answer 18

EGFR < 45-59

Question 19

evaluation for KT should be done

Answer 19

at least 6-12 months before anticipated dialysis

Question 20

when to not recommend transplant

Answer 20

multiple myeloma unless curative tx and in remission;
AL amyloidosis with extrarenal involvement, decompensated cirrhosis; severe irreversible lung disease; uncorrectable and symptomatic cardiac disease; central neurodegenerative disease

Question 21

Delay transplant evaluation until properly managed

Answer 21

unstable psych, substance disorder, ongoing health compromising nonadherent behavior, active infection, malignancy, cardiac disease, peripheral arterial disease; recent stroke, gi disease, hepatitis; severe hpt

Question 22

exception of infection that may proceed with transplant evaluation

Answer 22

hepatitis C

Question 23

exception in malignancies that can proceed with transplantation

Answer 23

low grade - prostate cancer (gleason score < 6) and renal tumors (<1 cm)

Question 24

pre-emptive transplantation with a living kidney donor as preferred treatment for transplant eligible CKD patients who

Answer 24

eGFR < 10 ml/min or earlier with symptoms; EgFR < 15 ml/min for children

Question 25

abstain from tobacco use at a minimum of ___ prior to waitlisting or living donor

Answer 25

1 month

Question 26

screening for current or former heavy tobacco smokers (>= 30 pack years)

Answer 26

chest CT scan

Question 27

antiplatelets except aspirin should be stopped ____ days prior to living donor transplantation

Answer 27

5 days

Question 28

contraindication to transplant in terms of anticoagulation

Answer 28

on direct acting oral anticoagulants (apixaban, rivaroxaban)

Question 29

management for symptomatic PCKD (pain, infection, malignancy, insufficient room for transplant)

Answer 29

staged or simultaneous native nephrectomy

Question 30

primary hyperoxaluria type 1

Answer 30

combined or sequential liver-kidney transplantation

Question 31

strategies to lower total body oxalate burden

Answer 31

intensive dialysis | diet modification and pyridoxine treatment

Question 32

HCV and compensated cirrhosis (without portal hypertension)

Answer 32

isolated kidney transplantation

Question 33

HCV and decompensated cirrhosis

Answer 33

combined liver-kidney transplantation and deferring HCV treatment until after transplantation

Question 34

monitoring of hbsag and hbv dna post transplant for hbsag negative, anti-hbc positive patients for

Answer 34

min of 1 year

Question 35

vaccination for varicella and MMR for seronegative candidates should be done

Answer 35

at least 4 weeks prior to transplantation

Question 36

live vaccines

Answer 36

MMR, VZV, shingles, yellow fever, oral typhoid, polio

Question 37

splenectomized patients

Answer 37

pneumococcal, hemophilus and meningococcal vaccination

Question 38

screening for bladder cancer

Answer 38

high level cyclophosphamide, heavy smoking of 30 pack years

Question 39

screening for bladder ca

Answer 39

cystoscopy

Question 40

screening for hcc

Answer 40

ultrasound, a-fetoprotein

Question 41

no waiting time for candidates with surgically curatively treated

Answer 41

``` nonmetastatic basal cell ca melanoma in situ small renal cell Ca < 3 cm prostate Ca gleason score < 6 carcinoma in situ (ductal, cervical) thyroid ca, follicular, papillarry < 3 cm superficial bladder cancer ```

Question 42

acute leukemia and high grade lymphoma

Answer 42

avoid transplant unless curative and remission and cancer free

Question 43

noninvasive CAD screening

Answer 43

asymptomatic candidates at high risk for CAD (DM, previous CAD) with poor functional capacity

Question 44

asymptomatic advanced triple vessel coronary disease

Answer 44

excluded

Question 45

asymptomatic candidates on dialysis for at least 2 years, risk factors for pulmonary hypertension

Answer 45

2d echo

Question 46

cut off for pulmonary artery systolic pressure

Answer 46

>45 or > 60 (R heart catheterization)

Question 47

exclude from transplant

Answer 47

uncorrectable CLass 3/4, severe CAD, EF < 30%, severe valvular disease

Question 48

cardiac amyloidosis

Answer 48

exclude

Question 49

clinically apparent PAD + abnormal noninvasive testing or prior vascular procedure

Answer 49

noncontrast CT imaging of the abdomen/pelvis

Question 50

at least ____ after a stroke or after a TIA before a KT

Answer 50

6 months after stroke | 3 months after TIA

Question 51

screen candidates with ADPKD disease for

Answer 51

intracranial aneurysms (high risk)

Question 52

if symptoms suggestive of PUD

Answer 52

EGD and Hpylori testing

Question 53

acute pancreatitis, should delay KT

Answer 53

minimum of 3 months after symptoms have resolved

Question 54

major complications of leptospiroris, marker of severity and indication for hospitalization

Answer 54

AKI (poorer prognosis)

Question 55

Features of leptospirosis associated AKI

Answer 55

sterile pyuria, tea colored urine, mild proteinuria to severe anuric acute renal failure, nonoliguric renal failure with mild hypokalemia, oliguria with hyperkalemia (severity of AKI)

Question 56

oliguria with hyperkalemia

Answer 56

poor prognosis

Question 57

pathology of leptospirosis associated AKI

Answer 57

acute tubular damage and tubulointerstitial nephritis

Question 58

lab findings associated with increase ind eath

Answer 58

neutrophilia and thrombocytopenia

Question 59

predictors of mortality in severe leptospirosis

Answer 59

crea > 3, age > 40, oliguria, platelet < 70k and pulmonary involvement

Question 60

Tubular dysfunction

Answer 60

hyponatremia and hypokalemia

Question 61

responsible for non-oliguria

Answer 61

vasopressin resistance

Question 62

urine output < 0.5 ml/kg/hr or M 400 ml/day or report decrease or no urine output with the last 12 hours

Answer 62

oligura

Question 63

predictors of oliguria

Answer 63

> 40 years, crackles, low arterial pH, hyponatremia, increased crea, elevated DB and AST, low platelet and low alkphos

Question 64

recommended map in leptospirosis

Answer 64

65-70 mmhg

Question 65

initial fluid resuscitation in shock

Answer 65

ballanced crystalloids

Question 66

If K is in the high normal value or with hyperkalemia

Answer 66

isotonic saline

Question 67

initial rate

Answer 67

20 ml/kg.hr or 500 ml within 15-30 minutes

Question 68

indications for acute rrt

Answer 68

uremic symptoms; pH <7.2, fluid overload, oliguria despite adequate hydration, crea > 3, K > 5 in an oliguric patient, ARDS, pulmo hemorrhage

Question 69

frequency of dialysis in leptospirosis

Answer 69

daily dialysis

Question 70

hemodynamically unstable dialysis modality

Answer 70

CRRT

Question 71

indications for pulse therapy

Answer 71

AKI plus one of the ff: platelet < 100k, MAP < 65, inotropes, ards, prolonged PT/PTT

Question 72

dose of pulse therapy

Answer 72

3 doses of MPPT 500 mg+ 1 dose of cyclophosphamide 60 mk IV

Question 73

Donors should stop smoking

Answer 73

at least 4 weeks before donation and life long abstinence

Question 74

evaluation of GFR

Answer 74

serum creatinine

Question 75

confirmation of GFR

Answer 75

measured GFR using inulin measured CrCl eGFR using crea and cystatin C repeated estimated GFR from serum crea

Question 76

acceptable GFR

Answer 76

> 90 ml/min

Question 77

GFR that should not donate

Answer 77

GFR < 60 ml/min

Question 78

acceptable AER

Answer 78

< 30 mg/day

Question 79

AER that should not donate

Answer 79

> 100 mg/day

Question 80

IgA nephropathy

Answer 80

do not donate

Question 81

evaluation for persistent microscopic hematuria

Answer 81

urinalysis and urine CS; cystoscopy and imaging, 24h urine stone panel, kidney biopsy

Question 82

elevated FBS, gestational DM or family history of DM in a first degree relative

Answer 82

2h OGTT or Hba1c

Question 83

repeat testing of HIV, HBC and HCV

Answer 83

within 28 days

Question 84

Genetic kidney disease that can cause kidney failure and APKD; pregnant

Answer 84

do not donate