Chronic Kidney Disease MCQs

Ans. is 'a' i.e., Hemolytic uremic syndrome Schistocytes, helment cells, triangle cells, burr cells are seen in microangiopathic hemolytic anemia (MAHA). Changes in erythrocyte morphology

Causes of secondary hyperlipidemia include: Type 2 diabetes mellitus chronic renal failure alcoholism (hypertriglyceridemia) drugs including: thiazides, glucocorticoids, oestrogens, cyclosporine, protease inhibitors hypothyroidism (Hypercholesterolemia) nephrotic syndrome. (Hypercholesterolemia) Reference: Harrison's Principles of Internal Medicine 20 th edition Chapter:400 Page number:2897

Ans. A i.e. Diabetes mellitus `Renal papillary necrosis, an accompaniment of acute pyelonephritis is most often seen in diabetics and is characterised by necrosis of renal papillae of one or both kidneys with sharped demarcation between necrotic and living tissue' — Dorlands Thus while papillary necrosis is a feature of more than one conditions mentioned in the question, it is most commonly seen with diabetes mellitus.

This patient has low calcium, high phosphate and very high PTH levels, which is suggestive of secondary hyperparathyroidism. Among the options 1α hydroxylase deficiency leads to secondary hyperparathyroidism. Reference: Harrison's Principles of Internal Medicine, 21 st edition, Ch:311, Pg:2313.

Other causes include: Stage 1 diabetic nephropathy Hydronephrosis Acromegaly Renal vein thrombosis Adult polycystic kidney disease Reference: Harrison's Principles of Internal Medicine, 21 st edition, Ch:311, Pg:2318

ACE inhibitors and ARB's reduce the intra glomerular pressure by the efferent arteriolar dilation. Non dihydropyridine CCB, Diltiazem and Verapamil are also antiproteinuric and renoprotective. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 311, Pg: 2319.

Causes of Anemia is CKD patients: Relative deficiency of erythropoietin due to decreased production by the diseased kidneys is the primary cause of anemia. Diminished red blood cell survival Bleeding diathesis Iron deficiency due to poor dietary absorption and gastrointestinal blood loss Hyperparathyroidism/bone marrow fibrosis Chronic inflammation Folate or vitamin B12 deficiency Hemoglobinopathy Comorbid conditions: hypo-/hyperthyroidism, pregnancy, HIV-associated disease, autoimmune disease, immunosuppressive drugs The target hemoglobin recommended in CKD is 10-11.5g/dL Apart from erythropoietin, prolyl hydroxylase inhibitors of endogeneous Hypoxia Inducible Factor are used in CKD. Eg: Roxadustat. Reference: Harrison's Principles of Internal Medicine, 21 st edition, Ch: 311, Pg: 2316.