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Question and answer links
- Q1: A patient with membranous nephropathy and serum albumin 1.8 g/dL develops flank pain, gross hematuria and a creatinine r · Answer
- Q2: A patient with cirrhosis and ascites has persistent AKI after appropriate correction of a documented volume deficit. Inf · Answer
- Q3: An acutely unwell adult has the results below. Creatinine was 1.0 mg/dL five days earlier. Which first interpretation us · Answer
Back to the Session 5 run sheet
Three individual retrieval decisions for the opening five minutes. Allow about 45 seconds per answer, followed by a short explanation. Record the first answer before discussion. This is formative readiness practice, not a validated assessment.
Q1A new complication of nephrotic syndrome
A patient with membranous nephropathy and serum albumin 1.8 g/dL develops flank pain, gross hematuria and a creatinine rise from 1.3 to 2.1 mg/dL over four days. What needs urgent exclusion?
Renal vein thrombosis — arrange appropriate imaging and same-day nephrology contact
Normal variation — repeat creatinine at the next routine visit
Lower-tract retention alone — an empty bladder excludes every postrenal cause
A steroid-responsive relapse — start prednisone before reassessing the diagnosis
Show answer and explanation · Link to this question
Correct answer: A
Learning point: Nephrotic syndrome increases thrombosis risk. The acute pain, hematuria and kidney-function change warrant urgent vascular evaluation while other causes of AKI are assessed. An empty bladder excludes neither ureteral obstruction nor vascular disease. Why not the others: B delays evaluation; C overinterprets a bladder scan; D prescribes before establishing the cause. Course reading: Evidence for this case
Q2Low urine sodium in cirrhosis
A patient with cirrhosis and ascites has persistent AKI after appropriate correction of a documented volume deficit. Infection, obstruction and nephrotoxic exposure have been evaluated. FENa remains below 1%. What is the best interpretation?
Low FENa proves more fluid will restore kidney function
HRS-AKI is a concern; low FENa does not distinguish it from other causes
Low FENa rules out any tubular injury
The diagnosis requires an automatic additional 48-hour albumin course
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Correct answer: B
Learning point: Sodium avidity is common in cirrhosis and is not a fluid-response test. Persistent AKI after appropriate resuscitation raises concern for hepatorenal physiology, but the assessment remains clinical and may involve more than one mechanism. Obtain hepatology/nephrology input; routine prolonged albumin administration without assessing volume can cause harm. Why not the others: A and C overinterpret FENa; D substitutes a fixed infusion interval for assessment of the patient. Course reading: Evidence for this case
Q3Read the BMP before naming the disease
An acutely unwell adult has the results below. Creatinine was 1.0 mg/dL five days earlier. Which first interpretation uses the systematic BMP read correctly?
| Test | Result | Reference range |
|---|---|---|
| Sodium | 128 mEq/L | 136–145 |
| Potassium | 6.2 mEq/L | 3.5–5.0 |
| Chloride | 96 mEq/L | 98–107 |
| Bicarbonate | 14 mEq/L | 22–26 |
| BUN | 72 mg/dL | 7–20 |
| Creatinine | 3.0 mg/dL | 0.7–1.3 |
| Glucose | 110 mg/dL | 70–140 random |
| Albumin | 4.0 g/dL | 3.5–5.0 |
| Calcium | 9.2 mg/dL | 8.6–10.2 |
| Magnesium | 2.0 mg/dL | 1.7–2.2 |
| Phosphorus | 5.4 mg/dL | 2.5–4.5 |
Hyponatremia alone; the other abnormalities can wait until it is corrected
Chronic G4 CKD because the calculated eGFR is low on today's report
Normal anion gap because sodium minus chloride is 32
Urgent hyperkalemia assessment, AG 18 with low bicarbonate, and stage 3 AKI by creatinine ratio
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Correct answer: D
Learning point: Read Na → K → Cl → bicarbonate → anion gap → BUN/creatinine → glucose, then Ca/Mg/phosphorus. AG = 128 − (96 + 14) = 18; albumin is normal. Creatinine is three times a recent baseline. Obtain an ECG and urgently manage confirmed hyperkalemia according to the clinical protocol while evaluating AKI and the acid-base disorder; a blood gas and cause-directed tests complete the assessment. Why not the others: A misses an immediate hazard; B labels chronicity from an acute change; C omits bicarbonate from the calculation. Course reading: Evidence for this case
Fictional cases. Educational use only.