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Chapter 18: Chronic Renal Failure and the Uremic Syndrome

Which of the following cases does NOT fulfill KDIGO criteria for chronic kidney disease?

A. A 28-year-old male patient with a persistently elevated serum creatinine of 6 mg/dL over the past 4 months.

B. A 67-year-old male patient with two simple cysts in the right kidney, without albuminuria or hematuria, and an estimated GFR of 68 mL/min.

C. A 58-year-old female patient with a 15-year history of diabetes, albumin-to-creatinine ratio of 258 mg/g, and an estimated GFR of 54 mL/min and declining over the past year.

D. A 70-year-old male patient with a history of poorly controlled chronic hypertension, a slowly rising serum creatinine over the past several years, and symptoms felt to be due to uremia.

The answer is B. The 67-year-old male with two simple cysts in the right kidney, without albuminuria or hematuria, and an estimated GFR of 68 mL/min, does not fulfill KDIGO criteria of CKD. Although the patient has structural abnormalities detected by imaging studies (specifically two simple renal cysts), they virtually carry no risk of subsequent renal function decline. Moreover, the eGFR is >60 mL/min and there are no markers of kidney damage, such as albuminuria or hematuria.

Option A, the 28-year-old male with a persistently elevated serum creatinine of 6 mg/dL over the past 4 months, most likely has CKD because that degree of elevation of the serum creatinine most likely reflects an eGFR of <60 mL/min. Furthermore, the serum creatinine elevation has persisted for >3 months, which excludes acute kidney injury.

Option C, the 58-year-old female with a 15-year history of diabetes, albumin-to-creatinine ratio of 258 mg/g, and an estimated GFR of 54 mL/min and declining over the past year, has CKD because her eGFR is <60 mL/min and has been dropping over 1 year. Additionally, as expected by her history of diabetes, she has A2 albuminuria.

Option D, the 70-year-old male with a history of poorly controlled chronic hypertension, a slowly rising serum creatinine, and symptoms felt to be due to uremia, has CKD because of the symptoms of uremia and the slowly rising serum creatinine over the past several years.

Which of the following factor(s) contribute to the pathophysiology of anemia of chronic kidney disease?

A. Decreased production of erythropoietin by the kidneys

B. Accelerated hemolysis due to uremia

C. Iron and folic acid deficiencies

D. All of the above are correct

The answer is D. The three listed factors contribute to the pathophysiology of the anemia of CKD. The most import one is decreased erythropoietin production by the failing kidneys. Accelerated hemolysis associated with uremia, nutritional ...

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