CKD IQ Test Preview: When should you suspect kidney disease? What measure is used to define chronic kidney disease? What UACR test result indicates albuminuria? Good luck.
Individuals at risk for chronic kidney disease (CKD) visit primary care clinicians every day. Initially silent and progressively fatal, early suspicion for and detection and treatment of the disease are critical for the best possible outcomes.
The 10-question quiz below is based on guidelines and recommendations from the Kidney Disease Outcomes Quality Initiative, the Kidney Disease Improving Global Outcomes, and the National Kidney Disease Education Program. Test your overall knowledge of CKD and of evidence-based approaches to diagnosis and treatment.
Answer: C. Both A. Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 for >3 months and B. >30 mg of urine albumin per gram of urine creatinine for >3 months are used to define CKD.
Answer: A. A variety of clinical characteristics. Prognosis for CKD based on a variety of characteristics and not a single measurement is advised because biomarkers for kidney function and damage are imprecise and there is variability among patients in disease progression.
3. For all patients with CKD, how does mortality risk from CVD complications compare with the risk of reaching end-stage kidney disease?
Answer: D. Risk is 10-fold higher. All persons with CKD should be considered at risk for CVD. Low eGFR and albuminuria are reported to be independently predictive of CVD and CVD mortality in addition to well-known Framingham risk factors for CVD.
Answer: B. ≈40% of patients with CKD have T2D. T2D is the leading cause of dialysis or kidney transplantation in the United States. In patients with diabetes and moderate to severe CKD, only about one-fourth are aware of their kidney disease.
Answer: B. False. Declining eGFR may reflect CKD progression and complications become more likely and more severe.
Answer: C. >30 mg/g. UACR is the preferred measure for screening, assessing, and monitoring kidney damage and may be the earliest sign of glomerular disease, including DKD.
Answer: D (is false). Concurrent use of ACEi and ARB for hypertension and albuminuria is NOT indicated.
Answer: C. 21–28 mEq/L. Treatment with oral alkali in patients with metabolic acidosis to achieve a normal serum bicarbonate level, 21–28 mEq/L, has been shown to slow CKD progression.
10. The “fire and forget” strategy for initiating statin-based therapy in patients with CKD involves which of the steps above?
Answer: D. A, B, and C. The “fire and forget” strategy is recommended for primary care physicians to initiate statin-based therapy in patients aged ≥50 years with CKD and eGFR <60 ml/min/1.73 m2 regardless of LDL-C levels.