Chronic Kidney Disease: Treatment and
Management Strategies questions with
correct solutions
What is the role of gliflozins in chronic kidney disease (CKD)? ✅✅Gliflozins have a
now-proven role in the treatment of diabetic kidney disease.
What are genome-specific therapies in CKD? ✅✅Genome-specific therapies are
established for certain patients with autosomal dominant polycystic kidney disease
(ADPKD) and are in clinical trials for APOL1-mediated kidney disease and certain forms
of hyperoxaluria.
When should therapy for CKD be initiated? ✅✅Therapy should be initiated well
before there is a measurable decline in GFR and certainly before CKD is established.
What should be monitored to assess CKD progression? ✅✅The rate of decline of
GFR should be measured sequentially and plotted for all patients.
What factors can cause an acceleration in the decline of GFR in CKD patients?
✅✅Factors include extracellular fluid volume depletion, uncontrolled hypertension,
urinary tract infection, new obstructive uropathy, exposure to nephrotoxic agents, and
reactivation of original diseases like lupus or vasculitis.
What is the impact of increased intraglomerular hypertension on kidney function?
✅✅Increased intraglomerular hypertension and glomerular hypertrophy are
maladaptive responses that promote ongoing decline of kidney function.
How does blood pressure relate to proteinuria in CKD? ✅✅Elevated blood pressure
increases proteinuria by increasing its flux across the glomerular capillaries.
What is the target blood pressure for proteinuric CKD patients? ✅✅The target blood
pressure is 130/80 mmHg.
Which medications are effective in slowing the progression of renal failure in CKD?
✅✅ACE inhibitors and angiotensin receptor blockers (ARBs) are effective in slowing
the progression of renal failure.
What is the effect of ACE inhibitors and ARBs on glomerular hypertension? ✅✅They
promote efferent vasodilatation, leading to a decline in glomerular hypertension.
What is the benefit of combining ACE inhibitors and ARBs in CKD treatment?
✅✅Combined treatment may lead to a greater reduction in proteinuria compared to
either agent alone.
, What are the risks associated with combining ACE inhibitors and ARBs? ✅✅There is
a greater incidence of acute kidney injury (AKI) and adverse cardiac events with
combination therapy.
What should be avoided in CKD treatment regarding ACE inhibitors and ARBs?
✅✅ACE inhibitor plus ARB therapy should be avoided due to the risks involved.
What does a progressive increase in serum creatinine concentration indicate when
using ACE inhibitors or ARBs? ✅✅It may suggest the presence of renovascular
disease within the large or small arteries.
Which calcium channel blockers may have superior antiproteinuric effects in CKD?
✅✅Diltiazem and verapamil may exhibit superior antiproteinuric and renoprotective
effects compared to dihydropyridines.
What are the two categories of response in managing chronic kidney disease (CKD)?
✅✅1. Progression associated with systemic and intraglomerular hypertension and
proteinuria (e.g., diabetic nephropathy, glomerular diseases) where ACE inhibitors and
ARBs are recommended. 2. Mild or absent proteinuria initially (e.g., ADPKD and other
tubulointerstitial diseases) where intraglomerular hypertension is less prominent and
other antihypertensive agents can be used.
What adjustments are needed for medication doses in CKD patients? ✅✅The
maintenance doses of many drugs need to be adjusted based on renal function, while
loading doses are generally unaffected. Drugs with >70% nonrenal elimination may not
require dose adjustment.
Which medications should be avoided in patients with CKD? ✅✅Metformin,
meperidine, oral anti-hyperglycemics eliminated by the kidney, and NSAIDs due to the
risk of worsening kidney function.
What types of medications may require dosage reduction in CKD patients? ✅✅Many
antibiotics, antihypertensives, and antiarrhythmics may require a reduction in dosage or
change in the dosing interval.
What should be avoided or used with caution in CKD patients regarding radiocontrast
agents? ✅✅Nephrotoxic radiocontrast agents and gadolinium should be avoided or
used according to strict guidelines.
What dietary management can provide temporary relief of uremic symptoms in CKD?
✅✅Dietary protein restriction may provide temporary relief of symptoms such as
anorexia, nausea, vomiting, lassitude, and pruritus.
Management Strategies questions with
correct solutions
What is the role of gliflozins in chronic kidney disease (CKD)? ✅✅Gliflozins have a
now-proven role in the treatment of diabetic kidney disease.
What are genome-specific therapies in CKD? ✅✅Genome-specific therapies are
established for certain patients with autosomal dominant polycystic kidney disease
(ADPKD) and are in clinical trials for APOL1-mediated kidney disease and certain forms
of hyperoxaluria.
When should therapy for CKD be initiated? ✅✅Therapy should be initiated well
before there is a measurable decline in GFR and certainly before CKD is established.
What should be monitored to assess CKD progression? ✅✅The rate of decline of
GFR should be measured sequentially and plotted for all patients.
What factors can cause an acceleration in the decline of GFR in CKD patients?
✅✅Factors include extracellular fluid volume depletion, uncontrolled hypertension,
urinary tract infection, new obstructive uropathy, exposure to nephrotoxic agents, and
reactivation of original diseases like lupus or vasculitis.
What is the impact of increased intraglomerular hypertension on kidney function?
✅✅Increased intraglomerular hypertension and glomerular hypertrophy are
maladaptive responses that promote ongoing decline of kidney function.
How does blood pressure relate to proteinuria in CKD? ✅✅Elevated blood pressure
increases proteinuria by increasing its flux across the glomerular capillaries.
What is the target blood pressure for proteinuric CKD patients? ✅✅The target blood
pressure is 130/80 mmHg.
Which medications are effective in slowing the progression of renal failure in CKD?
✅✅ACE inhibitors and angiotensin receptor blockers (ARBs) are effective in slowing
the progression of renal failure.
What is the effect of ACE inhibitors and ARBs on glomerular hypertension? ✅✅They
promote efferent vasodilatation, leading to a decline in glomerular hypertension.
What is the benefit of combining ACE inhibitors and ARBs in CKD treatment?
✅✅Combined treatment may lead to a greater reduction in proteinuria compared to
either agent alone.
, What are the risks associated with combining ACE inhibitors and ARBs? ✅✅There is
a greater incidence of acute kidney injury (AKI) and adverse cardiac events with
combination therapy.
What should be avoided in CKD treatment regarding ACE inhibitors and ARBs?
✅✅ACE inhibitor plus ARB therapy should be avoided due to the risks involved.
What does a progressive increase in serum creatinine concentration indicate when
using ACE inhibitors or ARBs? ✅✅It may suggest the presence of renovascular
disease within the large or small arteries.
Which calcium channel blockers may have superior antiproteinuric effects in CKD?
✅✅Diltiazem and verapamil may exhibit superior antiproteinuric and renoprotective
effects compared to dihydropyridines.
What are the two categories of response in managing chronic kidney disease (CKD)?
✅✅1. Progression associated with systemic and intraglomerular hypertension and
proteinuria (e.g., diabetic nephropathy, glomerular diseases) where ACE inhibitors and
ARBs are recommended. 2. Mild or absent proteinuria initially (e.g., ADPKD and other
tubulointerstitial diseases) where intraglomerular hypertension is less prominent and
other antihypertensive agents can be used.
What adjustments are needed for medication doses in CKD patients? ✅✅The
maintenance doses of many drugs need to be adjusted based on renal function, while
loading doses are generally unaffected. Drugs with >70% nonrenal elimination may not
require dose adjustment.
Which medications should be avoided in patients with CKD? ✅✅Metformin,
meperidine, oral anti-hyperglycemics eliminated by the kidney, and NSAIDs due to the
risk of worsening kidney function.
What types of medications may require dosage reduction in CKD patients? ✅✅Many
antibiotics, antihypertensives, and antiarrhythmics may require a reduction in dosage or
change in the dosing interval.
What should be avoided or used with caution in CKD patients regarding radiocontrast
agents? ✅✅Nephrotoxic radiocontrast agents and gadolinium should be avoided or
used according to strict guidelines.
What dietary management can provide temporary relief of uremic symptoms in CKD?
✅✅Dietary protein restriction may provide temporary relief of symptoms such as
anorexia, nausea, vomiting, lassitude, and pruritus.
