NEPHROLOGY COMPREHENSIVE EXAM • ABIM & ESENEPH BLUEPRINT • 2026/2027 EDITION
UPDATED FOR 2026/2027 • ABIM/ESENEPH BLUEPRINT • VERIFIED
NEPHROLOGY
COMPREHENSIVE EXAM
• 120 QUESTIONS
120 Comprehensive Nephrology Board Review Questions with Verified Correct Answers | Latest Blueprint
120 VERIFIED Q&As KDIGO 2026 ALIGNED BOARD FORMAT
• Verified ABIM/ESENeph Blueprint Case Vignettes + Reasoning
Overview — This 2026/2027 updated resource contains a comprehensive set of 120 nephrology board review questions
aligned with the ABIM Nephrology Certification Exam blueprint and the ESENeph/Nephrology SCE curriculum. Covers all
core domains with evidence-based KDIGO guideline applications and novel therapies.
✓ KEY FEATURES
• ✓ 120 comprehensive questions covering all core nephrology domains — blueprint-weighted
• ✓ Verified answers with evidence-based rationales — KDIGO, UKKA, ABIM standards
• ✓ Updated 2026/2027 KDIGO guideline applications — SGLT2i, complement inhibitors, AI diagnostics
• ✓ Clinical case vignettes and diagnostic reasoning exercises — board exam format
• ✓ Board exam format aligned with ABIM and ESENeph standards — scenario-based testing strategies
▣ CORE CONTENT AREAS (120 TOTAL QUESTIONS)
• Chronic Kidney Disease — 23 Qs — staging, SGLT2i/finerenone, anemia, CKD-MBD, progression
• Acute Kidney Injury & ICU Care — 16 Qs — KDIGO AKI, RRT timing, nephrotoxins, hepatorenal
• Sodium/Water & Acid-Base/Electrolytes — 17 Qs — hypo/hypernatremia, potassium, acid-base
• Glomerular & Vascular Disorders — 12 Qs — nephrotic/nephritic, IgA, ANCA, anti-GBM
• Kidney Transplantation — 11 Qs — rejection, CNI, BK, desensitization
• Dialysis — 12 Qs — hemodialysis adequacy, access, PD, complications
• Hypertension — 10 Qs — resistant HTN, renovascular, pregnancy
• Tubular, Interstitial & Cystic Disorders — 9 Qs — RTA, tubulointerstitial, PKD
• Calcium, Phosphorus & Stones — 4 Qs — hypercalcemia, nephrolithiasis
• Pharmacology — 6 Qs — diuretics, dosing in CKD, nephrotoxic drugs
▣ ANSWER F ORMAT
All correct answers are marked in bold green and include:
• • Evidence-based guideline rationales (KDIGO, UKKA, ABIM)
• • Clinical correlation applications and diagnostic reasoning
• • Pharmacologic mechanism explanations
• • Board exam blueprint alignment and testing strategies
🔹 UPDATES FOR 2026/2027
• 🔹 Reflects 2026/2027 ABIM Nephrology content specification revisions
• 🔹 Updated KDIGO clinical practice guideline applications (2024 CKD, Diabetes, GN, Transplant)
• 🔹 Enhanced integration of novel therapies (SGLT2 inhibitors, finerenone, complement inhibitors e.g., iptacopan/avacopan)
• 🔹 New artificial intelligence and diagnostic tool applications (AKI prediction, CKD progression models)
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
1 | KDIGO 2024-2026
, NEPHROLOGY COMPREHENSIVE EXAM • ABIM & ESENEPH BLUEPRINT • 2026/2027 EDITION
• 🔹 Revised hypertension and cardiovascular risk management protocols (KDIGO BP, AHA/ACC)
• 🔹 Updated dialysis and transplantation outcomes data (high-volume HDF, incremental dialysis)
• 🔹 New precision medicine and genetic testing applications (APOL1, Alport, cystic disease panels)
• 🔹 Revised health equity and social determinants in kidney care
———
120 VERIFIED QUESTIONS • NEPHROLOGY BOARD REVIEW • 2026/2027
SECTION 1 — CHRONIC KIDNEY DISEASE (23 QS)
Staging • Albuminuria • SGLT2i/Finerenone • Anemia • CKD-MBD • Acidosis • Lipids
1. A 41-year-old with diabetes, eGFR 25 mL/min/1.73m², ACR 210 mg/g, BP 147/89 on losartan is
reviewed. Per KDIGO 2024 CKD guideline, which intervention most reduces CKD progression and
cardiovascular risk?
A. Stop all RAAS blockade
B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor (dapagliflozin/empagliflozin) if eGFR ≥20 and initiate
finerenone if diabetic CKD with albuminuria
C. High-dose NSAID for proteinuria
D. Protein intake 2.5 g/kg/day
Correct Answer: B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor
(dapagliflozin/empagliflozin) if eGFR ≥20 and initiate finerenone if diabetic CKD with albuminuria
Rationale: KDIGO 2024 CKD/Diabetes: SGLT2i for CKD with eGFR ≥20 irrespective of diabetes + albuminuria; finerenone for
diabetic CKD with persistent albuminuria despite RAAS; BP <130/80 if albuminuria; avoid nephrotoxins. Case details (age 41, eGFR 25,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
2. A patient with CKD G4 (eGFR 38) has Hb 9.6 g/dL, ferritin 107 ng/mL, TSAT 26% . KDIGO anemia
management recommends:
A. IV iron regardless of stores and ESA to Hb 13 g/dL
B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional deficiency), then consider ESA if symptomatic
and Hb <10, targeting 10-11.5 avoiding >13
C. Transfuse to Hb 14
D. No workup needed
Correct Answer: B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional
deficiency), then consider ESA if symptomatic and Hb <10, targeting 10-11.5 avoiding >13
Rationale: Correct iron deficiency before ESA; ESA target not >11.5-13 due to stroke/MACE risk; evaluate for blood loss/B12/folate.
Case details (age 52, eGFR 38, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
3. A 63-year-old with CKD G4 A3 has Ca 9.1 mg/dL, PO4 4.4 mg/dL, PTH 191 pg/mL, 25-OH vitD 21.
CKD-MBD management per KDIGO is:
A. High calcium diet with calcium-based binders max dose
B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH trends not single value; avoid
severe hypocalcemia
C. No monitoring needed
D. Calcitriol high dose regardless of Ca
Correct Answer: B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH
trends not single value; avoid severe hypocalcemia
Rationale: KDIGO CKD-MBD: phosphate control, calcium balance, vitamin D repletion, PTH trend; avoid hypercalcemia from
calcium binders/active vitamin D; treat severe hyperparathyroidism. Case details (age 63, eGFR 51, values vignette-specific) highlight
board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
4. An adult with CKD and metabolic acidosis HCO3 18 mEq/L. KDIGO suggests:
A. No treatment unless HCO3 <10
B. Offer sodium bicarbonate if HCO3 <18 to slow progression, after addressing diet and meds, monitoring for Na overload/HF
C. Give NH4Cl
D. Acid load preferred
Correct Answer: B. Offer sodium bicarbonate if HCO3 <18 to slow progression, after addressing diet and meds,
monitoring for Na overload/HF
Rationale: KDIGO: treat <18 with NaHCO3 to 24-26 if tolerated; watch volume/BP; correct reversible causes. Case details (age 74,
eGFR 64, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
2 | KDIGO 2024-2026
, NEPHROLOGY COMPREHENSIVE EXAM • ABIM & ESENEPH BLUEPRINT • 2026/2027 EDITION
5. For a 35-yr-old smoker with CKD, statin therapy per KDIGO Lipid and cardiovascular risk is:
A. Never use statin in CKD
B. Statin ± ezetimibe for adults ≥50 with eGFR <60 not on dialysis (not started de novo on dialysis); lifestyle + BP/diabetes
control
C. High-dose statin dialysis optimal
D. Only after MI
Correct Answer: B. Statin ± ezetimibe for adults ≥50 with eGFR <60 not on dialysis (not started de novo on
dialysis); lifestyle + BP/diabetes control
Rationale: KDIGO Lipid: statin for ≥50 CKD non-dialysis; no new start on dialysis; avoid under-treatment due to perceived risk. Case
details (age 35, eGFR 77, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
6. A 46-yr-old with CKD G3b A3 is counseled on progression. The strongest risk predictor beyond eGFR
is:
A. Serum potassium alone
B. Albuminuria (ACR) magnitude — A3 > A2 > A1 predicts faster GFR decline and CV death
C. No predictor
D. Only age
Correct Answer: B. Albuminuria (ACR) magnitude — A3 > A2 > A1 predicts faster GFR decline and CV death
Rationale: ACR stratifies risk within same GFR; SGLT2i/RAAS reduce albuminuria and slow decline. Case details (age 46, eGFR 22,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
7. A 57-year-old with diabetes, eGFR 35 mL/min/1.73m², ACR 680 mg/g, BP 153/95 on no RAAS is
reviewed. Per KDIGO 2024 CKD guideline, which intervention most reduces CKD progression and
cardiovascular risk?
A. Stop all RAAS blockade
B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor (dapagliflozin/empagliflozin) if eGFR ≥20 and initiate
finerenone if diabetic CKD with albuminuria
C. High-dose NSAID for proteinuria
D. Protein intake 2.5 g/kg/day
Correct Answer: B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor
(dapagliflozin/empagliflozin) if eGFR ≥20 and initiate finerenone if diabetic CKD with albuminuria
Rationale: KDIGO 2024 CKD/Diabetes: SGLT2i for CKD with eGFR ≥20 irrespective of diabetes + albuminuria; finerenone for
diabetic CKD with persistent albuminuria despite RAAS; BP <130/80 if albuminuria; avoid nephrotoxins. Case details (age 57, eGFR 35,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
8. A patient with CKD G4 (eGFR 48) has Hb 12.0 g/dL, ferritin 293 ng/mL, TSAT 38% . KDIGO anemia
management recommends:
A. IV iron regardless of stores and ESA to Hb 13 g/dL
B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional deficiency), then consider ESA if symptomatic
and Hb <10, targeting 10-11.5 avoiding >13
C. Transfuse to Hb 14
D. No workup needed
Correct Answer: B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional
deficiency), then consider ESA if symptomatic and Hb <10, targeting 10-11.5 avoiding >13
Rationale: Correct iron deficiency before ESA; ESA target not >11.5-13 due to stroke/MACE risk; evaluate for blood loss/B12/folate.
Case details (age 68, eGFR 48, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
9. A 79-year-old with CKD G5 A3 has Ca 8.5 mg/dL, PO4 6.8 mg/dL, PTH 413 pg/mL, 25-OH vitD 27.
CKD-MBD management per KDIGO is:
A. High calcium diet with calcium-based binders max dose
B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH trends not single value; avoid
severe hypocalcemia
C. No monitoring needed
D. Calcitriol high dose regardless of Ca
Correct Answer: B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH
trends not single value; avoid severe hypocalcemia
Rationale: KDIGO CKD-MBD: phosphate control, calcium balance, vitamin D repletion, PTH trend; avoid hypercalcemia from
calcium binders/active vitamin D; treat severe hyperparathyroidism. Case details (age 79, eGFR 61, values vignette-specific) highlight
board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
3 | KDIGO 2024-2026
UPDATED FOR 2026/2027 • ABIM/ESENEPH BLUEPRINT • VERIFIED
NEPHROLOGY
COMPREHENSIVE EXAM
• 120 QUESTIONS
120 Comprehensive Nephrology Board Review Questions with Verified Correct Answers | Latest Blueprint
120 VERIFIED Q&As KDIGO 2026 ALIGNED BOARD FORMAT
• Verified ABIM/ESENeph Blueprint Case Vignettes + Reasoning
Overview — This 2026/2027 updated resource contains a comprehensive set of 120 nephrology board review questions
aligned with the ABIM Nephrology Certification Exam blueprint and the ESENeph/Nephrology SCE curriculum. Covers all
core domains with evidence-based KDIGO guideline applications and novel therapies.
✓ KEY FEATURES
• ✓ 120 comprehensive questions covering all core nephrology domains — blueprint-weighted
• ✓ Verified answers with evidence-based rationales — KDIGO, UKKA, ABIM standards
• ✓ Updated 2026/2027 KDIGO guideline applications — SGLT2i, complement inhibitors, AI diagnostics
• ✓ Clinical case vignettes and diagnostic reasoning exercises — board exam format
• ✓ Board exam format aligned with ABIM and ESENeph standards — scenario-based testing strategies
▣ CORE CONTENT AREAS (120 TOTAL QUESTIONS)
• Chronic Kidney Disease — 23 Qs — staging, SGLT2i/finerenone, anemia, CKD-MBD, progression
• Acute Kidney Injury & ICU Care — 16 Qs — KDIGO AKI, RRT timing, nephrotoxins, hepatorenal
• Sodium/Water & Acid-Base/Electrolytes — 17 Qs — hypo/hypernatremia, potassium, acid-base
• Glomerular & Vascular Disorders — 12 Qs — nephrotic/nephritic, IgA, ANCA, anti-GBM
• Kidney Transplantation — 11 Qs — rejection, CNI, BK, desensitization
• Dialysis — 12 Qs — hemodialysis adequacy, access, PD, complications
• Hypertension — 10 Qs — resistant HTN, renovascular, pregnancy
• Tubular, Interstitial & Cystic Disorders — 9 Qs — RTA, tubulointerstitial, PKD
• Calcium, Phosphorus & Stones — 4 Qs — hypercalcemia, nephrolithiasis
• Pharmacology — 6 Qs — diuretics, dosing in CKD, nephrotoxic drugs
▣ ANSWER F ORMAT
All correct answers are marked in bold green and include:
• • Evidence-based guideline rationales (KDIGO, UKKA, ABIM)
• • Clinical correlation applications and diagnostic reasoning
• • Pharmacologic mechanism explanations
• • Board exam blueprint alignment and testing strategies
🔹 UPDATES FOR 2026/2027
• 🔹 Reflects 2026/2027 ABIM Nephrology content specification revisions
• 🔹 Updated KDIGO clinical practice guideline applications (2024 CKD, Diabetes, GN, Transplant)
• 🔹 Enhanced integration of novel therapies (SGLT2 inhibitors, finerenone, complement inhibitors e.g., iptacopan/avacopan)
• 🔹 New artificial intelligence and diagnostic tool applications (AKI prediction, CKD progression models)
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
1 | KDIGO 2024-2026
, NEPHROLOGY COMPREHENSIVE EXAM • ABIM & ESENEPH BLUEPRINT • 2026/2027 EDITION
• 🔹 Revised hypertension and cardiovascular risk management protocols (KDIGO BP, AHA/ACC)
• 🔹 Updated dialysis and transplantation outcomes data (high-volume HDF, incremental dialysis)
• 🔹 New precision medicine and genetic testing applications (APOL1, Alport, cystic disease panels)
• 🔹 Revised health equity and social determinants in kidney care
———
120 VERIFIED QUESTIONS • NEPHROLOGY BOARD REVIEW • 2026/2027
SECTION 1 — CHRONIC KIDNEY DISEASE (23 QS)
Staging • Albuminuria • SGLT2i/Finerenone • Anemia • CKD-MBD • Acidosis • Lipids
1. A 41-year-old with diabetes, eGFR 25 mL/min/1.73m², ACR 210 mg/g, BP 147/89 on losartan is
reviewed. Per KDIGO 2024 CKD guideline, which intervention most reduces CKD progression and
cardiovascular risk?
A. Stop all RAAS blockade
B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor (dapagliflozin/empagliflozin) if eGFR ≥20 and initiate
finerenone if diabetic CKD with albuminuria
C. High-dose NSAID for proteinuria
D. Protein intake 2.5 g/kg/day
Correct Answer: B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor
(dapagliflozin/empagliflozin) if eGFR ≥20 and initiate finerenone if diabetic CKD with albuminuria
Rationale: KDIGO 2024 CKD/Diabetes: SGLT2i for CKD with eGFR ≥20 irrespective of diabetes + albuminuria; finerenone for
diabetic CKD with persistent albuminuria despite RAAS; BP <130/80 if albuminuria; avoid nephrotoxins. Case details (age 41, eGFR 25,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
2. A patient with CKD G4 (eGFR 38) has Hb 9.6 g/dL, ferritin 107 ng/mL, TSAT 26% . KDIGO anemia
management recommends:
A. IV iron regardless of stores and ESA to Hb 13 g/dL
B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional deficiency), then consider ESA if symptomatic
and Hb <10, targeting 10-11.5 avoiding >13
C. Transfuse to Hb 14
D. No workup needed
Correct Answer: B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional
deficiency), then consider ESA if symptomatic and Hb <10, targeting 10-11.5 avoiding >13
Rationale: Correct iron deficiency before ESA; ESA target not >11.5-13 due to stroke/MACE risk; evaluate for blood loss/B12/folate.
Case details (age 52, eGFR 38, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
3. A 63-year-old with CKD G4 A3 has Ca 9.1 mg/dL, PO4 4.4 mg/dL, PTH 191 pg/mL, 25-OH vitD 21.
CKD-MBD management per KDIGO is:
A. High calcium diet with calcium-based binders max dose
B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH trends not single value; avoid
severe hypocalcemia
C. No monitoring needed
D. Calcitriol high dose regardless of Ca
Correct Answer: B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH
trends not single value; avoid severe hypocalcemia
Rationale: KDIGO CKD-MBD: phosphate control, calcium balance, vitamin D repletion, PTH trend; avoid hypercalcemia from
calcium binders/active vitamin D; treat severe hyperparathyroidism. Case details (age 63, eGFR 51, values vignette-specific) highlight
board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
4. An adult with CKD and metabolic acidosis HCO3 18 mEq/L. KDIGO suggests:
A. No treatment unless HCO3 <10
B. Offer sodium bicarbonate if HCO3 <18 to slow progression, after addressing diet and meds, monitoring for Na overload/HF
C. Give NH4Cl
D. Acid load preferred
Correct Answer: B. Offer sodium bicarbonate if HCO3 <18 to slow progression, after addressing diet and meds,
monitoring for Na overload/HF
Rationale: KDIGO: treat <18 with NaHCO3 to 24-26 if tolerated; watch volume/BP; correct reversible causes. Case details (age 74,
eGFR 64, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
2 | KDIGO 2024-2026
, NEPHROLOGY COMPREHENSIVE EXAM • ABIM & ESENEPH BLUEPRINT • 2026/2027 EDITION
5. For a 35-yr-old smoker with CKD, statin therapy per KDIGO Lipid and cardiovascular risk is:
A. Never use statin in CKD
B. Statin ± ezetimibe for adults ≥50 with eGFR <60 not on dialysis (not started de novo on dialysis); lifestyle + BP/diabetes
control
C. High-dose statin dialysis optimal
D. Only after MI
Correct Answer: B. Statin ± ezetimibe for adults ≥50 with eGFR <60 not on dialysis (not started de novo on
dialysis); lifestyle + BP/diabetes control
Rationale: KDIGO Lipid: statin for ≥50 CKD non-dialysis; no new start on dialysis; avoid under-treatment due to perceived risk. Case
details (age 35, eGFR 77, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
6. A 46-yr-old with CKD G3b A3 is counseled on progression. The strongest risk predictor beyond eGFR
is:
A. Serum potassium alone
B. Albuminuria (ACR) magnitude — A3 > A2 > A1 predicts faster GFR decline and CV death
C. No predictor
D. Only age
Correct Answer: B. Albuminuria (ACR) magnitude — A3 > A2 > A1 predicts faster GFR decline and CV death
Rationale: ACR stratifies risk within same GFR; SGLT2i/RAAS reduce albuminuria and slow decline. Case details (age 46, eGFR 22,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
7. A 57-year-old with diabetes, eGFR 35 mL/min/1.73m², ACR 680 mg/g, BP 153/95 on no RAAS is
reviewed. Per KDIGO 2024 CKD guideline, which intervention most reduces CKD progression and
cardiovascular risk?
A. Stop all RAAS blockade
B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor (dapagliflozin/empagliflozin) if eGFR ≥20 and initiate
finerenone if diabetic CKD with albuminuria
C. High-dose NSAID for proteinuria
D. Protein intake 2.5 g/kg/day
Correct Answer: B. Continue maximally tolerated ACEi/ARB + add SGLT2 inhibitor
(dapagliflozin/empagliflozin) if eGFR ≥20 and initiate finerenone if diabetic CKD with albuminuria
Rationale: KDIGO 2024 CKD/Diabetes: SGLT2i for CKD with eGFR ≥20 irrespective of diabetes + albuminuria; finerenone for
diabetic CKD with persistent albuminuria despite RAAS; BP <130/80 if albuminuria; avoid nephrotoxins. Case details (age 57, eGFR 35,
values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
8. A patient with CKD G4 (eGFR 48) has Hb 12.0 g/dL, ferritin 293 ng/mL, TSAT 38% . KDIGO anemia
management recommends:
A. IV iron regardless of stores and ESA to Hb 13 g/dL
B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional deficiency), then consider ESA if symptomatic
and Hb <10, targeting 10-11.5 avoiding >13
C. Transfuse to Hb 14
D. No workup needed
Correct Answer: B. Treat iron deficiency first (oral/IV iron if ferritin ≤100/TSAT ≤20% or functional
deficiency), then consider ESA if symptomatic and Hb <10, targeting 10-11.5 avoiding >13
Rationale: Correct iron deficiency before ESA; ESA target not >11.5-13 due to stroke/MACE risk; evaluate for blood loss/B12/folate.
Case details (age 68, eGFR 48, values vignette-specific) highlight board-relevant decision thresholds per KDIGO 2024-2026 and ABIM
blueprint.
9. A 79-year-old with CKD G5 A3 has Ca 8.5 mg/dL, PO4 6.8 mg/dL, PTH 413 pg/mL, 25-OH vitD 27.
CKD-MBD management per KDIGO is:
A. High calcium diet with calcium-based binders max dose
B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH trends not single value; avoid
severe hypocalcemia
C. No monitoring needed
D. Calcitriol high dose regardless of Ca
Correct Answer: B. Restrict phosphate, use non-calcium binder if hypercalcemia, correct 25-OHD, manage PTH
trends not single value; avoid severe hypocalcemia
Rationale: KDIGO CKD-MBD: phosphate control, calcium balance, vitamin D repletion, PTH trend; avoid hypercalcemia from
calcium binders/active vitamin D; treat severe hyperparathyroidism. Case details (age 79, eGFR 61, values vignette-specific) highlight
board-relevant decision thresholds per KDIGO 2024-2026 and ABIM blueprint.
Nephrology Comprehensive Exam | 2026/2027 Edition | 120 Questions | ABIM & ESENeph Aligned | Verified Correct Answers
3 | KDIGO 2024-2026
