NEPHROLOGY COMPREHENSIVE EXAM - KDIGO 2026 / ABIM-ESENeph Blueprint - 2026/2027
Edition - 120 Comprehensive Questions with Verified Answers - NEWEST EXAM
CKD AKI Definition Classification KDIGO 2026
Description: CKD definition abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29 G5
less than 15 A categories albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g KDIGO 2024 heat map risk, AKI definition increase creatinine greater than or
equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr 6 hr stage 1 1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT,
prerenal vs ATN FENa less than 1 percent vs greater than 2 percent FEUrea less than 35 percent vs greater than 50 percent BUN/Cr greater than 20 vs less than 20
muddy brown casts ATN, diuretic resistance sequential nephron blockade add thiazide metolazone to loop furosemide.
Fluid Electrolyte Acid Base Disorders
Description: Hyponatremia evaluation volume status hypovolemic isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics symptomatic Na less than 120
hypertonic 3 percent saline correction limit less than 8-10 mEq per day chronic less than 6-8 high risk avoid osmotic demyelination central pontine myelinolysis,
hypernatremia water deficit TBW times (Na current/140 minus 1) TBW 0.6 male 0.5 female elderly 0.45 correct free water D5W, hyperkalemia management calcium
gluconate stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if acidosis albuterol, metabolic acidosis anion gap Na minus Cl plus HCO3
normal 8-12 high AG MUDPILES normal AG diarrhea RTA delta ratio evaluates mixed, metabolic alkalosis vomiting NG suction diuretics mineralocorticoid excess
treatment isotonic saline KCl acetazolamide, RTA Type 1 distal urine pH greater than 5.5 hypokalemia Type 2 proximal Fanconi bicarbonate wasting Type 4 hyperkalemia
hypoaldosteronism.
Glomerular Diseases Nephritic Nephrotic
Description: Nephritic hematuria RBC casts dysmorphic RBC hypertension oliguria azotemia protein less than 3.5 g vs nephrotic protein greater than 3.5 g edema
hypoalbuminemia hyperlipidemia hypercoagulable, ANCA vasculitis GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune crescentic rapidly
progressive, lupus nephritis ISN RPS Class I minimal mesangial II mesangial proliferative III focal less than 50 percent IV diffuse greater than or equal 50 percent most
severe V membranous VI advanced sclerosing treatment steroids mycophenolate cyclophosphamide, IgA nephropathy most common worldwide synpharyngitic hematuria
within 24 hr URI treatment ACE ARB fish oil steroids if progressive protein greater than 1 g, membranous primary anti-PLA2R 70-80 percent secondary malignancy lupus
hepatitis B NSAIDs nephrotic treatment conservative ACE immunosuppression high risk, FSGS primary vs secondary adaptive hyperfiltration obesity APOL1 genetic
treatment steroids CNIs, diabetic kidney disease hyperfiltration microalbuminuria 30-300 macroalbuminuria greater than 300 declining GFR treatment ACE ARB SGLT2i
finerenone GLP-1 RA glycemic BP control KDIGO 2022.
Tubulointerstitial Stones CKD-MBD Anemia
Description: Renal tubular acidosis Type 1 distal urine pH greater than 5.5 hypokalemia nephrocalcinosis Type 2 proximal Fanconi Type 4 hyperkalemia, kidney stones
calcium oxalate most common hypercalciuria hyperoxaluria hypocitraturia prevention hydration greater than 2.5 L urine thiazide citrate calcium phosphate struvite infection
uric acid low pH cystine genetic, CKD-MBD calcium phosphorus PTH vitamin D FGF23 secondary hyperparathyroidism treatment phosphate binders calcium carbonate
sevelamer lanthanum calcimimetics cinacalcet vitamin D analogs, anemia CKD decreased EPO iron deficiency treatment iron if ferritin less than 500 TSAT less than 30 IV
iron ESA if Hb less than 10 target 10-11.5 not greater than 13, nephrotic complications edema hypercoagulability VTE infection hyperlipidemia AKI vitamin D deficiency,
urinalysis active sediment RBC casts GN WBC casts pyelonephritis interstitial muddy brown ATN hyaline benign.
Hypertension Renal Vascular ADPKD Dialysis Transplant
Description: Renal artery stenosis resistant hypertension flash pulmonary edema abdominal bruit treatment ACE ARB if unilateral not bilateral revascularization if
fibromuscular dysplasia, ADPKD PKD1 PKD2 autosomal dominant kidney liver pancreatic cysts hypertension intracranial aneurysm screening tolvaptan if rapidly
progressive, dialysis indications AEIOU acidosis refractory electrolytes hyperkalemia intoxication overload volume uremia pericarditis encephalopathy, hemodialysis access
AV fistula preferred AV graft tunneled catheter temporary complications stenosis thrombosis infection steal syndrome aneurysm, peritoneal dialysis peritonitis cloudy
effluent greater than 100 WBC greater than 50 percent neutrophils culture abdominal pain IP antibiotics cefazolin ceftazidime ISPD, transplant immunosuppression
induction basiliximab anti-IL2R or ATG maintenance tacrolimus MMF steroids CNI nephrotoxicity, contrast induced AKI prevention hydration isotonic saline bicarbonate
minimize contrast hold NSAIDs diuretics low osmolar contrast.
Page 1 - Nephrology 120Q KDIGO 2026/2027 Newest
,Question 1: Q1: KDIGO 2024 CKD definition and classification G and A categories?
A. CKD abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29 G5
less than 15 albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g
B. Only GFR less than 60 for less than 1 month
C. No albuminuria categories
D. Only G categories no A
CORRECT ANSWER: A. CKD abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a
45-59 G3b 30-44 G4 15-29 G5 less than 15 albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g
RATIONALE:
KDIGO 2024 CKD definition abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29
G5 less than 15 A categories albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g or mg per mmol.
Question 2: Q2: KDIGO AKI definition staging?
A. Only urine criteria
B. No creatinine criteria
C. AKI increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr 6 hr stage 1
1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT
D. No staging
CORRECT ANSWER: C. AKI increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than
0.5 mL/kg/hr 6 hr stage 1 1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT
RATIONALE:
KDIGO AKI definition increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr for 6 hr stage 1
1.5-1.9x or 0.3 increase stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT or urine less than 0.3 mL/kg/hr 24 hr or anuria 12 hr.
Question 3: Q3: Prerenal vs ATN labs FENa FEUrea?
A. Prerenal FENa greater than 2 percent
B. Both FENa less than 1 percent
C. ATN FENa less than 1 percent
D. Prerenal FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN FENa greater than 2 percent FEUrea
greater than 50 percent muddy brown casts
CORRECT ANSWER: D. Prerenal FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN FENa
greater than 2 percent FEUrea greater than 50 percent muddy brown casts
RATIONALE:
Prerenal decreased perfusion FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN tubular injury FENa greater than 2
percent FEUrea greater than 50 percent muddy brown casts isosthenuria especially if on diuretics use FEUrea.
Question 4: Q4: Diuretic resistance and sequential nephron blockade?
A. Increase loop alone only
B. Add thiazide metolazone to loop furosemide inhibits distal tubule overcomes resistance monitor K Mg
C. No combination works
D. Only fluid restriction
CORRECT ANSWER: B. Add thiazide metolazone to loop furosemide inhibits distal tubule overcomes resistance monitor K Mg
RATIONALE:
Diuretic resistance sequential nephron blockade add thiazide metolazone chlorothiazide to loop furosemide blocks distal tubule compensatory Na reabsorption monitor K
Mg volume.
Question 5: Q5: Hyponatremia evaluation volume status and treatment SIADH vs hypovolemia?
A. Assess volume status hypovolemic give isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics treat cause
B. All hyponatremia give free water
C. All hyponatremia fluid restrict
D. No volume assessment needed
CORRECT ANSWER: A. Assess volume status hypovolemic give isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics treat
cause
RATIONALE:
Hyponatremia evaluate volume status hypovolemic loss of Na and water give isotonic saline euvolemic SIADH fluid restriction hypervolemic HF cirrhosis diuretics Na less
than 120 symptomatic hypertonic 3 percent saline careful correction less than 8-10 mEq per day avoid osmotic demyelination.
Question 6: Q6: Hyperkalemia management stepwise?
A. No calcium needed
B. Give K supplement
C. Calcium gluconate or chloride stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if acidosis
D. Only dialysis first
CORRECT ANSWER: C. Calcium gluconate or chloride stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if
acidosis
RATIONALE:
Hyperkalemia management calcium gluconate chloride stabilize cardiac membrane insulin 10 units plus glucose 25 g shift K into cells kayexalate sodium polystyrene
sulfonate loop diuretic dialysis sodium bicarbonate if metabolic acidosis albuterol shifts K.
Question 7: Q7: Metabolic acidosis anion gap calculation and delta ratio?
A. Normal AG 20-30
B. Anion gap Cl minus Na
Page 2 - Nephrology 120Q KDIGO 2026/2027 Newest
, C. No delta ratio concept
D. Anion gap Na minus Cl plus HCO3 normal 8-12 high AG acidosis MUDPILES normal AG acidosis diarrhea RTA delta ratio evaluates mixed disorders
CORRECT ANSWER: D. Anion gap Na minus Cl plus HCO3 normal 8-12 high AG acidosis MUDPILES normal AG acidosis diarrhea RTA delta
ratio evaluates mixed disorders
RATIONALE:
Anion gap Na minus (Cl plus HCO3) normal 8-12 high AG MUDPILES methanol uremia DKA paraldehyde INH lactic ethylene glycol salicylate normal AG diarrhea RTA
delta ratio (AG-12 minus (24-HCO3)) evaluates mixed high plus normal or metabolic alkalosis.
Question 8: Q8: Metabolic alkalosis causes treatment?
A. Only diarrhea causes alkalosis
B. Vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis treatment isotonic saline KCl acetazolamide if volume overloaded
C. No treatment needed
D. Only acid administration
CORRECT ANSWER: B. Vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis treatment isotonic saline KCl
acetazolamide if volume overloaded
RATIONALE:
Metabolic alkalosis causes vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis post hypercapnia treatment isotonic saline KCl if chloride
responsive acetazolamide if volume overloaded.
Page 3 - Nephrology 120Q KDIGO 2026/2027 Newest
, Question 9: Q9: Glomerulonephritis nephritic vs nephrotic presentation?
A. Nephritic hematuria RBC casts hypertension oliguria protein less than 3.5 g nephrotic protein greater than 3.5 g edema hypoalbuminemia
hyperlipidemia no hematuria RBC casts
B. Both same
C. Nephritic protein greater than 3.5 g
D. Nephrotic hematuria RBC casts main
CORRECT ANSWER: A. Nephritic hematuria RBC casts hypertension oliguria protein less than 3.5 g nephrotic protein greater than 3.5 g
edema hypoalbuminemia hyperlipidemia no hematuria RBC casts
RATIONALE:
Nephritic hematuria RBC casts dysmorphic RBC hypertension oliguria azotemia protein less than 3.5 g/day nephrotic protein greater than 3.5 g/day edema
hypoalbuminemia hyperlipidemia hypercoagulable no hematuria RBC casts.
Question 10: Q10: ANCA vasculitis types kidney involvement?
A. Only anti-GBM
B. Only immune complex GN
C. GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune GN crescentic rapidly progressive
D. No ANCA types
CORRECT ANSWER: C. GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune GN crescentic rapidly progressive
RATIONALE:
ANCA vasculitis GPA granulomatosis polyangiitis c-ANCA PR3 upper lower respiratory GN MPA microscopic polyangiitis p-ANCA MPO pauci-immune crescentic GN
rapidly progressive EGPA asthma eosinophilia.
Question 11: Q11: Lupus nephritis classification treatment?
A. Only steroids alone always sufficient
B. Only class V
C. No classification
D. Class I minimal mesangial II mesangial proliferative III focal IV diffuse most common severe V membranous VI advanced sclerosing treatment steroids
mycophenolate cyclophosphamide
CORRECT ANSWER: D. Class I minimal mesangial II mesangial proliferative III focal IV diffuse most common severe V membranous VI
advanced sclerosing treatment steroids mycophenolate cyclophosphamide
RATIONALE:
Lupus nephritis ISN RPS classification Class I minimal mesangial II mesangial proliferative III focal less than 50 percent IV diffuse greater than or equal 50 percent most
common severe V membranous VI advanced sclerosing greater than 90 percent treatment induction steroids mycophenolate or cyclophosphamide maintenance
mycophenolate azathioprine.
Question 12: Q12: IgA nephropathy most common glomerulonephritis worldwide presentation?
A. Only after 2 weeks infection
B. IgA nephropathy hematuria within 24 hr upper respiratory infection synpharyngitic proteinuria treatment ACE inhibitor fish oil steroids if progressive
C. No hematuria
D. Only nephrotic presentation always
CORRECT ANSWER: B. IgA nephropathy hematuria within 24 hr upper respiratory infection synpharyngitic proteinuria treatment ACE inhibitor
fish oil steroids if progressive
RATIONALE:
IgA nephropathy most common GN worldwide synpharyngitic hematuria within 24 hr URI vs post streptococcal GN 2-3 weeks after infection treatment ACE ARB fish oil
steroids if progressive protein greater than 1 g.
Question 13: Q13: Membranous nephropathy cause and anti-PLA2R?
A. Primary membranous anti-PLA2R antibody 70-80 percent secondary malignancy lupus hepatitis B NSAIDs treatment conservative ACE plus
immunosuppression if high risk
B. No antibody associated
C. Only secondary causes
D. No treatment options
CORRECT ANSWER: A. Primary membranous anti-PLA2R antibody 70-80 percent secondary malignancy lupus hepatitis B NSAIDs treatment
conservative ACE plus immunosuppression if high risk
RATIONALE:
Membranous nephropathy primary 70-80 percent anti-PLA2R phospholipase A2 receptor antibody secondary malignancy lupus hepatitis B NSAIDs presentation
nephrotic treatment conservative ACE immunosuppression if high risk protein greater than 8 g or declining GFR.
Question 14: Q14: FSGS types and treatment?
A. Only genetic
B. Only secondary
C. FSGS focal segmental glomerulosclerosis primary idiopathic secondary hyperfiltration obesity APOL1 genetic treatment steroids CNIs
D. No treatment
CORRECT ANSWER: C. FSGS focal segmental glomerulosclerosis primary idiopathic secondary hyperfiltration obesity APOL1 genetic
treatment steroids CNIs
RATIONALE:
FSGS focal segmental glomerulosclerosis primary idiopathic secondary adaptive hyperfiltration obesity reflux APOL1 high risk African descent genetic treatment steroids
first line if primary CNIs tacrolimus cyclosporine if steroid resistant.
Question 15: Q15: Diabetic kidney disease natural history treatment SGLT2i?
A. Only macroalbuminuria from start
Page 4 - Nephrology 120Q KDIGO 2026/2027 Newest
Edition - 120 Comprehensive Questions with Verified Answers - NEWEST EXAM
CKD AKI Definition Classification KDIGO 2026
Description: CKD definition abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29 G5
less than 15 A categories albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g KDIGO 2024 heat map risk, AKI definition increase creatinine greater than or
equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr 6 hr stage 1 1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT,
prerenal vs ATN FENa less than 1 percent vs greater than 2 percent FEUrea less than 35 percent vs greater than 50 percent BUN/Cr greater than 20 vs less than 20
muddy brown casts ATN, diuretic resistance sequential nephron blockade add thiazide metolazone to loop furosemide.
Fluid Electrolyte Acid Base Disorders
Description: Hyponatremia evaluation volume status hypovolemic isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics symptomatic Na less than 120
hypertonic 3 percent saline correction limit less than 8-10 mEq per day chronic less than 6-8 high risk avoid osmotic demyelination central pontine myelinolysis,
hypernatremia water deficit TBW times (Na current/140 minus 1) TBW 0.6 male 0.5 female elderly 0.45 correct free water D5W, hyperkalemia management calcium
gluconate stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if acidosis albuterol, metabolic acidosis anion gap Na minus Cl plus HCO3
normal 8-12 high AG MUDPILES normal AG diarrhea RTA delta ratio evaluates mixed, metabolic alkalosis vomiting NG suction diuretics mineralocorticoid excess
treatment isotonic saline KCl acetazolamide, RTA Type 1 distal urine pH greater than 5.5 hypokalemia Type 2 proximal Fanconi bicarbonate wasting Type 4 hyperkalemia
hypoaldosteronism.
Glomerular Diseases Nephritic Nephrotic
Description: Nephritic hematuria RBC casts dysmorphic RBC hypertension oliguria azotemia protein less than 3.5 g vs nephrotic protein greater than 3.5 g edema
hypoalbuminemia hyperlipidemia hypercoagulable, ANCA vasculitis GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune crescentic rapidly
progressive, lupus nephritis ISN RPS Class I minimal mesangial II mesangial proliferative III focal less than 50 percent IV diffuse greater than or equal 50 percent most
severe V membranous VI advanced sclerosing treatment steroids mycophenolate cyclophosphamide, IgA nephropathy most common worldwide synpharyngitic hematuria
within 24 hr URI treatment ACE ARB fish oil steroids if progressive protein greater than 1 g, membranous primary anti-PLA2R 70-80 percent secondary malignancy lupus
hepatitis B NSAIDs nephrotic treatment conservative ACE immunosuppression high risk, FSGS primary vs secondary adaptive hyperfiltration obesity APOL1 genetic
treatment steroids CNIs, diabetic kidney disease hyperfiltration microalbuminuria 30-300 macroalbuminuria greater than 300 declining GFR treatment ACE ARB SGLT2i
finerenone GLP-1 RA glycemic BP control KDIGO 2022.
Tubulointerstitial Stones CKD-MBD Anemia
Description: Renal tubular acidosis Type 1 distal urine pH greater than 5.5 hypokalemia nephrocalcinosis Type 2 proximal Fanconi Type 4 hyperkalemia, kidney stones
calcium oxalate most common hypercalciuria hyperoxaluria hypocitraturia prevention hydration greater than 2.5 L urine thiazide citrate calcium phosphate struvite infection
uric acid low pH cystine genetic, CKD-MBD calcium phosphorus PTH vitamin D FGF23 secondary hyperparathyroidism treatment phosphate binders calcium carbonate
sevelamer lanthanum calcimimetics cinacalcet vitamin D analogs, anemia CKD decreased EPO iron deficiency treatment iron if ferritin less than 500 TSAT less than 30 IV
iron ESA if Hb less than 10 target 10-11.5 not greater than 13, nephrotic complications edema hypercoagulability VTE infection hyperlipidemia AKI vitamin D deficiency,
urinalysis active sediment RBC casts GN WBC casts pyelonephritis interstitial muddy brown ATN hyaline benign.
Hypertension Renal Vascular ADPKD Dialysis Transplant
Description: Renal artery stenosis resistant hypertension flash pulmonary edema abdominal bruit treatment ACE ARB if unilateral not bilateral revascularization if
fibromuscular dysplasia, ADPKD PKD1 PKD2 autosomal dominant kidney liver pancreatic cysts hypertension intracranial aneurysm screening tolvaptan if rapidly
progressive, dialysis indications AEIOU acidosis refractory electrolytes hyperkalemia intoxication overload volume uremia pericarditis encephalopathy, hemodialysis access
AV fistula preferred AV graft tunneled catheter temporary complications stenosis thrombosis infection steal syndrome aneurysm, peritoneal dialysis peritonitis cloudy
effluent greater than 100 WBC greater than 50 percent neutrophils culture abdominal pain IP antibiotics cefazolin ceftazidime ISPD, transplant immunosuppression
induction basiliximab anti-IL2R or ATG maintenance tacrolimus MMF steroids CNI nephrotoxicity, contrast induced AKI prevention hydration isotonic saline bicarbonate
minimize contrast hold NSAIDs diuretics low osmolar contrast.
Page 1 - Nephrology 120Q KDIGO 2026/2027 Newest
,Question 1: Q1: KDIGO 2024 CKD definition and classification G and A categories?
A. CKD abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29 G5
less than 15 albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g
B. Only GFR less than 60 for less than 1 month
C. No albuminuria categories
D. Only G categories no A
CORRECT ANSWER: A. CKD abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a
45-59 G3b 30-44 G4 15-29 G5 less than 15 albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g
RATIONALE:
KDIGO 2024 CKD definition abnormal kidney structure or function greater than 3 months GFR categories G1 greater than 90 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29
G5 less than 15 A categories albuminuria A1 less than 30 A2 30-300 A3 greater than 300 mg/g or mg per mmol.
Question 2: Q2: KDIGO AKI definition staging?
A. Only urine criteria
B. No creatinine criteria
C. AKI increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr 6 hr stage 1
1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT
D. No staging
CORRECT ANSWER: C. AKI increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than
0.5 mL/kg/hr 6 hr stage 1 1.5-1.9x stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT
RATIONALE:
KDIGO AKI definition increase creatinine greater than or equal to 0.3 mg/dL within 48 hr or 1.5x baseline within 7 days or urine less than 0.5 mL/kg/hr for 6 hr stage 1
1.5-1.9x or 0.3 increase stage 2 2-2.9x stage 3 3x or greater than 4.0 or RRT or urine less than 0.3 mL/kg/hr 24 hr or anuria 12 hr.
Question 3: Q3: Prerenal vs ATN labs FENa FEUrea?
A. Prerenal FENa greater than 2 percent
B. Both FENa less than 1 percent
C. ATN FENa less than 1 percent
D. Prerenal FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN FENa greater than 2 percent FEUrea
greater than 50 percent muddy brown casts
CORRECT ANSWER: D. Prerenal FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN FENa
greater than 2 percent FEUrea greater than 50 percent muddy brown casts
RATIONALE:
Prerenal decreased perfusion FENa less than 1 percent FEUrea less than 35 percent BUN/Cr greater than 20 concentrated urine ATN tubular injury FENa greater than 2
percent FEUrea greater than 50 percent muddy brown casts isosthenuria especially if on diuretics use FEUrea.
Question 4: Q4: Diuretic resistance and sequential nephron blockade?
A. Increase loop alone only
B. Add thiazide metolazone to loop furosemide inhibits distal tubule overcomes resistance monitor K Mg
C. No combination works
D. Only fluid restriction
CORRECT ANSWER: B. Add thiazide metolazone to loop furosemide inhibits distal tubule overcomes resistance monitor K Mg
RATIONALE:
Diuretic resistance sequential nephron blockade add thiazide metolazone chlorothiazide to loop furosemide blocks distal tubule compensatory Na reabsorption monitor K
Mg volume.
Question 5: Q5: Hyponatremia evaluation volume status and treatment SIADH vs hypovolemia?
A. Assess volume status hypovolemic give isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics treat cause
B. All hyponatremia give free water
C. All hyponatremia fluid restrict
D. No volume assessment needed
CORRECT ANSWER: A. Assess volume status hypovolemic give isotonic saline euvolemic SIADH fluid restriction hypervolemic diuretics treat
cause
RATIONALE:
Hyponatremia evaluate volume status hypovolemic loss of Na and water give isotonic saline euvolemic SIADH fluid restriction hypervolemic HF cirrhosis diuretics Na less
than 120 symptomatic hypertonic 3 percent saline careful correction less than 8-10 mEq per day avoid osmotic demyelination.
Question 6: Q6: Hyperkalemia management stepwise?
A. No calcium needed
B. Give K supplement
C. Calcium gluconate or chloride stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if acidosis
D. Only dialysis first
CORRECT ANSWER: C. Calcium gluconate or chloride stabilize membrane insulin glucose shift kayexalate loop diuretic dialysis bicarbonate if
acidosis
RATIONALE:
Hyperkalemia management calcium gluconate chloride stabilize cardiac membrane insulin 10 units plus glucose 25 g shift K into cells kayexalate sodium polystyrene
sulfonate loop diuretic dialysis sodium bicarbonate if metabolic acidosis albuterol shifts K.
Question 7: Q7: Metabolic acidosis anion gap calculation and delta ratio?
A. Normal AG 20-30
B. Anion gap Cl minus Na
Page 2 - Nephrology 120Q KDIGO 2026/2027 Newest
, C. No delta ratio concept
D. Anion gap Na minus Cl plus HCO3 normal 8-12 high AG acidosis MUDPILES normal AG acidosis diarrhea RTA delta ratio evaluates mixed disorders
CORRECT ANSWER: D. Anion gap Na minus Cl plus HCO3 normal 8-12 high AG acidosis MUDPILES normal AG acidosis diarrhea RTA delta
ratio evaluates mixed disorders
RATIONALE:
Anion gap Na minus (Cl plus HCO3) normal 8-12 high AG MUDPILES methanol uremia DKA paraldehyde INH lactic ethylene glycol salicylate normal AG diarrhea RTA
delta ratio (AG-12 minus (24-HCO3)) evaluates mixed high plus normal or metabolic alkalosis.
Question 8: Q8: Metabolic alkalosis causes treatment?
A. Only diarrhea causes alkalosis
B. Vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis treatment isotonic saline KCl acetazolamide if volume overloaded
C. No treatment needed
D. Only acid administration
CORRECT ANSWER: B. Vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis treatment isotonic saline KCl
acetazolamide if volume overloaded
RATIONALE:
Metabolic alkalosis causes vomiting NG suction diuretics mineralocorticoid excess contraction alkalosis post hypercapnia treatment isotonic saline KCl if chloride
responsive acetazolamide if volume overloaded.
Page 3 - Nephrology 120Q KDIGO 2026/2027 Newest
, Question 9: Q9: Glomerulonephritis nephritic vs nephrotic presentation?
A. Nephritic hematuria RBC casts hypertension oliguria protein less than 3.5 g nephrotic protein greater than 3.5 g edema hypoalbuminemia
hyperlipidemia no hematuria RBC casts
B. Both same
C. Nephritic protein greater than 3.5 g
D. Nephrotic hematuria RBC casts main
CORRECT ANSWER: A. Nephritic hematuria RBC casts hypertension oliguria protein less than 3.5 g nephrotic protein greater than 3.5 g
edema hypoalbuminemia hyperlipidemia no hematuria RBC casts
RATIONALE:
Nephritic hematuria RBC casts dysmorphic RBC hypertension oliguria azotemia protein less than 3.5 g/day nephrotic protein greater than 3.5 g/day edema
hypoalbuminemia hyperlipidemia hypercoagulable no hematuria RBC casts.
Question 10: Q10: ANCA vasculitis types kidney involvement?
A. Only anti-GBM
B. Only immune complex GN
C. GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune GN crescentic rapidly progressive
D. No ANCA types
CORRECT ANSWER: C. GPA c-ANCA PR3 MPA p-ANCA MPO EGPA asthma eosinophils pauci-immune GN crescentic rapidly progressive
RATIONALE:
ANCA vasculitis GPA granulomatosis polyangiitis c-ANCA PR3 upper lower respiratory GN MPA microscopic polyangiitis p-ANCA MPO pauci-immune crescentic GN
rapidly progressive EGPA asthma eosinophilia.
Question 11: Q11: Lupus nephritis classification treatment?
A. Only steroids alone always sufficient
B. Only class V
C. No classification
D. Class I minimal mesangial II mesangial proliferative III focal IV diffuse most common severe V membranous VI advanced sclerosing treatment steroids
mycophenolate cyclophosphamide
CORRECT ANSWER: D. Class I minimal mesangial II mesangial proliferative III focal IV diffuse most common severe V membranous VI
advanced sclerosing treatment steroids mycophenolate cyclophosphamide
RATIONALE:
Lupus nephritis ISN RPS classification Class I minimal mesangial II mesangial proliferative III focal less than 50 percent IV diffuse greater than or equal 50 percent most
common severe V membranous VI advanced sclerosing greater than 90 percent treatment induction steroids mycophenolate or cyclophosphamide maintenance
mycophenolate azathioprine.
Question 12: Q12: IgA nephropathy most common glomerulonephritis worldwide presentation?
A. Only after 2 weeks infection
B. IgA nephropathy hematuria within 24 hr upper respiratory infection synpharyngitic proteinuria treatment ACE inhibitor fish oil steroids if progressive
C. No hematuria
D. Only nephrotic presentation always
CORRECT ANSWER: B. IgA nephropathy hematuria within 24 hr upper respiratory infection synpharyngitic proteinuria treatment ACE inhibitor
fish oil steroids if progressive
RATIONALE:
IgA nephropathy most common GN worldwide synpharyngitic hematuria within 24 hr URI vs post streptococcal GN 2-3 weeks after infection treatment ACE ARB fish oil
steroids if progressive protein greater than 1 g.
Question 13: Q13: Membranous nephropathy cause and anti-PLA2R?
A. Primary membranous anti-PLA2R antibody 70-80 percent secondary malignancy lupus hepatitis B NSAIDs treatment conservative ACE plus
immunosuppression if high risk
B. No antibody associated
C. Only secondary causes
D. No treatment options
CORRECT ANSWER: A. Primary membranous anti-PLA2R antibody 70-80 percent secondary malignancy lupus hepatitis B NSAIDs treatment
conservative ACE plus immunosuppression if high risk
RATIONALE:
Membranous nephropathy primary 70-80 percent anti-PLA2R phospholipase A2 receptor antibody secondary malignancy lupus hepatitis B NSAIDs presentation
nephrotic treatment conservative ACE immunosuppression if high risk protein greater than 8 g or declining GFR.
Question 14: Q14: FSGS types and treatment?
A. Only genetic
B. Only secondary
C. FSGS focal segmental glomerulosclerosis primary idiopathic secondary hyperfiltration obesity APOL1 genetic treatment steroids CNIs
D. No treatment
CORRECT ANSWER: C. FSGS focal segmental glomerulosclerosis primary idiopathic secondary hyperfiltration obesity APOL1 genetic
treatment steroids CNIs
RATIONALE:
FSGS focal segmental glomerulosclerosis primary idiopathic secondary adaptive hyperfiltration obesity reflux APOL1 high risk African descent genetic treatment steroids
first line if primary CNIs tacrolimus cyclosporine if steroid resistant.
Question 15: Q15: Diabetic kidney disease natural history treatment SGLT2i?
A. Only macroalbuminuria from start
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