Which change defines acute kidney injury?

A) Increased urine osmolality

B) Chronic proteinuria

C) Increased renal perfusion

D) Sudden GFR decline

D. Sudden GFR decline

Which set lists recognized causes of acute kidney injury?

A) Infection, toxins, trauma, dehydration, shock

B) Diabetes, hypertension, cysts, anemia, stones

C) Proteinuria, edema, hyperlipidemia, hypoalbuminemia

D) Cancer, cirrhosis, pancreatitis, asthma, gout

A. Infection, toxins, trauma, dehydration, shock

In septic AKI, severe catabolism accelerates degradation of which substrates?

A) Glucose and glycogen

B) Protein and amino acids

C) Fatty acids and ketones

D) Calcium and phosphate

B. Protein and amino acids

Which outcome cluster can result from catabolic AKI?

A) Poor healing, infection, hospitalization, mortality

B) Polycythemia, alkalosis, hypertension, fractures

C) Hypoglycemia, jaundice, ascites, bradycardia

D) Weight gain, edema, eosinophilia, hypothermia

A. Poor healing, infection, hospitalization, mortality

Why is medical nutrition therapy important in AKI?

A) It directly raises GFR

B) It prevents all dialysis

C) It reverses nephrotoxicity

D) Malnutrition increases mortality

D. Malnutrition increases mortality

Implementation of nutrition therapy in AKI depends on which factors?

A) Age, sex, height, race

B) Capsule, cortex, medulla, pelvis

C) Nutrition, catabolism, phase, urine output

D) Sodium, glucose, albumin, bilirubin

C. Nutrition, catabolism, phase, urine output

Which clinical indications help guide AKI nutrition therapy?

A) Uremia or volume overload

B) Hematuria or renal cysts

C) Polyuria or glucosuria

D) Ascites or encephalopathy

A. Uremia or volume overload

Which goals best match nutrition therapy in AKI?

A) Promote edema and catabolism

B) Preserve protein, skin, nutrients

C) Lower oxygen and glucose

D) Suppress appetite and urine

B. Preserve protein, skin, nutrients

AKI nutrition therapy also aims to maintain which homeostatic balances?

A) Calcium, bone, marrow

B) Insulin, cortisol, thyroid

C) Bile, clotting, digestion

D) Fluid, electrolytes, acid-base

D. Fluid, electrolytes, acid-base

A critically ill patient with AKI is started on continuous renal replacement therapy. Which abbreviation is used?

A) CKD

B) GFR

C) CRRT

D) RAAS

C. CRRT

Which definition best identifies chronic kidney disease?

A) Kidney abnormality over 3 months

B) Sudden GFR decline

C) Temporary dehydration injury

D) Acute nephrotoxin exposure

A. Kidney abnormality over 3 months

Which GFR criterion is consistent with CKD when present longer than 3 months?

A) <120 mL/min/1.73 m²

B) <90 mL/min/1.73 m²

C) <75 mL/min/1.73 m²

D) <60 mL/min/1.73 m²

D. <60 mL/min/1.73 m²

Which pair represents common causes of chronic kidney disease?

A) Trauma and dehydration

B) Diabetes and hypertension

C) Infection and nephrotoxins

D) Shock and ischemia

B. Diabetes and hypertension

Which set includes other causes of chronic kidney disease?

A) Asthma, gout, migraine

B) Cirrhosis, pancreatitis, hepatitis

C) Glomerulonephritis, polycystic disease, autoimmunity

D) Pneumonia, anemia, hypokalemia

C. Glomerulonephritis, polycystic disease, autoimmunity

Which complication cluster is associated with chronic kidney disease?

A) Anemia, bone, electrolytes, cardiovascular

B) Polycythemia, alkalosis, jaundice, asthma

C) Hyperthyroidism, seizures, arthritis, ulcers

D) Pancreatitis, ascites, hemoptysis, rash

A. Anemia, bone, electrolytes, cardiovascular

Protein restriction in predialysis CKD may slow progression by reducing what?

A) Renin release and EPO secretion

B) Tubular flow and urine output

C) Calcium absorption and phosphate binding

D) Hyperfiltration and uremic toxins

D. Hyperfiltration and uremic toxins

In predialysis CKD, the kidneys are damaged but the patient is not on dialysis yet. Eating lots of protein creates more nitrogen waste, which becomes uremic toxins.

What protein intake is generally recommended for CKD patients not on dialysis?

A) 0.2–0.4 g/kg/day

B) 0.6–0.8 g/kg/day

C) 1.2–1.5 g/kg/day

D) 1.8–2.0 g/kg/day

B. 0.6–0.8 g/kg/day

Why do hemodialysis patients generally need about 1.2 g/kg/day protein?

A) Reduced intestinal absorption

B) Increased renal filtration

C) Dialysis leads to amino acid losses

D) Decreased uremic toxin production

C) Dialysis leads to amino acid losses

Hemodialysis filters the blood, but it can also remove amino acids, so ur gonna need more protein

Compared with predialysis CKD, peritoneal dialysis often requires what protein adjustment?

A) Higher protein intake

B) Lower protein intake

C) No protein intake

D) Ketogenic protein intake

A. Higher protein intake

Peritoneal dialysis causes protein loss into the dialysate fluid.

Sodium restriction in CKD helps control which issues?

A) Anemia and bone pain

B) Acidosis and hyperkalemia

C) Uremia and proteinuria

D) Blood pressure and fluid retention

D. Blood pressure and fluid retention

Potassium restriction may be needed in CKD to prevent which complication?

A) Hypokalemia

B) Hyperkalemia

C) Hypocalcemia

D) Hypernatremia

B. Hyperkalemia

Phosphorus restriction in CKD helps prevent which paired complications?

A) Anemia and uremia

B) Hyperkalemia and acidosis

C) Osteodystrophy and secondary hyperparathyroidism

D) Hypertension and fluid retention

C. Osteodystrophy and secondary hyperparathyroidism

In CKD, hyperphosphatemia can directly contribute to which vascular complication?

A) Aneurysm rupture

B) Vasculitis

C) Venous thrombosis

D) Vascular calcification

D. Vascular calcification

in ckd, i will not be able to get rid of my phosphate. so phosphate will build up in blood and bind with calcium. the calcium-phosphate buildup in the vessel walls will lead to vascular calcification

A CKD patient has persistent hyperphosphatemia despite diet changes. Which therapy may be required to control serum phosphorus?

A) Loop diuretics

B) Phosphate binders

C) Potassium binders

D) Calcium blockers

B. Phosphate binders

Which CKD patient most likely requires fluid restriction?

A) Polyuria and hypokalemia

B) Hematuria and fever

C) Proteinuria without edema

D) Oliguria or fluid overload

D. Oliguria or fluid overload

A CKD patient develops normocytic anemia. Which decreased hormone production best explains this?

A) Renin

B) Calcitriol

C) Erythropoietin

D) Aldosterone

C. Erythropoietin

Impaired vitamin D activation in CKD most directly contributes to which paired complications?

A) Hyperkalemia and acidosis

B) Hypocalcemia and bone disease

C) Hypernatremia and edema

D) Hypoglycemia and anemia

B. Hypocalcemia and bone disease

CKD → ↓ active vitamin D → ↓ calcium absorption from gut → hypocalcemia

Hemodialysis removes excess waste and fluid primarily by diffusion across what?

A) Peritoneal membrane

B) Glomerular basement membrane

C) Tubular epithelium

D) Semipermeable membrane

D. Semipermeable membrane

Peritoneal dialysis uses which structure as the dialysis membrane?

A) Peritoneal membrane

B) Bowman capsule

C) Renal capsule

D) Pleural membrane

A. Peritoneal membrane

A patient on peritoneal dialysis gains weight and develops hyperglycemia. Which dialysate component explains this?

A) Amino acids

B) Phosphate

C) Glucose

D) Urea

C. Glucose

Peritoneal dialysis fluid often contains glucose. Glucose pulls water out of the blood into the dialysate, which helps remove extra fluid. But some glucose can be absorbed into the body.

Patients receiving dialysis are at increased risk for which nutritional complication?

A) Protein-energy malnutrition

B) Iron overload

C) Vitamin D toxicity

D) Hyperalbuminemia

A. Protein-energy malnutrition

Nutrition therapy for nephrotic syndrome may include which intervention to control edema?

A) Sodium restriction

B) Potassium loading

C) Phosphate loading

D) Fluid liberalization

A. Sodium restriction

Why is excessive protein intake generally avoided in nephrotic syndrome?

A) It worsens hyperkalemia

B) It causes cystinuria

C) It worsens proteinuria

D) It causes struvite stones

C. It worsens proteinuria

Nephrolithiasis refers to formation of what?

A) Renal cysts

B) Kidney stones

C) Glomerular scars

D) Ureteral strictures

B. Kidney stones

Which urine-related factor strongly increases kidney stone risk?

A) High urine volume

B) Low urine volume

C) Low urine calcium

D) High urine pH

B. Low urine volume

Which intervention is most important for preventing recurrent nephrolithiasis?

A) Increasing fluid intake

B) Eliminating dietary calcium

C) Increasing sodium intake

D) Restricting all protein

A. Increasing fluid intake

Which substance is found in the most common kidney stone type?

A) Uric acid

B) Struvite

C) Calcium oxalate

D) Cystine

C. Calcium oxalate

Which food set is high in oxalate?

A) Eggs, rice, apples

B) Milk, yogurt, cheese

C) Fish, chicken, turkey

D) Spinach, nuts, tea

D. Spinach, nuts, tea

A patient with calcium oxalate stones asks what to limit. Which advice is most appropriate?

A) Limit oxalate-rich foods

B) Avoid all dietary calcium

C) Increase sodium intake

D) Increase animal protein

A. Limit oxalate-rich foods

Low dietary calcium can increase calcium oxalate stone risk by increasing what?

A) Urinary sodium loss

B) Gut oxalate absorption

C) Uric acid solubility

D) Citrate excretion

B. Gut oxalate absorption

Low calcium intake → less oxalate bound to calcium in gut → more oxalate absorbed → more oxalate in urine → ↑ calcium oxalate stone risk

Uric acid kidney stones are associated with which urinary and serum pattern?

A) Hypouricemia, alkaline urine

B) Hypercalcemia, dilute urine

C) Hyperuricemia, acidic urine

D) Cystinuria, neutral urine

C. Hyperuricemia, acidic urine

Struvite stones are associated with which condition?

A) Urease-positive urinary infections

B) Low dietary calcium

C) Hyperuricemia and gout

D) Isolated cystinuria

A. Urease-positive urinary infections

Cystine stones occur in patients with which inherited disorder?

A) Cystinuria

B) Alkaptonuria

C) Homocystinuria

D) Hartnup disease

A. Cystinuria

Restricting sodium intake helps prevent calcium stones by reducing what?

A) Urinary oxalate absorption

B) Urinary calcium excretion

C) Serum phosphate levels

D) Serum uric acid

B. Urinary calcium excretion

High sodium intake → ↑ urinary sodium excretion → calcium follows sodium in urine → ↑ urinary calcium excretion → ↑ calcium stone risk

Animal protein increases kidney stone risk by increasing urinary excretion of what?

A) Sodium and phosphate

B) Calcium and uric acid

C) Potassium and citrate

D) Magnesium and bicarbonate

B. Calcium and uric acid

Patients with CKD are at increased risk for which major complication?

A) Cardiovascular disease

B) Acute pancreatitis

C) Pulmonary embolism

D) Adrenal insufficiency

A. Cardiovascular disease

Malnutrition in renal disease commonly results from which combination?

A) Polyphagia, obesity, alkalosis

B) Poor appetite, restrictions, catabolism

C) Hyperthyroidism, diarrhea, fever

D) Protein excess, edema, hyperglycemia

B. Poor appetite, restrictions, catabolism

A patient with uremia develops gastrointestinal symptoms and reduced intake. Which symptom cluster is expected?

A) Diarrhea, hunger, jaundice

B) Constipation, thirst, flushing

C) Nausea, vomiting, poor appetite

D) Dysphagia, bleeding, polyphagia

C. Nausea, vomiting, poor appetite

Which laboratory value is commonly used as a nutritional marker in renal disease?

A) Serum albumin

B) Serum potassium

C) Serum creatinine

D) Serum sodium

A. Serum albumin

Patients with renal disease often require monitoring of which diet-related factors?

A) Calcium, glucose, iron, zinc

B) Protein, fat, fiber, vitamins

C) Potassium, phosphorus, sodium, fluid

D) Chloride, copper, iodine, folate

C. Potassium, phosphorus, sodium, fluid