Context,Questions,Correct Answers
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases",1. The mechanism of action of aliskiren to improve BP control includes: <br> a. Direct action on peripheral vasculature <br> b. Centrally-mediated vasodilatation <br> c. Decreased formation of angiotensin I and angiotensin II <br> d. Effects on calcium channels,C
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases",2. Side-effects that may be anticipated in the use of aliskiren include: <br> a. Cough <br> b. Angioedema <br> c. Elevated transaminases <br> d. Hyperkalemia,D
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases","3. The true statement about pediatric HTN is: <br> a. Aliskiren has the safest antihypertensive medication side-effect profile published to date. <br> b. Pediatric HTN is generally defined statistically as a sustained level of BP that is consistently >95th percentile for age, gender and stature. <br> c. All pediatric patients diagnosed with HTN must be managed with antihypertensive medications as soon as the diagnosis is confirmed. <br> d. Children will likely outgrow HTN by the time they finish puberty.",B
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases","4. Before the development of aliskiren, reasons that limited availability of compounds that act as a direct renin inhibitors included all but: <br> a. Serious side effect profiles. <br> b. Poor bioavailability. <br> c. High production costs. <br> d. Low renin specificity.",A
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases",5. A true statement about renin is: <br> a. It is secreted by the liver when there is inflammation. <br> b. It cleaves the substrate angiotensinogen to form angiotensin I. <br> c. It is produced by the kidney only in CKD stage 4 or higher. <br> d. It is produced by osteoblasts.,B
"Aliskiren, the first direct renin inhibitor: assessing a role in pediatric hypertension and kidney diseases",6. The antihypertensive classes that may influence the RAAS include all but: <br> a. Angiotensin-converting enzyme inhibitors <br> b. Angiotensin receptor blockers <br> c. Beta blockers <br> d. Centrally acting agents <br> e. Aldosterone inhibitors,D
Assessment of nutritional status in children with chronic kidney disease and on dialysis,1. Which of the following factors is not a risk factor for PEW in children with CKD? <br> a. Young age at onset of end-stage renal disease <br> b. Polyuria <br> c. Proteinuric kidney disease <br> d. Poor compliance,B
Assessment of nutritional status in children with chronic kidney disease and on dialysis,2. Which of the following hormones does not cause anorexia in CKD? <br> a. Desacyl ghrelin <br> b. Obestatin <br> c. Neuropeptide Y <br> d. Acyl ghrelin,D
Assessment of nutritional status in children with chronic kidney disease and on dialysis,3. Which of the following parameters is recommended by the NKF KDOQI guidelines for the assessment of nutritional status in children with CKD? <br> a. Serum albumin <br> b. Mid-arm muscle circumference <br> c. BMI-for-height/age percentile or SDS <br> d. BMI-for-age percentile or SDS,C
Assessment of nutritional status in children with chronic kidney disease and on dialysis,4. Which of the following biochemical parameters has not been proposed as a nutritional parameter? <br> a. Total lymphocyte count <br> b. Serum Immunoglobulins <br> c. Serum pre-albumin <br> d. Serum creatinine,B
Assessment of nutritional status in children with chronic kidney disease and on dialysis,5. Which of the following factors has to be considered causative of PEW in children with CKD? <br> a. Chronic inflammation <br> b. Low dialysis dose <br> c. Metabolic acidosis <br> d. Hormonal factors,D
Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease–mineral and bone disorder,1. Which of the following drugs has been associated with the development of CUA in multiple human observational studies? <br> a. Warfarin <br> b. Non-calcium containing binders <br> c. Prednisolone <br> d. Low-molecular-weight heparins <br> e. Cinacalcet,A
Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease–mineral and bone disorder,2. Which of the following statements regarding sodium thiosulphate treatment is incorrect? <br> a. STS may alleviate pain in CUA <br> b. STS is not dialysed and can therefore be given during haemodialysis <br> c. STS can cause metabolic acidosis <br> d. Long-term use of STS can result in reduced bone mineral density <br> e. STS treatment can be used as part of a multimodal treatment for CUA,B
Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease–mineral and bone disorder,3. Which one of these treatments has not been reported in the management of CUA? <br> a. Tissue plasminogen activator <br> b. Bisphosphonates <br> c. Hyperbaric oxygen <br> d. Surgical debridement <br> e. Topical tacrolimus,E
Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease–mineral and bone disorder,4. Which of the following statements is correct regarding paediatric CUA? <br> a. It is frequently seen in paediatric peritoneal dialysis patients <br> b. STS treatment is contra-indicated in paediatric CUA patients. <br> c. There have been multiple studies investigating CUA in the paediatric population <br> d. Pain is a feature of CUA in paediatric patients <br> e. Puberty is an independent risk factor for the development of CUA,D
Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease–mineral and bone disorder,"5. Identify the incorrect statement regarding CUA registries <br> a. CUA registries and studies are actively recruiting patients in Germany and the UK. <br> b. The German registry has recruited approximately 30 patients per year. <br> c. Registry work enables a greater understanding of the risk factors, clinical course, outcomes and current treatment strategies in use. <br> d. Registry work enables treatments to be introduced without the need for randomized controlled trials. <br> e. CUA registries are being developed outside Germany and the UK",D
Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD),1. Extrarenal complications of ARPKD include: <br> a. Interrupted aortic arch <br> b. Caroli disease <br> c. Colonic diverticula <br> d. Inguinal hernia <br> e. Cardiac valve disease,B
Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD),"2. What percentage of children that survive the neonatal period will develop evidence of portal hypertension over time? <br> a. Almost every child <br> b. Close to 0% <br> c. Almost 50% <br> d. Depending on the clinical database, 10–15% <br> e. Close to 95%",C
Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD),3. What is the pathogenesis of systemic hypertension in ARPKD? <br> a. Volume overload <br> b. Combination with hyponatremia <br> c. Excessive release of angiotensin II followed by vasoconstriction <br> d. Poor renal function <br> e. All of the above are possible explanations,E
Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD),4. Which is the wrong answer? Treatment options of gastro-esophageal varices in children with ARPKD include: <br> a. Regular EGD monitoring in patients with PH <br> b. Esophageal band ligation <br> c. Sclerotherapy <br> d. Non-selective beta-blockers <br> e. Cyanoacrylate glue,D
Clinical manifestations of autosomal recessive polycystic kidney disease (ARPKD),5. Which is the wrong answer? Contributing factors to the disease phenotype in ARPKD include: <br> a. Hormonal effects (estrogens) <br> b. Combination of mutations <br> c. Disease-modifying genes <br> d. Mutation of both PKD1 and PKD2 (“double hit”) <br> e. None of the above,D
Cardiovascular changes during chronic hypertensive states,1. The pathophysiological mechanisms leading to hypertensive heart disease are: <br> a. Interstitial and perivascular fibrosis <br> b. Myocardial ischemia <br> c. Changes in the extracellular matrix <br> d. All of the above,D
Cardiovascular changes during chronic hypertensive states,2. Which of the items listed below cannot be classified as subclinical target organ damage: <br> a. Left ventricular hypertrophy (LVH) <br> b. Increased intima media thickness (IMT) <br> c. Hemorrhagic stroke <br> d. Increased pulse wave velocity,C
Cardiovascular changes during chronic hypertensive states,"3. For cardiovascular risk stratification in adults, which of the following are used: <br> a. Elevated blood pressure <br> b. Age <br> c. Glucose level <br> d. All of the above",D
Cardiovascular changes during chronic hypertensive states,"4. In the general population: <br> a. Hypertension is the most important risk factor for global mortality <br> b. The increase of 20 mm Hg in systolic blood pressure (BP) or 10 mmHg in diastolic DBP is associated with a doubling of cardiovascular risk <br> c. Target organ damage (LVH, increased IMT) is already present in childhood <br> d. All of the above are true",D
Cardiovascular changes during chronic hypertensive states,5. The most common cardiovascular disease in pediatric dialysis patients is: <br> a. Systolic heart failure <br> b. Diastolic heart failure <br> c. Arrhythmia <br> d. Cardiomyopathy,C
Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation,1. The outcome of renal transplantation in infants with a genetic form of nephrotic syndrome is usually: <br> a. worse than in older children <br> b. comparable to that in older children <br> c. better than in older children,b
Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation,2. The risk for recurrence of nephrotic syndrome after transplantation in patients with a genetic kidney disease is: <br> a. very high <br> b. moderate <br> c. very low,c
Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation,3. Recurrence of nephrotic syndrome after renal transplantation is most common in patients with mutations in the: <br> a. nephrin gene (NPHS1) <br> b. podocin gene (NPHS2) <br> c. phospholipase c-epsilon gene (NPHS3),a
Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation,"4. Because of recurrence risk, a child with nephrin gene mutations should receive the graft from: <br> a. one of the parents <br> b. an unrelated, deceased donor <br> c. either a living-related or deceased donor",c
Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation,5. Patients with a post-transplant recurrence of nephrotic syndrome have been successfully treated with a combination of: <br> a. increased prednisone and anti-thymocyte globulin <br> b. plasma exchange and cyclophosphamide <br> c. increased cyclosporine and mycophenolate,b
Combined liver and kidney transplantation in children,1. The main indications for combined liver–kidney transplantation (CLKT) in children are: <br> a. Primary hyperoxaluria type 1 (PH1) and autosomal recessive polycystic kidney disease (ARPKD) <br> b. PH1 and atypical hemolytic uremic syndrome (aHUS) <br> c. aHUS and methylmalonic acidemia (MMA) <br> d. aHUS and PH1,a
Combined liver and kidney transplantation in children,2. The major life-threatening surgical complication after CLKT is: <br> a. Ureteral stricture of the kidney graft <br> b. Thrombosis of liver artery <br> c. Thrombosis of the kidney artery <br> d. Biliary stricture,b
Combined liver and kidney transplantation in children,3. The major immunological problem after CLKT is: <br> a. Acute antibody-mediated rejection of the liver graft <br> b. Chronic rejection of the liver graft (vanishing bile duct syndrome) <br> c. Chronic rejection of the kidney graft <br> d. Acute cellular rejection of the liver,c
Combined liver and kidney transplantation in children,4. CLKT is performed: <br> a. More often in children than in adults <br> b. Often in patients with liver failure and hepatorenal syndrome (HRS) <br> c. More often than isolated kidney transplantation in PH1 patients <br> d. Usually as the first transplantation in ARPKD patients,c
Combined liver and kidney transplantation in children,5. The outcome of CLKT is: <br> a. Better in infants than in older children and adolescents <br> b. Better in ARPKD as compared to PH1 <br> c. Better in MMA than in PH1 <br> d. Better in MMA than in ARPKD,b
Encapsulating peritoneal sclerosis in children,1. In a child on chronic PD which one of the criteria listed below is required to confirm a diagnosis of EPS? <br> a. ileus or bowel perforation <br> b. recurrent abdominal pain with vomiting and severe malnutrition <br> c. recurrent abdominal pain with US findings of ascites and a thick-walled and matted bowel loops <br> d. abdominal pain with laparotomy finding of volvulus <br> e. peritoneal biopsy sample showing calcification of the peritoneum,c
Encapsulating peritoneal sclerosis in children,"2. Regarding EPS in children, which one of the following statements is true? <br> a. EPS is never seen in children <br> b. EPS may be seen in children who have never received PD <br> c. EPS may be seen in children on chronic PD after they have been converted to HD <br> d. EPS is never seen in children who have received biocompatible PD fluid <br> e. EPD is never seen in children who have not had peritonitis",c
Encapsulating peritoneal sclerosis in children,3. Which one of the following features is not seen on CT scan in a child with EPS? <br> a. small intraperitoneal nodules and other CT findings of peritoneal mesothelioma <br> b. peritoneal calcification <br> c. peritoneal thickening <br> d. ascites <br> e. small bowel dilatation and abnormal peristalsis,a
Encapsulating peritoneal sclerosis in children,"4. In a child who has been on PD for 5 years which one of the following management strategies is most appropriate? <br> a. PD should be stopped immediately and the child put on HD <br> b. 6-monthly CT scans of the abdomen should be performed to screen for peritoneal calcification <br> c. 6-monthly peritoneal biopsies should be taken to screen for peritoneal sclerosis <br> d. the patient and family should be counseled that there is a risk of EPS, and every effort made to perform renal transplantation <br> e. the child should be started on tamoxifen to prevent the development of EPS",d
Encapsulating peritoneal sclerosis in children,"5. In a child with a confirmed diagnosis of EPS, which one of the following treatments should not be performed? <br> a. total parenteral nutrition <br> b. regular flushing of the peritoneal cavity with high dose steroids <br> c. HD <br> d. prednisolone with or without additional immunosuppression <br> e. tamoxifen",b
Gadolinium and nephrogenic systemic fibrosis: an update,"1. In relation to Gd-based contrast agents: <br> a. They are used in MRI, mainly to highlight inflammation and neoplasia, and in MRA <br> b. In a patient with renal impairment, Gd contrast agents are preferable to iodinated contrast media as used in CT <br> c. They can be effectively removed with hemodialysis, avoiding development of nephrogenic systemic fibrosis <br> d. Nonchelated Gd is highly toxic in vivo, causing encephalopathy, hemolysis, anemia, and nephrotoxicity <br> e. They have a higher rate of non-NSF-related adverse events compared with iodinated contrast used in CT",a
Gadolinium and nephrogenic systemic fibrosis: an update,"2. The following statement relating to the clinical features of nephrogenic systemic fibrosis is NOT true: <br> a. Features can include hyperpigmented patches, skin thickening, and joint contractures <br> b. NSF may appear clinically similar to other dermatological conditions, such as scleroderma <br> c. NSF typically occurs rapidly following exposure to Gd <br> d. The clinical picture is variable and must be assessed in combination with histopathological features from deep-skin biopsy in order to make a confident diagnosis <br> e. Clinical changes can improve following restoration of a patient’s renal function",c
Gadolinium and nephrogenic systemic fibrosis: an update,"3. For patients with NSF: <br> a. 15 % have a rapidly progressive course <br> b. There is a 48 % mortality rate attributable to NSF <br> c. Most patients become wheelchair bound due to restricted mobility <br> d. There are more than 500 biopsy-confirmed cases in the literature <br> e. In a patient with continuing renal impairment, no treatment has been consistently shown to improve symptoms of NSF",e
Gadolinium and nephrogenic systemic fibrosis: an update,"4. With regard to risk minimization for NSF: <br> a. Dialysis following Gd contrast administration consistently prevents the development of NSF <br> b. Gadodiamide (Omniscan), gadoversetamide (Optimark), and gadopentetate dimeglumine (Magnevist) are classified as high risk for NSF and are contraindicated in patients with severely impaired renal function <br> c. Gd contrast agents should never be used in neonates <br> d. It is safe for women to continue breast feeding following Gd administration <br> e. Incidence of NSF has not dropped significantly since the implementation of guidelines limiting Gd contrast agent administration",b
Gadolinium and nephrogenic systemic fibrosis: an update,"5. Relating to NSF in children: <br> a. NSF is more common in neonates and infants than in older children <br> b. Creatinine blood testing is mandatory in all patients prior to Gd administration <br> c. Gd use is essential to MRA <br> d. Gadoversetamide (Optimark) is contraindicated in neonates <br> e. Risk of NSF means that there is an absolute contraindication to the use of Gd in patients with renal impairment, and an alternative imaging modality must be used",d
Histopathological diagnosis of acute and chronic rejection,1. Antibody-mediated (humoral) rejection—What is correct? <br> a. Is exceedingly rare later than 1 year after transplantation <br> b. Presents with tubulitis in the kidney biopsy <br> c. Is one important contributor to allograft loss <br> d. Only affects ABO-incompatible transplant recipients,c
Histopathological diagnosis of acute and chronic rejection,2. Chronic antibody-mediated rejection—What is wrong? <br> a. Is characterized by structural remodeling of the kidney microvasculature <br> b. By definition requires detection of a donor-specific antibody <br> c. Is synonymous to “chronic allograft nephropathy” <br> d. Electron microscopy is a helpful diagnostic tool in this context,c
Histopathological diagnosis of acute and chronic rejection,3. Endarteritis/Endothelialitis—What is wrong? <br> a. Is considered a sign of T-cell-mediated rejection according to the current Banff classification <br> b. Is currently disregarded for the diagnosis of acute rejection if not accompanied by an interstitial inflammatory infiltrate or tubulitis <br> c. May be antibody mediated in some cases <br> d. Affects small as well as larger intrarenal arteries,b
Histopathological diagnosis of acute and chronic rejection,4. ABO-incompatible transplantation—What is wrong? <br> a. Diagnosis of antibody-mediated rejection in these cases is based upon presence or absence of C4d-staining in peritubular capillaries <br> b. The outcome is comparable to ABO-compatible kidney transplantation <br> c. Is performed in children as well as in adults <br> d. May represent one of the scenarios in which accommodation occurs,a
Histopathological diagnosis of acute and chronic rejection,5. Borderline acute cellular rejection—What is correct? <br> a. Designates cases in which a diagnosis of acute cellular rejection cannot be made because of insufficient material <br> b. Designates cases that are “borderline” between acute cellular and acute humoral rejection <br> c. Designates cases in which either the amount of interstitial infiltrate or the degree of tubulitis is not sufficient to make a diagnosis of acute cellular rejection <br> d. Is always treated as an acute cellular rejection,c
Hypophosphatemic rickets due to perturbations in renal tubular function,"1. Rickets due to renal tubular disorders is characterized by: <br> a. High serum PTH, low phosphate, low 1,25(OH)2D3 <br> b. Low serum phosphate, normal PTH, normal serum calcium <br> c. Hypercalciuria, high PTH, high 1,25(OH)2D3 <br> d. Hyperphosphatemia, high PTH, low 1,25(OH)2D3",b
Hypophosphatemic rickets due to perturbations in renal tubular function,2. The treatment of genetic hypophosphatemic rickets with hypercalciuria (HHRH/SLC34A3) includes: <br> a. Calcitriol and phosphate <br> b. Phosphate and thiazides <br> c. Calcitriol alone <br> d. Phosphate alone,d
Hypophosphatemic rickets due to perturbations in renal tubular function,3. The nephrocalcinosis in treated patients with XLH is due to: <br> a. Calcium phosphate deposits <br> b. Calcium oxalate deposits <br> c. Combination of calcium oxalate and calcium phosphate deposits <br> d. Unknown,a
Hypophosphatemic rickets due to perturbations in renal tubular function,4. Secondary hyperparathyroidism develops in patients with XLH due to: <br> a. Insufficient intake of calcium <br> b. Nephrocalcinosis-related deterioration in kidney function <br> c. High oral doses of phosphate unbalanced by sufficient intake of calcitriol <br> d. As part of the natural history of the disease,c
Hypophosphatemic rickets due to perturbations in renal tubular function,5. Which of the following statements about X-linked dominant hypophosphatemic rickets (XLH) is not correct: <br> a. XLH manifests in the second decade of life <br> b. XLH is the most common form of hereditary rickets <br> c. XLH results from mutation of the PHEX gene <br> d. Hyperphosphaturia in XLH is caused by high circulating levels of fibroblast growth factor 23 (FGF-23),a
Malignancies after pediatric kidney transplantation: more than PTLD?,1. Which of the following is true? <br> a. The spectrum of cancer is the same among pediatric and adult solid organ transplant (SOT) recipients <br> b. Post-transplant lymphoproliferative disease (PTLD) is the most frequent malignancy after pediatric SOT <br> c. The 5-year incidence rate of PTLD is 5–10% in pediatric kidney transplant (KTx) recipients <br> d. Gastric cancer is especially high in patients from Mediterranean countries <br> e. PTLD is the only known Epstein–Barr virus (EBV)-related malignancy,b
Malignancies after pediatric kidney transplantation: more than PTLD?,2. Which of the following malignant diseases is not related to infectious pathogens? <br> a. PTLD <br> b. Kaposi’s sarcoma (KS) <br> c. Renal cell carcinoma (RCC) <br> d. Hepatocellular carcinoma (HCC) <br> e. Vulvar cancer,c
Malignancies after pediatric kidney transplantation: more than PTLD?,3. The risk of developing PTLD in pediatric KTx patients is increased for patients: <br> a. EBV-seronegative at transplantation <br> b. Beyond 5 years after transplantation <br> c. Receiving living-related grafts <br> d. After hemodialysis <br> e. None of the above,a
Malignancies after pediatric kidney transplantation: more than PTLD?,4. Which regular follow-up analysis is not recommended for a standard follow-up cancer screening program after pediatric SOT? <br> a. Gastroscopy <br> b. EBV-PCR <br> c. Regular presentation to dermatologist <br> d. Regular presentation to gynaecologist (female patients only) <br> e. Regular presentation to transplant physician,a
Malignancies after pediatric kidney transplantation: more than PTLD?,5. Which of the following malignant diseases has an increased incidence after SOT? <br> a. Squamous cell carcinoma <br> b. Lung carcinoma <br> c. Renal cell carcinoma <br> d. Lip carcinoma <br> e. All of the above,e
Venous thromboembolism in pediatric nephrotic syndrome,"1. Overall, childhood VTE is associated with what increase in likelihood of in-hospital death? a. 6 % b. 6-fold (RR=6) c. 60 % d. 16 % e. 60-fold (RR=60)",b
Venous thromboembolism in pediatric nephrotic syndrome,2. Approximately what percentage of pediatric VTE patients develop recurrent VTE? a. 3 % b. 52 % c. 12 % d. 71 % e. 32 %,c
Venous thromboembolism in pediatric nephrotic syndrome,3. What is the strongest risk factor for pediatric VTE? a. Presence of infection b. Immobilization c. Presence of anti-phospholipid antibodies d. Heritable thrombophilia e. Presence of a central venous catheter,e
Venous thromboembolism in pediatric nephrotic syndrome,"4. For children with NS, the majority of clinically apparent VTE develop within how long after diagnosis? a. 1 month b. 6 months c. 9 months d. 3 months e. 12 months",b
Venous thromboembolism in pediatric nephrotic syndrome,5. Antithrombin supplementation may become necessary with the use of which anticoagulants? a. Warfarin b. Vitamin K antagonists c. Tissue-type plasminogen activator d. Heparin e. Aspirin,d
Solid organ transplantation following end-organ failure in recipients of hematopoietic stem cell transplantation in children,1. All of the following are causes of early renal dysfunction in patients who undergo HSCT EXCEPT a. Calcineurin inhibitor toxicity b. Hepatorenal syndrome c. Platinum agent nephrotoxicity d. Thrombotic microangiopathy e. BMT nephropathy,e
Solid organ transplantation following end-organ failure in recipients of hematopoietic stem cell transplantation in children,2. What is the MOST common cause of nephrotic syndrome in the post-HSCT period? a. Minimal change nephrotic syndrome b. Membranoproliferative glomerulonephritis c. Focal segmental glomerulosclerosis d. Membranous glomerulonephritis e. Infection-associated nephrotic syndrome,d
Solid organ transplantation following end-organ failure in recipients of hematopoietic stem cell transplantation in children,3. All of the following are hallmarks of BMT nephropathy EXCEPT a. Hypertension b. Late renal dysfunction c. Low incidence and mortality rate of <10 % d. Disproportionate anemia e. Endothelial damage and coagulation abnormalities,c
Remnant nephron physiology and the progression of chronic kidney disease,"1. In the absence of intervention, the progression of CKD to end-stage usually is: a. Inhibited by acidosis b. Linear with respect to time c. Unaffected by blood pressure d. All of the above",b
Remnant nephron physiology and the progression of chronic kidney disease,2. Oxygen consumption by the whole kidney is: a. Increased in CKD b. Driven primarily by potassium regulation c. Disproportionate to the mass of the kidney d. Most important for glomerular filtration,c
Remnant nephron physiology and the progression of chronic kidney disease,3. Complement activation in CKD is: a. A mediator of progression b. Exacerbated by acidosis c. Related to inflammatory cell infiltration d. All of the above,d
Remnant nephron physiology and the progression of chronic kidney disease,4. Reactive oxygen species (ROS) may affect cell function by: a. Reacting with thiol groups on signaling molecules b. Binding to structural molecules in the cell c. Propagating free radicals through lipid peroxidation d. All of the above,d
Remnant nephron physiology and the progression of chronic kidney disease,5. The renin–angiotensin–aldosterone system may accelerate progressive kidney disease by: a. Inhibiting TGF-β production b. Preventing apoptosis c. Decreasing HIF-1α expression d. Promoting cell hypertrophy,d
Psychosocial support for children and families requiring renal replacement therapy,"1. Psychosocial care of families with children requiring renal replacement therapy does NOT require: a. Evaluation of information needs of child and family b. Evaluation of support needs including social work assessment c. Discussion and information sharing at multiprofessional team meetings d. Liaison with clinical psychology for problems with child, siblings and families e. Routine evaluation by child and adolescent psychiatrist",e
Psychosocial support for children and families requiring renal replacement therapy,2. Children who are needle phobic or apprehensive of potentially painful procedures do NOT require: a. Preparation before procedures by play therapists or child life specialists b. Use of local anaesthetic creams or sprays c. Routine use of general anaesthetics d. Distraction techniques to divert attention e. Early referral to clinical psychologist,c
Psychosocial support for children and families requiring renal replacement therapy,3. Which of the following statements regarding educational issues in children on RRT is TRUE: a. Young people on RRT have comparable educational outcomes to peers b. Uraemia has no effect on cognitive function c. Haemodialysis prevents children doing schoolwork during treatment d. Absenteeism from school is at low levels (<5 %) in children following renal transplantation e. Liaison between hospital and home school teachers facilitates educational progress,e
Psychosocial support for children and families requiring renal replacement therapy,4. Which of the following statements in respect of adolescent patients requiring RRT is TRUE: a. Adolescents should all be treated in an adolescent unit b. Treatment choices should be made by parents in all those younger than 14 years of age c. Transition and transfer to adult renal centres should be completed by 16 years of age d. Poor adherence to medication occurs only in poor socio-economic circumstances e. Youth workers provide personal and group support for this group of patients,e
Psychosocial support for children and families requiring renal replacement therapy,5. Which of the following statements is NOT TRUE in treating children with RRT a. Ethical decisions should be based upon “greater best interests” of the child and family b. Immigration status and race have no impact upon choice of therapy c. Strategies for home support may alleviate the burden of care and prevent “burn out” in families d. Health-related quality of life measures may be a valuable tool for longitudinal assessment of children on RRT as well as their parents e. The “psychosocial prescription” is of minor importance in treating children with RRT,e
Metabolic syndrome in children with chronic kidney disease and after renal transplantation,1. An obligatory criterion of MS according to the IDF definition is: a) arterial hypertension b) hypertriglyceridemia c) low-LDL cholesterol d) increased waist circumference e) a and d,d
Metabolic syndrome in children with chronic kidney disease and after renal transplantation,2. The prevalence of MS in children after Rtx a) is lower than in general population b) is the same as in general population c) is higher than in general population and the same as in children on dialysis d) is higher than in general population and higher than in children on dialysis e) is the same as in children on dialysis,d
Metabolic syndrome in children with chronic kidney disease and after renal transplantation,"3. The clinical presentation of obesity-related glomerulopathy is a) severe arterial hypertension, hematuria, proteinuria b) hematuria with proteinuria c) isolated proteinuria d) severe nephrotic syndrome with rapidly declining renal function e) non-proteinuric, slowly progressive CKD",c
Metabolic syndrome in children with chronic kidney disease and after renal transplantation,4. The most important risk factors of NODAT are: a) preemptive kidney transplantation b) use of high doses of corticosteroids and calcineurin inhibitors c) previous long treatment with peritoneal dialysis d) CAKUT as primary renal disease e) b and c,e
Metabolic syndrome in children with chronic kidney disease and after renal transplantation,"5. Prevention and treatment of MS in CKD and after Rtx should be based on: a) metformin b) intensive antihypertensive treatment with ACEi/ARBs plus metformin c) increased physical activity plus metformin d) increased physical activity, dietary modifications and ACEi/ARBs in the case of elevated blood pressure e) only ACEi",d
Nephron number and its determinants in early life: a primer,1. Which of the following statements regarding the normal nephron number is true? <br> a. There is a narrow range of variation in normal nephron number within and among various populations. <br> b. Persons whose nephron number falls within the normal range should expect to have a lifetime of normal kidney function. <br> c. Most of the population-wide variability in nephron number is determined early in life. <br> d. Estimates of nephron number in adults may be artificially increased due to postnatal nephron acquisition.,c
Nephron number and its determinants in early life: a primer,2. Which in utero exposure can lead to a reduction of nephron number? <br> a. Corticosteroids <br> b. Ethanol <br> c. Protein/calorie malnutrition <br> d. Vitamin A deficiency <br> e. All of the above,e
Nephron number and its determinants in early life: a primer,3. Which of the following can be used to accurately determine the nephron number in an adolescent patient with a history of acute kidney injury? <br> a. Acid maceration method <br> b. Fractionator–disector technique <br> c. Renal volume measurement by ultrasound <br> d. Serum creatinine and cystatin C <br> e. None of the above,e
Nephron number and its determinants in early life: a primer,"4. Since nephrons develop until 34–36 weeks gestational age, infants born prematurely are at risk for decreased nephron number due to: <br> a. Exposure to nephrotoxic medications <br> b. Frequent occurrence of acute kidney injury <br> c. Ex utero hemodynamic alterations <br> d. Suboptimal nutrition <br> e. All of the above",e
Nephron number and its determinants in early life: a primer,5. The parents of a one year-old child born with intrauterine growth restriction ask about preserving his nephrons and decreasing their son’s long term risk of chronic kidney disease. Each of the following would be sound recommendations EXCEPT: <br> a. Avoid nephrotoxic medications <br> b. Begin vitamin A supplementation <br> c. Encourage appropriate postnatal weight gain and avoidance of obesity <br> d. Obtain measurement of blood pressure at each check-up according to American Academy of Pediatrics guidelines,b
Rational use of antihypertensive medications in children,"1. An 8-year-old girl presents with obesity and stage I hypertension confirmed on repeat measurements in the clinic setting and at school. Initial screening laboratory tests were reassuring, with well-balanced electrolytes, normal renal function tests, and a normal urinalysis. Renal ultrasound with Doppler interrogation was unremarkable. An echocardiogram revealed no evidence of left ventricular hypertrophy. The most appropriate intervention at this time is: <br> a. Prescribe a thiazide diuretic <br> b. Prescribe an ACE inhibitor <br> c. Prescribe a beta-blocker <br> d. Provide appropriate counseling regarding therapeutic lifestyle modification",d
Rational use of antihypertensive medications in children,"2. A 12-year-old boy is referred from urology with new-onset elevations in BP in the setting of known reflux nephropathy. In the clinic, his BP measurements fulfill criteria for stage II hypertension. Initial evaluations are notable for an estimated GFR of 65 ml/min/1.73m2 and 3+ proteinuria by dipstick. Which of the following drug classes would be considered most appropriate in this setting? <br> a. Thiazide diuretic <br> b. Calcium channel blocker <br> c. ACE inhibitor <br> d. Direct vasodilator",c
Rational use of antihypertensive medications in children,3. ACE Inhibitors and ARBs are absolutely contraindicated in patients with unilateral renal artery stenosis. <br> a. True <br> b. False,b
Rational use of antihypertensive medications in children,4. Which of the following medication classes should be avoided as primary therapy in the hypertensive athlete? <br> a. Diuretics <br> b. Beta-blockers <br> c. Calcium channel blockers <br> d. a and b,d
Rational use of antihypertensive medications in children,5. Most monogenic forms of hypertension are readily treated with calcium channel blockers. <br> a. True <br> b. False,b
Renal consequences of parenteral nutrition,1. The major indication for PN in children is: <br> a. Acute pancreatitis <br> b. Intestinal failure <br> c. Malnutrition in dialyzed patients <br> d. Burns,b
Renal consequences of parenteral nutrition,2. The composition of PN differs from that of EN in that PN does not contain: <br> a. Amino acids <br> b. Complex carbohydrate <br> c. Lipid <br> d. Arginine,b
Renal consequences of parenteral nutrition,"3. In patients receiving PN, suppression of immune function may be a consequence of: <br> a. High sodium load <br> b. Inadequate vitamin content <br> c. High omega-6 to omega-3 polyunsaturated fatty acid ratio <br> d. Low glucose content",c
Renal consequences of parenteral nutrition,4. Intradialytic PN: <br> a. Is likely to be inadequate as a sole source of nutrition <br> b. Is routinely used in children in the UK <br> c. Is less well tolerated than standard PN <br> d. Can only be administered in small volumes due to risk of fluid overload,a
Renal consequences of parenteral nutrition,5. Electrolyte disturbances in patients receiving PN: <br> a. Are very uncommon since PN formulations have improved <br> b. Are only seen in patients receiving short-term PN <br> c. Are rarely affected by concurrent medications and co-morbidities <br> d. Are potentially avoidable,d
Renal consequences of parenteral nutrition,"6. Renal stone disease in patients receiving PN: <br> a. Is exclusive to patients with intestinal failure <br> b. Is a consequence of the high pH of PN formulations <br> c. May be a consequence of low calcium intake, vitamin D administration, and hyperparathyroidism <br> d. Are usually due to infection",c
Renal tubular dysgenesis,1. RTD is characterized at the histological level by: <br> a. Reduced number of proximal tubules <br> b. Dysplasia with presence of primitive ducts <br> c. Constant increase in renin expression <br> d. Thickening of arterial/arteriolar walls <br> (Choose all correct answers),"a, d"
Renal tubular dysgenesis,2. Autosomal recessive RTD is characterized by: <br> a. Oligohydramnios <br> b. Hypertension at birth <br> c. In utero growth retardation <br> d. Large hyperechogenic kidneys,a
Renal tubular dysgenesis,"3. In autosomal recessive RTD, <br> a. Mutations have been identified in AGT, REN, ACE and AGTR1 <br> b. REN mutations are the most frequent <br> c. There is a strict correlation between the mutated gene and the phenotype <br> d. Increase in renin expression is a marker for REN mutation",a
Renal tubular dysgenesis,"4. In the twin-to-twin transfusion syndrome, <br> a. Increased renal renin expression is observed in both twins <br> b. High plasma renin level is observed in both twins <br> c. RTD is observed in the donor twin <br> d. Severe outcome is only observed in the donor twin <br> (Choose all correct answers)","b, c"
Renal tubular dysgenesis,"5. In fetuses exposed to RAS blockers, RTD is observed <br> a. after exposure during the first trimester of gestation <br> b. after exposure during the second trimester of gestation <br> c. after exposure during the third trimester of gestation <br> d. The long-term evolution is favorable in all neonates with spontaneous recovery of diuresis <br> (Choose all correct answers)","b, c"
Strategies for the preservation of residual renal function in pediatric dialysis patients,1. Studies in adults have shown that the following components of RRF are associated with decreased mortality: <br> a. Urinary creatinine clearance <br> b. Urine volume <br> c. Both A & B <br> d. Neither A nor B,c
Strategies for the preservation of residual renal function in pediatric dialysis patients,"2. Potential clinical benefits of maintained RRF in children with ESRD include: <br> a. Decreased cardiovascular complications <br> b. Control of hyperphosphatemia <br> c. Decreased need for erythropoietin-stimulating agents <br> d. A & B <br> e. A, B & C",e
Strategies for the preservation of residual renal function in pediatric dialysis patients,3. The following strategy has NOT been advocated to preserve RRF during hemodialysis include: <br> a. Aggressive ultrafiltration until hypotension is induced <br> b. Use of ultrapure dialysate <br> c. Use of biocompatible dialyzers <br> d. Avoidance of nephrotoxic medications whenever possible,a
Strategies for the preservation of residual renal function in pediatric dialysis patients,4. Use of low GDP-dialysate in children receiving chronic peritoneal dialysis is: <br> a. Clearly associated with maintenance of residual renal function <br> b. Advocated when possible <br> c. Associated with increased circulating advanced glycosylation end products which can affect mesothelial cell mass and function,b
Trace elements in dialysis,"1. Which of the following statements is true? a. Trace elements are known substances that are present in very low concentrations in biological fluids or tissues. b. Molybdenum is a trace element. c. Cadmium, chromium, nickel, and vanadium probably accumulate in dialysis patients. d. In analytical chemistry, a trace element is an element in a sample that has an average concentration of less than 100 parts per million measured in atomic count or less than 100 micrograms per gram. e. All of the above.",e
Trace elements in dialysis,"2. Which of the following statements is true? a. Cadmium has an important biological role in higher organisms. b. The hexavalent form of chromium is benign. c. Vanadium is very toxic and exposure is likely to cause permanent health problems or death. d. Chronic lead toxicity causes abdominal pain, confusion, headache, anemia, and irritability. e. Manganese, zinc, copper, and selenium cannot accumulate in CKD.",c
Trace elements in dialysis,"3. Which of the following statements is false? a. Zinc is one of the most important micronutrients and deficiency is common worldwide, potentially causing failure to thrive, dermatitis, and inflammatory disease. b. Zinc is an intrinsic metal and a cofactor for multiple enzyme systems, including angiotensin converting enzyme, alkaline phosphatase, carbonic anhydrase, DNA and RNA polymerases, copper-zinc superoxide dismutase, and metallothionein. c. CKD patients are at a low risk for zinc deficiency because of accumulation of zinc due to decreased renal clearance. d. Zinc levels range between 25.9 and 108.8 ug/l in healthy children. e. Zinc has measurable levels in bottled water but its concentration in high purity dialysis water is negligible.",c
Trace elements in dialysis,4. Which of the following statements is true? a. There is no safe lead level for children. b. Children on dialysis have a higher prevalence of elevated lead levels than adult dialysis patients. c. Hemodialysis feed water in academic centers is not a significant source of lead. d. Dialysis fluid does not serve as a source of excessive loss of lead. e. All of the above.,e
Uric acid and the kidney,1. Mutations in which of the following transporters/proteins have been implicated in familial juvenile hyperuricemic nephropathy (FJHN): a. Glut9 b. URAT1 c. UMOD d. OAT1,c
Uric acid and the kidney,"2. A child with a serum uric acid level of 0.5 mg/dl and with decreased FEUA will likely have: a. Fanconi syndrome b. Hereditary xanthinuria, with deficiency of XO enzyme c. SIADH d. Diabetes mellitus",b
Uric acid and the kidney,"3. A 10-year-old kidney transplant recipient has high serum uric acid level. His current immunosuppression is cyclosporine, prednisone and azathioprine. He was started on allopurinol. Which of the following is a correct recommendation regarding his current immunosuppression: a. Stopping azathioprine and starting mycophenolate mofetil b. Stopping cyclosporine and starting tacrolimus c. Decreasing the azathioprine dose by half and monitoring for bone marrow suppression d. No changes to his medications",e
Uric acid and the kidney,4. Serum uric acid levels among neonates: a. Are lowest at birth b. Directly proportional to gestational age c. Are highest at birth d. Are lower in infants with perinatal complications e. Increase during the first week of life,c
Uric acid and the kidney,"5. Which of the following statements are true regarding acute uric acid nephropathy in children? a. Occurs when serum uric acid levels exceed 4–6 mg/dl b. (Uua × Scr)/(Ucr), mg/dl > 0.57 is suggestive of acute uric acid nephropathy c. The pathologic features of acute uric acid nephropathy are irreversible d. Most commonly occurs with enzymatic defects e. A urine uric acid-to-creatinine ratio of >1 is suggestive of acute uric acid nephropathy",e
Therapeutic plasma exchange for the treatment of pediatric,1. Plasma exchange is accepted as a first-line therapy for treatment of these conditions EXCEPT: a) Recurrent FSGS b) Antibody-mediated kidney allograft rejection c) Lupus nephritis d) ANCA-associated rapidly progressive glomerulonephritis and dialysis dependence e) Atypical HUS due to autoantibody to factor H,c
Therapeutic plasma exchange for the treatment of pediatric,2. Which of the following complication is NOT associated with citrate anticoagulation a) Hypocalcemia b) Hypotension c) Metabolic alkalosis d) Hypokalemia e) Paresthesias,d
Therapeutic plasma exchange for the treatment of pediatric,"3. A 10-year-old girl presents with anemia, thrombocytopenia and renal failure. A diagnosis of aHUS is made and plasma exchange initiated. The replacement solution to be used should be: a) Albumin 5 % b) A combination of albumin 5 % and normal saline c) Packed red blood cells d) Fresh frozen plasma",d
Therapeutic plasma exchange for the treatment of pediatric,4. A 2-year-old boy (weight 10 kg) is 1-year post-renal transplant. He has evidence of acute antibody-mediated rejection on transplant biopsy. Therapy with automated equipment for plasma exchange is considered. Which of the following statement is TRUE: a) Plasma exchange cannot be performed because he is too young b) A combination of albumin and normal saline can be used for the replacement fluid c) The circuit should not be primed with blood products d) Peripheral venous access can be used for the procedure,b
Targeted therapy aimed at cancer stem cells Wilms’ tumor,1. Which of the following statements regarding Wilms’ tumor epidemiology is correct? a. Most patients have familial history b. WT is the most frequent pediatric tumor c. Two thirds of all WT cases cannot be linked to any genetic aberration d. The tumor is more common among males,c
Targeted therapy aimed at cancer stem cells Wilms’ tumor,"2. What is the definition of a cancer stem cell? a. Activation of pluripotency genes (ie Oct4, Sox2, Nanog) b. Multi-drug resistance c. Formation of tumor spheres in low-adherence cultures d. Self-renewal and differentiation capacities",d
Targeted therapy aimed at cancer stem cells Wilms’ tumor,3. Which of the following assays does not serve as a method for CSC identification and isolation? a. Doubling time assay b. Side population assay c. Label retention cell assay d. Colony formation assay,a
Targeted therapy aimed at cancer stem cells Wilms’ tumor,4. What is the common practice for WT patients? a. Nephrectomy and postoperative radiotherapy b. Targeted therapy aimed at cancer stem cells c. A combination of surgery and chemotherapy d. Conservative treatment based on low protein diet,c
Targeted therapy aimed at cancer stem cells Wilms’ tumor,"5. Choose the incorrect sentence regarding the results of an anti-NCAM1 antibody-drug conjugate (HuN901-DMI)? a. In vitro, the treatment resulted in depletion of the cell’s ‘stemness’ properties (CFU capacity, proliferation) b. HuN901-DMI treatment presented a toxic effect, represented by mice weight loss c. Treatment of mice bearing human WTs with high NCAM1 expression resulted in complete eradication of the tumors in the majority of cases d. Treatment of low NCAM1 expressing WT xenograft resulted in reduction of tumor size followed by a plateau",b
Urinary schistosomiasis,1. The following contributes to the epidemiological pattern of schistosomiasis except: <br> a. Extreme poverty <br> b. Dam construction <br> c. Type of molluscs <br> d. Tourism <br> e. Cold climate,e
Urinary schistosomiasis,2. All are reasons for greater incidence of urogenital schistosomiasis in children except: <br> a. Recreational activity <br> b. Poor education <br> c. Higher serum level of IgM <br> d. Urinary tract infection,d
Urinary schistosomiasis,3. Urogenital schistosomiasis is a potent mediator of transitional cell carcinoma of the bladder: <br> a. True <br> b. False,b
Urinary schistosomiasis,4. Katayama fever is due to one of the following: <br> a. Cercaria skin penetration <br> b. Schistosomule migration <br> c. Miracidium in the bladder wall <br> d. Hypersensitivity to egg antigen,d
Urinary schistosomiasis,5. One of the following is a fairly reliable means of detecting active bladder infection: <br> a. Urine microscopy <br> b. Confocal laser scanning microscopy <br> c. Ultrasonography <br> d. Cystoscopy,b
Urinary schistosomiasis,"6. An effective preventive strategy for endemic urinary schistosomiasis should include: <br> a. Adequate treatment of bacterial cystitis <br> b. Mass chemotherapy <br> c. Health education <br> d. Water supply <br> e. Relocation from endemic zone <br> i. a and c <br> ii. a and b <br> iii. b, c and d <br> iv. a and e",iii
Urinary schistosomiasis,7. A true statement about schistosomal glomerulopathy: <br> a. The most common pathogen is S. hematobium <br> b. Histological type III is due to Salmonella superinfection <br> c. Granulomatous egg deposit in renal tissue is common <br> d. Not seen in the absence of bladder infestation <br> e. Low serum C3 is common <br> i. a and b <br> ii. a and e <br> iii. c only <br> iv. None of the above,iv
Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease,"1. Among the following options, a child with chronic kidney disease (CKD) or end-stage renal disease (ESRD) would MOST likely a constellation of abnormalities in lipid profiles is: <br>A) There is significant evidence that cardiovascular disease is common <br>B) Atherosclerosis develops early (Stage 1 and 2 CKD) in the course of renal disease <br>C) Evidence is either lacking or inconclusive regarding the relationship between dyslipidemia and CVD <br>D) Studies show that children with ESRD have damage limited to the media of the coronary arteries <br>E) Coronary artery disease is more commonly observed in children versus adults with CKD/ESRD",C
Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease,2. The MOST accurate statement regarding cardiovascular disease (CVD) in children with CKD/ESRD who have dyslipidemia is: <br>A) There is significant evidence that cardiovascular disease is common <br>B) Atherosclerosis develops early (Stage 1 and 2 CKD) in the course of renal disease <br>C) Evidence is either lacking or inconclusive regarding the relationship between dyslipidemia and CVD <br>D) Studies show that children with ESRD have damage limited to the media of the coronary arteries <br>E) Coronary artery disease is more commonly observed in children versus adults with CKD/ESRD,C
Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease,3. The MOST accurate statement about dyslipidemia in pediatric renal transplant patients is: <br>A) Dyslipidemia typically is limited to elevated serum cholesterol <br>B) The rates of dyslipidemia generally decline in the first year after transplantation <br>C) There is a proven relationship between dyslipidemia and graft dysfunction <br>D) The role of medications in the pathogenesis of dyslipidemia is unproven <br>E) Dyslipidemia is a proven risk factor for cardiovascular disease,B
Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease,"4. For a child with dyslipidemia, the INITIAL approach to therapy should include: <br>A) Pharmacological therapy with a statin <br>B) Discontinuation of all medications that may be contributing to dyslipidemia <br>C) Specific lipid-lowering therapy targeting the specific lipid(s) levels that are abnormal <br>D) Lifestyle change and dietary counseling <br>E) Referral to a cardiologist to tailor therapy based on cardiological status",D
Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease,"5. Among the following, the MOST accurate statement regarding statin therapy for children with or without renal disease is: <br>A) There are a multitude of randomized, controlled trials showing that the benefits of statin therapy outweigh the risks <br>B) The most abundant evidence showing the efficacy and safety of statins in children with renal disease is for patients with nephrotic syndrome <br>C) Several classes of statins have been approved by the Food and Drug Administration <br>D) For children with CKD, statin therapy is approved for children age 5 years and older <br>E) Adverse events uncommonly include elevations in liver transaminases",B
Developmental changes in renal function and drug disposition in children,"1. Which of the following statements about the glomerular filtration rate is true: <br>A) The postnatal increase in glomerular filtration rate is predominantly due to the increase in glomerular capillary surface area <br>B) Glomerulogenesis is always complete by the time of birth <br>C) When corrected for body surface area, the glomerular filtration rate remains constant after birth <br>D) The glomerular filtrate of the adult is an ultrafiltrate of plasma unlike that of the neonate <br>E) Superficial nephrons are formed before juxtamedullary nephrons due to centrifugal pattern of nephron maturation",A
Developmental changes in renal function and drug disposition in children,"2. Which statement about proximal tubule transport is correct? <br>A) While there is substantial reabsorption of solutes, the composition of the luminal fluid remains constant along the proximal tubule <br>B) There is an isoform switch of the Na+/H+ exchanger from NHE8 to NHE3 during postnatal development <br>C) PTH is responsible for the developmental increase in proximal tubular phosphate transport <br>D) The main driving force for solute transport is the apical membrane Na+/K+-ATPase pump <br>E) The osmolality of the luminal fluid of the late proximal tubular fluid is higher than that in the peritubular capillaries",B
Developmental changes in renal function and drug disposition in children,3. Which of the following statements is true about the collecting duct: <br>A) Transport by the cortical collecting duct is predominantly regulated by vasopressin <br>B) The reabsorption of sodium across the apical membrane is via an electroneutral mechanism <br>C) There is a maturational increase in both the apical epithelial sodium channel and potassium channel during post-natal development <br>D) Sodium transport is mediated by an aldosterone-sensitive channel designated ROMK <br>E) The low intracellular potassium concentration in this segment is due to the basolateral Na+/K+-ATPase,C
Developmental changes in renal function and drug disposition in children,4. Which of the following is true regarding urinary dilution in the neonate: <br>A) Urinary dilution occurs in the collecting duct <br>B) The diluting segment is permeable to water in the neonate compromising the diluting capacity <br>C) A neonate cannot drink enough free water to develop hyponatremia <br>D) The neonate can dilute urine to 50 mOsm/kg H2O <br>E) Adults with normal diluting capacity can excrete 30% of their glomerular filtrate as free water,D
Developmental changes in renal function and drug disposition in children,"5. Which of the following is true regarding the developmental changes in urinary concentrating ability: <br>A) The term neonate can concentrate urine to 600 mOsm/kg H2O <br>B) The final urine osmolality in the neonate is dependent on aquaporin 1 trafficking to the apical membrane <br>C) The neonate cannot concentrate urine above the plasma osmolality <br>D) Unlike adults, vasopressin does not regulate urine osmolality in the premature neonate",A
Primary hyperoxaluria in children,"1. Which of the following is an indication for metabolic screening of lithogenic risk factors, including hyperoxaluria? <br>A) A single renal stone in a 3-year-old boy <br>B) Four episodes of renal colic in a 25-year-old woman <br>C) Renal failure with severely hyperechoic kidneys in a 4-month-old baby <br>D) All of the above",D
Primary hyperoxaluria in children,2. What is the recommended approach to treating early-stage hyperoxaluria? <br>A) Sodium restriction and urine alkalinization <br>B) Extracorporeal shockwave lithotripsy <br>C) Hyperhydration and citrate supplements <br>D) Restriction of oxalate-rich food,C
Primary hyperoxaluria in children,"3. A 7-year-old boy is referred after having passed two kidney stones. Two older sisters suffered a few episodes of renal colic at a young age, but repeated US scans are negative for stones or nephrocalcinosis. All three siblings have elevated urinary oxalate levels. Family history of ESRD is negative. What is the most likely diagnosis? <br>A) PH1 <br>B) PH2 <br>C) PH3 <br>D) Secondary hyperoxaluria",C
Primary hyperoxaluria in children,4. Which of the following is not recommended for treating a child with advanced renal failure due to PH? <br>A) Early start of peritoneal dialysis <br>B) Preemptive liver transplantation <br>C) Combined liver and kidney transplantation <br>D) Daily hemodialysis,A
Acute and chronic antibody-mediated rejection in pediatric kidney transplantation,1. The detection of DSAs in a pediatric kidney recipient <br> a. is always associated with antibody-mediated rejection <br> b. is always associated with C4d detection in kidney biopsy <br> c. should primarily be treated with immunoadsorption/plasmapheresis <br> d. is suspicious for chronic under-immunosuppression,d
Acute and chronic antibody-mediated rejection in pediatric kidney transplantation,2. Treatment of chronic antibody-mediated rejection is not performed with <br> a. IVIGs <br> b. Bortezomib <br> c. Methotrexate <br> d. Rituximab,c
Acute and chronic antibody-mediated rejection in pediatric kidney transplantation,3. Steroid-free immunosuppression <br> a. increases the number of patients with DSA detection <br> b. leads to higher MFI values in case of DSA detection <br> c. increases the number of patients with chronic humoral rejection <br> d. is not associated with an increased risk of HLA antibody formation,d
Acute and chronic antibody-mediated rejection in pediatric kidney transplantation,4. Which is the following is not a histologic feature of antibody-mediated rejection? <br> a. glomerulitis <br> b. tubulitis <br> c. IF/TA <br> d. hyalinosis of small arteries,b
Acute and chronic antibody-mediated rejection in pediatric kidney transplantation,5. The worst outcome is associated with <br> a. IF/TA in kidney biopsy <br> b. Inflammation in kidney biopsy <br> c. IF/TA and inflammation in kidney biopsy <br> d. IF/TA and C4d detection in kidney biopsy,c
An overview of disparities and interventions in pediatric kidney transplantation worldwide,"1. For patients in Belgium and the Netherlands, what is the difference between native and immigrant children in the median time from initiating dialysis until receiving a kidney transplantation? <br> a. 2 months <br> b. 4 months <br> c. 6 months <br> d. 8 months",c
An overview of disparities and interventions in pediatric kidney transplantation worldwide,"2. Changing the organ allocation system is one means of addressing disparities in kidney transplantation. One such change was the “Share-35” system implemented by the USA in 2005. What effect did this change have on racial disparities in pediatric kidney transplantation in the USA? <br> a. It had no effect <br> b. It reduced disparities in DDKT, but increased disparities in LDKT <br> c. It increased disparities in both DDKT and LDKT <br> d. It reduced disparities in LDKT, but increased disparities in DDKT",b
An overview of disparities and interventions in pediatric kidney transplantation worldwide,"3. Concerns of non-adherence are often cited as a reason to delay kidney transplantation. In the two studies of non-adherence in the pre-transplant ESRD population cited in this review, what was the approximate rate of non-adherence identified? <br> a. 10 % <br> b. 20 % <br> c. 30 % <br> d. 40 %",b
An overview of disparities and interventions in pediatric kidney transplantation worldwide,4. What percentage of Australian aboriginal children underwent pre-emptive renal transplantation between 1990 and 2011? <br> a. 0 % <br> b. 10 % <br> c. 20 % <br> d. 30 %,a
An overview of disparities and interventions in pediatric kidney transplantation worldwide,"5. One factor associated with poor transplant outcomes is non-adherence. In studies of the U.S. pediatric transplantation population, which of the following has been found to be an independent predictor of non-adherence? <br> a. Racial or ethnic identification <br> b. Reliance on public insurance <br> c. Increased SES <br> d. Younger age",b
Biologics in renal transplantation,1. Monoclonal antibodies (Ab) used in renal transplantation: <br> a. Are always depleting Ab <br> b. Are aimed to B cells only <br> c. May be depleting or blocking Ab <br> d. Are used only to treat rejection <br> e. Are not used in children,c
Biologics in renal transplantation,"2. The effect of biologics on specific cell-target receptors: <br> a. Is always longer with the use of polyclonal Ab <br> b. Is never longer than 2 weeks after a single dose <br> c. Is shorter in tacrolimus-treated patients <br> d. Is drug and dose dependent and may last from 2 weeks to > 12 months <br> e. Has no clinical importance, as this depends on maintenance immunosuppression",d
Biologics in renal transplantation,3. The risk of PTLD is higher in young children receiving biologic agents after renal transplantation because: <br> a. They are more frequently desensitized than adolescents <br> b. They have higher risk of recurrence of primary disease <br> c. They need more blood transfusions after transplantation <br> d. They are more often EBV-seronegative < 10 years of age <br> e. They often have tonsillitis,d
Biologics in renal transplantation,"4. Combination of IVIG and rituximab, used for desensitization or treatment of humoral rejection: <br> a. Is given to block T-cell-derived cytokines <br> b. Allows removal of circulating DSA and blocks their further production by B cells <br> c. Decreases the risk of rituximab-related infectious complications by IVIG <br> d. Is not used in children <br> e. Is used in minimization protocols",b
Biologics in renal transplantation,"5. While administering depletional antibodies: <br> a. There is no need for monitoring <br> b. Monitoring drug concentration is mandatory <br> c. Monitoring target-cell count is useful to assess the effect and sometimes adjust the next dose <br> d. Monitoring concomitant CNI concentration is necessary, as there is CYP3P-driven interaction <br> e. Every dose must be adjusted to current CD4/CD8 ratio",c
Diabetic kidney disease in children and adolescents,"1. A 15-year-old boy suffering from type 1 diabetes of 10 years’ duration has a urine albumin excretion of 280 mg/day based on a timed mid-day urine sample. What is the next best step? <br> a. Start an angiotensin converting enzyme inhibiting agent <br> b. Obtain a repeat urine sample to confirm microalbuminuria (random albumin/creatinine ratio is adequate) <br> c. Obtain a repeat first-void urine sample to exclude orthostatic proteinuria <br> d. Determine if the patient had fever, dehydration, seizure, intense exercise or any other causes of transient proteinuria prior to collection of the urine sample <br> e. c and d",e
Diabetic kidney disease in children and adolescents,"2. A 7-year old girl suffering from type 1 diabetes and normal BP presents with a urine albumin/creatinine ratio of 150 mg/g in a first-void urine sample and you are assured by the parents that she has had no recent fever, seizure, dehydration or any potential causes of transient proteinuria. What is the next best step? <br> a. Start an angiotensin converting enzyme inhibiting agent <br> b. Repeat her urine albumin excretion in a timed urine collection to estimate her daily creatinine excretion. <br> c. Optimize risk factors (A1c, blood pressure); she is too young to receive angiotensin converting enzyme inhibiting agents <br> d. Repeat her urine albumin excretion in another random sample <br> e. There is no need to follow her albumin excretion. DKD does not develop this soon after diabetes onset.",b
Diabetic kidney disease in children and adolescents,"3. A 17-year-old Samoan girl suffering from type 2 diabetes for 7 years presents with BP 150/95, A1c 10, BMI 32, LDL 190, and urine albumin excretion of 200 mg/day. What is the next best management step to reduce her risk of progression to advanced DKD and other diabetic complications? <br> a. Controlling A1c <br> b. Controlling blood pressure <br> c. Encouraging weight loss <br> d. Treating macroalbuminuria (RAS inhibition) <br> e. Treating dyslipidemia <br> f. Work-up of secondary hypertension <br> g. All of the above",g
Diabetic kidney disease in children and adolescents,"4. A 11-year-old boy presents with type 1 diabetes (for 6 years), poor glycemic control (A1c 11), poorly controlled hypertension (BP 165/94), 2 g/day proteinuria, hematuria, and GFR ∼50. What is the best management? <br> a. Control risk factors (A1c, BP). This is most likely rapidly progressing DKD. <br> b. Initiate work-up for other causes of kidney disease <br> c. Initiate work-up for secondary hypertension <br> d. Obtain a repeat first-void urine sample to exclude orthostatic proteinuria <br> e. b and c",e
Diabetic kidney disease in children and adolescents,"5. A 16-year-old Hispanic girl with recently diagnosed type 2 diabetes presents with poorly controlled diabetes (A1c 9.8), hypertension (BP 163/98), dyslipidemia (LDL 189), obesity (BMI 38), and an elevated urine albumin excretion (130 mg/g). Which of the following statements is incorrect? <br> a. Her albuminuria must be benign or have other causes of kidney disease because it takes at least 1 year to even see the first structural changes of diabetes and several more years to develop albuminuria. <br> b. Given her young age, her hypertension requires work-up to exclude causes of secondary hypertension <br> c. She is at high risk of developing and rapidly progressing overt DKD despite her short diabetes duration because of many coexisting risk factors, including insulin resistance, hypertension, poor glycemic control, and dyslipidemia. <br> d. She is at high risk of glycemic failure on oral agents and requires transition to insulin. <br> e. Her presentation is consistent with early DKD as young onset type 2 diabetes is often associated with microalbuminuria and other risk factors at diagnosis. <br> f. In this young person with a high risk of early mortality, weight is one of the most significant risk factors to modify.",a
Defining Nephrotic Syndrome from an Integrative Genomics Perspective,"1. Goals of molecular profiling of NS using integrative genomics strategies include: <br> a. Defining subpopulations of affected individuals who share similar disease pathophysiology <br> b. Elucidating disease mechanisms and identifying targets for therapeutic intervention <br> c. Identifying DNA, RNA, or protein biomarkers that can predict clinical outcomes <br> d. All of the above",d
Defining Nephrotic Syndrome from an Integrative Genomics Perspective,"2. Characteristics of an integrative, systems genomics approach to disease include: <br> a. Contextualizing cellular or molecular defects within the overall functioning of the individual <br> b. The use of existing genome-scale datasets across molecular subtypes (DNA, RNA, protein) <br> c. Application of bioinformatics and computational methods to discover associations between molecular datasets <br> d. Investigating molecular and clinical data concomitantly to discover novel associations <br> e. All of the above",e
Defining Nephrotic Syndrome from an Integrative Genomics Perspective,3. Comparing gene-expression levels in the glomeruli of patients with nephrotic syndrome (NS) versus living-related kidney donors can provide the following types of information: <br> a. Genes that are differentially expressed in NS versus normal kidneys <br> b. Groups of genes that are co-regulated in the disease state versus the control state <br> c. Sets of genes that have correlation with an outcome measure such as degree of proteinuria or histologic subtype of glomerular disease <br> d. All of the above,d
Defining Nephrotic Syndrome from an Integrative Genomics Perspective,"4. In small cohorts, studying the urinary protein profiles has resulted in the identification of sets of proteins associated with: <br> a. Chronic kidney disease of all etiologies <br> b. Specific glomerulopathies such as IgA nephropathy, FSGS, and lupus nephritis <br> c. Diabetic nephropathy <br> d. Acute kidney allograft rejection <br> e. All of the above",e
Defining Nephrotic Syndrome from an Integrative Genomics Perspective,"5. A strength of the Nephrotic Syndrome Study Network (NEPTUNE) as it relates to an integrated, “omics” approach to nephrotic syndrome is: <br> a. The collection of blood, urine, renal biopsy tissue and dense, prospective clinical information from a large cohort of unrelated patients with NS for molecular (DNA, RNA, protein, metabolites) integration with clinical characteristics on a genome-wide scale <br> b. The chance to analyze kidney-specific gene expression profiles in a randomized-control, intention-to-treat trial <br> c. The ability to use new “omics” technologies and analytic approaches to study effects of monogenic forms of NS on epigenetic marks and gene expression in kindreds with multiply-affected members <br> d. Allows multi-dimensional analysis of genome-wide RNA, DNA, epigenetic, protein, clinical, and renal histologic data in patients with not only NS, but also congenital anomalies of the kidney and urinary tract (CAKUT)",a
"Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes","1. Which of the following statements pertaining to relapsing peritonitis is true? <br> a. An episode that occurs within 4 weeks of completion of therapy for an earlier episode attributable to the same organism, or one sterile episode is labeled as relapsing peritonitis. <br> b. The majority of relapsing peritonitis episodes are caused by Gram-positive organisms in adults. <br> c. Gram-negative organisms are most commonly identified in relapsing peritonitis episodes in children. <br> d. Catheter removal and at least 3 weeks of antibiotic treatment are necessary before catheter reinsertion in relapsing peritonitis.",a
"Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes","2. Which of the following statements about repeat peritonitis is true? <br> a. A peritonitis episode occurring more than 30 days after a prior episode, if the different organism is isolated from the peritoneal effluent. <br> b. Occurs following approximately 40 % of primary peritonitis episodes. <br> c. Is not a delayed form of a relapsing episode. <br> d. Has the same patterns of causative organisms and therapeutic response of relapsing peritonitis.",c
"Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes",3. Which of the following statements pertaining to zoonotic peritonitis is correct? <br> a. PD effluent culture results from zoonotic organisms can take 3–7 days until positive. <br> b. Transmission of MRSA infection from pets to humans does not occur. <br> c. Hand washing is unlikely to prevent peritonitis when regular contact with pets occurs in subjects performing PD. <br> d. Exclusion of pets from the room where APD takes place is not recommended.,a
Early life obesity and chronic kidney disease in later life,1. The kidney can be programmed by: <br> a. Birth weight <br> b. Renal sympathetic nerves <br> c. Renin–angiotensin system <br> d. All of the above,d
Early life obesity and chronic kidney disease in later life,2. A decreased nephron number causes: <br> a. Increase in the filtration surface area <br> b. Glomerular hypertrophy <br> c. Decrease in stroke volume <br> d. Decrease in BP levels,b
Early life obesity and chronic kidney disease in later life,3. Rapid postnatal growth during early life is associated with: <br> a. Hyperphagia <br> b. Leptin resistance <br> c. Hyperinsulinemia <br> d. All of the above,d
Early life obesity and chronic kidney disease in later life,4. Early postnatal overnutrition may affect renal dysfunction in later life by: <br> a. Preventing apoptosis <br> b. Increasing telomere length <br> c. Promoting glomerular filtration per nephron <br> d. Decreasing reactive oxygen species production,c
Early life obesity and chronic kidney disease in later life,5. The RAS may affect renal programming by: <br> a. Increasing inflammatory cell infiltration <br> b. Decreasing cell hypertrophy <br> c. Inhibiting cell apoptosis <br> d. All of the above,a
Evidence-based guidelines for the management of hypertension in children with chronic kidney disease,"1. Recommendations for blood pressure management in children with CKD are based on some pediatric evidence for all of the guidelines below, except: <br> a) 4th Task Force Report <br> b) European Society of Hypertension guideline <br> c) K/DOQI hypertension guideline <br> d) KDIGO blood pressure management guideline",d
Evidence-based guidelines for the management of hypertension in children with chronic kidney disease,2. The recommended method of blood pressure measurement in children with CKD is by auscultation of clinic blood pressure for all of the guidelines below except: <br> a) 4th Task Force Report <br> b) European Society of Hypertension guideline <br> c) K/DOQI hypertension guideline <br> d) KDIGO blood pressure management guideline,b
Evidence-based guidelines for the management of hypertension in children with chronic kidney disease,3. The only clinical practice guideline to recommend a blood pressure target for the initiation of antihypertensive medication is: <br> a) 4th Task Force Report <br> b) European Society of Hypertension guideline <br> c) K/DOQI hypertension guideline <br> d) KDIGO blood pressure management guideline,d
Evidence-based guidelines for the management of hypertension in children with chronic kidney disease,"4. Which of the following statements regarding good clinical practice guidelines is false? <br> a) Is based on a thorough systematic review of current evidence <br> b) Provides ratings for the strength of recommendation and quality of evidence <br> c) If well written, can provide recommendations for practitioners to follow in clinical practice for the following decade <br> d) Is based on a transparent process for development, with documentation of potential conflicts of interest",c
Evidence-based guidelines for the management of hypertension in children with chronic kidney disease,"5. Which of the following statements on the benefits and cautions regarding clinical practice guidelines is false? <br> a) When translated into clinical practice, can reduce practice variation amongst practitioners <br> b) May be used inappropriately by hospital administrators to create clinical performance measures <br> c) There is no benefit to a recommendation based only on expert opinion <br> d) Statements are intended for a specific clinical situation and are not meant to be generalized",c
Henoch–Schönlein purpura nephritis,1. For how long should the urine be tested for hematuria and albuminuria in patients with HSP? <br> a) 4 weeks <br> b) 3 months <br> c) 6 months <br> d) 12 months <br> e) Continuously every 6 months,c
Henoch–Schönlein purpura nephritis,2. In which histological compartment is IgA mainly deposited in a renal biopsy sample of HSPN patients? <br> a) Endothelial surface <br> b) Glomerular basal membrane <br> c) Peritubular interstitium <br> d) Bowman’s space <br> e) Mesangium,e
Henoch–Schönlein purpura nephritis,"3. The deposited immune complexes in HSPN typically contain: <br> a) IgA2, C3 and IgG <br> b) Galactose-deficient IgA1 <br> c) IgM–IgA2 immune complexes <br> d) IgA1–IgA2 immune complexes <br> e) Fibrin",b
Henoch–Schönlein purpura nephritis,"4. In HSPN, aberrant glycosylation is found where? <br> a) In the variable part of the light IgA1 chain <br> b) In the constant part of the heavy IgA2 chain <br> c) In the hinge region of the heavy IgA1 chain <br> d) In the constant part of the light IgA1 chain <br> e) In the junction protein of both IgA1 and IgA2 polymers",c
Henoch–Schönlein purpura nephritis,5. The estimated risk of chronic kidney disease in pediatric HSPN patients with nephritic or nephrotic syndrome is <br> a) 5 % <br> b) 10 % <br> c) 20 % <br> d) 50 % <br> e) 75 %,c
HLA sensitisation: can it be prevented?,1. Which of the following is true regarding HLA? <br> a) Red blood cells do not possess HLA. <br> b) HLA class II is mainly present on antigen-presenting cells. <br> c) An example of HLA class II is HLA-G. <br> d) CD4 T-cells interact with HLA class I to cause cell lysis.,b
HLA sensitisation: can it be prevented?,2. Which of the following patients has the highest risk of sensitisation? <br> a) A 6-month-old receiving red cells to prime haemodialysis lines. <br> b) A 2-year-old receiving a red blood cell transfusion at the time of transplantation surgery. <br> c) A 10-year-old girl on haemodialysis receiving platelets prior to removal of her infected line. <br> d) A 10-year-old girl with a failed transplant receiving a red blood cell transfusion following graft nephrectomy.,d
HLA sensitisation: can it be prevented?,"3. Which of the following is true regarding HLA-matching programs for transplantation? <br> a) The risk of rejection from HLA-A- and -B-mismatching is negligible. <br> b) Patients sensitised to HLA-DR, for example from previous -DR mismatch in a failed allograft, face significantly longer waiting times and poorer graft outcomes. <br> c) HLA matching is not clinically significant in the modern immunosuppressive era with the use of B-cell-depleting agents such as ATG and rituximab. <br> d) The presence of DSA pre-transplant is not associated with increased risks of antibody-mediated rejection.",b
HLA sensitisation: can it be prevented?,4. What is the most effective practice for preventing HLA sensitisation? <br> a) Avoidance of transfusions and optimisation of erythropoiesis-stimulating agents and iron stores. <br> b) Using washed red cells for transfusion. <br> c) Using leukodepleted red cells for transfusion. <br> d) Using HLA-matched red cells for transfusion.,a
HLA sensitisation: can it be prevented?,"5. Regarding the management of failed allografts, which of the following is true? <br> a) Allograft nephrectomies should be routinely performed as the graft is no longer functioning. <br> b) Cessation of immunosuppression in the presence of a failed allograft in situ is not associated with sensitisation. <br> c) Nephrectomies are indicated for persisting anaemia despite optimisation of medical treatment. <br> d) Nephrectomies should not be performed as they are liable to absorb antibodies and have been found to benefit subsequent retransplantation.",c
"Long-term, low-dose prophylaxis against urinary tract infections in young children",1. Which one of the following statements is true? a. UTI is more prevalent in girls across all age groups b. Acquired renal damage is more common in boys than girls c. E. coli colonizing the preputial area in boys is the reason for the difference in bacteria causing UTI between boys and girls d. Circumcision lowers the risk for UTI in infant boys by 90%,d
"Long-term, low-dose prophylaxis against urinary tract infections in young children","2. Which one of the following statements is true? a. The association between renal damage and VUR was revealed after the introduction of VCUG in the 1950s b. VUR seldom disappears spontaneously c. In children with dilating VUR, there is no difference between boys and girls regarding the rate of UTI recurrence d. Randomized controlled studies have shown that children with non-dilating VUR benefit from antibiotic prophylaxis",a
"Long-term, low-dose prophylaxis against urinary tract infections in young children",3. Which one of the following statements is true? a. High antibiotic activity in the intestine is important for a prophylactic agent to be effective b. Recurrent UTI susceptible to ongoing prophylaxis is a sign of good adherence c. There is an increased risk of resistant bacteria in recurrent UTI up to 6 months after treatment with antibiotics d. The goal for prophylaxis is to eradicate all bacteria in the periurethral area,c
"Long-term, low-dose prophylaxis against urinary tract infections in young children",4. Which one of the following statements is true? a. The resistance of E. coli to trimethoprim is around 20 % and similar all over the world. b. The main disadvantage of nitrofurantoin is the high incidence of gastrointestinal adverse effects c. Trimethoprim is rapidly excreted and urine concentrations are below inhibitory concentrations within a few hours after a single dose d. All cephalosporins have the same negative effect on the microbial flora,b
"Long-term, low-dose prophylaxis against urinary tract infections in young children",5. Which one of the following statements is true? a. Antibiotic treatment increases the risk of recurrent UTI b. Bacteria in the urine should always be eradicated regardless of symptoms c. Cranberries have been proven to protect from UTI in children d. There is no correlation between bladder and bowel dysfunction and UTI,a
Management of proteinuria in the transplanted patient,1. How frequent is proteinuria in children after renal transplantation: a. 5–10 % b. 10–20 % c. 20–40 % d. 40–80 %,d
Management of proteinuria in the transplanted patient,2. What is the recommended method for assessment of proteinuria in transplanted children? a. Albuminuria alone b. Total proteinuria and alpha-1-microglobulinuria c. Alpha-1-microglobulinuria alone d. Total proteinuria and albuminuria,d
Management of proteinuria in the transplanted patient,"3. The main causes of persistent post-transplant proteinuria are: a. Proteinuria from the diseased native kidneys b. mTOR inhibitors and calcineurin inhibitors c. Recurrence of FSGS, hypertension and rejection d. Older donor age and delayed graft function",c
Management of proteinuria in the transplanted patient,4. The consequences of proteinuria after transplantation are: a. Hyperfiltration b. Impaired graft function and survival c. Edema and hypertension d. Hypotension,b
Management of proteinuria in the transplanted patient,5. Angiotensin receptor blockers can further decrease proteinuria in children already treated with angiotensin-converting enzyme inhibitors by: a. 10–20 % b. 20–30 % c. 30–40 % d. 40–60 %,c
New Onset Diabetes After Transplant,1. Which of the following is NOT a possible risk factor for development of NODAT in children? a) African American race b) Obesity c) Peritoneal dialysis therapy d) Family history of diabetes e) Cystinosis as an underlying disease,c
New Onset Diabetes After Transplant,2. What is the reported incidence of NODAT in children? a) 3–13 % b) 25 % c) 30 % d) 30–50 %,a
New Onset Diabetes After Transplant,"3. Which of the following statements is CORRECT? a) FPG is a sensitive test to detect pre- and post-transplant hyperglycemia b) HCV infection is a risk factor for development of NODAT in untreated adults c) Early post-transplant hyperglycemia can predict NODAT d) NODAT is associated with an increase in cardiovascular events and death in children e) b, c and d",e
New Onset Diabetes After Transplant,4. Which of the following statements is INCORRECT regarding the pathogenesis of NODAT? a) Glucocorticoids increase gluconeogenesis and insulin resistance by reducing peripheral glucose uptake and tissue sensitivity to insulin b) Obesity increases peripheral insulin resistance c) The diabetogenic effect of TAC is through direct islet cell toxicity d) CsA is more diabetogenic than TAC e) The diabetogenic effects of glucocorticoids and CNIs is dose- and duration-dependent,d
New Onset Diabetes After Transplant,"5. The best approach to prevent NODAT is: a) Aggressive life style modification in overweight patients b) Early screening for glucose metabolic abnormalities pre-transplant to allow early intervention c) Implement steroid-free immunosuppressant protocol in low immunologic risk patients d) Avoid CNI and use sirolimus instead for immunosuppression post-transplantation e) a, b and c",e
Nocturnal intermittent hemodialysis,1. The term intensified dialysis refers to: A. Increasing blood flow B. Increasing dialysate flow C. More visits of the patients by staff D. Increasing time on dialysis,D
Nocturnal intermittent hemodialysis,2. Average single pool Kt/V in intensified programs is: A. 1.8–4.3 B. 4.5–9.0 C. never higher than 6.0 D. 3.5–5.8,B
Nocturnal intermittent hemodialysis,"3. In intensified HD programs, phosphate control is on average: A. better than on conventional HD B. unchanged compared to conventional HD because of the increased nutritional status C. dramatically improved, if HDF is added D. age dependent",A
Nocturnal intermittent hemodialysis,4. To optimize HD the most promising approach is: A. double time on dialysis B. add HDF C. optimizing blood flow D. using high flux filters and increasing dialysate flow,A
Nocturnal intermittent hemodialysis,5. In adult patients complications of vascular access on SDHD are: A. reduced in comparison to conventional HD B. increased in comparison to conventional HD C. unchanged in comparison to conventional HD D. have not been investigated,B
Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children,1. The following statements regarding measurement of renal function are false EXCEPT: a) Serum creatinine is a reliable screening tool. b) eGFR estimation by Schwartz formula is accurate in infants. c) eGFR overestimates the degree of renal dysfunction in transplant patients. d) Serum creatinine may be normal despite renal insufficiency in the pre-transplant period. e) Micro-albuminuria is not used as a screening test for chronic kidney disease.,d
Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children,2. The following statements regarding CRI post-transplant are true EXCEPT: a) Peri-operative renal dysfunction has an impact on post-transplant CRI and mortality. b) Peri-operative AKI may get better in certain HT patients with better haemodynamics. c) Chronic calcineurin inhibitor exposure is the most common cause for progressive CRI after transplant. d) Hypertension and hyperlipidaemia need to be controlled to minimise progression of CKD. e) Risk of CRI decreases with increasing post-transplant survival.,e
Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children,3. The following statements regarding risk factors for later renal dysfunction for thoracic transplant recipients are true EXCEPT: a) ISHLT Report 2012 did not find any association with type of CNI and later renal dysfunction. b) Earlier era of transplantation has been shown to have a higher risk. c) Certain subgroups such as those with congenital heart disease are at higher risk. d) Prolonged need for Dialysis pre- or post-transplant has been reported to be a significant risk factor for mortality after HT. e) The number of rejection episodes in recipient has no influence on long-term CRI if appropriately managed.,e
Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children,"4. The following statements regarding CNI are true EXCEPT: a) CNI cause direct nephrotoxicity. b) CNI nephrotoxicity is dose dependent, but the effect modified by individual genetic susceptibility. c) CNI nephrotoxicity decreases with duration of exposure. d) CNI toxicity has limited potential for reversibility. e) Early high exposure leads to progressive decline in renal function.",c
Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children,5. Strategies to facilitate renal recovery include the following EXCEPT: a) Minimization of CNI dosage. b) Aggressive management of hyperlipidaemia. c) Aggressive management of hypertension. d) Vigilance for adverse drug interactions. e) Aggressive diuresis and chronic effective volume contraction.,e
Primary hyperoxalurias: diagnosis and treatment,"1. Which of the following is an indication for metabolic screening of lithogenic risk factors, including hyperoxaluria? a) A single renal stone in a 3-year-old boy b) Four episodes of renal colic in a 25-year-old woman c) Renal failure with severely hyperechoic kidneys in a 4-month-old baby d) All of the above",d
Primary hyperoxalurias: diagnosis and treatment,2. What is the recommended approach to treating early-stage hyperoxaluria? a) Sodium restriction and urine alkalinization b) Extracorporeal shockwave lithotripsy c) Hyperhydration and citrate supplements d) Restriction of oxalate-rich food,c
Primary hyperoxalurias: diagnosis and treatment,"3. A 7 year-old boy is referred after having passed two kidney stones. Two older sisters suffered a few episodes of renal colic at a young age, but repeated US scans are negative for stones or nephrocalcinosis. All three siblings have elevated urinary oxalate levels. Family history of ESRD is negative. What is the most likely diagnosis? a) PH1 b) PH2 c) PH3 d) Secondary hyperoxaluria",c
Primary hyperoxalurias: diagnosis and treatment,4. Which of the following is not recommended for treating a child with advanced renal failure due to PH? a) Early start of peritoneal dialysis b) Preemptive liver transplantation c) Combined liver and kidney transplantation d) Daily hemodialysis,a
Viral-associated glomerulopathies in children,1. Which laboratory method alone is MOST indicative of a direct viral infection of the kidney? A. Elution of viral-specific antibodies from kidney tissue B. Viral culture of urine C. Immunostaining for viral antigen in kidney tissue D. Viral inclusion bodies on electron microscopy of kidney tissue E. PCR of kidney tissue for viral nucleic acid sequences,E
Viral-associated glomerulopathies in children,2. What is the most common histopathology seen in patients with nephropathy associated with hepatitis B virus? A. Membranous nephropathy B. Membranoproliferative glomerulonephritis C. Mesangioproliferative glomerulonephritis D. Pauci-immune glomerulonephritis E. Focal segmental glomerulosclerosis,A
Viral-associated glomerulopathies in children,"3. Based on the only viral surveillance study that tested the proportion of nephrotic syndrome relapses occurring within days of a viral infection (performed in the early 1980s), how commonly do viral syndromes induce relapse? A. 100 % of the time B. >50 % of the time C. only some of the time D. never",B
Viral-associated glomerulopathies in children,"4. Besides HIV, there is evidence sufficient to warrant investigation for which viral infection in children with collapsing glomerulopathy? A. Influenza virus B. Respiratory syncytial virus C. Human herpes virus 7 D. Enterovirus E. Cytomegalovirus",E
Viral-associated glomerulopathies in children,5. Immunization with heat killed virus or recombinant viral proteins might trigger glomerulopathies via which mechanism? A. Reactivation of latent viral infection B. Lymphoproliferation and cryoglobulinemia C. Non-specific activation of auto-antibody producing cells D. Induction of glomerular giant syncytia-like cells E. Direct toxicity of the adjuvant,C
Vasculitis: do we know more to classify better?,1. Which classification criteria were updated by the Chapel Hill Consensus Conference (CHCC) 2012? A. ACR 1990 B. EULAR 2008 C. CHCC 1994 D. DCVAS 2010 E. None of the above,C
Vasculitis: do we know more to classify better?,2. Which ANCA-associated vasculitis was not classified as a separate entity prior to CHCC 2012? A. GPA B. MPA C. EGPA D. PAN E. TAK,B
Vasculitis: do we know more to classify better?,3. What is a significant distinguishing feature added to the definition of polyarteritis nodosa (PAN) in CHCC 2012? A. Positive ANCA B. Negative ANCA C. Granulomatous inflammation D. Eosinophil-rich inflammation E. None of the above,B
Vasculitis: do we know more to classify better?,4. Which of the following vasculitides is most commonly associated with the mucocutaneous lymph node syndrome? A. IgA vasculitis B. Takayasu arteritis C. Kawasaki disease D. Microscopic polyangiitis E. Giant cell arteritis,C
Vasculitis: do we know more to classify better?,5. What type of vessels are primarily affected in large-vessel vasculitis (LVV)? A. Capillaries B. Arterioles C. Venules D. Aorta and its branches E. Medium-sized arteries,D
The long-term management and outcomes of cloacal anomalies,1. In embryology: a) the cloaca is separated into the urogenital and anorectum between 4 and 6 weeks of gestation; b) the allantois is not related to the primitive cloaca; c) the ureters drain separately from the primitive hindgut; d) in the female the urethra is derived from both the urogenital groove and the urogenital canal.,a
The long-term management and outcomes of cloacal anomalies,"2. Cloacal anomalies are not associated with the following: a) duplication, including bicornuate and didelphic uterus b) fibular agenesis; c) sacral and spinal anomalies; d) trachea–oesophageal anomalies.",b
The long-term management and outcomes of cloacal anomalies,"3. Which following statements are true: a) vaginal delivery is not possible with a cloacal anomaly; b) a shorter common channel has been shown to lead to less sexual dysfunction; c) continence rates for both urine and stool fall by 50 % if the channel length is >3 cm; d) following good surgery in infancy, revision rates are<2.",c
Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?,1. Liver disease in ARPKD occurs because of: a) Abnormalities in the hepatic diverticulum b) Defective formation of hepatocytes c) Abnormalities in the development of the hepatic arteries d) Ductal plate malformations e) Poor development of the pancreatic bud,d
Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?,"2. In a patient with ARPKD and advanced kidney failure, combined liver kidney transplant may be considered in association with which one of these conditions? a) ESKD b) Cerebral aneurysms c) Caroli’s disease d) Recurrent UTI e) Uremic cardiomyopathy",c
Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?,3. A 4-year-old male with ARPKD has been called for a combined liver kidney transplant. The nephrology team has been requested to do intra-operative CRRT. The purpose of CRRT in this situation would be to: a) Correct coagulation disturbances b) Treat cardiac arrhythmias c) Prevent blood loss d) Maintain lower serum potassium e) Lower serum creatinine,d
Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?,4. What percent of children with ARPKD will have both severe kidney and liver disease? a) 90 % b) 80 % c) 10 % d) 2 % e) 40 %,e
Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?,5. Diagnostic testing in a child with ARPKD being considered for transplantation will include all except: a) Magnetic resonance pancreatico-cholangiogram b) Upper gastrointestinal endoscopy c) Doppler ultrasound of the kidney d) Doppler ultrasound of the portal venous system e) Chest X-ray,c
Tuberous sclerosis complex: the past and the future,1. Mutational analysis of TSC1 and TSC2 is negative in a patient with a shagreen patch and multiple renal angiomyolipomas measuring 3 cm in diameter. a) The diagnosis of TSC is excluded. b) The diagnosis of TSC is suspected. c) The diagnosis of TSC is definite. d) Mutational analysis should be repeated.,c
Tuberous sclerosis complex: the past and the future,2. Abdominal MRI shows a renal fat-poor lesion measuring 4 cm that has been stable in growth for 2 years. What action do you take? a) Plan kidney-sparing surgery. b) Perform a needle biopsy. c) Plan an abdominal MRI in 6 months’ time. d) Plan an abdominal ultrasound in 6 months’ time.,c
Tuberous sclerosis complex: the past and the future,3. A patient with TSC presents to the emergency unit with a bleeding angiomyolipoma. What action do you take? a) Perform kidney-sparing surgery. b) Perform a total nephrectomy. c) Perform embolization followed by corticosteroid therapy. d) Treat the patient with an mTORi.,c
Tuberous sclerosis complex: the past and the future,4. What are the new recommendations for the preferred surveillance of renal lesions in TSC? a) Renal ultrasound every 1 to 3 years b) CT of the abdomen every 1 to 3 years c) MRI of the abdomen every 1 to 3 years d) Blood pressure and renal function assessment every 1 to 3 years.,c
Tuberous sclerosis complex: the past and the future,5. Everolimus is a potential target treatment for TSC because it a) Inhibits the activation of mTOR b) Inhibits the overactivation of mTOR c) Inhibits the cell cycle d) Inhibits the formation of blood vessels,b
Tobacco and the pediatric chronic kidney disease population,1. On which of the following structure(s) do nicotine receptors exist: a. Mesangial cells b. Basement membrane c. Collecting tubules d. Loop of Henle e. None of the above,a
Tobacco and the pediatric chronic kidney disease population,2. Which of the following is NOT a barrier to effective tobacco counseling reported by pediatric nephrologists: a. Lack of training b. Lack of time c. Poor reimbursement d. Parental resistance e. Unfamiliarity with billing,d
Tobacco and the pediatric chronic kidney disease population,3. The earliest period of initiating tobacco use among adolescents with CKD reported in the literature is: a. 11th grade b. 6th grade c. 8th grade d. 10th grade e. 9th grade,b
Tobacco and the pediatric chronic kidney disease population,4. Second-hand smoke exposure has been associated with which of the following: a. Normal levels of C-reactive protein b. Insignificant cognitive impairment c. Decreased aortic distensibility d. Increased bone mineral density e. Normal blood pressure load,c
Tobacco and the pediatric chronic kidney disease population,"5. Which of the following is true about the using cotinine measurement as an objective measure of tobacco use: a. It has a long half-life, >36 h b. Metabolism is dependent on renal function c. Cotinine can only be measured in body fluids d. It is recommend for routine clinical use, especially in detecting low levels of exposure e. Cotinine clearance from the body is independent of gender and age",b
Tobacco and the pediatric chronic kidney disease population,6. Effective tobacco cessation and avoidance counseling involves which of the following: a. Assessing intention to use tobacco as often as possible b. Participation of all members of the pediatric nephrology team c. Encouraging smoke-free homes and cars for parents who are not interested in quitting d. Conspicuous display in each patient’s medical record of tobacco status e. All of the above,e
Therapeutic drug monitoring in pediatric renal transplantation,1. Which answer is wrong? Therapeutic drug-monitoring is reasonable when: A) There is an association of drug concentration and pharmacological effect B) There are drug–drug interactions C) The therapeutic window is wide D) There is no or inadequate response to standard dose E) Side-effects appear,C
Therapeutic drug monitoring in pediatric renal transplantation,2. Which of the following statements is correct? A) Pharmacokinetic monitoring stands for a concentration–time relationship B) Pharmacodynamic monitoring stands for a concentration–time relationship C) Pharmacogenetic monitoring is highly variable over a patient’s life D) The area under the concentration–time curve (AUC) can be exactly calculated by simply adding trough level and peak concentration E) C0 values are sometimes higher than Cmax values,A
Therapeutic drug monitoring in pediatric renal transplantation,"3. Which of the following is correct? A) Glucocorticoids are well suited for pharmacokinetic drug monitoring B) Absorption, distribution, metabolism and clearance of a drug do not change with a child’s development C) Inter-individual variability of plasma concentrations is not an argument for TDM D) Generic formulations of a drug may not have identical PK as the original formulation E) Trough levels are not a surrogate marker for AUC",D
Therapeutic drug monitoring in pediatric renal transplantation,"4. Which of the following statements is incorrect? A) Clearance of tacrolimus depends on age, time after transplant and liver function B) Tacrolimus is extensively bound to erythrocytes C) Despite limitations in C2 monitoring of CsA may be helpful to detect overexposed patients D) There is a PK/PD relationship of MPA AUC values and the risk of acute rejection episodes in the initial period after renal transplantation E) MPA exposure hardly shows any inter-patient variability",E
Therapeutic drug monitoring in pediatric renal transplantation,5. Which of the following is incorrect? A) Antacids do influence MPA exposure B) TDM of everolimus is not recommended because it has no potential to improve efficacy and to reduce toxicity C) For TDM using pharmacokinetic parameters it is important to know whether the drug has been taken after a meal or in a fasting state D) When TDM is conducted using pharmacokinetic parameters the drug’s concentration is measured in the desired biological matrix E) Inosine monophosphate dehydrogenase may serve as a biomarker for MPA efficacy,B
Therapeutic drug monitoring in pediatric renal transplantation,1. Which answer is wrong? Therapeutic drug-monitoring is reasonable when: A) There is an association of drug concentration and pharmacological effect B) There are drug–drug interactions C) The therapeutic window is wide D) There is no or inadequate response to standard dose E) Side-effects appear,C
Therapeutic drug monitoring in pediatric renal transplantation,2. Which of the following statements is correct? A) Pharmacokinetic monitoring stands for a concentration–time relationship B) Pharmacodynamic monitoring stands for a concentration–time relationship C) Pharmacogenetic monitoring is highly variable over a patient’s life D) The area under the concentration–time curve (AUC) can be exactly calculated by simply adding trough level and peak concentration E) C0 values are sometimes higher than Cmax values,A
Therapeutic drug monitoring in pediatric renal transplantation,"3. Which of the following is correct? A) Glucocorticoids are well suited for pharmacokinetic drug monitoring B) Absorption, distribution, metabolism and clearance of a drug do not change with a child’s development C) Inter-individual variability of plasma concentrations is not an argument for TDM D) Generic formulations of a drug may not have identical PK as the original formulation E) Trough levels are not a surrogate marker for AUC",D
Therapeutic drug monitoring in pediatric renal transplantation,"4. Which of the following statements is incorrect? A) Clearance of tacrolimus depends on age, time after transplant and liver function B) Tacrolimus is extensively bound to erythrocytes C) Despite limitations in C2 monitoring of CsA may be helpful to detect overexposed patients D) There is a PK/PD relationship of MPA AUC values and the risk of acute rejection episodes in the initial period after renal transplantation E) MPA exposure hardly shows any inter-patient variability",E
Therapeutic drug monitoring in pediatric renal transplantation,5. Which of the following is incorrect? A) Antacids do influence MPA exposure B) TDM of everolimus is not recommended because it has no potential to improve efficacy and to reduce toxicity C) For TDM using pharmacokinetic parameters it is important to know whether the drug has been taken after a meal or in a fasting state D) When TDM is conducted using pharmacokinetic parameters the drug’s concentration is measured in the desired biological matrix E) Inosine monophosphate dehydrogenase may serve as a biomarker for MPA efficacy,B
Tuberous sclerosis complex the past and the future,1. Mutational analysis of TSC1 and TSC2 is negative in a patient with a shagreen patch and multiple renal angiomyolipomas measuring 3 cm in diameter. a) The diagnosis of TSC is excluded. b) The diagnosis of TSC is suspected. c) The diagnosis of TSC is definite. d) Mutational analysis should be repeated.,c
Tuberous sclerosis complex the past and the future,2. Abdominal MRI shows a renal fat-poor lesion measuring 4 cm that has been stable in growth for 2 years. What action do you take? a) Plan kidney-sparing surgery. b) Perform a needle biopsy. c) Plan an abdominal MRI in 6 months’ time. d) Plan an abdominal ultrasound in 6 months’ time.,c
Tuberous sclerosis complex the past and the future,3. A patient with TSC presents to the emergency unit with a bleeding angiomyolipoma. What action do you take? a) Perform kidney-sparing surgery. b) Perform a total nephrectomy. c) Perform embolization followed by corticosteroid therapy. d) Treat the patient with an mTORi.,c
Tuberous sclerosis complex the past and the future,4. What are the new recommendations for the preferred surveillance of renal lesions in TSC? a) Renal ultrasound every 1 to 3 years b) CT of the abdomen every 1 to 3 years c) MRI of the abdomen every 1 to 3 years d) Blood pressure and renal function assessment every 1 to 3 years.,c
Tuberous sclerosis complex the past and the future,5. Everolimus is a potential target treatment for TSC because it a) Inhibits the activation of mTOR b) Inhibits the overactivation of mTOR c) Inhibits the cell cycle d) Inhibits the formation of blood vessels,b
A systems-based approach to managing blood pressure in children following kidney transplantation,2. Nonphysician providers can play important roles in BP management including: a. Recognizing abnormal BP b. Managing medications according to protocol c. Providing self-management support to patients d. Coordinating close follow-up e. All of the above,e
A systems-based approach to managing blood pressure in children following kidney transplantation,3. Which one of the following is the most frequent pattern of abnormal BP in children with kidney transplantation? a. Diurnal hypertension b. Nocturnal hypertension c. White-coat hypertension d. Combined diurnal and nocturnal hypertension,b
A systems-based approach to managing blood pressure in children following kidney transplantation,4. Self-management of BP is most effective if it includes: a. Education b. Frequent interaction with nonphysician providers for BP follow-up c. Behavior modification strategies d. Protocol-based medication management e. All of the above,e
A systems-based approach to managing blood pressure in children following kidney transplantation,5. Which of the following statements is true? a. Controlling BP is more important than the selection of any specific agent b. ACE inhibitors are preferable in the presence of proteinuria c. Minimizing steroids is shown to improve BP control d. Evidence-based standardized treatment protocols improve BP control e. All of the above,e
Abnormalities of vascular structure and function in pediatric hypertension,1. Which vascular parameter predicted future CV events in the Framingham Heart Study? a) cIMT b) PWV c) AIx d) FMD e) Venous plethysmography,b
Abnormalities of vascular structure and function in pediatric hypertension,2. Adolescents with chronic renal insufficiency have a thinner carotid artery than patients requiring dialysis. a) True b) False,a
Abnormalities of vascular structure and function in pediatric hypertension,3. Brachial flow-mediated dilation is a robust measure of arterial stiffness. a) True b) False,b
Abnormalities of vascular structure and function in pediatric hypertension,4. Which measure of arterial stiffness can be calculated from 24-h ambulatory BP recordings? a) AIx b) FMD c) AASI d) LFD,c
Abnormalities of vascular structure and function in pediatric hypertension,5. Renal transplant has led to improvement in which of the following vascular parameters? a) cIMT b) LFD c) AIx d) FMD e) Venous plethysmography,a
Acute pyelonephritis in children,1. Which children are at major risk of UTIs and pyelonephritis? a) Children undergoing immunosuppressive therapy b) No risk factors can be associated with fUTI in children c) Children with urinary tract abnormalities d) Neonates,c
Acute pyelonephritis in children,"2. Which are the best predictors of complications in infants (<90 days) with AP? a) The presence of fever b) High fever and normal C-reactive protein value c) No markers d) Bad clinical condition, an increase in C-reactive protein, creatinine, and procalcitonin levels but no fever",d
Acute pyelonephritis in children,"3. Which diagnostic approach do the recent guidelines suggest after a first fUTI? a) Top-down approach b) Performing a US, while VCUG and DMSA scanning for selected at-risk children c) Complete imaging work-up (US, DMSA scan, and VCUG) in all children d) No imaging",b
Acute pyelonephritis in children,4. What is the risk of chronic kidney damage in children following a fUTI? a) < 0.5 % b) 5 % c) 10 % d) >20 %,a
Acute pyelonephritis in children,"5. What is the best treatment of a well-appearing infant >2 months of age with AP, according to the most recent guidelines? a) Parental antibiotic treatment and hospitalization b) Oral antibiotic treatment for 10–14 days c) Initial oral antibiotic followed by parenteral treatment d) Initial parenteral antibiotic followed by oral treatment",b
Assessment of kidney function in preterm infants lifelong implications,"1. The human kidney forms from which sequential developmental stages? a. Pronephros, metanephros, mesonephros b. Antinephros, neonephros, humanonephros c. Metanephros, mesonephros, pronephros d. Pronephros, mesonephros, metanephros",d
Assessment of kidney function in preterm infants lifelong implications,2. What is considered the gold standard for measurement of GFR in infants? a. Iohexol b. Inulin c. Creatinine clearance d. Para-aminohippurate clearance,b
Assessment of kidney function in preterm infants lifelong implications,3. An endogenous marker of GFR must fulfill all of the following criteria except it: a. Must be freely filtered by the glomerular barrier b. Must be secreted and reabsorbed by the renal tubule at an equal rate c. Must be produced at a constant rate d. Must not be protein bound,b
Assessment of kidney function in preterm infants lifelong implications,4. The nephron endowment is determined by which of the following: a. Intra-uterine environment b. Genetic polymorphisms of intra-uterine drivers of nephrogenesis c. Prematurity and post-natal completion of nephrogenesis d. All of the above,d
Assessment of kidney function in preterm infants lifelong implications,5. Which of the following subjects does not have oligonephronia? a. Six-year-old born 36 weeks preterm with a serum creatinine of 0.4 mg/dl and a TKV/m2=160 ml/m2 b. Fifteen-year-old obese male with unilateral renal agenesis with a TKVof 135 ml and a BSA=2.00 m2 c. Three-year-old born extremely preterm and low birth weight with serum creatinine of 0.6 mg/dl and a TKV/m2=85 ml/m2 d. Six-year-old born at term with IUGR who is growing well along the 15th percentile for length and the 50th percentile for weight.,a
Autophagy in renal diseases,1. Which of the following compounds does NOT induce autophagy: a. mTOR inhibitor b. Metformin c. Curcumin d. Chloroquine e. Caspase inhibitor f. Cyclin-dependant kinase inhibitors g. Triptolide,e
Autophagy in renal diseases,"2. One of the following sentences is incorrect: a. Macroautophagy is a degradation system for long-lived cytoplasmic proteins and dysfunctional organelles b. Microautophagy is a selective degradative process. It involves engulfment of cytoplasmic cargo by direct invagination of the lysosomal membranes into autophagic tubes c. The unique features of chaperone-mediated autophagy are the selectivity on the degraded proteins and the direct translocation of substrate proteins across the lysosomal membrane without the requirement for the formation of additional vesicles d. Autophagy is a major protective mechanism allowing cell survival in response to multiple stressors and helping organisms to defend against degenerative, inflammatory, infectious, and neoplastic diseases",b
Autophagy in renal diseases,3. What is the significance of increased LC3-II in a sample? a. Autophagy stimulation b. Autophagy suppression c. Suppressed autophagic flux d. Enhanced autophagic flux e. Either autophagy stimulation or suppressed autophagic flux f. Either autophagy stimulation or enhanced autophagic flux,e
Autophagy in renal diseases,4. How do podocytes and tubular cells differ in autophagy dynamics? a. Podocytes are more dependent on CMA than tubular cells b. Podocytes show no sign of macroautophagy in normal physiological conditions c. Tubular cells are more dependent on CMA than podocytes d. Tubular cells show no signs of macroautophagy in starved conditions,c
Autophagy in renal diseases,"5. How do autophagy and apoptosis interconnect? (2 answers are correct) a. Autophagy degrades the pro-apoptotic caspases b. Caspases cleave and inactivate different autophagy proteins c. Autophagy degrades damaged mitochondria, a source of apoptosis initiation via the intrinsic pathway d. Pro-apoptotic proteins Bcl-2 family proteins Bax and Bak bind and inhibit Beclin1, thereby preventing autophagy",b
Blood pressure assessment from BP level to BP variability,"1. Oscillometric BP device: a) Measures both SBP and DBP directly b) Only SBP is measured directly, DBP is calculated c) MAP and DBP are measured; SBP is calculated by the BP device d) Only MAP is measured directly, whereas SBP and DBP are calculated",d
Blood pressure assessment from BP level to BP variability,2. There is evidence that left ventricular hypertrophy and subclinical arterial injury are significantly correlated with BP values assessed by: a) Office measurements b) Home BP measurements and office measurements c) Both office and ambulatory BP monitoring d) ABPM only,d
Blood pressure assessment from BP level to BP variability,3. Long-term BP variability can be assessed using: a) Electrocardiogram tracing b) ABPM monitoring (performed only once) c) Clinic-to-clinic or home BP monitoring d) Beat-to-beat BP variability,c
Blood pressure assessment from BP level to BP variability,4. SD SBP assessed by ABPM: a) Indicates amplitude of BP b) SD >10 mmHg indicates physiological nocturnal dipping c) Is a marker of BP variability d) Is a measure of acrophase,c
Blood pressure assessment from BP level to BP variability,5. Acrophase is: a) The height of the amplitude of BP circadian rhythm b) Time from midnight to the highest value of BP in BP rhythm c) The measure of nocturnal dipping d) Measured from home BP readings,b
Diuretics in the treatment of hypertension,"1. In children and adults with hypertension, which of the following antihypertensive agents are considered appropriate for first-line pharmacologic therapy? a) ACE inhibitors b) ARBs c) Calcium channel blockers d) Thiazide diuretics e) All of the above",e
Diuretics in the treatment of hypertension,2. Which of the following thiazide diuretics is associated with a greater improvement in the 24-h blood pressure profile? a) Chlorthalidone b) Hydrochlorothiazide c) Chlorothiazide d) Metolazone,a
Diuretics in the treatment of hypertension,"3. Loop diuretics (e.g., furosemide) may be useful when hypertension is associated with which of the following conditions? a) Essential hypertension b) Chronic kidney disease c) ENaC mutations d) Anuric patients on chronic hemodialysis",b
Diuretics in the treatment of hypertension,4. A documented allergy to sulfa-based antibiotics is a contraindication to the use of thiazide diuretics? a) True b) False,b
Diuretics in the treatment of hypertension,5. Which of the following is the proposed mechanism for the blood pressure-lowering effect associated with chronic thiazide therapy? a) A decrease in the ECF volume b) Decreased cardiac output c) A reduction in the RAAS activity d) Vasodilation,d
Growth hormone therapy in children with CKD after more than two decades of practice,1. Which is NOT true? Improved final height in children who are on RRT is associated with: a. Older age at start of RRT b. A more recent era for the start of RRT c. Cumulative percentage time with a transplant d. Greater HtSDS at initiation of RRT e. Longer duration of dialysis,e
Growth hormone therapy in children with CKD after more than two decades of practice,"2. Which of the following does not occur in CKD? a. GH levels may be increased b. GH secretion is reduced by metabolic acidosis, malnutrition, and steroids c. Growth hormone binding protein levels are high d. SOCS dephosphorylate the GH-activated JAK-STAT cascade and so exert a GH-regulated negative feedback loop e. GH increases the ratio of IGF-1 to IGFBP3",c
Growth hormone therapy in children with CKD after more than two decades of practice,3. Which of the following factors at the start of treatment is not associated with a good response to rhGH? a. Younger age b. Lower HtSDS c. Greater target-height deficit d. Better growth velocity e. Greater bone age retardation,d
Growth hormone therapy in children with CKD after more than two decades of practice,4. Which is true? rhGH is associated with: a. Acceleration of bone age compared to chronological age b. Increased rate of progression of CKD c. Rejection episodes in transplant patients d. No improvement in body composition e. Benign intracranial hypertension,e
Growth hormone therapy in children with CKD after more than two decades of practice,5. Which is NOT true? RhGH: a. Has been shown to be effective in RCTs over 2 years of treatment b. It is unlikely that this height gain will be lost and is therefore expected to contribute to an improvement in final height. c. There are RCTs of its effect on final height d. The final height of children on RRT is improving e. The contribution of rhGH to the improvement in final height is unknown,c
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,"1. According to the current literature, the overall HRQoL of patients on PD compared with patients on HD is: a) Less impaired b) Equally impaired c) More impaired d) No sufficient evidence",b
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,2. Which medical factor has not been associated with impaired HRQoL? a) Final height b) Side effects of immunosuppressive regimen c) Level of serum hemoglobin d) Level of serum urea,d
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,"3. Compared with parent-proxy HRQoL scores, patients report: a) Higher HRQoL scores b) Lower HRQoL scores c) Comparable HRQoL scores d) Scores are never obtained from both patients and caregivers",a
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,"4. Which statement is true regarding sufficient support of adolescent patients? a) Adolescent patients should be consciously checked and overheard to prevent them from not following medical recommendations b) Adolescent patients should be encouraged to manage their own health and to take responsibility in their treatment c) Adolescent patients often do not want to share their experiences and coping strategies with other patients d) Adolescent patients should not be informed about risk-taking behaviors, as this could make such behaviors more likely to be attempted",b
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,5. The risk for developmental delay regarding neurocognitive functioning is the highest for patients with ESRD onset at age: a) <1 year b) 1–2 years c) 2–5 years d) >6 years,a
Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice,6. Adult survivors of pediatric ESRD report: a) High scores on both emotional and physical HRQoL domains b) Low scores on both emotional and physical HRQoL domains c) High scores on emotional domains but low scores on physical HRQoL domains d) Low scores on emotional domains but high scores on physical HRQoL domains,c
Kidney retransplantation in children following rejection and recurrent disease,1. Which of the following is true regarding the current state of kidney retransplantation? a. There are decreasing numbers of patients on the DD wait list awaiting retransplantation b. Graft survival rate increases with subsequent transplants c. Recent changes in organ allocation policy to pediatric patients have resulted in the increased use of HLA-mismatched organs d. Repeat transplant patients comprise approximately 25 % of the pediatric wait list,c
Kidney retransplantation in children following rejection and recurrent disease,2. The outcome (graft survival rate) of a retransplant is: a. The same as an initial graft b. ±15 % lower than an initial graft c. Better if the failed graft remains in situ d. Not influenced by the recurrence of the primary disease,b
Kidney retransplantation in children following rejection and recurrent disease,"3. Which of the following is true? a. BK polyoma virus nephropathy has a high rate of recurrence, and therefore should be a contraindication to retransplantation b. FSGS is the most common disease that recurs in pediatric retransplant recipients. c. EBV-associated post-transplant lymphoproliferative disease has a high rate of recurrence in subsequent grafts d. The rate of recidivism in non-adherent patients is relatively high, and therefore non-adherence should be a contraindication to retransplantation",b
Kidney retransplantation in children following rejection and recurrent disease,4. Which of the following is true of BK nephropathy and EBV PTLD following an initial graft loss? a. They do not recur following retransplantation b. They are a contraindication to retransplantation c. Viral prophylaxis is uniformly effective in preventing recurrence following retransplantation d. Recurrence is limited following retransplantation,d
Kidney retransplantation in children following rejection and recurrent disease,5. All of the following treatments may be required to facilitate retransplantation EXCEPT: a. Reduction in HLA PRA b. Reduction in DSA c. Reduction in putative biomarker d. Enhance activation of the classical complement pathway,d
Lessons learned from the ESPN/ERA–EDTA Registry,1. A population-based registry (please select 2 answers): a. is an organized system that uses observational study methods to collect uniform data from a population defined by a particular disease b. must include both individuals with and without the disease c. allows an exhaustive registration of cases in order to provide reliable epidemiological data d. does not allow monitoring trends in incidence and prevalence of the disease over time e. is a superior methodology to randomized controlled trials in the hierarchy of evidence in therapy.,"a, c"
Lessons learned from the ESPN/ERA–EDTA Registry,"2. Registry data on patient characteristics, incidence and prevalence of RRT in Europe showed that (please select 2 answers): a. glomerulonephritis is the most common primary disease requiring RRT b. incidence of RRT has remained relatively stable around 6 pmarp in children <15 years c. incidence of pediatric RRT has constantly increased over the past 10 years d. considerable differences in incidence and prevalence exist between countries e. hemodialysis is the most common RRT modality among incident patients.","b, d"
Lessons learned from the ESPN/ERA–EDTA Registry,3. Patient survival on RRT (please select one answer): a. is the highest in the youngest age group (<5 years of age) b. is around 85 % at 4 years after the start of RRT c. is higher in children starting with dialysis than in preemptive kidney transplant recipients d. is >75 % at 5 years in those who started dialysis during the neonatal period e. is similar in Europe and in the USA.,d
Lessons learned from the ESPN/ERA–EDTA Registry,4. Which of the following ESPN/ERA–EDA Registry findings regarding CKD complications are true? (please select two answers): a. high Hb levels are associated with low ferritin levels (25–50 ng/ml) among dialysis patients b. uncontrolled hypertension is more prevalent in PD than in HD patients c. hyperlipidemia is uncommon after successful kidney transplantation d. around a quarter of RRT children reach an adult height below the 3rd percentile e. more than one third of adolescents on RRT are overweight or obese.,"a, e"
Lessons learned from the ESPN/ERA–EDTA Registry,"5. In studies focusing on rare diseases, the ESPN/ERA–EDTARegistry found that (please select one answer): a. the onset of RRT for cystinosis has been delayed over time b. patient survival improved over time in children with cystinosis and in those with oxalosis c. kidney graft survival is poorer in children with oxalosis receiving a kidney transplantation alone as compared with liver–kidney transplantation d. the majority of patients with CAKUT who progress to ESRD will start RRT during adulthood e. all of the above.",e
Paediatric obesity and renal transplantation: current challenges and solutions,"1. Regarding the definition of obesity in children: a. Waist-to-hip ratio is the most widely accepted measurement of excess weight; b. Individual clinical obesity is defined as a weight ≥91st centile; c. Clinical overweight in population measurements is defined as a weight ≥85th centile; d. Obesity is defined as a BMI in excess of 25 kg m2; e. The reference datasets of the IOTF, CDC and WHO are the least commonly used reference ranges for paediatric obesity.",c
Paediatric obesity and renal transplantation: current challenges and solutions,2. Following renal transplantation in obese paediatric recipients: a. Wound infection rates are reduced if sirolimus is used; b. Delayed graft function occurs with equal incidence with increasing levels of obesity; c. Delayed graft function is primarily caused by the surgeon taking too long to perform the operation; d. Patient survival is no different from the survival of patients on dialysis; e. Graft survival is equivalent to that observed in normal weight recipients.,e
Paediatric obesity and renal transplantation: current challenges and solutions,3. Regarding outcomes following renal transplantation in paediatric recipients: a. The risk of acute rejection is comparable with that of normal weight patients; b. The risk of patient death is higher in all obese recipients than in normal weight recipients; c. The risk of patient death from cardiovascular disease and infection is higher in normal weight recipients; d. The effects of the metabolic syndrome are eradicated by renal transplantation; e. The risk of metabolic complications is lower with steroid free immunosuppressive regimens.,a
Paediatric obesity and renal transplantation: current challenges and solutions,4. In considering weight management and transplantation: a. Obesity in children is influenced by parents' eating habits; b. Weight gain post-transplantation is lower in pre-transplant obese children; c. Bariatric surgery following transplantation has shown a clear benefit in improving graft survival and is recommended; d. There is no role for steroid weaning regimens; e. Psychosocial factors have no role in managing post-transplant obesity.,a
Paediatric obesity and renal transplantation: current challenges and solutions,5. Regarding paediatric renal transplantation: a. Child and adolescent obesity is not a current concern; b. Weight tends to fall rather than increase following transplantation in this age group; c. Younger age and excess pre-transplantation weight is associated with increased weight following transplantation; d. Graft survival is unaffected by weight in paediatric renal transplantation; e. Obese children should be deferred from transplantation until they lose weight.,c
Pathophysiology and clinical presentations of salt-losing tubulopathies,"1. In 1962 Bartter and colleagues described their two index patients in the following way: besides hyperplasia of the juxtaglomerular complex with hyperaldosteronism and hypokalemic alkalosis, both patients, a 5-year-old black boy and a 25-year-old black male patient, had symptoms of tetany as indicated by positive Chvostek’s and Trousseau’s sign as well as carpopedal spasm. The boy’s urine osmolality rose after dehydration for 24 h to 717 mOsm per kilogram body weight. No other key features are described in this patient. The key features of the older patient were as follows isosthenuria, renal calcified deposits, and serum levels of chloride down to 41.3 mEq/l. Which diagnosis is your first choice for both the young boy and the adult patient when applying the new physiologic classification? a) boy: DC1; adult: L-DC1 type b) boy: L2; adult: DC1 type c) boy: DC1; adult: DC2 type d) boy: DC2; adult: L1 type",c
Pathophysiology and clinical presentations of salt-losing tubulopathies,"2. In 1966 Gitelman and colleagues published the case reports of two sisters aged of 47 and 41 years and one unrelated 22-year-old woman, as follows. Besides hypokemia and hypomagnesemia, all three white patients had normal specific gravity on random urine specimen (the two sisters) or a slightly reduced maximal urinary concentration (the young woman). Despite documented hypomagnesemia in all three patients, only the young female, who also had marked metabolic alkalosis with hypochloremia, sometimes displayed signs of tetany, such as carpopedal spasm and a positive sign of Trousseau. What is the most likely diagnosis of the two sisters and the unrelated young woman? a) sisters: DC3 and unrelated woman: DC2 type b) sisters: DC1 and unrelated woman: DC2 type c) sisters: DC2 and unrelated woman: DC1 type d) sisters: DC1 and unrelated woman: DC1 type",b
Pathophysiology and clinical presentations of salt-losing tubulopathies,"3. In 1974 McCredie and colleagues published a series of four pediatric case reports in which they described a variant of Bartter’s syndrome with hypercalciuria in potassium-losing nephropathy. All four children were born prematurely, and in all cases pregnancy was associated with polyhydramnios. All infants failed to thrive and had a vasopressin-insensitive urinary concentrating defect. Hypokalemia was not necessarily present on initial presentation. Urine calcium was high in all patients, and nephrocalcinosis was a constant finding. What are the most likely diagnoses of these four children? a) L2 type b) L-DC2 type c) L-DC1 type d) L1 type",a
Pathophysiology and clinical presentations of salt-losing tubulopathies,"4. When comparing different types of SLTs with each other, which comparison demonstrates best the compensatory function of ClC-Ka (in TAL)? a) L1 with L2 type b) DC2 with L-DC1 type c) L1 with L-DC1 type d) DC1 with DC2 type",b
Pathophysiology and clinical presentations of salt-losing tubulopathies,5. Which functional protein is not directly stimulated by increased urinary flow in the distal part of the nephron? a) ENaC b) BK channels c) H+-ATPase d) COX 2 e) Na-K-ATPase,e
Perioperative fluid management and postoperative hyponatremia in children,1. Which of the following BEST explains the increased risk of hyponatremia in postoperative patients? a) Patients are limited to oral water intake only when made NPO (nil per os) in the pre-operative phase b) Patients often have multiple non-osmotic stimuli for ADH release c) Patients predominantly receive hypotonic IV fluid in the intraoperative period d) Patients are not at increased risk of developing hyponatremia in the postoperative period,b
Perioperative fluid management and postoperative hyponatremia in children,2. Which of the following is MOST true about IV fluid therapy in postoperative patients? a) Postoperative patients should receive IV fluid rate at twice the maintenance rate (calculated by the Holliday/Segar method) for the first 12 h after surgery since there is high volume loss during surgery b) The use of hypotonic IV fluid in the postoperative period has been shown to increase the risk of postoperative hyponatremia c) The IV fluid administration rate in the postoperative phase does not affect the risk of postoperative hyponatremia at all d) Generally healthy postoperative patients tolerate various types and amounts of IV fluid therapy without complications,b
Perioperative fluid management and postoperative hyponatremia in children,"3. A 14-year old boy is admitted to the PICU for postoperative care following a lobectomy to treat necrotizing pneumonia. On exam, he is alert, awake, and in mild distress from pain. His heart rate is 114 with blood pressure of 92/42. His eyes appear mildly sunken. Which of the following should be AVOIDED in this patient’s postoperative care? a) Correct his volume deficiency with isotonic IV fluid b) Start patient-controlled analgesia (PCA) for pain control c) Minimize nauseous stimuli d) Start 5 % dextrose in 0.9 % saline at twice maintenance rate",d
Perioperative fluid management and postoperative hyponatremia in children,4. Which of the following IV fluid is hyperosmolar and isotonic to plasma? a) 5 % dextrose and 0.45 % saline b) 0.9 % saline c) 5 % dextrose and 0.9 % saline d) Lactated Ringer’s,c
Perioperative fluid management and postoperative hyponatremia in children,"5. A 12-year-old girl underwent an appendectomy 24 h ago and she has been receiving 5 % dextrose–0.45 % saline at 80 mL/h. She is euvolemic on exam and is in no distress or pain. She continues to have nausea and is slowly advancing her diet. Her electrolyte panel is notable for plasma [Na] of 131 mEq/L. The next BEST step is to a) Give her ondansetron and make her NPO b) Have her eat salty food c) Give her 3 % saline bolus d) Stop her current IVF and, if oral intake is insufficient, place her on 5 % dextrose–0.9 % saline",d
Platelet abnormalities in nephrotic syndrome,1. Which statement about platelet activation is true? a. Von Willebrand factor contributes to platelet adhesion via the platelet PAR4 receptor. b. Increased cytosolic calcium concentrations stimulate platelet activation. c. Coagulation factor VIII stimulates secretion of platelet-dense granules. d. Increased cytosolic calcium concentrations prevent degranulation of dense and α-granules.,b
Platelet abnormalities in nephrotic syndrome,2. Which of the following agents is not an inducer of platelet aggregation? a. Collagen b. Arachidonic acid c. cAMP d. Thrombin,c
Platelet abnormalities in nephrotic syndrome,3. Which of the following mechanisms is not involved in increased platelet activation during idiopathic nephrotic syndrome? a. Elevated plasma levels of platelet-activating substances b. Factor V Leiden thrombophilia c. Decreased plasma levels of platelet inhibitory proteins d. A reduced negative charge of the platelet surface,b
Platelet abnormalities in nephrotic syndrome,"4. How many days should aspirin be withheld before reliable platelet aggregation tests can be performed? a. At least 5 days, because it causes reversible inhibition of cyclooxygenase-1 b. At least 3 days, because it causes reversible inhibition of cyclooxygenase-1 c. At least 10 days, because it causes irreversible inhibition of cyclooxygenase-1 d. At least 1 day, because it causes irreversible inhibition of cyclooxygenase-1",c
Platelet abnormalities in nephrotic syndrome,"5. Which of the following methods is the best measurement of platelet function in the clinical laboratory? a. Quantification of platelet microparticles b. Measurement of platelet count and mean platelet volume c. Light transmission aggregometry after induction with an agonist such as ADP, collagen, epinephrine, arachidonic acid or thrombin d. ELISA for soluble platelet activation markers such as β-thromboglobulin and platelet-derived growth factor",c
Podocyte directed therapy of nephrotic syndrome: can we bring the inside out?,1. Which of the following answers is correct? a) The mTOR pathway is inactivated in diabetes. b) mTOR inhibitors can induce proteinuria. c) mTOR inhibitors have only immune modulatory functions. d) mTOR inhibitors bind to special receptors on the podocyte surface.,b
Podocyte directed therapy of nephrotic syndrome: can we bring the inside out?,2. Which of the following proteins is neither a unit of the podocyte cytoskeleton nor has a direct interaction with it? a) Actin b) Synaptopodin c) ZO-1 d) Nephrin,c
Podocyte directed therapy of nephrotic syndrome: can we bring the inside out?,3. Which of the following is a podocyte-specific drug? a) Cyclosporine b) Prednisolone c) Rituximab d) mTOR inhibitors e) None of the above,e
Podocyte directed therapy of nephrotic syndrome: can we bring the inside out?,4. Which of the following statements is correct? a) Human podocytes express CD20. b) Human podocytes do not express the angiotensin II type 1 receptor c) Human podocytes express the glucocorticoid receptor d) Human podocytes express the abatacept-binding partner under physiological conditions.,c
Podocyte directed therapy of nephrotic syndrome: can we bring the inside out?,5. Which statement is correct? a) VEGF inhibitors only have renal side effects on the glomerular endothelium b) Bevacizumab has a protective effect on podocytes c) VEGF inhibitors can lead to foot process effacement d) VEGF receptors are only expressed on glomerular endothelial cells,c
Renal transplantation in infants,1. Infants form a special group of pediatric renal transplant recipients. Of all pediatric recipients they account for: a. <10 % b. 10–19 % c. 20–29 % d. 30–39 % e. >40 %,a
Renal transplantation in infants,2. Acute rejections are nowadays diagnosed less often than before. Their frequency in infant renal transplantation is: a. 40–60 % b. 30–39 % c. 20–29 % d. 5–19 % e. < 5 %,d
Renal transplantation in infants,"3. Infant kidney transplant recipients are often seronegative for Epstein–Barr virus (EBV) at the time of transplantation. The risk for post-transplant lymphoproliferative disorder (PTLD) in seronegative recipients, as compared to seropositive subjects, is: a. 2-fold b. 5-fold c. 8-fold d. 10-fold e. 20-fold",b
Renal transplantation in infants,4. In infant renal transplantation the major cause of early graft loss is: a. acute rejection b. unrinary tract infection c. ureteral stenosis d. lymphocele e. vascular thrombosis,e
Renal transplantation in infants,5. The overall outcome of renal transplantation in infants is nowadays good. Graft survival ten years after the operation is: a. 50 % b. 60 % c. 70 % d. 80 % e. 99 %,d
Role of therapeutic plasmapheresis in ANCA-associated vasculitis,1. True or false: Plasma exchange is a well-proven treatment for vasculitis-associated pulmonary hemorrhage.,False
Role of therapeutic plasmapheresis in ANCA-associated vasculitis,2. True or false: Plasma exchange removes IgG selectively from the circulation.,False
Role of therapeutic plasmapheresis in ANCA-associated vasculitis,"3. True or false: Plasma exchange has been shown to reduce the incidence of ESKD in severe, acute, ANCA-associated vasculitis.",True
Role of therapeutic plasmapheresis in ANCA-associated vasculitis,4. True or false: Plasma exchange has been shown to reduce mortality when used in treating severe acute ANCA-associated vasculitis.,False
Role of therapeutic plasmapheresis in ANCA-associated vasculitis,5. True or false: Composite study endpoints always increase the sensitivity of a study.,False
"Severe antenatally diagnosed renal disorders: background, prognosis and practical approach",1) The most frequent diagnoses leading to renal oligohydramnios are (please select two): a. Cystinosis b. Lower urinary tract obstruction with renal hypo/dysplasia c. Autosomal recessive polycystic kidney disease d. Primary hyperoxauria type 1 e. Bilateral ureteric-pelvic junction obstruction,"b,c"
"Severe antenatally diagnosed renal disorders: background, prognosis and practical approach",2) Renal oligohydramnios is associated with which two postnatal complications: a. Prematurity b. Pulmonary hypoplasia c. Renal insufficiency d. Intracerebral bleeding e. Prolonged icterus neonatorum,"b,c"
"Severe antenatally diagnosed renal disorders: background, prognosis and practical approach",3) Outcome of fetuses with renal oligohydramnios are (please select three answers): a. Is easy to predict using clinical case series b. Can be predicted using fetal urine and serum markers c. Is difficult to predict because of clinical heterogeneity postnatally d. Is dependent on initial patient care and therefore referral to experienced centers is important e. Is usually determined by presence of initial pulmonary morbidity,"c,d,e"
"Severe antenatally diagnosed renal disorders: background, prognosis and practical approach",4) The following pulmonary complications after renal oligohydramnios have to be anticipated (please select two answers): a. Pneumothorax b. Pulmonary hypoplasia with need of mechanical ventilation c. History of allergic asthma in childhood d. Risk of recurrent pneumonia e. The risk of pulmonary problems is low and can be neglected,"a,b"
"Severe antenatally diagnosed renal disorders: background, prognosis and practical approach","5) Counselling of families in the presence of renal oligohydramnios (please select three answers): a. Is not necessary since outcome is always fatal. Termination of pregnancy should be performed as early as possible. b. Is difficult due to the potentially heterogeneous clinical course after delivery. c. Should be performed by obstetricians alone or a geneticist in the situation of ARPKD. d. Should be performed by a multidisciplinary team including obstetricians, neonatologists, paediatric nephrologist and ideally a psychologist. e. Should include adequate information about long-term medical consequences (e.g. chronic renal disease, dialysis and chronic morbidity)","b,d,e"
The glomerular permeability factors in idiopathic nephrotic syndrome,1. A relapse of nephrotic syndrome after kidney transplantation is: A. never observed in case of SRNS related to a mutation of a gene coding for a podocyte’s protein. B. observed in all cases of FSGS not related with a mutation of a gene coding for a podocyte’s protein. C. often observed in case of FSGS not related with a mutation of a gene coding for a podocyte’s protein and never observed when such a mutation is present. D. often observed in case of FSGS not related with a mutation of a gene coding for a podocyte’s protein and rarely observed when such a mutation is present.,D
The glomerular permeability factors in idiopathic nephrotic syndrome,2. The molecular weight of the focal sclerosis permeability factor (FSPF) is situated: A. between 30 and 50 kDa B. between 50 and 180 kDa C. above 180 kDa D. under 30 kDa,A
The glomerular permeability factors in idiopathic nephrotic syndrome,3. Recurrence of massive proteinuria after renal transplant for SRNS and FSGS: A. may be prevented by pre-emptive plasma exchange B. is not reversible even when treated early by plasma exchange C. is always reversible under rituximab treatment D. is reversible after plasma exchange even when histological lesions are already present,A
The glomerular permeability factors in idiopathic nephrotic syndrome,4. The soluble urokinase-type plasminogen activator receptor (su-PAR) has been shown: A. to have a molecular weight superior to the FSPF B. not to be able to induce proteinuria in mouse C. to be increased in blood of patients with FSGS only D. to be consistently correlated with the degree of proteinuria in the diseases studied E. to be inversely correlated with eGFR and most probably to be the consequence of a reduced clearance,E
The glomerular permeability factors in idiopathic nephrotic syndrome,5. What is the parameter which should be able to differentiate with certainty MCD- from FSGS-associated nephrotic syndrome at an early stage? A. urinary CD80 B. serum suPAR C. serum suPAR corrected for eGFR D. serum suPAR/urinary CD80 ratio E. none of them,E
Toxic environmental exposures and kidney health in children,"1. Which of the following is TRUE regarding the epidemiology of kidney disease due to environmental exposures? a. Cadmium and lead co-exposure is associated with a significantly higher risk of albuminuria and CKD than either exposure alone. b. Aristolochic acid nephropathy is associated with acute tubular injury but has not been associated with ESRD. c. Chelation studies in patients with lead nephropathy have been overall disappointing, with no evidence of improvement in GFR with chelation therapy. d. Most of the known environmental toxins primarily affect the glomerulus.",a
Toxic environmental exposures and kidney health in children,2. Which of the following have been proposed as possible etiologies of CKDu? a. Infections. b. Recurrent dehydration. c. Pesticides. d. Chronic NSAID exposure. e. All of the above.,e
Toxic environmental exposures and kidney health in children,3. What is the proposed mechanism of acute kidney injury and nephrotoxicity of melamine? a. Proximal tubulopathy. b. Immune-complex-mediated glomerulonephritis. c. Urinary obstruction from melamine-induced urinary stones. d. Chronic tubulointerstitial nephritis.,c
Toxic environmental exposures and kidney health in children,4. Which of the following heavy metals are not known to accumulate in the body (bioaccumulative) after exposure? a. Lead. b. Cadmium. c. Arsenic. d. Uranium.,c
Toxic environmental exposures and kidney health in children,5. Which of the following is NOT a known exposure to lead in the modern world? a. Residential paint. b. Gasoline. c. Dental amalgams. d. Mining operations. e. Plumbing.,c
Translational implications of endothelial cell dysfunction in association with chronic allograft rejection,1. The response of graft microvascular ECs to alloimmune targeting following transplantation includes: a) The induced expression of adhesion molecules and chemokines b) An uncontrolled angiogenesis response c) A change in phenotype that promotes the recruitment of leukocytes within the graft d) All of the above,d
Translational implications of endothelial cell dysfunction in association with chronic allograft rejection,2. Vascular endothelial growth factor (VEGF): a) Is delivered within the graft by infiltrating mononuclear cells b) Is produced within the graft in response to local hypoxia c) Acts as an angiogenesis factor d) Acts as a leukocyte chemoattractant e) All of the above,e
Translational implications of endothelial cell dysfunction in association with chronic allograft rejection,"3. In ECs, mTOR signaling: a) Is downregulated upon alloimmune targeting of the graft b) Elicits cell proliferation, growth, and activation responses c) Is induced by cell intrinsic expression of DEPTOR d) All of the above",b
Translational implications of endothelial cell dysfunction in association with chronic allograft rejection,"4. Micro-RNAs: a) Function to promote the expression of target mRNAs b) Can regulate EC activation and microvascular stability c) Can be secreted in body fluids such as urine, where they are unstable and are rapidly degraded by RNases d) All of the above",b
Translational implications of endothelial cell dysfunction in association with chronic allograft rejection,"5. Among the following, which have been proposed as non-invasive biomarkers of chronic allograft rejection: a) Plasma angiogenic factors b) Plasma miRNAs c) Urinary miRNAs d) All of the above",d
Transplant immuno-diagnostics: crossmatch and antigen detection,1. HLA class II proteins are expressed almost exclusively on: a. All nucleated cells b. Antigen-presenting cells c. Red blood cells d. The vascular endothelium,b
Transplant immuno-diagnostics: crossmatch and antigen detection,2. Antibody-antigen binding primarily causes cell injury and death by: a. Activation of the classical complement pathway by binding C1q and formation of the membrane attack complex (MAC) b. Activation of the alternative complement pathway c. Recruitment of natural killer (NK) cells d. Phagocytosis by neutrophils,a
Transplant immuno-diagnostics: crossmatch and antigen detection,3. Limitations of the CDC crossmatch include: a. Oversaturation of antibodies b. Background cell death from a critically ill donor c. DNA dye passively entering healthy cells d. Neutralizing donor antibodies against complement,b
Transplant immuno-diagnostics: crossmatch and antigen detection,4. Strengths of solid-phase assays include all of the following EXCEPT: a. High-throughput analysis b. Improved class II antibody detection c. Controls for non-HLA antibodies d. Decreased risk of the prozone effect,d
Transplant immuno-diagnostics: crossmatch and antigen detection,5. C1q-based solid-phase assays: a. Directly bind C1q to whole donor cells b. Rely on recipient sera to provide C1q c. Are independent of IgG MFI strength d. Detect C4d deposition on HLA-coated beads,c
Vaccinations in children on immunosuppressive medications for renal disease,1. The following are true regarding vaccines in immunosuppressed children: a. Polysaccharide vaccines produce a better immunological and anamnestic response than live or conjugated vaccines. b. The process of attenuation makes live vaccines safe. c. Achievement of adequate specific antibody titers confirms protection to that disease. d. Both humoral and cell-mediated immune pathways to vaccine response may be disturbed in patients on immunosuppressive drugs.,d
Vaccinations in children on immunosuppressive medications for renal disease,2. The routine national immunization schedule requires the following adjustments for children on immunosuppressive medications: a. Vaccination is delayed by at least 6 months for children who have received RTX therapy. b. Annual influenza vaccine is recommended in all children over 6 months of age. c. Hepatitis B surface antibody titers should be checked and maintained at >10 mIU/ml with additional vaccine doses. d. Live vaccines are usually avoided. e. All of the above are correct.,e
Vaccinations in children on immunosuppressive medications for renal disease,3. In children with steroid-sensitive nephrotic syndrome: a. All vaccinations should be avoided until the child is in remission for 3 months. b. Varicella vaccination may be given when off steroids or on minimal alternate-day dose. c. Pneumococcal vaccine is contraindicated as it will reduce the index of suspicion for an invasive pneumococcal disease. d. All patients having received hepatitis B vaccine in infancy retain adequate antibody levels.,b
Vaccinations in children on immunosuppressive medications for renal disease,4. With regards to live vaccination in RT patients: a. Intranasal influenza vaccine can be safely administered post-RT. b. Varicella vaccine can be given if exposed to a patient with chicken pox. c. Incomplete course of OPV before RT should be completed with IPV. d. Varicella vaccine is avoided in siblings of RT recipients on IS therapy.,c
Vaccinations in children on immunosuppressive medications for renal disease,5. In a child awaiting RT: a. Accelerated vaccine schedules are generally avoided b. Live vaccines are avoided during the last 3 months prior to RT c. Hepatitis B double the normal dose has no proven benefit d. Influenza vaccine can be administered from 6 months onwards,d
A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children,1. Which of the following is NOT one of the three fundamental questions of the Model for Improvement? a) What are we trying to accomplish? b) How will we know that change is an improvement? c) What change can we make that will result in improvement? d) How long will it take to see improvement?,d
A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children,2. Which of the following is a secondary driver in a key driver diagram where pediatric PD-related peritonitis reduction is the primary aim? a) Education and experience of the dialysis staff b) Evaluation of the home environment c) Assessment of and attention to health literacy d) All of the above,d
A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children,3. Which catheter insertion technique is associated with increased risk for peritonitis? a) Open insertion b) Laparoscopic insertion c) Both d) Neither,d
A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children,"4. According to the ISPD guidelines, which of the following contamination events require treatment with prophylactic antibiotics? a) A contamination of the end of the transfer set that occurs before dialysate is instilled b) Disconnection of the tubing during the dialysis procedure c) Both d) Neither",b
A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children,5. Which of the following statements regarding health literacy is true? a) Low health literacy has been shown to influence risk for PDI in pediatric CPD patients b) Low health literacy among adult CKD patients has been associated with increased utilization of emergency services c) Most parents of children with chronic conditions have low health literacy d) All of the above e) None of the above,b
Acute kidney injury and fluid overload in infants and children after cardiac surgery,"1. Using KDIGO AKI criteria, what minimum creatinine change defines AKI? a) Creatinine increase of 0.3 mg/dl b) Creatinine increase of 0.5 mg/dl c) Creatinine increase of 2 times baseline d) Creatinine increase of 0.3 mg/dl or 1.5 times baseline e) Creatinine increase of 0.5 mg/dl or 2 times baseline",d
Acute kidney injury and fluid overload in infants and children after cardiac surgery,"2. What is the most common timeframe for AKI after CPB in infants and children? a) First 24–48 h, lasting for 1–2 days b) First 24–48 h, lasting for 4 days c) First 72–96 h, lasting for 1–2 days d) First 72–96 h, lasting for 4 days e) Greater than 7 days, lasting for 1 day",a
Acute kidney injury and fluid overload in infants and children after cardiac surgery,3. Which of the following is a biomarker of renal tubule structural injury? a) Cystatin-C b) Creatinine c) Urine output d) NephroCheck,d
Acute kidney injury and fluid overload in infants and children after cardiac surgery,4. Which of the following is not associated with fluid overload? a) Decreased nutritional absorption b) Increased rate of infection c) Decreased myocardial contraction d) Increased mortality e) Increased lung compliance,e
Acute kidney injury and fluid overload in infants and children after cardiac surgery,"5. In an infant with oliguria after cardiac surgery, which of the following therapies is shown to be associated with less fluid overload and a lower rate of prolonged mechanical ventilation? a) Dobutamine b) Peritoneal dialysis c) Nesiritide d) Furosemide e) Aminophylline",b
Anemia in nephrotic syndrome: approach to evaluation and treatment,1. Which of the following is the major source of iron for erythropoiesis? a) Iron absorbed from the gastrointestinal tract b) Iron stored in the liver and spleen c) Iron released from aged red blood cells d) Bone marrow e) Newly formed erythrocytes,c
Anemia in nephrotic syndrome: approach to evaluation and treatment,2. Hepcidin regulates systemic iron homeostasis by which of the following processes? a) Binding of iron in plasma and excretion through the kidneys b) Inhibition of ferritin formation c) Inhibition of iron entry into the bone marrow d) Internalization and degradation of ferroportin e) Prevention of iron storage in macrophages,d
Anemia in nephrotic syndrome: approach to evaluation and treatment,3. Which of the following is a pathophysiologic mechanism of anemia in nephrotic syndrome include: a) Increased urinary losses of transferrin and iron b) Decreased production of transferrin c) Downregulation of the soluble transferrin receptor d) Increased urinary losses of free hemoglobin e) Erythropoietin resistance,a
Anemia in nephrotic syndrome: approach to evaluation and treatment,4. Which of the following is true of the role of drugs and metals in the etiology of anemia in nephrotic syndrome? a) Copper deficiency is not associated with any morphological changes in erythropoietic cells b) Copper deficiency is difficult to treat in patients with nephrotic syndrome c) The use of ACEIs is not associated with anemia in patients with kidney disease d) The effect of ACEIs on erythropoiesis is unknown e) ACEIs may cause anemia by lowering circulating levels of erythropoietin and inhibiting erythropoiesis in the process,e
Anemia in nephrotic syndrome: approach to evaluation and treatment,"5. Of anemia in nephrotic syndrome, which of the following statements is correct? a) Anemia is always corrected by iron and erythropoietin supplementation b) Patients with steroid-sensitive nephrotic syndrome are more likely to develop iron deficiency anemia c) Anemia does not occur in patients with nephrotic syndrome and normal kidney function d) The use of erythropoietin should be considered only when plasma erythropoietin levels are low e) The pathophysiologic mechanisms are likely multifactorial and incompletely understood",e
C3 Glomerulopathy,1. The final diagnosis of C3G is established based on: a) Clinical symptoms alone b) Light microscopy alone c) Immunohistochemistry and electron microscopy d) Combination of clinical symptoms and light microscopy e) Low C3 levels alone,c
C3 Glomerulopathy,2. Common clinical and laboratory features of C3G do not include: a) Proteinuria b) Nephrotic syndrome c) Nephritic syndrome d) Low C3 levels e) Low C4 levels,e
C3 Glomerulopathy,3. Complement mutations and autoantibodies found in C3G patients affect mainly: a) C5b-9 formation b) Decay of C3 convertase c) C3a formation d) C1q inhibition e) Endothelial surface regulation,b
C3 Glomerulopathy,4. Treatment options commonly NOT used in C3G include: a) ACE inhibitors b) MMF c) Eculizumab d) AT2 antagonists e) Steroids,d
C3 Glomerulopathy,5. PIGN patients which might represent C3G patients show: a) Humps in kidney biopsy b) Persistently low C3 levels and continuous proteinuria and/or hematuria c) Streptococcal infections d) Predominant IgG staining in kidney biopsy e) Hematuria,b
Cognitive remediation in pediatric chronic kidney disease,"1. In children and adolescents, neurocognitive deficits and dysfunctions: a) Only occur in those with ESKD. b) Occur in those with ESKD, but can be seen in mild to moderate chronic kidney disease c) Only occur in the presence of documented brain injury d) All the above",b
Cognitive remediation in pediatric chronic kidney disease,2. The effects of CKD on neurocognitive functioning during childhood may be different from those observed in adults owing to brain elasticity and neurodevelopmental growth. a) True b) False,a
Cognitive remediation in pediatric chronic kidney disease,3. Attention deficit/hyperactivity disorder (ADHD) has been reported in pediatric-onset CKD/ESKD in: a) 10–20% of patients b) 20–30% of patients c) 30–40% of patients d) 40–50% of patients e) >50% of patients,b
Cognitive remediation in pediatric chronic kidney disease,4. There are well known and robust cognitive interventions for children and adolescents with CKD. a) True b) False,b
Cognitive remediation in pediatric chronic kidney disease,"5. Cognitive remediation programs: a) Have been tested and designed only for adult use. b) Have been tested and designed for children with CKD/ESKD. c) Have been tested and designed for children and adolescents, and hold promise for children with CKD/ESKD. d) Have no inherent value for children and adolescents with CKD/ESRD.",c
Current status of pediatric renal transplant pathology,1. Which statement regarding the Banff Classification is incorrect? a) The most common type of acute T-cell-mediated rejection today is Banff Borderline. b) Arteritis without tubulointerstitial infiltrates qualifies as acute T-cell-mediated rejection. c) The Banff classification is updated biannually. d) It has been thoroughly validated for AB0-incompatible renal transplants. e) Currently only transplant vasculopathy is recognized as being chronic T-cell mediated rejection.,d
Current status of pediatric renal transplant pathology,2. Which statement regarding antibody-mediated rejection (ABMR) is correct? a) According to the current Banff Classification set of rules it is impossible to diagnose ABMR without C4d positivity. b) C4d staining of peritubular capillaries has high sensitivity but low specificity for ABMR. c) Arteritis has recently been added to the Banff Classification set of rules as an indicator of acute ABMR. d) The presence of any immune complexes on electron microscopy rules out a diagnosis of ABMR. e) Chronic ABMR is the second most common cause for chronic transplant loss after chronic calcineurin-inhibitor (CNI) toxicity.,c
Current status of pediatric renal transplant pathology,3. Which statement regarding thrombotic microangiopathy (TMA) in renal transplants is correct? a) TMA is most frequently caused by CNI toxicity. b) Recurrent TMA should be ruled out in all cases. c) TMA due to ABMR can be clearly distinguished from recurrent TMA by the presence of glomerulitis and peritubular capillaritis in the former. d) Chronic glomerular TMA can show subepithelial immune complexes. e) Chronic arterial changes in recurrent TMA can be clearly distinguished histologically from transplant vasculopathy.,b
Current status of pediatric renal transplant pathology,"4. Which statement regarding recurrent glomerular diseases is incorrect? a) Primary focal and segmental glomerulosclerosis (FSGS) almost always recurs as the collapsing type, regardless of the primary histological pattern in the native kidney. b) Immunoglobulin A glomerulonephritis is one of the most common primary diseases to recur in renal transplants. c) In children recurrent disease accounts for less transplant losses than in adults. d) Dense deposit disease can recur in renal transplants as thrombotic microangiopathy. e) The most likely cause for nephrotic range proteinuria in a renal transplant starting just after implantation is recurrent FSGS.",a
Current status of pediatric renal transplant pathology,"5. Which statement about polyomavirus nephropathy is incorrect? a) The infection causing polyomavirus nephritis almost always stems from the kidney transplant. b) The most frequent type to cause polyomavirus nephropathy is BK virus. c) Polyomavirus spreads from the urothelium up into the tubular system but it can only infect the parietal epithelial cell of a glomerulus, not the visceral epithelial cells (podocytes). d) Only replicative infection with polyomavirus gives positive staining on immunohistochemistry with antibodies against SV-40. e) The renal biopsy is far less sensitive than blood or urine tests for polyomavirus nephropathy.",c
Delayed graft function and its management in children,1. What is the most common current definition of DGF? a) Complete anuria during 7 days after renal transplantation b) No decrease of serum creatinine after 3 days post-transplant c) Increase of the baseline post-transplant serum creatinine by 30% at the 3rd day post-transplant d) Requirement for dialysis during the first 7 days post-transplant e) Inadequate diuresis during the first 2 days post-transplant,d
Delayed graft function and its management in children,2. The incidence of delayed graft function (DGF): a) Is higher in children than in adult kidney recipients due to technical difficulties with paediatric renal transplantation b) Depends mostly from the use or non use of steroids after transplantation c) Is zero in living-related transplantation d) Is lower in children than in adult kidney recipients due to the allocation policy addressing younger deceased donors to children and frequent use of living-related donors e) Depends mostly on the dose and blood concentration of tacrolimus at day 3 post-transplant,d
Delayed graft function and its management in children,"3. Ischaemia/reperfusion injury: a) Is recipient age-dependent b) Never occurs in living-related procurement and transplantation c) Is a two-step clinical event related to prolonged renal ischaemia and harmful reperfusion, involving several metabolic and immunological mechanisms d) May be completely prevented by infusion of erythropoietin to the renal graft e) Is not reversible in cardiac-death deceased donation",c
Delayed graft function and its management in children,"4. Direct pre-transplant haemodialysis: a) Should be avoided as it increases the risk of DGF b) Should be performed at least 1 day before transplantation as performed later it increases the risk of DGF c) Should always be performed with the most biocompatible dialyzer membrane d) Should be of low clearance e) Should be performed at any time once necessary, however with no excessive ultrafiltration",e
Delayed graft function and its management in children,5. Patients with DGF: a) Present 50% of acute rejection within first 3 months after transplantation b) Present very low 5-year graft survival c) Should never be given tacrolimus d) Should always be given thymoglobuline e) Are at minor risk of acute rejection,e
Drug-associated acute kidney injury: who’s at risk?,1. Why is serum creatinine a poor biomarker for renal function? a. It only rises when >0 % of glomerular function is lost b. Volume expansion can lower serum creatinine values c. Creatinine production is dependent on muscle mass and may also be affected by muscle perfusion d. All of the above,d
Drug-associated acute kidney injury: who’s at risk?,2. There is a standardized method to assess nephrotoxicity of medications? a. True b. False,b
Drug-associated acute kidney injury: who’s at risk?,3. Which of the following is NOT a typical phenotype of drug-associated kidney disease? a. AKI b. Glomerular disorder c. Nephrolithiasis d. Tubular dysfunction e. Oliguria,e
Drug-associated acute kidney injury: who’s at risk?,4. Which of the following is a cell-cycle arrest biomarker? a. NGAL b. L-FABP c. TIMP-2 d. Cystatin-C,c
Endemic bladder calculi in children,1. The most common urinary risk factors in children with endemic bladder calculi are: a) Hyperphosphaturia and hyperoxaluria b) Hypocitraturia and hypovolemia c) Hyperuricosuria and hypercalciuria d) Hyperammonuria and hyperuricosuria,b
Endemic bladder calculi in children,2. Endemic bladder calculi are mostly composed of: a) Calcium oxalate and phosphates b) Ammonium acid urate and struvite c) Ammonium acid urate or mixture with calcium oxalate d) Uric acid and calcium oxalate,c
Endemic bladder calculi in children,3. The most common risk factor for endemic ammonium acid urate bladder calculi is: a) Vitamin A deficiency b) Diarrhea c) Oxalate-rich diet d) Diet poor in animal protein,d
Endemic bladder calculi in children,4. Pneumatic lithoclast disintegrates stone using the energy source: a) Compressed air b) Electro-hydraulics c) Laser light d) Ultrasound energy,a
Endemic bladder calculi in children,"5. Endemic bladder calculi are: a) Frequent and commonly recur shortly after removal b) Usually solitary, but frequently recur after removal c) Usually solitary and rarely recur once removed d) Commonly multiple, but never recur after removal",c
Endemic bladder calculi in children,6. Endemic bladder stones are common in the following countries except: a) Sudan b) Thailand c) Turkey d) Ukraine,d
Enhancing dialyser clearance—from target to development,1. Which dialyser characteristic reduces small solute clearance? a) High flux membrane b) Hydrophilic dialyser membrane c) High-porosity dialyser membrane d) High adsorptive membrane structure.,d
Enhancing dialyser clearance—from target to development,2. Which statement about superflux dialysers is correct? a) Membrane pore size allows similar permeability to the glomerulus b) Some middle molecular weight solutes and protein-bound toxin clearances are increased c) Studies have reported clinical benefits d) There is no increase in albumin loss.,b
Enhancing dialyser clearance—from target to development,"3. Which advantage(s) do microfluidic dialyser designs potentially offer? a) Reduced priming and extracorporeal volume b) Reduced complement, platelet and leukocyte activation c) More effective convective clearance than high-flux capillary dialysers d) All of above.",d
Enhancing dialyser clearance—from target to development,4. Which approach does not significantly increase protein-bound toxin clearance? a) More frequent dialysis b) Infusing hypertonic saline infusion to the dialyser blood inlet c) Switching from hydrophilic to hydrophobic dialyser membranes d) Including mesoporous activated carbon in the extracorporeal circuit.,a
Enhancing dialyser clearance—from target to development,"5. How can the bio-incompatibility of activated carbon be reduced, but retaining absorptive capacity? a) Coating external surface of the carbon particles b) Adding activated carbon to the dialysate c) Using microporous activated carbon dialysers d) Using dual layer composite dialyser designs",d
Extrarenal effects of FGF23,1. Which is NOT true? Stimulators of FGF23 serum levels in CKD are: a. Phosphate load b. Treatment with active vitamin D c. Secondary hyperparathyroidism d. Treatment with calcimimetics e. Klotho deficiency,d
Extrarenal effects of FGF23,2. Which of the following statements regarding the actions of FGF23 on the heart is NOT true? a. FGF23 activates the calcineurin/NFAT signaling pathway b. FGF23 induces left ventricular hypertrophy c. FGF23 binds to its co-receptor Klotho d. FGF23 activates FGF receptor 4 e. FGF23 is locally produced in cardiac myocytes,c
Extrarenal effects of FGF23,3. Which of the following statements regarding vascular comorbidity in CKD patients is NOT true? a. FGF23 serum levels are associated with arterial stiffness and vascular calcification in CKD patients b. FGF23 promotes vascular calcification ex vivo in the presence of normal and increased phosphate levels c. The negative association between elevated FGF23 levels and endothelial function in human studies may be partly explained by concomitant Klotho deficiency d. Renal transplantation results in a rapid normalization of FGF23 levels together with other alterations in mineral metabolism correlating with improved endothelial function e. Endothelial dysfunction is characterized by an imbalance between NO bioavailability and upregulation of NADPH oxidase and reactive oxygen species,b
Extrarenal effects of FGF23,4. Which is NOT true? a. FGF23 and Klotho are not expressed in the brain b. FGF23 serum levels are associated with cognitive dysfunction in CKD patients c. FGF23 impacts on neuronal morphology and synaptic density in hippocampal cells d. FGF23 and Klotho are present in cerebrospinal fluid in humans and mainly originate from the brain e. FGF23 overexpression in rodents results in cognitive dysfunction and impaired spatial learning,a
Extrarenal effects of FGF23,5. Which is NOT true? Promising therapeutic measures to reduce FGF23 serum levels in CKD patients are: a. Calcimimetics b. Nicotinamid c. Restoration of Klotho levels by use of ACE inhibitors d. Dietary phosphate restriction e. Calcium-containing phosphate binders,e
HLA epitope matching in pediatric renal transplantation,"1. Which of the following statements about HLA epitopes is incorrect: a) The same epitope present on two different HLA antigens can explain the cross-reactivity of an antibody that binds both antigens. b) Each HLA antigen contains multiple epitopes that can potentially bind anti-HLA antibody c) All members of an HLA serotype (e.g., HLA-A2) have the same amino acid sequence and therefore identical epitopes. d) HLA epitopes are defined as the region of the HLA antigen that binds to the paratope of an anti-HLA antibody e) The cluster of amino acid residues that plays a key role in determining antibody binding specificity is sometimes referred to as the ‘functional epitope’ region",c
HLA epitope matching in pediatric renal transplantation,2. Which of the following statements concerning HLA eplets is true? a) Eplets are defined as linear sequences of three amino acids on the surface of HLA molecules b) Eplets are clusters of amino acids that theoretically define the functional epitopes that determine HLA antibody binding specificity c) Eplets have been determined by antibody absorption/elution studies of serum containing anti-HLA antibodies d) Eplets are composed of 15–25 amino acid residues that bind to the paratope of an antibody e) Eplets typically cover an area of 650–900 Å2,b
HLA epitope matching in pediatric renal transplantation,3. Which one of the following has not been shown in clinical studies addressing the role of eplet mismatches in transplantation? a) The number of locus-specific class II eplet mismatches is predictive of HLA-DR and HLA-DQ de novo DSA development post renal transplant b) HLA-DQ eplet mismatch of less than 17 is associated with low risk of locus-specific de novo DSA formation c) Class II eplet mismatch is associated with the development of transplant glomerulopathy d) Class I eplet mismatch > 10 in pediatric heart transplantation is associated with increased risk of graft failure compared with class I eplet mismatch < 10 e) Class I eplet mismatch (highest vs. lowest quartile) in lung transplantation is associated with increased risk of chronic lung allograft dysfunction (CLAD).,e
HLA epitope matching in pediatric renal transplantation,"4. Which of the following statements concerning pediatric renal transplantation is true? a) Eplet mismatch has been shown to be superior in predicting clinical outcomes compared to traditional HLA mismatch for pediatric patients receiving kidney transplants b) HLA matching in pediatric transplantation is not important as the developing immune system rapidly develops tolerance to foreign HLA c) Many children will require multiple transplants during their lives and therefore strategies to prevent HLA sensitization are important d) Deceased donor allocation policies that give priority to pediatric transplant recipients result in better histocompatibility matching for these patients e) Children with related potential donors should not enter paired kidney exchange programs, as this will result in poorer histocompatibility matching from unrelated paired donors",c
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease,1. How can qualitative research complement quantitative studies? a) Explain findings from a quality of life survey b) Evaluate patient satisfaction with new transition program c) Inform the design of a new intervention to improve adherence d) All of the above,d
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease,2. Which of the following is not a principle of data collection in qualitative research? a) Data or theoretical saturation b) Constructivist—i.e. meaning is built by the interaction between the researcher and participants c) Systematic and scientific d) Fixed and controlled experimental setting,d
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease,"3. If you were planning to conduct a qualitative study to understand adolescents’ perspectives on medicine-taking in kidney transplantation, what would be the best sampling strategy to capture a range of experiences? a) Purposive b) Snowballing c) Random d) Convenience",a
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease,4. What is member-checking? a) Ascertaining the reasons for non-participation b) Cross-checking participant responses against medical records c) Comparing participants views with findings from other studies conducted in different settings d) Obtaining and integrating feedback from participants on the preliminary findings,d
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease,5. Which of the following principles reflects strategies to demonstrate that the findings may be relevant to other settings and populations? a) Credibility b) Confirmability c) Transferability d) Dependability,c
Inflammation in IgA nephropathy,1. Which statement on IgAN pathogenesis is correct? a. Galactosylation of the IgA1 light chains is strongly increased in IgAN patients b. Galactose-deficient IgA1 molecules appear as monomers in the serum c. Sera from IgAN patients contain elevated levels of autoantibodies against undergalactosylated IgA1 d. Podocytes are not involved in IgAN pathogenesis,c
Inflammation in IgA nephropathy,"2. According to the most recent GWAS analyses in IgAN patients, which compartment might play a central role in IgAN development? a. T lymphocytes b. Resident renal dendritic cells c. Pararenal lymph nodes d. Waldeyer’ ring e. The intestinal immunity",e
Inflammation in IgA nephropathy,"3. The 2012 KDIGO guidelines suggest: a. Tonsillectomy in all IgAN patients b. A 6-month corticosteroid course in IgAN patients who are still proteinuric at >1 g/day and have preserved renal function (i.e., GFR > 50ml/min/1.73 m2) c. MMF in Asian IgAN patients d. Calcineurin inhibitors in IgAN patients with crescentic IgAN variants e. To stop supportive measures when these had been ineffective over 3–6 months",b
Inflammation in IgA nephropathy,4. Supportive measures in IgAN patients do not include: a. Antihypertensive treatment primarily with dihydropyridine calcium-channel blockers b. ACE inhibitors or ARBs as first-choice antihypertensive drugs c. Smoking cessation d. Control of lipid levels e. Restriction of NaCl intake,a
Inflammation in IgA nephropathy,"5. Which statement about the recent STOP-IgAN trial is correct? a. During the 6-month run-in phase ACE inhibitor or ARB treatment was stopped in all participants. b. All randomized patients received immunosuppressants according to their renal function c. Numbers of patients who developed a reduction of eGFR of ≥15 ml/min during the 3-year trial phase were comparable in both treatment groups, i.e., between those on supportive and those on additional immunosuppressive therapy d. Adverse events occurred with comparable frequencies in patients under supportive and those under additional immunosuppressive treatment",c
Life expectancy with chronic kidney disease: an educational review,1. Proteinuria predicts progressive renal failure if greater than: a) 50 mg/mmol creatinine (0.5 g/d) b) 100 mg/mmol creatinine (1.0 g/d) c) 150 mg/mmol creatinine d) 200 mg/mmol creatinine,a
Life expectancy with chronic kidney disease: an educational review,2. Life expectancy is reduced when eGFR falls below: a) 60 ml/min b) 50 ml/min c) 50 ml/min d) 30 ml/min,a
Life expectancy with chronic kidney disease: an educational review,3. Life expectancy on dialysis in USA has stopped increasing a) Since 2000 b) Since 2005 c) Since 2010 d) Is still increasing,d
Life expectancy with chronic kidney disease: an educational review,4. The increased relative risk of dying in young patients with CKD is: a) Cardiovascular b) Cancer c) Infection d) None of these,a
Lower urinary tract obstruction: fetal intervention based on prenatal staging,"1. What is the best indication for fetal vesicoamniotic shunting? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced/absent amount of amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced/absent amount of amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts, and absence of corticomedullar differentiation associated with reduced or absent amniotic fluid and nonfavorable urinary analysis after 18 weeks of gestation. e) There is no indication.",b
Lower urinary tract obstruction: fetal intervention based on prenatal staging,"2. What are the main characteristics of stage I LUTO? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid, and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced or absent amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced or absent amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts and absence of corticomedullar differentiation associated with anhydramnios, and nonfavorable urinary analysis after 18 weeks of gestation. e) Presence of normal fetal bladder, bilateral mild hydronephrosis, and normal amount of amniotic fluid after 18 weeks of gestation.",a
Lower urinary tract obstruction: fetal intervention based on prenatal staging,"3. What are the main characteristics of stage IV LUTO–intrauterine fetal renal failure? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid, and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced or absent amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced or absent amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts and absence of corticomedullar differentiation associated with anhydramnios, and nonfavorable urinary analysis after 18 weeks of gestation. e) Presence of normal fetal bladder, bilateral mild hydronephrosis, and normal amount of amniotic fluid after 18 weeks of gestation.",d
Lower urinary tract obstruction: fetal intervention based on prenatal staging,4. What is the best perinatal management of fetuses with stage I LUTO at 28 weeks of gestation? a) Delivery and postnatal care. b) Fetal vesicoamniotic shunting. c) Fetal cystoscopy to identify the cause of the obstruction and to treat it specifically. d) Expectant prenatal management with weekly fetal US follow-up and delivery at term. e) Open fetal vesicostomy.,d
Lower urinary tract obstruction: fetal intervention based on prenatal staging,"5. What is the best perinatal management of fetuses with stage IV LUTO at 28 weeks of gestation? a) Delivery now and postnatal care. b) Fetal vesicocamniotic shunting. c) Fetal cystoscopy to identify the cause of the obstruction and then treat it specifically. d) Expectant prenatal management with weekly fetal US follow-up and delivery after 34 weeks, preferentially close to term. e) Open fetal vesicostomy.",d
Measuring and estimating glomerular filtration rate in children,1. Normal GFR for children is above a. 60 mL/min/1.73 m2 b. 75 mL/min/1.73 m2 c. 90 mL/min/1.73 m2 d. 120 mL/min/1.73 m2,c
Measuring and estimating glomerular filtration rate in children,2. The gold standard for direct GFR measurement is a. Renal clearance of inulin b. Plasma clearance of iohexol c. Renal clearance of iothalamate d. Plasma clearance of inulin,a
Measuring and estimating glomerular filtration rate in children,"3. When the reduced plasma clearance protocol with only late blood samples is used, then a. The AUC is overestimated and can be corrected with the Bröchner-Mortensen formula b. The AUC is underestimated and can be corrected with the Bröchner-Mortensen formula c. The GFR is overestimated and can be corrected with the Bröchner-Mortensen formula d. The GFR is underestimated and can be corrected with the Bröchner-Mortensen formula",c
Measuring and estimating glomerular filtration rate in children,4. The updated bedside Schwartz equation is a. eGFR=0.368 L/Scr b. eGFR=0.413 L/Scr c. eGFR=107.3/[Scr/Q] d. eGFR=0.413 L/CysC,b
Measuring and estimating glomerular filtration rate in children,5. Scr-based equations should be avoided a. For adolescents b. For healthy children c. For children with CKD d. For children with reduced muscle mass,d
Nutritional management in the critically ill child with acute kidney injury: a review,1. All of the following are metabolic derangements in AKI except: a. increased secretion of catabolic hormones b. decreased secretion of anabolic hormones c. reduced peripheral lipoprotein lipase d. increased hepatic triglyceride levels.,d
Nutritional management in the critically ill child with acute kidney injury: a review,2. Which of the following statements about markers of nutritional status in AKI is false? a. anthropometric variables may be interfered with by the fluid status of the critically ill child b. laboratory markers such as albumin and transferrin are negative markers of inflammation c. body composition parameters are always helpful in the clinical setting of AKI d. limited data are available on growth hormone/insulin-like growth factor axis changes in critically ill patients in the ICU to be used in clinical practice.,c
Nutritional management in the critically ill child with acute kidney injury: a review,"3. Which of the following statements is true about energy needs in critically ill children? a. the gold standard to quantify energy needs in children and in adults is the measurement of actual energy consumption by indirect calorimetry b. resting energy expenditure calculations in patients receiving continuous RRT are always reliable c. the Schofield equation should not be used in children as it has no correlation with indirect calorimetry d. The Schofield equation can be calculated from the weight, mid-arm circumference, and age.",a
Nutritional management in the critically ill child with acute kidney injury: a review,"4. Which of the following statements is true about protein losses in dialysis? a. in a pediatric study, glutamine losses during CRRT accounted for 25 % of all amino acid losses b. during RRT, there is no need to account for protein losses in the dialysate c. clearance of amino acids in children on CRRT is in the range of 60–100 ml/min/1.73 m2 d. AKI is a state of low protein turnover.",a
Nutritional management in the critically ill child with acute kidney injury: a review,"5. Which of the following statement is not true? a. for children receiving CRRT for prolonged periods, serum levels of water soluble vitamins should be monitored, and additional supplementation may be required b. additional folate supplementation is needed in children who are receiving CRRT for prolonged periods c. for children on acute PD and HD, 100 % of the recommended nutrient intake of micronutrients can be considered the target d. there is evidence to prove that all patients on CRRT should receive glutamine supplements.",d
Peritoneal dialysis for the management of pediatric patients with acute kidney injury,"1. Which of the following statement is true: a) Peritoneal surface area in infants is lower than that in adults (per unit weight) b) To perform PD, an ICU environment is not always necessary c) PD is not safe in patients with bleeding diathesis d) Controlled and precise fluid balance can be obtained with acute intermittent PD",b
Peritoneal dialysis for the management of pediatric patients with acute kidney injury,2. The maximum dwell volume in PD is: a) 800 ml/m2 b) 1000 ml/m2 c) 1200 ml/m2 d) 1400 ml/m2,d
Peritoneal dialysis for the management of pediatric patients with acute kidney injury,3. All of the following are true with reference to composition of standard 1.7 % peritoneal dialysis fluid with the exception of: a) Osmolarity of 355 mOsm/l b) Sodium of 130 mmol/l c) Potassium of 2 mmol/l d) Dextrose of 1.7 g/dl,c
Peritoneal dialysis for the management of pediatric patients with acute kidney injury,4. Which of the following regimens of PD has highest small solute clearance as compared to standard PD: a) Tidal PD b) Continuous flow PD c) High-volume PD d) All have similar solute clearances,b
Potassium regulation in the neonate,1. Potassium regulation by the feedforward mechanism: a) Is mediated by aldosterone b) Is activated 6 h after a glucose-containing meal c) Is activated 6 h after ingesting a potassium-containing meal d) Is triggered by elevated [K+] in gastrointestinal tract e) Is triggered by elevated [K+] in plasma.,d
Potassium regulation in the neonate,2. The neonatal kidney is programmed to preserve potassium. A potential mechanism involves the following: a) Increased activity of Na+/K+-ATPase b) Increased activity of apical ROMK c) Increased expression of H+/K+-ATPase d) Increased expression of Maxi-K channels e) Increased expression of NKCC2.,c
Potassium regulation in the neonate,"3. Which following statement is TRUE, regarding NOH of the newborn: a) Is a benign condition b) Is more frequent in late pre-term infants c) Is the result of impaired feedforward mechanism d) Is the result of impaired transcellular potassium shift e) Should be treated if plasma [K+] exceeds 6 meq/L.",d
Potassium regulation in the neonate,"4. A 4-day-old premature infant developed a plasma [K+] = 2.3 meq/L, [HCO3−] = 26 meq/L. The ECG is normal. Of the following, the BEST therapeutic approach is: a) Add 40 meq/L of KCl to 0.45 saline solution with 5% dextrose water b) Add 40 meq/L of KCl to 0.45 saline solution without dextrose c) Add 60 meq/L of KCl to 0.45 saline solution without dextrose d) Administer KCl at a dose of 1 mEq/kg in 0.9 normal salts intravenously in 1 h e) Administer potassium citrate at a dose of 1–2 meq/kg/day by oral route",b
Potassium regulation in the neonate,"5. You get a laboratory report of [K+] = 7 meq/L in a 2-day-old infant, born at 29 weeks of postmenstrual age. The ECG is normal. You should: a) Administer sodium polysterene resin 1 g/kg as enema b) Administer NaHCO3 1meq/kg intravenously over 1 h c) Administer calcium gluconate 10% 1 ml/kg intravenously over 15 min d) Administer albuterol by nebulizer continuously until [K+] <6 meq/L e) Repeat blood sample.",e
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies,1. Which statement is true regarding proteinuria and CKD: a) Proteinuria is an indicator of glomerular dysfunction b) Proteinuria is an indicator of tubular dysfunction c) Proteinuria induces interstitial inflammation and apoptosis of proximal tubular cells d) RAAS plays an important role on proteinuria-induced fibrosis e) All of the above,e
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies,2. In the Italian Pediatric registry of chronic renal failure: a) All predialysis patients aged <18 years with a GFR of <75 ml/min/1.73 m2 in Italy are included b) The GFR was estimated from serum Cr using the Schwartz equation and proteinuria was based on baseline 24-h urine measurements c) By multivariate analysis the baseline Up/c correlated with a faster decline in eGFR irrespective of the baseline GFR d) In patients with renal hypodysplasia ACEi did delay the progression of CKD,c
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies,3. In the randomized control trial of low protein diet on progression of CKD: a) Both low-protein diet as well as proteinuria were associated with CKD progression b) The design is a randomized multicenter study in children aged 2–18 years c) GFR was estimated and the proteinuria was assessed using 24-h urine measurements d) Proteinuria >40 mg/kg/day was a predictor of progression,b
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies,4. In the ESCAPE trial: a) 30–40 % of the patients had hypodysplasia as the primary cause of CKD b) Greater degree of proteinuria was associated with an overall risk of reaching ESKD or 50 % reduction in GFR with a HR of 1.46 c) GFR was estimated and the proteinuria was assessed using mostly random Up/c d) The patients were followed over a period of 4 years,b
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies,"5. In the CKiD study: a) Children 1–16 years of age with GFR 15–90 ml/min/1.73 m2 have been followed for >10 years b) GFR is measured using plasma iohexol disappearance curves and the proteinuria is assessed using 24-h urine collection c) Nephrotic-range proteinuria was one of the predictors of progression for patients with a glomerular but not nonglomerular cause of CKD. d) Among the nonglomerular cases of CKD; CKD progressed faster in the presence of elevated Up/c, elevated BP or both.",d
Pubertal development in children with chronic kidney disease,1. Which is NOT true? Impairment of pubertal height gain in children with CKD is associated with: a. Exposure to glucocorticoids b. An earlier era for the start of renal replacement therapy c. Age at renal transplantation d. Growth hormone treatment e. Duration of dialysis,d
Pubertal development in children with chronic kidney disease,2. Which of the following statements regarding skeletal maturation in CKD patients is NOT true? a. The severity of the relative growth retardation at the time of puberty correlates positively with the delay in bone maturation b. Linear growth and bone maturation are dissociated during puberty c. Final height prediction models are reliable d. GH treatment does not accelerate bone maturation e. Treatment with sex steroids is associated with accelerated bone maturation,c
Pubertal development in children with chronic kidney disease,3. Which of the following does NOT occur in adolescents with end-stage CKD? a. LH and FSH levels may be increased b. Gonadal hormone levels may be decreased c. Pituitary GH secretion may be decreased d. IGF binding capacity is usually normal e. A state of hypergonadotropic hypogonadism is frequently observed in patients with long-standing dialysis,d
Pubertal development in children with chronic kidney disease,4. Which is NOT true? a. Pubertal delay is rarely seen nowadays in patients with end-stage CKD b. GH treatment may result in precocious puberty in CKD patients c. GH treatment does not increase total pubertal height gain d. GH treatment results in catch-up growth during the prepubertal age e. Withdrawal of glucocorticoids within the first 6 months after transplantation results in normal pubertal growth and adult height in the majority of patients,b
Pubertal development in children with chronic kidney disease,5. Which is NOT true? Renal transplantation with use of daily steroids: a. Is associated with obesity b. Has been shown to increase total pubertal height gain compared with healthy children c. May require GH treatment in the case of persistent growth failure d. Is associated with reduced pituitary GH secretion e. Is associated with low plasma IGF-1 levels,b
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume?,"1. All statements below regarding small pores are true except one: a) Are less abundant than large pores b) Are 1/10,000-fold less abundant than AQP1 c) Allow dialytic solute removal d) Permit diffusive and convective transport",a
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume?,2. All statements below regarding sodium sieving are true except one: a) Occurs during the early phase of exchange b) Is a parameter of AQP1 channels function c) Is correlated to UF d) Is independent of peritoneal membrane solute permeability,d
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume?,3. All statements below regarding osmotic conductance are true except one: a) Can be expressed in milliliters of UF per gram of glucose absorbed b) Is more accurately estimated applying 3.86 % glucose dialysate than applying 1.36 % glucose dialysate c) Is not impacted by peritoneal surface area recruitment d) Is an evaluation of the functional relation between the small pores and the AQP1 channels,c
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume?,4. All statements below regarding DSR are true except two: a) Is essentially realized by diffusive transport in conventional PD b) Peritoneal sodium absorption is usually negligible c) Can be estimated from UF volume in CAPD d) May be improved by modifying dwell volume and dwell time within one session e) Should be measured in automated PD,"a, b"
Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology,"1. Our current understanding of suPAR: a) Decreased in non-proteinuric diseases such as cancer, sepsis; b) Decreased in CKD patients with eGFR of <30 ml/min/1.73 m2; c) A cellular receptor for urokinase; d) A useful biomarker in pediatric patients with FSGS.",c
Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology,2. Proposed mechanism of action of rituximab in SRNS: a) Stabilizes SMPDL-3b in human differentiated podocytes; b) Decreases B cell activation markers; c) Causes hypergammaglobulinemia in remission of SRNS; d) Activates T cells.,a
Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology,3. Considering novel therapies for FSGS: a) Galactose increases albumin permeability in rat glomeruli incubated in serum of patients with FSGS; b) Adalimumab is a monoclonal antibody that binds the T-cell costimulatory molecule B7-1; c) Abatacept inhibits TNF-alpha receptor activation; d) None of the above.,d
Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology,4. High-risk group that will benefit from genetic testing in FSGS: a) Nephrotic syndrome associated with syndromes or malformations; b) Age of diagnosis between 0–12 months of age; c) Family history of chronic kidney disease; d) All of the above.,d
Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology,5. Conclusions of the FSGS Clinical Trial: a) Rate of progression to ESRD was highest with cellular FSGS; b) Experimental treatment rituximab was compared to control treatment cyclosporine; c) Statistically significant results were not attained secondary to small sample size; d) The trial exclusively evaluated pediatric patients with FSGS.,c
Stop adding insult to injury—identifying and managing risk factors for the progression of acute kidney injury in children,"1. Progression following AKI is defined as: a) Increasing severity of acute kidney injury b) Recovery of plasma creatinine to baseline c) A durable change in kidney structure or function detected by biomarkers, imaging or histopathology d) Extra-renal complications following AKI",c
Stop adding insult to injury—identifying and managing risk factors for the progression of acute kidney injury in children,"2. Following an acute kidney insult, which of the following are true? a) Plasma creatinine may not change b) Injury initiates repair mechanisms c) Adaptive repair results in progression d) Progression can lead to chronic sequelae","a, b, d"
Stop adding insult to injury—identifying and managing risk factors for the progression of acute kidney injury in children,3. Risk factors for progression following AKI in children include: a) Chronic kidney disease b) Repeated episodes of AKI c) Severity of the kidney insult d) Interstitial fluid overload,"a, b, c"
Stop adding insult to injury—identifying and managing risk factors for the progression of acute kidney injury in children,4. Clinical management priorities to reduce progression following AKI include: a) Early angiotension-converting enzyme inhibition b) Diuretic therapy c) Optimizing kidney perfusion d) All of the above,c
Stop adding insult to injury—identifying and managing risk factors for the progression of acute kidney injury in children,5. Mechanistic pathways for future therapies include: a) Oxidative stress b) Cell cycle modification c) Histone deacetylase inhibition d) All of the above,d
The path to chronic kidney disease following acute kidney injury,1. Which of the following mechanisms have been proposed in the progression of CKD following an AKI episode? a) Nephron loss leading to glomerular hyperfiltration b) Tubulointerstitial fibrosis c) Endothelial injury and reduced vascular density d) Maladaptive repair mechanisms including cell cycle disruption and epigenetic changes e) All of the above,e
The path to chronic kidney disease following acute kidney injury,2. Which of the following renal pathology findings have not been identified in premature infants with severe AKI through prior autopsy studies? a) Cystic dilatation of Bowman’s capsule b) Podocyte effacement c) Cystic dilatation of tubules d) Lower glomerular counts compared to term infants,b
The path to chronic kidney disease following acute kidney injury,"3. Outside of albuminuria and a reduced GFR, paediatric observational studies have identified which of the following abnormalities in survivors in neonatal AKI? a) Tubular proteinuria b) Urinary concentrating defects c) Supranormal GFR values indicating potential hyperfiltration d) Hypertension e) All of the above",e
The path to chronic kidney disease following acute kidney injury,4. Which of the following statements is false in regards to defining AKI in neonates a) Defining AKI in neonates is challenging in the first days of life due to the effects of maternal creatinine and a naturally improving GFR b) Existing long term follow-up studies have shown a significant amount of hetereogenity in defining neonatal AKI c) The recently proposed neonatal modified KDIGO definition utilizes an absolute serum creatinine increase of 0.3 mg/dl (26.5 μmol/l) to define AKI within a period of 7 days d) The recently proposed neonatal RIFLE urine output criteria is based on a retrospective study that revealed that Boliguria^ thresholds higher than >0.5 cc/kg/h are associated with mortality,c
The path to chronic kidney disease following acute kidney injury,"5. After an AKI episode in the neonatal period, which of the following children would not be considered as having CKD as per the KDIGO definition (2012): a) A 5-year-old male with a reduced eGFR of 75 ml/min/1.73 m2 with small kidneys on ultrasound for age and size b) A 10-year-old female with an albumin:creatinine ratio of 50 mg/g on a first morning urine×2 and an eGFR of 90 ml/min/1.73 m2 c) A 14-year-old male with an elevated eGFR of 160 ml/min/1.73 m2 with no abnormalities on blood work, urine tests or imaging. d) A 3-year-old female with persistent hypertension with a measured GFR of 90 ml/min/1.73 m2 and no imaging, bloodwork or urine abnormalities. e) c and d",e
Treatment of renal angiomyolipoma in tuberous sclerosis,"1. What yearly follow-up investigations are recommended for a 14-year-old boy with TSC after angiomyolipoma bleeding and partial nephrectomy? a) None b) Abdominal MRI scan, skin check, neurological screening, assessment of renal function, proteinuria, and blood pressure control c) Abdominal MRI scan d) Symptom-oriented investigations only",b
Treatment of renal angiomyolipoma in tuberous sclerosis,"2. A 16-year-old female TSC patient is presenting with two asymptomatic angiomyolipoma, diameter 2 cm in each kidney, and with two renal cysts, diameter 5 cm on the right side. Management: a) No further follow-up b) Nephrectomy right kidney c) Embolization of angiomyolipoma d) MRI scan every 1–3 years, no intervention",d
Treatment of renal angiomyolipoma in tuberous sclerosis,"3. A 22-year-old TSC patient is presenting with an emergency angiomyolipoma bleeding from the right kidney. What is the recommended treatment? a) Embolization (in combination with corticosteroids) if possible, otherwise nephrectomy b) Watch and wait c) Transfusion of red blood cells (RBC) d) Start treatment with everolimus",a
Treatment of renal angiomyolipoma in tuberous sclerosis,"4. Should a 3-year-old child suspected of having TSC undergo the following investigations? a) MRI scan of the brain b) MRI scan of the brain, electroencephalogram (EEG), MRI scan of the abdomen c) MRI scan of the brain, EEG, echocardiogram, and electrocardiogram (ECG) d) MRI scan of the brain and abdomen, EEG, echocardiogram, and ECG, and dermatological and dental exam",d
Treatment of renal angiomyolipoma in tuberous sclerosis,5. What is the leading cause of death in adult TSC patients? a) Myocardial infarction b) Infection c) Epilepsy d) Renal complications,d
"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring","1. Tubulointerstitial dysfunction is often accompanied by electrolyte abnormalities that include: A. Hyperkalemia, hyperchloremia, and metabolic acidosis B. Hyperkalemia, hyponatremia, and metabolic acidosis C. Hypokalemia, hypernatremia, and metabolic alkalosis D. Hypokalemia, hyperchloremia, and metabolic acidosis",A
"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring",2. What is the most common type of uveitis present in patients with TINU syndrome? A. Anterior uveitis B. Posterior uveitis C. Intermediate uveitis D. Panuveitis,A
"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring",3. The most common underlying etiology of TIN is A. TINU syndrome B. Inflammatory bowel disease C. Drug induced D. Infection,C
"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring","4. Regarding drug-induced TIN, which of the following is false? A. TIN can recur after re-exposure to the drug B. Eosinophils are a predominant finding on renal biopsy C. NSAIDs are a common cause for drug-induced TIN D. The risk for drug-induced TIN increases with increasing dose of the drug",D
"Tubulointerstitial nephritis: diagnosis, treatment, and monitoring",5. Which of the following is a low-molecular-weight protein that can be used as a urinary biomarker for diagnosing and monitoring TIN? A. Beta2-microglobulin (B2M) B. Monocyte chemotactic peptide-1 (MCP-1) C. TIN antigen D. Mucin-1,A
An interprofessional approach to managing children with treatment-resistant enuresis,Which of the following is the least likely factor to cause enuresis:  a) Large overnight urine volume b) Poor sleep arousal c) Child’s laziness d) Bladder overactivity e) Low bladder capacity,c
An interprofessional approach to managing children with treatment-resistant enuresis,Which of the following is FALSE about sleep and enuresis:  a) Children with enuresis have difficulty arousing from sleep b) Treating obstructive sleep apnoea may reduce enuresis c) Treating insomnia with melatonin may improve enuresis d) Children are more likely to wet when they are tired e) Reducing sleep time may improve enuresis long term,e
An interprofessional approach to managing children with treatment-resistant enuresis,Which of the following is FALSE about fluids and enuresis:  a) ADH increases overnight urine production b) High fluid intake in the evening increases overnight urine production c) Diabetes insipidus increases overnight urine production d) Overnight feeds increases overnight urine production e) Polyuria increases overnight urine production,a
An interprofessional approach to managing children with treatment-resistant enuresis,What is NOT a cause for alarm failure:  a) Incorrect position of the alarm sensor b) Child fails to wake to the alarm sound c) Parents waking the child when the alarm sounds d) Child failing to get out of bed to void in the toilet when alarm sounds e) Alarm does not sound (e.g. flat batteries),c
An interprofessional approach to managing children with treatment-resistant enuresis,Which statement below best describes what an interdisciplinary approach involves?  a) Practitioners providing treatment within their discipline b) One practitioner transferring care to another practitioner c) Multiple practitioners from different disciplines seeing the same patient at different times d) Practitioners from different disciplines working together to provide a common treatment plan e) Practitioners providing treatment outside their own field,d
Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease,Which of the following patient populations is at risk for ACKD?  a) Patients with CKD b) Patients on chronic dialysis c) Transplant recipients d) All the above,d
Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease,Which of the following factors is/are NOT associated with ACKD? (include all that apply)  a) Duration of dialysis therapy b) Asian ancestry c) Primary renal disorder d) Use of calcineurin inhibitor,"b, c"
Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease,Which of the following criteria are specific for the diagnosis of ACKD in children?  a) De novo cyst development b) Large echogenic kidneys c) Increase in cyst size on serial imaging d) Complex cyst,a
Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease,What is the most serious complication of ACKD?  a) Abdominal pain b) Renal cell carcinoma c) Infection d) Bleeding or hematoma formation,b
Acquired cystic kidney disease: an under-recognized condition in children with end-stage renal disease,"Which of the following statements regarding the proposed surveillance scheme for pediatric patients is/are NOT true? (include all that apply)  a) In transplant recipients, only native kidneys should be screened annually b) Ultrasound is the initial screening modality of choice c) Secondary imaging tools for complex cysts include contrast-enhanced CT or MRI d) The Bosniak renal cyst classification scheme can be applied to ultrasound findings","a, c, d"
Acute kidney injury: emerging pharmacotherapies in current clinical trials,"In critically ill hospitalized children, the incidence of AKI is estimated to be:  a. 5% b. 10% c. 15% d. 25% e. 50%",d
Acute kidney injury: emerging pharmacotherapies in current clinical trials,"The mechanism of action of alkaline phosphatase in treating AKI is:  a. Conversion of ATP and ADP to adenosine, which has anti-inflammatory effects b. Phosphorylation of bacterial endotoxins c. Alkalinization of the urine d. Antioxidant effect e. Unknown",a
Acute kidney injury: emerging pharmacotherapies in current clinical trials,The use of iron chelators in treating AKI is most likely to be hampered by:  a. Lack of pharmaceutical agents that can chelate labile iron in humans b. Lack of efficacy of iron chelation in humans c. Lack of preclinical data on iron chelation d. High cost of iron chelators e. Multiple systemic side effects,e
Acute kidney injury: emerging pharmacotherapies in current clinical trials,"Of the following, a promising pharmaceutical approach in AKI will likely include:  a. Dopamine b. Mannitol c. Calcium channel blockade d. Furosemide e. A different combination of agents for different clinical scenarios",e
Acute kidney injury: emerging pharmacotherapies in current clinical trials,"Of the following, a promising strategy in AKI will likely include:  a. Continuing current supportive care strategies b. Initiating pharmacotherapies after serum creatinine has doubled c. Initiating pharmacotherapies after acute dialysis has begun d. Using novel biomarkers of AKI to trigger early interventions e. Treating only the underlying cause",d
Anemia in chronic kidney disease,"Among children on dialysis, which of the following is NOT a risk factor for anemia:a). Low serum albuminb). Increased parathyroid hormone (PTH) levelsc). High serum ferritind). Use of bioincompatible dialysatee). High residual urine output",e
Anemia in chronic kidney disease,Hepcidin negatively affects iron absorption and mobilization by:  a. Stimulating the production of transferrin b. Enhancing the activity of erythroferrone c. Downregulating ferroportin expression d. Upregulating ferroportin expression e. Inhibiting EPO production,c
Anemia in chronic kidney disease,What is a common side effect of ESA therapy in CKD patients?  a. Hypotension b. Hypertension c. Hypokalemia d. Hyperkalemia e. Leukopenia,b
Anemia in chronic kidney disease,Which of the following is TRUE about iron metabolism in CKD?  a. Iron is predominantly stored in the liver as ferritin b. Hepcidin is decreased in CKD c. CKD patients are at risk for absolute iron deficiency d. Functional iron deficiency is rare in CKD e. EPO levels are typically high in CKD,c
Anemia in chronic kidney disease,Which of the following statements is FALSE regarding anemia in CKD?  a. Anemia is associated with increased mortality in pediatric CKD patients b. Anemia can exacerbate cardiovascular disease in CKD patients c. EPO production is upregulated in CKD d. Iron deficiency can contribute to ESA hyporesponsiveness e. Nutritional deficiencies may exacerbate anemia in CKD,c
Clinical management of nocturnal enuresis,Which of the following statements regarding nocturnal enuresis (NE) is true?  a) Enuresis occurs more often in girls b) Almost all enuretic children have nocturnal polyuria c) ADHD is not associated with enuresis d) Arousal dysfunction is an important factor e) Organic forms of bladder dysfunction in enuresis are a frequent problem,d
Clinical management of nocturnal enuresis,Secondary enuresis means a relapse of nocturnal incontinence after a dry period of:  a) 1 month b) 2 months c) 6 weeks d) 12 weeks e) 6 months,e
Clinical management of nocturnal enuresis,The first-line therapy for all subtypes of enuresis is:  a) Alarm therapy b) Urotherapy c) Desmopressin d) Imipramine e) Oxybutynin,b
Clinical management of nocturnal enuresis,Symptoms of nonmonosymptomatic enuresis (NMNE) are:  a) Urgency b) Daytime incontinence c) Increased voiding frequency d) Holding maneuvers e) All of the above,e
Clinical management of nocturnal enuresis,Which of the following statements regarding desmopressin is true?  a) Long-term treatment success of desmopressin is better than that of alarm therapy b) Desmopressin should be taken immediately before going to bed c) Treatment success of desmopressin is >80% d) Water intoxication with convulsions is an important side effect e) Fluid restriction in the evening during desmopressin therapy is not necessary,d
Blood pressure management in children on dialysis,1. Which of the following methods for dry weight assessment is associated with better BP control in children on hemodialysis?	a) Brain natriuretic peptide b) Inferior vena cava diameter c) Blood volume monitoring d) Lung ultrasound e) All the above,c
Blood pressure management in children on dialysis,2. The most important source of dietary sodium in children is:	a) Salt added to the food during processing b) Salt added while cooking c) Salt added at the table d) Sodium occurring naturally in food e) All the above in the same amount,a
Blood pressure management in children on dialysis,3. Sodium removal during peritoneal dialysis can be maximized by:	a) Decreasing dwell time b) Reducing dwell numbers c) Increasing dwell volume d) Reducing dwell volume e) Volumes and dwells do not affect sodium removal during peritoneal dialysis,c
Blood pressure management in children on dialysis,4. Improvement of blood pressure in pediatric studies on children treated with dialysis has been obtained by means of:	a) Reduction of dialysate sodium concentration b) Daily hemodiafiltration c) Nocturnal hemodialysis d) Nocturnal hemodiafiltration e) All the above,e
Blood pressure management in children on dialysis,5. Which of the following drugs is removed by hemodialysis?	a) Carvedilol b) Calcium channel blockers c) Angiotensin receptor blockers d) Atenolol e) Labetalol,d
Current strategies to predict and manage sequelae of posterior urethral valves in children,Antenatal diagnosis of posterior urethral valves is:  a) Made in about half the cases b) Always made by observing a keyhole sign c) Ruled out by a normal sized urinary bladder d) Only made in the presence of bilateral hydronephrosis,a
Current strategies to predict and manage sequelae of posterior urethral valves in children,Bladder dysfunction in children with PUV is:  a) Reversed by treating the obstruction b) A significant contributor to the progression of CKD c) Prevented by early treatment d) Equally severe in all cases,b
Current strategies to predict and manage sequelae of posterior urethral valves in children,"Which statement about vesicoureteral reflux in children with PUV is false?  a) High-grade vesicoureteral reflux is common in infants with posterior urethral valves b) High-grade vesicoureteral reflux must be aggressively corrected to assist treatment of bladder dysfunction c) Significant hydronephrosis can be found in infants with PUV in the absence of VUR d) If indicated, CIC can be safely commenced in the presence of vesicoureteral reflux.",b
Current strategies to predict and manage sequelae of posterior urethral valves in children,"The treatment options for polyuria, large-capacity bladder and incontinence in a 7-year-old with PUV incised in infancy would include all except:  a) Clean intermittent catheterisation b) Frequent/double voiding c) Desmopressin and fluid restriction d) Nocturnal bladder drainage",c
Current strategies to predict and manage sequelae of posterior urethral valves in children,Which of the following statements about renal transplantation in children with PUV is true?  a) The need for transplantation is on the wane b) Transplantation is usually needed in children without bladder dysfunction c) Aggressive bladder management pre-transplant is the key to good graft longevity d) Transplantation cannot be considered in children on assisted bladder emptying (CIC),c
Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation,1. All statements below regarding the use of ABPM are true except one:	a. ABPM is inferior compared to blood pressure measurements taken in the clinical setting for improving a subject’s risk stratification. b. ABPM identifies patients with white-coat hypertension. c. ABPM identifies patients with masked hypertension. d. ABPM provides a better estimate of a subject’s true mean blood pressure than blood pressure measurements taken in the clinical setting.,a
Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation,2. What is the best method of measuring blood pressure for the diagnosis and treatment monitoring of hypertension in renal transplant recipients?	a. Home blood pressure measurements. b. ABPM. c. Blood pressure measurements taken in the clinical setting. d. All of them are alike.,b
Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation,"3. What should be done in a recipient with hypertension that is diagnosed in the clinical setting and who has verified hypertensive-related organ damage?	a. Confirm hypertension by ABPM. b. Start antihypertensive treatment without delay and monitoring treatment with ABPM. c. After confirming hypertension by means of ABPM, treatment monitor should only rely upon blood pressure measurements taken in the clinical setting. d. Answers a) and c) are correct.",b
Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation,4. In treated hypertensive renal transplant recipients with ambulatory controlled blood pressure:	a. The annual loss of renal allograft function is expected to be similar to normotensive recipients. b. In hypertensive recipients with initially diagnosed left ventricular hypertrophy it is most likely to observe a regression of left ventricular mass under successfully long-term controlled blood pressure. c. Uncontrolled hypertension has been shown to be associated with increased carotid intima-media thickness. d. All answers are correct.,d
Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation,"In pediatric kidney transplant recipients, masked hypertension is:  a) Hypertension that is only present during clinical visits b) Hypertension that is undetected by clinical BP measurements but identified by ABPM c) Hypertension that occurs only at night d) Hypertension that is resistant to treatment",b
Educational review: measurement of GFR in special populations,"Which one of the following statements is FALSE?  a) Creatine supplements do not affect serum creatinine level. b) High-protein diet is associated with increased GFR. c) An average teenage boy may have 15–20% less fat mass compared with an average girl of same age. d) The difference in lean body mass can be accounted for by indexing the GFR to TBW, rather than to BSA.",a
Educational review: measurement of GFR in special populations,"Which of the following statements is TRUE?  a) Creatinine-based eGFR is more accurate than eGFR based on both cystatin C and creatinine. b) In patients with muscle wasting, creatinine-based eGFR may be falsely elevated. c) Higher muscle mass can cause overestimation of creatinine-based eGFR through decreased creatinine levels. d) Conditions like spina bifida and muscular dystrophy do not impact eGFR calculations.",b
Educational review: measurement of GFR in special populations,Which of the following statements is TRUE?  a) Most eGFR formulae work reliably in obese patients. b) Using BSA derived from ideal body weight rather than using absolute body weight does not make a difference in eGFR calculations. c) Indexing eGFR to BSA in obese patients leads to GFR overestimation. d) Cystatin-C-based eGFR formulae outperform creatinine-based ones.,d
Educational review: measurement of GFR in special populations,"Please select the TRUE statement:  a) In a term neonate, renal function changes every day after delivery. b) For at least 72 h, neonatal creatinine largely reflects maternal renal function. c) The best way to reflect changes in neonatal renal function of premature babies are reference intervals based on chronological age after birth. d) Cystatin C is present in large quantities in the maternal placenta.",c
Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment,Which statement about dysfunctional voiding (DV) is true?  a) DV is always due to an underlying neurological condition. b) DV can be diagnosed solely based on patient history. c) DV often presents with symptoms of lower urinary tract dysfunction. d) DV is best treated with invasive urodynamic studies.,c
Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment,What is the primary treatment for dysfunctional voiding?  a) Medication to relax the bladder muscles. b) Surgery to correct the bladder outlet obstruction. c) Biofeedback and pelvic floor muscle retraining. d) Catheterization to ensure complete bladder emptying.,c
Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment,Which of the following is NOT a common symptom of dysfunctional voiding?  a) Urinary incontinence b) Recurrent urinary tract infections c) Vesicoureteric reflux d) Increased bladder capacity,d
Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment,What non-invasive diagnostic tool is commonly used to diagnose dysfunctional voiding?  a) Cystoscopy b) Uroflowmetry c) Intravenous pyelogram d) MRI of the pelvic floor,b
Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment,Which of the following conditions is often associated with dysfunctional voiding?  a) Neurogenic bladder b) Chronic kidney disease c) Overactive bladder d) Diabetes insipidus,c
Generic immunosuppressants,Which regulatory authority has the weakest guidelines for the registration of 'critical dose drug' generics:  a) Food and Drug Administration (FDA) b) European Medicines Agency (EMA) c) Mexican Drug Regulatory Agency (Coferis) d) Health Canada Food and Drug Administration,a
Generic immunosuppressants,Which immunosuppressant is not a 'critical dose drug':  a) Sirolimus b) Tacrolimus c) Cyclosporine d) Mycophenolate mofetil,d
Generic immunosuppressants,Which aspect of generic immunosuppressants has the greatest unintended impact on patient safety:  a) Uncontrolled switch between different formulations b) Lower Cmax of non-innovator drug c) Different dissolution d) Ontogeny of drug disposition,a
Generic immunosuppressants,"The generic formulations for which drug do not meet any of the bioequivalence recommendations of the FDA, EMA or Health Canada:  a) Cyclosporine b) Everolimus c) Sirolimus d) Tacrolimus",d
Expanding the role of vasopressin antagonism in polycystic kidney diseases: From adults to children?,Which of the following statements about autosomal dominant polycystic kidney disease (ADPKD) is correct?  a) ADPKD is mainly caused by mutations in the PKD2 gene. b) ADPKD is the fourth leading cause of end-stage renal disease (ESRD) in adults. c) Patients with PKD1 mutations have a less severe renal phenotype compared to PKD2 mutations. d) Hypertension and cardiovascular disease are rare causes of morbidity and mortality in ADPKD patients.,b
Expanding the role of vasopressin antagonism in polycystic kidney diseases: From adults to children?,Which of the following is true about the role of vasopressin (AVP) in polycystic kidney disease (PKD)?  a) AVP decreases cyclic adenosine monophosphate (cAMP) levels. b) AVP is not involved in the pathogenesis of PKD. c) AVP antagonists have been shown to slow cyst growth in PKD. d) AVP directly reduces cyst formation.,c
Expanding the role of vasopressin antagonism in polycystic kidney diseases: From adults to children?,Which statement is correct regarding the clinical trial of tolvaptan in pediatric ADPKD patients?  a) The trial has shown conclusive evidence of efficacy in children. b) The trial aims to describe the effect of tolvaptan on kidney function decline. c) The trial excludes patients with rapidly progressive disease. d) The trial is focused on adult patients only.,b
Expanding the role of vasopressin antagonism in polycystic kidney diseases: From adults to children?,What is the main function of the vasopressin V2 receptor (V2R) in the kidney?  a) V2R regulates sodium excretion. b) V2R controls the reabsorption of calcium. c) V2R mediates water reabsorption in the collecting ducts. d) V2R is involved in the secretion of potassium.,c
Expanding the role of vasopressin antagonism in polycystic kidney diseases: From adults to children?,Which of the following pathways is primarily affected in polycystic kidney disease?  a) Wnt signaling b) cAMP signaling c) MAPK/ERK signaling d) STAT3 signaling,b
Hearing loss and renal syndromes,"A 17-year-old boy has sensorineural hearing loss, hematuria, and proteinuria with GBM thickening on electron microscopy, and thrombocytopenia. Mutation in which of the following genes is the most likely cause of his symptoms? a) COL4A5 b) COL4A3 c) MYH9 d) COQ2 e) CD151",c
Hearing loss and renal syndromes,"A 1-year-old boy has small dysplastic kidneys, triphalangeal thumbs, and a history of imperforate anus corrected in the neonatal period. What is the child’s most likely underlying diagnosis? a) Townes–Brocks syndrome b) Branchio-oto-renal syndrome c) CHARGE syndrome d) Abruzzo–Erickson syndrome e) Wolfram syndrome",a
Hearing loss and renal syndromes,"A 16-year-old boy with recently diagnosed X-linked Alport syndrome has proteinuria (1.5 g/day), normal blood pressure, and eGFR of 85 ml/min/1.73 m2. What treatment should be initiated to slow the progression of chronic kidney disease? a) Calcineurin inhibitor b) Calcium channel blocker c) Beta blocker d) Thiazide diuretic e) ACE inhibitor",d
Hearing loss and renal syndromes,"A 5-year-old has sensorineural deafness, hypokalemia, metabolic alkalosis, and polyuria. Mutation in which of the following genes is likely to be the cause of his symptoms? a) SLC12A1 (Na-K-2Cl co-transporter) b) KCNJ1 (ROMK potassium channel) c) KCNJ10 (Kir4.1 potassium channel) d) BSND (Barttin) e) ATP6B1 (B1 subunit of H+-ATPase)",e
Graft nephrectomy in children,"Regarding the surgical techniques of graft nephrectomy, which of the following statements is FALSE?  a) All intraperitoneal grafts are explanted via the intraperitoneal approach. b) The extra-capsular approach is preferred soon after transplantation, as the surrounding tissue has not yet become adherent to the capsule of the graft. c) The intra-capsular approach is preferred late after transplantation as little allogeneic tissue is left in situ. d) Renal artery embolisation may be used before graft nephrectomy to reduce intraoperative bleeding and transfusion requirements.",c
Graft nephrectomy in children,"Regarding the indications for graft nephrectomy, which of the following statements is FALSE?  a) Unsalvageable acute arterial and/or venous graft thromboses are absolute indications for graft nephrectomy. b) Minimally invasive strategies, such as renal artery embolisation, should be considered first for graft malignancy, before graft nephrectomy. c) Graft nephrectomy can be performed at the time of retransplantation. d) BK nephropathy is a relative indication for graft nephrectomy, if antiviral treatments have been unsuccessful.",b
Graft nephrectomy in children,"Regarding allosensitisation, which of the following are NOT considered to be likely sensitising events?  a) Blood transfusion b) Pregnancy c) Transplantation d) Plasma exchange",d
Infections and the kidney: a tale from the tropics,AKI in leptospirosis typically presents as:  a) Non-oliguric AKI with hypokalemia b) Oliguric AKI with hypokalemia c) Hyperphosphatemia and hypocalcemia d) Hyperkalemia with metabolic alkalosis,a
Infections and the kidney: a tale from the tropics,AKI in malaria is secondary to:  a) Direct invasion of the renal parenchyma by malarial parasite b) Ischemia to the tubules c) Interstitial nephritis d. Secondary to anti-malarials causing nephrotoxicity,b
Infections and the kidney: a tale from the tropics,"Urinary schistosomiasis typically presents as:  a) AKI b) Lower urinary tract symptoms like dysuria, pollakiuria c) Tubulointerstitial nephritis d) All of the above",b
Infections and the kidney: a tale from the tropics,Which of the following tropical infections is known to cause chronic kidney disease?  a) Tuberculosis b) Typhoid fever c) Dengue shock syndrome d) Yellow fever,a
Infections and the kidney: a tale from the tropics,Which of the following is the most common form of renal involvement in tropical infections?  a) Glomerulonephritis b) AKI c) Chronic kidney disease d) Obstructive uropathy,b
Hypercalcemia: a consultant’s approach,1. Pseudohypercalcemia can be seen in:	a) Low-serum ionized calcium concentration. b) Hypoalbuminemia. c) Pseudohypoparathyroidism. d) Hyperalbuminemia. e) Severe combined immune deficiency.,d
Hypercalcemia: a consultant’s approach,2. Elevated Ca concentrations induce the following CaSR-mediated effect:	a) Water reabsorption is reduced by inhibiting the tubular response to ADH. b) Water reabsorption is reduced by inhibiting the CaSR mesangial transporters. c) Water reabsorption is enhanced by inhibiting the tubular response to ADH. d) Water reabsorption is unaffected. e) Water reabsorption is reduced by stimulating proximal tubular sodium reabsorption.,a
Hypercalcemia: a consultant’s approach,"3. Post-renal transplant hypercalcemia may occur as a result of:	a) Calcineurin inhibitor induced PTH production. b) Delayed graft function induced 1,25 (OH)2 vitamin D production. c) Pre-transplant hyperplastic parathyroid glands. d) Dietary non-compliance. e) Hidden parathyroid adenoma.",c
Hypercalcemia: a consultant’s approach,"4. Following hydration, the drug of choice in addressing most cases of hypercalcemia is:	a) Furosemide. b) Calcitonin. c) Corticosteroids. d) Bisphosphonates. e) Phosphate.",d
Hypercalcemia: a consultant’s approach,"5. To exert their effect, calcimimetics;	a) Have to have extracellular calcium present. b) Have to have 1,25 (OH)2 vitamin D present. c) Have to have an abnormal CaSR present. d) Have to have high serum phosphate present. e) Have to be given concomitantly with bisphosphonates.",a
Life with one kidney,The incidence of SFK is estimated to be:  a) One in approximately 500 b) One in approximately 1400 c) One in approximately 2000 d) One in approximately 4300,b
Life with one kidney,The most common etiology of SFK is:  a) Genetic b) Associated with gestational diabetes c) Drug use during gestation d) Unknown,d
Life with one kidney,"The sequence of events in the hyperfiltration hypothesis is:  a) Systemic hypertension, glomerular hypertension, GFR increase, albuminuria b) Systemic hypertension, glomerular hyperfiltration, albuminuria, GFR decline c) Glomerular hyperfiltration, glomerular hypertension, systemic hypertension, GFR decline d) Glomerular hyperfiltration, albuminuria, GFR increase, systemic hypertension",c
Life with one kidney,"Follow-up in patients with a SFK:  a) Is only indicated in specific circumstances, such as a GFR <60 ml/min/1.73 m2 b) Is indicated in all children with a SFK c) Is indicated in all patients with a SFK, with a reduced intensity of follow-up after 10 years d) Is indicated in all patients with a SFK",d
Life with one kidney,Which of the following factors is NOT associated with an increased risk of renal injury in congenital SFK:  a) Male sex b) Increasing age c) Additional anomalies in the SFK or urinary tract renal hypertrophy,a
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",The chronic nephrotoxicity risk is highest with which of the following chemotherapy agents?  a) Carboplatin b) Ifosfamide c) Cisplatin d) Methotrexate,c
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following conditions may result from cisplatin treatment?  a) Hyperkalemia b) Hypomagnesemia c) Hypercalcemia d) Hyponatremia,b
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",What is a common late effect of unilateral nephrectomy in childhood cancer survivors?  a) Hypotension b) Glomerular hyperfiltration c) Hypophosphatemia d) Metabolic acidosis,b
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following is a risk factor for developing nephrotoxicity in childhood cancer survivors?  a) Age above 10 at diagnosis b) Higher cumulative dose of nephrotoxic chemotherapy c) Absence of radiation therapy d) Short duration of cancer treatment,b
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following is NOT a common clinical feature of chronic nephrotoxicity due to ifosfamide?  a) Hypophosphatemia b) Glycosuria c) Hypertension d) Tubular acidosis,c
Moving on: transitioning young people with chronic kidney disease to adult care,"Transition is:  a) The transfer of care from paediatric to adult services b) Something that can be organised quickly c) A process that involves only paediatric care providers d) Not a single event in time, but rather a well-planned process that occurs over time, involving the transfer of care from the paediatric healthcare service to the adult healthcare service",d
Moving on: transitioning young people with chronic kidney disease to adult care,The risk of graft failure is highest for those in which age group?  a) Adolescence and early adulthood b) 50- to 60-year olds c) 40- to 50-year olds d) 5- to 10-year olds,a
Moving on: transitioning young people with chronic kidney disease to adult care,Which outcomes have been reported post-transition compared to pre-transition?  a) No change in medication adherence b) Worsening medication adherence c) Increased graft loss d) No change in graft loss e) All of the above,e
Moving on: transitioning young people with chronic kidney disease to adult care,Which interventions have been reported to improve transition in the literature?  a) Multidisciplinary transition clinic b) Residential camps c) Electronic apps d) Websites and social media support e) a and b,e
Moving on: transitioning young people with chronic kidney disease to adult care,How many randomised controlled trials have been reported on transition in CKD/ESKD?  a) 0 b) 1–4 c) 5–10 d) 10 +,a
Liver involvement in kidney disease and vice versa,Which of the following conditions is most likely to cause hepatorenal syndrome?  a) Chronic hepatitis B b) Alcoholic liver disease c) Non-alcoholic fatty liver disease (NAFLD) d) Autoimmune hepatitis,b
Liver involvement in kidney disease and vice versa,Which of the following is the least likely to cause renal disease?  a) Primary biliary cirrhosis b) Wilson's disease c) Hemochromatosis d) Hepatitis C,b
Liver involvement in kidney disease and vice versa,What is the main clinical feature of hepatorenal syndrome?  a) Proteinuria b) Oliguria c) Hematuria d) Pyuria,b
Liver involvement in kidney disease and vice versa,What is the first-line treatment for hepatorenal syndrome?  a) Liver transplantation b) Renal replacement therapy c) Terlipressin and albumin  d) Diuretics,c
Liver involvement in kidney disease and vice versa,"Which condition is characterized by liver disease, neurological symptoms, and kidney involvement?  a) Wilson's disease b) Hepatitis B c) Primary sclerosing cholangitis d) Gilbert's syndrome",a
Muscle wasting in chronic kidney disease,Muscle wasting in children with CKD is associated with:  a) Age b) Sex c) Tanner stage d) CKD stage e) Parental BMI,d
Muscle wasting in chronic kidney disease,The etiology of muscle wasting in children with CKD includes:  a) Poor nutritional intake b) Inflammation c) Acidosis d) Growth hormone resistance e) All of the above,e
Muscle wasting in chronic kidney disease,BMI in children must be expressed as a percentile or Z-score adjusted by:  a) Age b) Ethnicity c) Height/age d) CKD staging e) Parental BMI,c
Muscle wasting in chronic kidney disease,Cachexia or protein energy wasting in children with CKD is best characterized by:  a) Weight standard deviation score b) Weight loss c) Linear growth d) Presence of inflammation e) Hypoalbuminemia,c
Muscle wasting in chronic kidney disease,Manifestations of cachexia or protein energy wasting in children with CKD include:  a) Anorexia b) Elevated metabolic rate c) Loss of protein reserves d) Body composition changes do not normalize on energy supplementation e) All of the above,e
Mycophenolate mofetil for sustained remission in nephrotic syndrome,1. What statement on nephrotic syndrome in childhood is correct?	a) Idiopathic nephrotic syndrome is by far the least frequent glomerular disease in childhood. b) About a half of patients with relapses have frequently relapsing nephrotic syndrome with one third to one half of these being steroid dependent. c) Azathioprine is the preferred steroid-sparing agent for treatment of nephrotic syndrome in childhood. d) Prolonged use of steroids for treatment of nephrotic syndrome in childhood is generally tolerated without any side effects. e) There is broadly based consensus of steroid-sparing treatment of nephrotic syndrome in childhood.,b
Mycophenolate mofetil for sustained remission in nephrotic syndrome,2. Mycophenolic acid is	a) an ester prodrug of Mycophenolate Mofetil b) acts as an inhibitor of inosine monophosphate dehydrogenase c) counteracts the expansion of mesangial matrix d) has no systemic toxicity at all e) seems to have an antiproteinuric effect Which statements are correct?,c
Mycophenolate mofetil for sustained remission in nephrotic syndrome,3. What statement on pharmacokinetics of mycophenolic acid is false?	a) There is a poor correlation between MMF dose and MPA exposure. b) The pharmacologically inactive 7-O-MPA glucuronide (MPAG) is the major metabolite of MPA. c) MPA exhibits significant inter- and intra-patient variability in drug pharmacokinetics. d) Therapeutic drug monitoring of Mycophenolate Mofetil plays no role in children with nephrotic syndrome. e) Exposure to MPA needs to be higher in children with nephrotic syndrome to be efficacious than in pediatric renal transplant recipients.,d
Mycophenolate mofetil for sustained remission in nephrotic syndrome,"4. What statement on the therapeutic properties of Mycophenolate Mofetil (MMF) is correct?	a) MMF is not a therapeutic option in children with steroid-sensitive nephrotic syndrome experiencing frequent relapses or steroid dependency. b) When using MMF as long-term immunosuppression, no further follow-up to detect potential side effects is warranted. c) MMF is always beneficial in patients with steroid-resistant nephrotic syndrome. d) The KDIGO expert working group has not recommended MMF for patients with FRNS/SDNS experiencing steroid toxicity. e) MMF has immunosuppressive and antiproteinuric effects.",e
Mycophenolate mofetil for sustained remission in nephrotic syndrome,"5. Critically reviewing published studies on Mycophenolate Mofetil (MMF) for sustained remission in nephrotic syndrome one has to consider that	a) there are important limitations to the interpretation and comparability of published studies including study design, sample size, patient selection, clinical endpoints, carry-over effects and duration of follow-up. b) it is not possible to finally determine efficacy of MMF from the published uncontrolled studies, c) it is currently unclear how long patients with frequently relapsing nephrotic syndrome, steroid-dependent nephrotic syndrome or steroid-resistant nephrotic syndrome should be treated with MMF. Which statements are correct?",a
Mycophenolate mofetil for sustained remission in nephrotic syndrome,"6. What statement on principal limitations of clinical trials in patients with relapsing nephrotic syndrome is correct?	a) All steroid-sparing drugs used for treatment of the nephrotic syndrome have only weak immunosuppressive properties. b) The idiopathic nephrotic syndrome may follow its natural course and may resolve with time. Treatment effects may thus be falsely attributed to a particular medication. c) Pharmacokinetics of mycophenolic acid do not show large inter- and intra-individual variability. d) The clinical response to steroids is always constant. e) The disease affects mainly girls, and results of all studies may be biased by a preponderance of female participants.",b
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),Muscle wasting in children with CKD is associated with:  a) Age b) Sex c) Tanner stage d) CKD stage e) Parental BMI,d
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),The etiology of muscle wasting in children with CKD includes:  a) Poor nutritional intake b) Inflammation c) Acidosis d) Growth hormone resistance e) All of the above,e
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),BMI in children must be expressed as a percentile or Z-score adjusted by:  a) Age b) Ethnicity c) Height/age d) CKD staging e) Parental BMI,c
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),Cachexia or protein energy wasting in children with CKD is best characterized by:  a) Weight standard deviation score b) Weight loss c) Linear growth d) Presence of inflammation e) Hypoalbuminemia,c
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),Manifestations of cachexia or protein energy wasting in children with CKD include:  a) Anorexia b) Elevated metabolic rate c) Loss of protein reserves d) Body composition changes do not normalize on energy supplementation e) All of the above,e
Muscle wasting in chronic kidney disease,Muscle wasting in children with CKD is associated with:  a) Age b) Sex c) Tanner stage d) CKD stage e) Parental BMI,d
Muscle wasting in chronic kidney disease,The etiology of muscle wasting in children with CKD includes:  a) Poor nutritional intake b) Inflammation c) Acidosis d) Growth hormone resistance e) All of the above,e
Muscle wasting in chronic kidney disease,BMI in children must be expressed as a percentile or Z-score adjusted by:  a) Age b) Ethnicity c) Height/age d) CKD staging e) Parental BMI,c
Muscle wasting in chronic kidney disease,Cachexia or protein energy wasting in children with CKD is best characterized by:  a) Weight standard deviation score b) Weight loss c) Linear growth d) Presence of inflammation e) Hypoalbuminemia,c
Muscle wasting in chronic kidney disease,Manifestations of cachexia or protein energy wasting in children with CKD include:  a) Anorexia b) Elevated metabolic rate c) Loss of protein reserves d) Body composition changes do not normalize on energy supplementation e) All of the above,e
Mycophenolate mofetil for sustained remission in nephrotic syndrome,Which of the following statements about mycophenolate mofetil (MMF) is correct?  a) MMF is a calcineurin inhibitor. b) MMF has high systemic toxicity. c) MMF is recommended for children with frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) to achieve sustained remission of proteinuria. d) MMF is not suitable for children with steroid-resistant nephrotic syndrome (SRNS).,c
Mycophenolate mofetil for sustained remission in nephrotic syndrome,What is a potential side effect of MMF that requires counseling in female patients?  a) Nephrotoxicity b) Teratogenicity c) Hepatotoxicity d) Neurotoxicity,b
Mycophenolate mofetil for sustained remission in nephrotic syndrome,Which of the following factors influences the pharmacokinetics of mycophenolic acid (MPA) in patients treated with MMF?  a) Age b) Weight c) Ethnicity d) Both inter- and intra-patient variability,d
Mycophenolate mofetil for sustained remission in nephrotic syndrome,Why is therapeutic drug monitoring (TDM) important in patients treated with MMF?  a) To monitor for nephrotoxicity b) To avoid relapses c) To prevent infections d) To detect teratogenic effects,b
Mycophenolate mofetil for sustained remission in nephrotic syndrome,"In randomized controlled trials (RCTs) comparing MMF with calcineurin inhibitors in children with nephrotic syndrome, which of the following statements is correct?  a) MMF was found to be more effective than calcineurin inhibitors. b) Calcineurin inhibitors were found to be more effective than MMF. c) MMF had more severe side effects than calcineurin inhibitors. d) There was no difference in effectiveness between MM",b
Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?,1. True or false. Chronic renal findings are infrequently found in patients who experience AKI and survive to hospital discharge?,False
Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?,"2. Following an episode of AKI, what is the most appropriate time to assess survivors for CKD?	a) 1 week b) 1 month c) 3 months d) 3 years",c
Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?,3. Which of the following should be monitored in a patient who has experienced AKI and is thought to be at high risk for chronic renal disease?	a) Urine protein content b) Serum creatinine c) Blood pressure d) All of the above,d
Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?,4. Which of the following are currently hampering our ability to assess the causal association between AKI and CKD?	a) A lack of studies containing a non-AKI comparator group b) Inconsistent definitions of AKI c) The absence of a consensus definition for CKD d) The infrequency with which AKI is seen in hospitalized patients,a
Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm?,5. CKD in children is defined as:	a) Serum creatinine of ≥ 3 mg/dL (265 umol/L) b) GFR < 60 mL/min/1.73 m2 c) GFR > 180 mL/min/1.73 m2 d) GFR 60–90 mL/min/1.73 m2 with evidence of kidney injury or damage e) b and d,e
Muscle wasting in chronic kidney disease,Muscle wasting in children with CKD is associated with:  a) Age b) Sex c) Tanner stage d) CKD stage e) Parental BMI,d
Muscle wasting in chronic kidney disease,The etiology of muscle wasting in children with CKD includes:  a) Poor nutritional intake b) Inflammation c) Acidosis d) Growth hormone resistance e) All of the above,e
Muscle wasting in chronic kidney disease,BMI in children must be expressed as a percentile or Z-score adjusted by:  a) Age b) Ethnicity c) Height/age d) CKD staging e) Parental BMI,c
Muscle wasting in chronic kidney disease,Cachexia or protein energy wasting in children with CKD is best characterized by:  a) Weight standard deviation score b) Weight loss c) Linear growth d) Presence of inflammation e) Hypoalbuminemia,c
Muscle wasting in chronic kidney disease,Manifestations of cachexia or protein energy wasting in children with CKD include:  a) Anorexia b) Elevated metabolic rate c) Loss of protein reserves d) Body composition changes do not normalize on energy supplementation e) All of the above,e
Role of renal sympathetic nerve activity in prenatal programming of hypertension,Which of the following prenatal insults can lead to small for gestational age (SGA) neonates?  a) Maternal dietary protein deprivation b) Uteroplacental insufficiency c) Prenatal administration of dexamethasone d) All of the above,d
Role of renal sympathetic nerve activity in prenatal programming of hypertension,What is the main effect of renal denervation in prenatally programmed rats?  a) It prevents the development of hypertension in programmed rats b) It has no significant effect on control rats c) It reduces blood pressure in programmed rats d) All of the above,d
Role of renal sympathetic nerve activity in prenatal programming of hypertension,Which of the following is NOT a factor that may play a role in the prenatal programming of hypertension?  a) Reduction in nephron number b) Dysregulation of the systemic renin-angiotensin system c) Increased vascular tone d) Increased glomerular filtration rate (GFR),d
Role of renal sympathetic nerve activity in prenatal programming of hypertension,What is the effect of a maternal low protein diet on sodium transport in prenatally programmed rats?  a) It decreases sodium transport b) It increases sodium transport c) It has no effect on sodium transport d) It reduces sodium reabsorption,b
Role of renal sympathetic nerve activity in prenatal programming of hypertension,What effect does the administration of furosemide have on blood pressure in programmed rats?  a) It increases blood pressure b) It normalizes blood pressure c) It decreases blood pressure in control rats d) It has no effect on blood pressure,b
"Renal, auricular, and ocular outcomes of Alport syndrome and their current management","Regarding the diagnosis of Alport syndrome, which is the correct opinion?  a) A family history of hematuria is necessary to make the diagnosis b) The exclusion diagnosis can be made if a patient presents with nephrotic proteinuria c) In a young boy, if there is no glomerular basement membrane splitting revealed by electron microscopy, this means that the boy is not suffering from Alport syndrome d) Genetic testing is required for a definitive diagnosis",d
"Renal, auricular, and ocular outcomes of Alport syndrome and their current management",The diagnosis of Alport syndrome is confirmed by:  a) Diffuse GBM lamellation b) A COL4A5 mutation or two COL4A3/COL4A4 mutations c) A family history of hematuria d) Hearing loss,b
"Renal, auricular, and ocular outcomes of Alport syndrome and their current management",Which drugs are recommended for the treatment of Alport syndrome?  a) Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers b) Cyclosporin A c) Steroids if a patient presents with heavy proteinuria d) Aldosterone inhibitors only,a
"Renal, auricular, and ocular outcomes of Alport syndrome and their current management",The manifestation that is highly suggestive of the diagnosis of Alport syndrome is:  a) Hematuria b) Cataract c) Anterior lenticonus d) Hearing loss,c
"Renal, auricular, and ocular outcomes of Alport syndrome and their current management",The typical ocular abnormalities in Alport syndrome include:  a) Near-sightedness b) Cataract c) Color blindness d) Anterior lenticonus,d
Role of renal sympathetic nerve activity in prenatal programming of hypertension,Which of the following is NOT a factor that could cause hypertension in programmed rats?  a) Reduced nephron number b) Increased sodium transport c) Dysregulation of the renin–angiotensin system d) Increased tubular potassium secretion,d
Role of renal sympathetic nerve activity in prenatal programming of hypertension,What effect does renal denervation have on blood pressure in programmed rats?  a) It reduces blood pressure to levels comparable to control rats b) It increases blood pressure c) It has no effect on blood pressure d) It causes a temporary reduction in blood pressure,a
Role of renal sympathetic nerve activity in prenatal programming of hypertension,Which prenatal insult is mentioned as leading to small for gestational age (SGA) neonates?  a) Maternal protein deprivation b) Maternal vitamin deficiency c) Maternal hyperglycemia d) Maternal hypercalcemia,a
Role of renal sympathetic nerve activity in prenatal programming of hypertension,Which sodium transporter is upregulated in the proximal tubules of programmed rats?  a) Na+/H+ exchanger (NHE3) b) Sodium-glucose cotransporter c) Na+/K+/2Cl- cotransporter (NKCC2) d) Epithelial sodium channel (ENaC),a
Survival in children requiring chronic renal replacement therapy,1. What is roughly the 5-year survival rate for an average pediatric patient starting RRT in a developed country?	a. 90% b. 80% c. 70% d. 60%,a
Survival in children requiring chronic renal replacement therapy,2. Which patient group has seen the greatest improvement in survival over the past decade?	a. Youngest patients b. Pubertal patients c. Patients with a CAKUT diagnosis d. Patients receiving a pre-emptive transplant,a
Survival in children requiring chronic renal replacement therapy,3. Which patient population has an increased risk of cardiovascular mortality?	a. Black patients b. Youngest patients c. Hemodialysis patients d. All of the above,d
Survival in children requiring chronic renal replacement therapy,Which of the following is a key factor in the decision to withhold or withdraw treatment in some infants requiring dialysis?  a) High risk of infection b) Difficulties in nutrition and growth c) High prevalence of severe comorbidities d) Perceived unacceptable quality of life e) All of the above,e
Survival in children requiring chronic renal replacement therapy,What percentage of neonates and infants placed on dialysis now survive long enough to reach the minimum age and body weight required for successful transplantation?  a) 50% b) 60% c) 70% d) 80% e) 90%,d
The gut–kidney axis in IgA nephropathy: role of microbiota and diet on genetic predisposition,Which IgA is prevalent in the mesangial deposits of patients with IgA nephropathy?  a) monomeric IgA1 b) polymeric IgA1 c) polymeric IgA2 d) secretory IgA,b
The gut–kidney axis in IgA nephropathy: role of microbiota and diet on genetic predisposition,Which pathway is associated with IgA nephropathy from GWAS studies?  a) IgA immune response b) Tonsil mucosal immunity c) Intestinal immune network for IgA production and protozoan infections d) Gut dysbiosis,c
The gut–kidney axis in IgA nephropathy: role of microbiota and diet on genetic predisposition,Tonsillectomy in patients with IgA nephropathy  a) Prevents progression in all cohorts b) Prevents progression in European cohorts c) Does not provide further benefits in addition to steroids in comparison to steroids alone d) Improves the innate immunity reactions,c
The gut–kidney axis in IgA nephropathy: role of microbiota and diet on genetic predisposition,Microbiota and IgA nephropathy  a) May modulate the IgA1 glycosylation b) The tonsillar microbiota plays a role in progression of IgA nephropathy c) Is independent of diet d) Is independent from the environment,a
The gut–kidney axis in IgA nephropathy: role of microbiota and diet on genetic predisposition,IgA nephropathy and intestinal diseases: what is proved so far?  a) A pathogenetic link between gluten and IgA nephropathy in experimental animals b) IgA nephropathy and celiac disease are the same disease c) IgA nephropathy and inflammatory bowel diseases are the same disease d) No correlation between IgA nephropathy and intestinal diseases,a
Thrombotic microangiopathy following haematopoietic stem cell transplant,1. Which of the following statements is false? a) Transplant-associated thrombotic microangiopathy is more common following autologous haematopoietic stem cell transplantation. b) Calcineurin inhibitor treatment may predispose patients to TA-TMA. c) Some patients may be genetically predisposed to developing TA-TMA. d) Conditioning regimens may predispose to TMA. e) Pulmonary hypertension 1 week after transplantation may indicate a high risk of later development of TA-TMA.,a
Thrombotic microangiopathy following haematopoietic stem cell transplant,"2. Which two of the following statements are false? a) Low platelet count does not confirm a diagnosis of TATMA. b) Diarrhoea in a recipient of a haematopoietic stem cell transplant can be caused by infection or graft versus host disease, but not by TA-TMA. c) Patients with TA-TMA may have multisystem disease, including cardiac and CNS involvement. d) Diagnosis of TA-TMA can be aided by biopsy of affected tissues. e) There are no internationally accepted criteria for establishing a diagnosis of TA-TMA.","a,b"
Thrombotic microangiopathy following haematopoietic stem cell transplant,"4. Which two of the following statements are true? a) Untreated, TA-TMA can be a devastating disease with a very high mortality rate. b) Plasma exchange is useful, as it replenishes ADAMTS13 levels. c) If eculizumab treatment is started, it needs to be continued throughout life. d) Patients with TA-TMA almost all have very low plasma concentrations of complement C3. e) The presence of hypertension and heavy proteinuria together strongly suggests a diagnosis of TA-TMA.",d
Thrombotic microangiopathy following haematopoietic stem cell transplant,"5. Which of the following statements is false? a) Endothelial damage caused by conditioning regimens may contribute to the pathogenesis of TA-TMA. b) Complement activation, especially the alternative pathway, appears to play an important role in the pathogenesis of TA-TMA. c) NETosis is an attempt by the body to combat TA-TMA and therapies that promote it are likely to be effective at treating TA-TMA. d) Platelet activation probably plays an important role in the pathogenesis of TA-TMA. e) Neutrophil extracellular traps can activate complement and damage endothelial cells.","a,e"
Thrombotic microangiopathy following haematopoietic stem cell transplant,3. Which of the following is NOT an appropriate therapeutic choice in a patient with TA-TMA: a) Treatment with eculizumab b) Treatment with rituximab c) Treatment with defibrotide d) Treatment with cyclosporine and sirolimus,d
Vitamin and trace element deficiencies in the pediatric dialysis patient,"1. Which of the following statements most accurately describes the role of thiamine in normal homeostasis? a) Thiamine is a coenzyme for the conversion of pyruvate to acetyl coenzyme A, and the deficiency of thiamine leads to accumulation of pyruvate with metabolization to lactate. b) Thiamine is a water-soluble vitamin required for the enzyme transketolase in the pentose phosphate pathway. c) Risk for thiamine depletion is highest in those patients on filtration-based methods of dialysis receiving primarily parenteral nutrition with high-carbohydrate nutrition sources. d) The majority of thiamine stores are present in the body as thiamine pyrophosphate. e) All of the above.",e
Vitamin and trace element deficiencies in the pediatric dialysis patient,Clinical manifestations of zinc deficiency include all of the following except: a) Chronic diarrhea and malnutrition/weight lossc) Delayed sexual maturation (hypogonadism and oligospermia) d) Alopecia and oral lesions e) All of the above are manifestations b) Delayed wound healing,e
Vitamin and trace element deficiencies in the pediatric dialysis patient,"4. Which of the following most accurately describes the role of dialysis on selenium levels? a) Prolonged CRRT may increase the risk for significant selenium depletion. b) Selenium removal is significant from PD and requires additional supplementation exceeding the DRI. c) Serum selenium levels are high in the adult maintenance HD population compared to non-dialysis patients and may be reflective of poor clearance during dialysis. d) Selenium deficiency has no clinical impact on secondary systemic outcomes (e.g., cardiovascular or endocrine) in the dialysis population. e) Soy-based formulas are preferred for children on dialysis as these provide increased selenium compared to cow’s milk formula.",a
Vitamin and trace element deficiencies in the pediatric dialysis patient,"Which of the following statements regarding ascorbic acid (vitamin C) are true? a) Vitamin C is required as a critical co-factor for prolylhydroxylase and lysyl-hydroxylase in the synthesis of elastin. b) Vitamin C potentiates free radical events and augments endothelial dysfunction at the level of the vascular endothelium. c) Vitamin C deficiency may manifest with symptoms of scurvy—specifically long bone changes, gingival hyperplasia and bleeding, and perifollicular hemorrhage. d) Vitamin C is not removed via PD or HD, but rather deficiency is thought to be exclusively secondary to dietary restrictions in the ESRD population, particularly potassium-laden fruits. e) Vitamin C can freely be supplemented at >100% of the DRI value given that there are no systemic sequelae from over-supplementation in the ESRD population.",c
Vitamin and trace element deficiencies in the pediatric dialysis patient,What is a common clinical feature of severe pyridoxine (Vitamin B6) deficiency?  a) Hypercalcemia b) Hemolytic anemia c) Hypokalemia d) Sideroblastic anemia,d
Expanding the Role of Vasopressin Antagonism in Polycystic Kidney Diseases: From Adults to Children?,1. Which of the following statements about PKD is true?	a) ARPKD never occurs in adults b) ADPKD does not become symptomatic before 30 years c) Liver involvement is exclusive for ARPKD d) ADPKD always results in ESRD e) ARPKD is 20× less common but generally has a more severe phenotype than ADPKD,e
Expanding the Role of Vasopressin Antagonism in Polycystic Kidney Diseases: From Adults to Children?,"2. Which mechanism is true in the pathogenesis of PKD?	a) PKD is always initiated by mutations in PKD1 b) Apart from the PKD1, PKD2 and PKHD1, no other known mutations lead to PKD c) Disturbed interactions between polycystins can lead to PKD d) Mutations in both PKD1 and PKD2 are needed to develop PKD e) PKHD1 mutations lead to an exclusive liver phenotype",c
Expanding the Role of Vasopressin Antagonism in Polycystic Kidney Diseases: From Adults to Children?,3. Which two of the following statements are true regarding osmoregulation in PKD?	a) A decreased urinary concentration capacity is specific for PKD b) An increased AVP and V2R has been observed in PKD animal models c) The osmoregulation defect in PKD involves only a central mechanism d) The osmoregulation defect in PKD involves only a renal mechanism e) Increased AVP could further worsen cystogenesis,b
Expanding the Role of Vasopressin Antagonism in Polycystic Kidney Diseases: From Adults to Children?,4. Which answer is true regarding cAMP in PKD?	a) cAMP is decreased secondary to increased intracellular Ca2+ b) cAMP can be targeted by AVP antagonists only c) AVP is a strong agonist of cAMP in CD cells d) cAMP increases proliferation and secretion in cystic epithelium e) c) and d),"e,c,d"
Expanding the Role of Vasopressin Antagonism in Polycystic Kidney Diseases: From Adults to Children?,5. Which statement is true regarding AVP antagonists in PKD?,d
Liver involvement in kidney disease and vice versa,"Consultation of an expert hepatologist is needed for the following indications (one is not true): a) Transient, asymptomatic increase in transaminases b) Jaundice in a 4-week-old infant c) INR ≥ 2 in association with a chronic liver disease d) Hepatic encephalopathy",a
Liver involvement in kidney disease and vice versa,The eGFR in patients with chronic liver disease underestimates the degree of CKD due to: a) Reduced hepatic production of creatinine b) Malnutrition and loss of muscle mass c) Volume expansion d) All the above,d
Liver involvement in kidney disease and vice versa,Combined liver and kidney transplantation is sometimes needed for the following indications: a) aHUS b) Methylmalonic academia c) Familial amyloidosis polyneuropathy d) All the above,d
Liver involvement in kidney disease and vice versa,What are the most common risk factors for liver involvement in patients with ADPKD (one is not true): a) Female gender b) Age c) Family member with ADPKD-related LT d) CKD stage,c
Liver involvement in kidney disease and vice versa,Hepatitis B infection in children should be treated if: a) Cholestasis is present b) Elevated transaminases for at least 6 months c) The patient is sexually active d) Always in children,b
Liver involvement in kidney disease and vice versa,The three major causes of renal involvement in LT patients are (one is not true): a) Pre-existing renal disease b) Immunosuppression-related infection c) Perioperative renal ischemia d) Nephrotoxic medication,b
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following statements about chronic nephrotoxicity is correct? a) The most common adverse effect of nephrectomy is tubular dysfunction. b) Radiotherapy exposing the kidneys may cause hypertension years after treatment. c) Ifosfamide causes hypomagnesaemia. d) The commonest manifestation of the tubular toxicity of platinum drugs is the Fanconi syndrome. e) Acute kidney injury usually leads to later tubular toxicity.,b
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",The most common presentation of chronic ifosfamide nephrotoxicity in children is: a) Acute kidney injury. b) Hypomagnesaemia. c) Hypophosphataemia. d) Hypocalcaemia. e) Haematuria.,c
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following statements about prevention or prediction of chronic nephrotoxicity is correct? a) Mesna prevents cisplatin nephrotoxicity. b) Children with ifosfamide-induced hypophosphataemia should always be switched from ifosfamide to cyclophosphamide. c) Mannitol prevents ifosfamide nephrotoxicity. d) The use of new drugs in which preclinical studies have not demonstrated renal toxicity will eliminate the risk of chronic nephrotoxicity. e) Absence of renal toxicity at the end of anticancer treatment does not exclude future chronic nephrotoxicity.,e
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Platinum drug nephrotoxicity in children: a) Is more common after carboplatin than after cisplatin. b) Recovers by 10 years after treatment. c) Randomised controlled trial evidence shows it can be prevented by amifostine. d) Can lead to cardiac arrhythmias. e) Is commoner in infants than in older children.,d
"Late renal toxicity of treatment for childhood malignancy: risk factors, long-term outcomes, and surveillance",Which of the following statements about management of chronic nephrotoxicity is correct? a) Renal transplantation for ESRD is contraindicated in CCS. b) Magnesium supplements may be required to treat or prevent complications of platinum drug nephrotoxicity. c) Vitamin D should be avoided in children with ifosfamide nephrotoxicity. d) Hypertension is to be expected in patients with cisplatin nephrotoxicity and does not need to be treated. e) GFR should be measured (not calculated) every year in CCS.,b
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),What are the consequences of Stx-Gb3 interactions on susceptible cells? a) This interaction leads to cell death or production of chemokines/cytokines depending on the target cell and toxin concentration. b) This interaction leads only to the production of chemokines/ cytokines in target cells. c) This interaction leads to death of target cells d) This interaction leads to apoptosis or proliferation of renal cells depending on the toxin concentration.,a
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),"How does STEC trigger the intestinal immune response? a) Although LPS, Hly, flagellin and intimin trigger an intestinal inflammatory response, Stx inhibits it. b) STEC triggers the intestinal immune response through Stx-production. c) STEC triggers the intestinal immune response through several bacterial components, mainly LPS, Hly flagellin, intimin, and Stx. d) STEC trigger the intestinal immune response through several bacterial components, however, Stx is irrelevant because Gb3 is absent from human gut.",c
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),How could systemic inflammation participate in Stx-HUS development? a) Systemic inflammation induces an anti-thrombotic response. b) Systemic inflammation neutralizes Stx. c) Systemic inflammation is irrelevant for HUS outcome. d) Systemic inflammation and thrombotic response are mutually exacerbated.,d
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),"What have mouse models based on intravenous Stx and LPS injection contributed to our understanding? a) These models better reproduce clinical aspects of Stx-HUS compared to intravenous Stx injection, thus supporting the concept that systemic inflammation (triggered by LPS) plays a central pathogenic role during HUS. b) These models better reproduces gastrointestinal features of children infected with STEC, as LPS is a major component of STEC. c) These models do not contribute any additional or supplemental information compared to mouse models based on intravenous Stx injection. d) These models better reproduce neurological alterations of children infected with STEC, because LPS is neurotropic.",a
Pathogenic role of inflammatory response during Shiga toxin-associated hemolytic uremic syndrome (HUS),"According to evidence recorded from Stx-HUS patients, which components of the immune response are activated? a) Cytokine production and activation of the classical pathway of complement. b) Activation of all components of inflammation: PMN, monocytes, complement, cytokines and chemokines. c) Th1-specific cellular response and chemokine release d) Activation of local immune response in the gut, without systemic response.",b
A guide to missing data for the pediatric nephrologist,1. Which of the following describes data where the probability of missingness is related to one or more measured variables?     a) Missing at completely random     b) Missing at random     c) Not missing at random     d) Normally Distributed,b
A guide to missing data for the pediatric nephrologist,2. All of the following are appropriate methods of accounting for missing data in longitudinal studies except?     a) Last observation carried forward     b) Joint distribution model     c) Mixed-effects model using maximum likelihood estimation     d) Generalized estimating equation with multiple imputation,a
A guide to missing data for the pediatric nephrologist,3. Which of the following is recommended when performing multiple imputation?     a) Adhering to a parsimonious model building strategy     b) Including the outcome variable in the imputation model     c) Limiting the number of sensitivity analyses     d) Avoiding the use of chained equations,b
A guide to missing data for the pediatric nephrologist,4. Which of the following is the least useful strategy where data are missing at random?     a) Multiple imputation     b) Likelihood-based models     c) Joint distribution modelling     d) Complete case analysis,d
Acute kidney injury in children with chronic liver disease,1. Which one is the least common cause of AKI in patients with liver disease?  a) Hypovolemia  b) ATN  c) Infections  d) HRS,d
Acute kidney injury in children with chronic liver disease,2. A terlipressin responder is one who has:  a) Pre-renal AKI  b) Severe HRS with SCr > 7 mg/dl  c) Early increase in mean blood pressure followed by return to baseline  d) Early onset AKI with modest increase in SCr and sustained increase in blood pressure,d
Acute kidney injury in children with chronic liver disease,3. Which one of the following statements is NOT true about AKI in liver disease?  a) Definition of AKI in liver and non-liver disease patients is different  b) SCr can be reliably used to diagnose AKI in these patients  c) Biomarkers help to differentiate ATN from HRS  d) Cystatin C can be a useful adjunct in diagnosis of AKI,b
Acute kidney injury in children with chronic liver disease,4. The KDIGO definition differs from the IAC 2012 definition with the following exception?  a) Use of SCr as a marker  b) Utilization of continuous RRT  c) Defines response to treatment  d) Definition of what constitutes the baseline SCr values,b
Acute kidney injury in children with chronic liver disease,"5. Which of the following is the initial management of HRS?  a) Prometheus system  b) TIPSS  c) MARS  d) Treat associated conditions, volume expansion and vasoconstrictors",d
Assessment and management of fluid overload in children on dialysis,1. Physical examination of a 30 kg child by an experienced physician will detect signs of fluid overload when the level approaches:     a) 500 ml     b) 1 litres     c) 2 litres     d) 3 litres,d
Assessment and management of fluid overload in children on dialysis,"2. In order to minimize fluid overload in children on hemodialysis, the ultrafiltration rate should be increased until:     a) Intradialytic symptoms occur     b) Intradialytic hypotension occurs     c) Myocardial stunning is evident on speckle tracking echocardiography     d) None of the above",d
Assessment and management of fluid overload in children on dialysis,"3. In children on peritoneal dialysis, sodium clearance can be enhanced by the following measures:     a) Shortening the dwell time to short cycles     b) Addition of an icodextrin daytime exchange     c) Minimising sodium containing drugs     d) Lower glucose concentration dialysate",b
Assessment and management of fluid overload in children on dialysis,"4. In a 2 year old child, inter-dialytic weight gain is affected by the following:     a) Dietary sodium intake     b) Nutritional prescription     c) Total daily fluid intake     d) All of the above",d
Assessment and management of fluid overload in children on dialysis,5. Which of the following statements are true:     a) NT-proBNP is a plasma marker of myocardial damage     b) Lung ultrasound detects generalized fluid overload via thickened interlobular septae     c) Multi-frequency bioimpedance spectroscopy estimates intravascular and extravascular water content     d) Blood volume transducers detect absolute changes in intravascular volume,b
Acute pancreatitis in children on chronic maintenance dialysis,"1. In children on chronic dialysis, acute pancreatitis is:  a) A predictable complication  b) A frequent complication  c) A complication related to the peritoneal dialysis modality only  d) A complication that should be considered in case of persistent abdominal pain",d
Acute pancreatitis in children on chronic maintenance dialysis,"2. In children on chronic dialysis, acute pancreatitis is:  a) More frequent than adults on dialysis  b) More frequent than peers with normal renal function  c) A frequent complication of long-term dialysis (duration > 36 months)  d) All of the above",b
Acute pancreatitis in children on chronic maintenance dialysis,"3. In children on chronic dialysis, occurrence of acute pancreatitis:  a) Is usually related to a single and specific etiological factor  b) Is often related to gallstones and alcohol abuse  c) Is related to the type of dialysis modality, rather than uremia per se  d) Has been related to the use of some antiepileptic drug",d
Acute pancreatitis in children on chronic maintenance dialysis,"4. In a child on PD with abdominal pain, diagnosis of acute pancreatitis:  a) Can be formulated only if serum amylase rises 3 times upper normal values  b) Can be sometimes confused with peritonitis  c) Should be confirmed on the basis of serum amylase levels and abdominal imaging  d) Is easy to confirm with abdominal ultrasonography",c
Acute pancreatitis in children on chronic maintenance dialysis,5. When treating a child on peritoneal dialysis with acute pancreatitis:  a) Enteral feeding can be continued if tolerated  b) Opioid analgesics are always contraindicated  c) Dialysis should be discontinued and/or shifted to hemodialysis  d) All of the above,a
Benefits and risks of protocol biopsies in pediatric renal transplantation,1. The rationale to do a protocol biopsy is:     a) The lack of non-invasive methods to diagnose subclinical rejection     b) Treatment of subclinical rejection might improve long-term outcome of the allograft     c) Serum creatinine does not change with subclinical rejection or early acute rejection     d) Rate of complications with protocol biopsies are low     e) All of the above,e
Benefits and risks of protocol biopsies in pediatric renal transplantation,2. The most common complication of protocol biopsies is:     a) AVF     b) Aneurysm     c) Loss of allograft     d) Perinephric hematoma     e) Bowel perforation,d
Benefits and risks of protocol biopsies in pediatric renal transplantation,3. The right timing of a protocol biopsy is:     a) One to 3 months after transplantation     b) Six months after transplantation     c) Twelve months after transplantation     d) Every 3 months after transplantation for 1 year     e) It has not been established yet,e
Benefits and risks of protocol biopsies in pediatric renal transplantation,"4. During the biopsy, an increased number of passes have been implicated in:     a) Vascular lesions     b) Pain     c) Allograft loss     d) Perinephric hematoma     e) All of the above",a
Benefits and risks of protocol biopsies in pediatric renal transplantation,5. The main obstacle (s) that prevent protocol biopsies from becoming standard of care in every transplant center is (are):     a) Lack of treatment for acute rejection     b) Cost and safety     c) Experience     d) Right timing has not been established     e) Non-invasive methods are available,b
Assessment of dialysis adequacy beyond urea kinetic measurements,1. Kt/Vurea     a) Is not affected by patient size     b) Is an assessment of middle molecule clearance     c) Can be used to assess small solute clearance     d) Correlates with residual kidney function     e) Is consistently correlated with patient outcome,c
Assessment of dialysis adequacy beyond urea kinetic measurements,"2. Dialysis should be started when:     a) The urea is over 55 mmol/l, but other biochemistry and urine output are normal     b) The GFR is 5 ml/min/1.73m2 but the child is asymptomatic and urine output is maintained     c) The GFR is 11 ml/min/1.73m2 and retransplantation will not be possible     d) The GFR is 8 ml/min/1.73m2 and there is resistant anaemia     e) The GFR is 10 ml/min/1.73m2 but there is decreasing urine output and salt and water retention causing difficult to treat hypertension",e
Assessment of dialysis adequacy beyond urea kinetic measurements,"3. Dialysis access     a) Insertion of a Tenckhoff catheter is a straight forward surgical procedure that can be undertaken by a surgeon without specific training     b) Leakage of PD fluid along the catheter track does not usually cause infection and resolves spontaneously     c) Children aged 3 years are too young for an AV fistula, even in the hands of experienced staff     d) Central venous line infection can lead to vessel stenosis     e) Children with AV fistulae are admitted to hospital more than those with a central venous line",d
Assessment of dialysis adequacy beyond urea kinetic measurements,"4. Residual kidney function     a) Allows renal tubular secretion of protein bound molecules     b) Does not influence volume control, phosphate or potassium clearance     c) Does not benefit mortality     d) Is classically reduced by episodes of hypertension     e) Diuretics will not help urine output",a
Assessment of dialysis adequacy beyond urea kinetic measurements,5. Intradialytic fluid accumulation     a) Is often on a background of an already raised ECF     b) Is driven by the patient’s primary drive for water rather than salt ingestion     c) Elevated ECF at the end of dialysis is associated with inflammation which promotes protein anabolism     d) Is best removed by rapid UF during dialysis     e) Does not contribute to hypertension,a
Clinical aspects of tacrolimus use in paediatric renal transplant recipients,1. Which of the following is not a common side effect of tacrolimus?     a) Hypermagnesaemia     b) Hypertension     c) Tremor     d) Hyperkalaemia     e) De novo diabetes mellitus,a
Clinical aspects of tacrolimus use in paediatric renal transplant recipients,2. Which of the following statements is true?     a) TAC has a broad therapeutic window     b) Food ingestion does not affect TAC pharmacokinetics     c) While commencing treatment with fluconazole the dose of TAC should be increased to avoid underexposure and acute allograft rejection     d) Children have higher relative TAC dose requirements than adults     e) The difference in relative TAC dose requirements between adults and children can be explained by the maturation of the hepatic CYP3A4/A5,d
Clinical aspects of tacrolimus use in paediatric renal transplant recipients,3. Which statement regarding TAC pharmacogenetics is true?     a) The prevalence of the CYP3A5*1 allele is higher in Western European than in African populations     b) CYP3A5 expressers have lower TAC dose requirements     c) It has been shown that the routine pre-transplantation CYP3A5*1/*3 testing contributes to the lower incidence of acute allograft rejection in the early postoperative period     d) It is recommended to increase the standard TAC dose by 1.5- to 2-fold in CYP3A5 expressers,d
Clinical aspects of tacrolimus use in paediatric renal transplant recipients,4. Which statement is false?     a) AUC is a more accurate method of evaluation of TAC exposure than a pre-dose concentration (trough level)     b) TAC concentrations should be measured in plasma     c) In most centers the target TAC pre-dose concentration 3 months after renal transplantation is set between 5 and 15 ng/ml     d) There is a need to develop biomarkers which would allow an early and non-invasive detection of kidney injury,b
Clinical aspects of tacrolimus use in paediatric renal transplant recipients,5. Intra-patient variability in TAC exposure:     a) denotes the variability in exposure following administration of a given dose to children with the same weight     b) is lowest in adolescents     c) is associated with the risk of late acute allograft rejection     d) statements a and c are true     e) none of the above statement are true,c
Biologics for childhood systemic vasculitis,The efficacy of rituximab in the treatment of ANCA-associated vasculitis suggests that the pathogenesis of AAV is related to:  a. Macrophages  b. T cells  c. B cells  d. NK cells,c
Biologics for childhood systemic vasculitis,Randomized clinical trials in GPA and MPA in adults demonstrated that compared to traditional therapy rituximab:  a. was less effective for relapsing patients  b. was non-inferior in allowing a successful steroid taper  c. had significantly fewer adverse events  d. was more effective for sustaining remission in patients on dialysis,b
Biologics for childhood systemic vasculitis,Clinical trials demonstrated that infliximab compared to traditional therapy for Kawasaki disease:  a. reduced treatment resistance  b. had significantly more side effects  c. had a greater reduction in coronary artery Z score in refractory patients  d. was as effective as a second IVIG infusion in refractory patients,d
Biologics for childhood systemic vasculitis,"Of the following autoinflammatory diseases, the risk of developing polyarteritis nodosa is increased in:  a. Familial Mediterranean fever (FMF)  b. Tumor necrosis factor receptor-associated periodic syndrome (TRAPS)  c. Periodic fever with aphthous stomatitis, pharyngitis, and adenitis (PFAPA)  d. Hyper IgD with periodic fever syndrome (HIDS)",a
Extra-renal manifestations of atypical hemolytic uremic syndrome,Mutations in this complement factor gene increase the risk of cardiovascular complications in aHUS to around 20%?  a. CFI  b. CFH  c. CFB  d. MCP,b
Extra-renal manifestations of atypical hemolytic uremic syndrome,Diarrhea is a presenting symptom in approximately ___% of patients with aHUS?  a. 10  b. 20  c. 40  d. 50  e. 80,c
Extra-renal manifestations of atypical hemolytic uremic syndrome,Cardiovascular complications in aHUS are typically associated with atherosclerotic vascular disease?  a. True  b. False,b
Extra-renal manifestations of atypical hemolytic uremic syndrome,"Extra-renal manifestations of aHUS occur most often in this system, and are reported in 8 to 48% of cases.  a. Gastrointestinal  b. Ocular  c. Pulmonary  d. Cardiovascular  e. Neurologic",e
Extra-renal manifestations of atypical hemolytic uremic syndrome,Abdominal visceral manifestations of aHUS include?  a. Pancreatitis  b. Ischemic colitis  c. Transaminitis  d. IBD  e. All of the above,e
Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS),1. The following neurological complication can occur in the setting of STEC HUS:     a) Seizures     b) Stroke     c) Coma     d) All of the above,d
Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS),2. Hyperglycemia in the acute setting of STEC HUS is due to:     a) Dextrose containing dialysate solutions     b) Stress response of the body     c) Pancreatic involvement in STEC HUS     d) Dextrose containing IV fluids,c
Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS),3. Which of the following gastrointestinal complications may occur several months after STEC HUS:     a) Hepatitis     b) Bowel stricture     c) Appendicitis     d) Meckel’s diverticulum,b
Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS),4. The following extrarenal involvement has not been described with STEC HUS     a) Elevated bilirubin     b) Diabetes mellitus     c) Pigmented gallstones     d) Arthritis,d
Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS),5. Circulatory collapse occurs suddenly in a 3-year-old girl on day 2 of admission with STEC HUS. The patient is on peritoneal dialysis. One important test to order at that time is:     a) Coombs testing     b) Cardiac ECHO     c) Ultrasound of the pancreas     d) Repeat stool cultures,b
Fundamental insights into autosomal dominant polycystic kidney disease from human-based cell models,"Which cell line is not a published human ADPKD-derived cell model until now?  a. Cell lines from ADPKD patients obtained from urine  b. Cell lines from ADPKD patients obtained from nephrectomies  c. Cell lines from ADPKD patients obtained from skin, reprogrammed to hPSCs  d. Cell lines with ADPKD patient-derived PKD2 mutations, inserted using CRISPR  e. Cell lines with PKD2 knockout or knockdown",d
Fundamental insights into autosomal dominant polycystic kidney disease from human-based cell models,"Which statement is true about the immortalisation procedure?  a. If cells are immortalised using SV40 LT, it does not matter with which vector they were immortalised.  b. SV40 LT can stimulate proliferation through suppression of the tumour suppressor gene p53 (amongst interference with other pathways).  c. Cells immortalised with SV40 LT will never become senescent.  d. Immortalisation with hTERT alone does not affect cell properties.  e. HK-2 cells and RCTEs are immortalised with the same constructs and, hence, are interchangeable.",b
Fundamental insights into autosomal dominant polycystic kidney disease from human-based cell models,"Which markers are expected on cell lines from proximal tubular origin?  a. AQP1, ECAD, MDR1, AQP2  b. AQP1, NCAD, MDR1, AQP2  c. AQP1, NCAD, MDR1, NCC  d. AQP2, ECAD, MDR1, NHE3  e. AQP1, NCAD, MDR1, NHE3",e
Fundamental insights into autosomal dominant polycystic kidney disease from human-based cell models,What has not been described in ADPKD patient-derived cells?  a. Decreased ciliary [Ca2+]-influx upon shear stress in several cystic-derived cell lines  b. A decrease in [cAMP] upon tolvaptan administration in several cystic-derived cell lines  c. An increase in mTOR activity in human proximal tubular-derived cell lines with PKD2 KD  d. cAMP-generating agonists stimulate proliferation in several cystic-derived cell lines  e. Full-length PC1 expression is decreased in several cystic-derived cell lines,b
Fundamental insights into autosomal dominant polycystic kidney disease from human-based cell models,Which statement is not true about in vitro cyst formation?  a. Cyst formation in Matrigel is a useful model to study the efficacy of potential drugs  b. Cyst formation is stimulated by increased cAMP levels  c. Cyst formation in 3D cultures can be used to screen for potential therapeutic compounds  d. Cyst formation is only dependent on the presence of primary cilia  e. Cyst formation can be induced by forskolin,d
Hypertensive crisis in children and adolescents,"1. A 17-year-old previously healthy boy presents in the emergency department with a few hours of pounding headache, chest pain, and anxiety. Initial evaluation showed heart rate of 110 beats per minute and BP 165/64. Physical examination is otherwise unremarkable. Which one of the following tests is likely to determine the cause of elevated BP in this patient?     a) Thyroid stimulating hormone     b) Plasma renin activity     c) Urine drug screen     d) Plasma metanephrine",c
Hypertensive crisis in children and adolescents,"2. Match the following symptoms of hypertensive crisis with the most possible etiology of hypertension:     a) Tachycardia     b) Striae     c) Abdominal mass     d) Sweating, flushing     1. Autosomal recessive polycystic kidney disease     2. Hyperthyroidism     3. Catecholamine producing tumors     4. Cushing syndrome","a-2, b-4, c-1, d-3"
Hypertensive crisis in children and adolescents,3. Which route of administration should be preferentially used in children with hypertensive emergency:     a) Oral     b) Intravenous bolus drugs     c) Intramuscular injection     d) Continuous intravenous infusion,d
Hypertensive crisis in children and adolescents,4. How fast should be the BP lowered in the first 6 h in children with hypertensive crisis?     a) As fast as possible     b) Approximately 25% of the planned BP reduction     c) Approximately 25% of the actual BP level     d) To the BP level of the 95th percentile,b
Hypertensive crisis in children and adolescents,5. Which drugs should be used in neonates with great caution:     a) Alpha-blocker     b) Beta-blockers     c) ACE inhibitors     d) Calcium channel blockers,c
Management of chronic renal allograft dysfunction and when to re-transplant,1. According to United Kingdom Renal Registry data which of the following attributes is associated with more rapid progression in failing allografts?     a. Cause of native kidney disease     b. Diabetes mellitus     c. White race     d. Female sex     e. Young age,b
Management of chronic renal allograft dysfunction and when to re-transplant,2. Regarding second and subsequent transplantation candidates     a. They are more likely to develop cancer     b. Should be weaned off immunosuppression     c. Comprise more than 10% of listed patients in the United States     d. Mortality rates are approximately 10% in the first year after graft failure     e. Comprise a higher proportion of the waiting list in adults than children in the United States,c
Management of chronic renal allograft dysfunction and when to re-transplant,3. The period leading up to allograft loss is associated with which of the following?     a. Poor blood pressure control     b. Mineral bone disease     c. Higher prevalence of anaemia     d. Metabolic alkalosis     e. A high prevalence of pre-emptive vascular access placement,a
Management of chronic renal allograft dysfunction and when to re-transplant,4. Which of the following factors are likely to increase sensitisation after failure of a renal transplant?     a. Episodes of late rejection     b. Nephrectomy     c. Blood loss and associated transfusion     d. Extra capsular technique of nephrectomy     e. Maintenance of dual immunosuppression,e
Management of chronic renal allograft dysfunction and when to re-transplant,"5. Which of the following is true related to transplant nephrectomy?     a. Up to 50% of children require graft nephrectomy     b. It is more likely after severe rejection     c. It is more likely after late, as opposed to early, renal allograft failure     d. Usually results in the removal of all allogeneic material     e. May result in new antibody detection due to loss of the sponge effect",e
Management of high blood pressure in children: similarities and differences between US and European guidelines,1. The prevalence of pediatric hypertension in Europe is:     a. higher in northern Europe     b. lower in western Europe     c. higher in southern Europe     d. lower in male children,c
Management of high blood pressure in children: similarities and differences between US and European guidelines,2. The age at which the adolescent and adult blood pressure thresholds for hypertension merge is:     a. higher in the US guidelines compared to the ESH guidelines     b. 13 years old in the US guidelines     c. the same in the US guidelines and ESH guidelines     d. lower for males compared to females,b
Management of high blood pressure in children: similarities and differences between US and European guidelines,3. The new normative table that provides the age/sex/height-based BP percentiles of the US guidelines:     a. is derived from children who were of healthy weight     b. is the same as the normative table used in the ESH guideline     c. is derived from children all over the world     d. has been simplified compared to previous versions,a
Management of high blood pressure in children: similarities and differences between US and European guidelines,4. Home BP pressure monitoring in children:     a. is discussed in detail in the US guidelines     b. does not have separate normative data for interpretation     c. should be performed only after the age of 12 years     d. is recommended by the ESH guidelines for hypertension diagnosis,d
Management of high blood pressure in children: similarities and differences between US and European guidelines,5. All children should be screened for hypertension:     a. at each health care encounter     b. every 6 months if prior BPs are high normal according to ESH guidelines     c. every other year if prior BPs are normal according to US guidelines     d. earlier than 3 years of age only if CVD risk factors are present,d
Neonatal hypertension: an educational review,1. What is the most common method of blood pressure measurement in neonates?     a) Doppler     b) Ultrasound     c) Intra-arterial     d) Oscillometric,d
Neonatal hypertension: an educational review,"2. The proper method to take a neonatal blood pressure is:     a) 1.5 hours after a feed     b) While asleep     c) 3 different times, two minutes apart     d) All of the above",d
Neonatal hypertension: an educational review,3. Neonatal hypertension for a > 2-week-old neonate is defined as:     a) > 95th percentile for PMA     b) Systolic BP > 80     c) MAP > 60     d) > 90th percentile for birth weight,a
Neonatal hypertension: an educational review,4. The most common cause of neonatal hypertension is:     a) Cardiovascular     b) Respiratory     c) Renal     d) Iatrogenic,c
Neonatal hypertension: an educational review,5. Evaluation of neonatal hypertension should always include which of the following:     a) Renal ultrasound with Doppler     b) Plasma renin     c) Thyroid studies     d) Head ultrasound,a
"Neonatal hypertension: cases, causes, and clinical approach",1. Which of the following is not part of the typical initial evaluation of a neonate with hypertension?  a) BUN and Creatinine  b) Urinalysis  c) Thyroid studies  d) Renal ultrasound with Doppler  e) Medication review,c
"Neonatal hypertension: cases, causes, and clinical approach",2. What is the most frequently implicated etiology for a neonate with hypertension?  a) Renal vein thrombosis  b) Dexamethasone  c) Bronchopulmonary dysplasia  d) Catheter-associated thromboembolism  e) Malignant tumors,d
"Neonatal hypertension: cases, causes, and clinical approach","3. Which is a true statement regarding measurement of neonatal blood pressure?  a) Blood pressures obtained in the calf are equivalent to upper arm blood pressure values for the first 6 months  b) Measurement of blood pressure should be performed during feeding for optimal accuracy  c) Positioning of infant does not alter blood pressure measurement  d) Blood pressure should not be obtained more than one time, as repeated assessment may impact accuracy",a
"Neonatal hypertension: cases, causes, and clinical approach",4. What is the most common long-term outcome of neonatal hypertension?  a) Resolution of hypertension during NICU stay  b) Ongoing hypertension requiring stable but ongoing antihypertensive management  c) Progression of disease with escalation of antihypertensive therapy  d) Resolution of hypertension by 1 year of age  e) Surgical correction,d
"Neonatal hypertension: cases, causes, and clinical approach",5. Which of the following is not a recommended class of blood pressure medication for premature neonates with hypertension?  a) Calcium channel blockers  b) Direct vasodilator  c) β - antagonists  d) Angiotensin receptor blockers  e) Diuretics,d
Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome,1. Which enzyme is responsible for converting prednisone to prednisolone?     a) CYP3A4     b) 11β-HSD-1     c) P-glycoprotein     d) 11β-HSD-2,b
Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome,2. What percentage of children with nephrotic syndrome achieve complete remission with prednisone or prednisolone treatment?     a) 50%     b) 60%     c) 80%     d) 90%,d
Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome,3. Which genetic factor can influence the pharmacokinetics and pharmacodynamics of glucocorticoids in nephrotic syndrome?     a) CFTR gene     b) CYP3A5 polymorphism     c) BRCA1 gene     d) HLA-B27,b
Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome,4. What is the main therapeutic effect of glucocorticoids in nephrotic syndrome?     a) Antiviral     b) Anti-inflammatory     c) Antibacterial     d) Antifungal,b
Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome,5. What is a common side effect of long-term glucocorticoid use in nephrotic syndrome?     a) Hyperglycemia     b) Hypotension     c) Bradycardia     d) Hypoglycemia,a
"Primary vesicoureteral reflux: what have we learnt from the recently published randomized, controlled trials",1. What percentage of VUR patients’ siblings had no history of UTI?     a) 20%     b) 40%     c) 75%,c
"Primary vesicoureteral reflux: what have we learnt from the recently published randomized, controlled trials",2. What is the estimated median years to resolution for grade IV VUR?     a) 3.1 years     b) 6.5 years     c) 9.5 years     d) 12.5 years,c
"Primary vesicoureteral reflux: what have we learnt from the recently published randomized, controlled trials",3. Do the RCTs reviewed above prove that VUR is a risk factor for     a) UTI     b) Acute pyelonephritis (APN)     c) Renal parenchymal damage     d) All of the above     e) None of the above,e
"Primary vesicoureteral reflux: what have we learnt from the recently published randomized, controlled trials","4. In Hoberman’s study, what percentage of children < 2 years of age with febrile UTI presented focal defects on DMSA scan compatible with acute pyelonephritis?     a) 20%     b) 50%     c) 60%     d) 75%",c
"Primary vesicoureteral reflux: what have we learnt from the recently published randomized, controlled trials",5. When could urinary antibiotic prophylaxis be started in VUR patients?     a) After first febrile UTI     b) Never     c) In patients with documented APN recurrences     d) In patients presenting asymptomatic bacteriuria,c
The role of properdin in complement-mediated renal diseases: a new player in complement-inhibiting therapy,"1. Which statement about properdin is not true?  a) Properdin oligomerizes in dimers, trimers, and tetramers only upon stimulation  b) Properdin can recruit C3b and FB for new convertase assembly  c) Properdin stabilizes AP C3/C5 convertases, but not those of the classical and lectin pathway  d) Properdin oligomerization is essential for its function in vivo",a
The role of properdin in complement-mediated renal diseases: a new player in complement-inhibiting therapy,"2. Which factors should be taken into account when the function of properdin is studied:  a) Species differences  b) Aggregation of properdin upon freeze-thawing  c) The source of properdin: purified from serum, freshly released from cells, or in serum context  d) All of the above",d
The role of properdin in complement-mediated renal diseases: a new player in complement-inhibiting therapy,3. Properdin is mainly produced by:  a) Hepatocytes  b) Leukocytes  c) Hepatocytes and leukocytes  d) Endothelial cells,b
The role of properdin in complement-mediated renal diseases: a new player in complement-inhibiting therapy,"4. Which of the following statements regarding the proposed role of properdin in renal disease is not true?  a) In proteinuria, properdin initiates and amplifies local complement activation on proximal tubular epithelial cells and thereby contributes to tubulointerstitial injury  b) Properdin prevents C5 conversion and thereby it has protecting roles in C3G  c) In aHUS properdin may both be involved in triggering the onset of disease as well as in exacerbating the thromboinflammatory course of disease  d) Properdin can be important for clearance of dangerous pathogens and altered self-cells, but its requirement for AP activation is not equal for all targets.",b
The role of properdin in complement-mediated renal diseases: a new player in complement-inhibiting therapy,"5. Which of the following statements regarding properdin-dependent and -independent C3NeF is true?  a) Properdin-dependent C3NeF are associated with a selective C3 consumption, which resembles the complement profile of FH-/-/P-/- knockout mice  b) Properdin-independent C3NeF are associated with a selective C3 consumption and are most often found in C3GN  c) Properdin-dependent C3NeF are associated with elevated terminal pathway activation markers and are mainly found in C3GN  d) Properdin-independent C3NeF are associated with elevated terminal pathway activation markers and are most often found in C3GN",c
Should ACE inhibitors and ARBs be used in combination in children?,1. Which of the following is NOT an angiotensin-mediated effect on AT1 receptors?     a) Renal vasoconstriction     b) Stimulation of aldosterone release     c) Enhanced natriuresis     d) Increased cardiac contractility,c
Should ACE inhibitors and ARBs be used in combination in children?,"2. Despite ACE inhibition, activation of RAAS may persist due to each of the following EXCEPT:     a) Local tissue Ang II production by serine proteases     b) Increased renin secretion     c) Increased potassium-induced aldosterone release     d) Increased angiotensinogen production",d
Should ACE inhibitors and ARBs be used in combination in children?,"3. Which of the following mechanisms explains why ACEIs, but not ARBs, are typically associated with cough and angioedema as potential side effects?     a) Decreased bradykinin breakdown     b) Increased bradykinin production by proteases     c) Increased compensatory Ang I production     d) Increased local nitric oxide synthesis",a
Should ACE inhibitors and ARBs be used in combination in children?,4. The ONTARGET study found that adults with increased vascular disease risk who took combination ACEI/ARB therapy had a lower risk in which of the following outcomes compared to adults receiving ACEI monotherapy?     a) Progression of albuminuria     b) Doubling of serum creatinine     c) Need for renal replacement therapy     d) Mortality,a
Should ACE inhibitors and ARBs be used in combination in children?,"5. The VA-NEPHRON study, which compared dual ACEI/ARB therapy to ARB on progression to ESRD in adults with type 2 diabetes, was terminated early due to a higher rate of which of the following in the dual therapy group?     a) Doubling of serum creatinine     b) Acute kidney injury     c) Need for renal replacement therapy     d) Cardiovascular mortality",b
Towards adulthood with a solitary kidney,"In humans, nephrogenesis is completed at a) 28–30 weeks gestation b) 32–34 weeks gestation c) Normal term d) 3 months of age e) 2 years of age",b
Towards adulthood with a solitary kidney,The most common cause for congenital solitary kidney is a) Multicystic dysplastic kidney b) Renal agenesis/aplasia c) Renal vein thrombosis d) Severe hydronephrosis,b
Towards adulthood with a solitary kidney,The risk of developing ESRD in living donors at 15 to 25 years after unilateral nephrectomy is a) 0 to 5% b) 5 to 10% c) 10 to 20% d) 20 to 30% e) 30 to 40%,b
Towards adulthood with a solitary kidney,Non-pharmacological renoprotection in children with a solitary kidney include a) Normal sodium intake b) Protein intake < 1 g/kg per day c) Limited intake of vitamin D d) Hydration > 2 L/24 h per 1.73 m2 e) High potassium intake,a
Treating the idiopathic nephrotic syndrome: are steroids the answer?,1. The first-line treatment of the first flare of idiopathic nephrotic syndrome in childhood is based on     a) Triamcinolone     b) Prednisone or prednisolone     c) Angio-converting enzyme inhibitors     d) Dexamethasone     e) Thyroid extracts,b
Treating the idiopathic nephrotic syndrome: are steroids the answer?,2. What is the optimal duration of the daily dose of steroids at first flare?     a) 2 weeks     b) 3 weeks     c) 4 weeks     d) 5 weeks     e) At least 6 weeks,c
Treating the idiopathic nephrotic syndrome: are steroids the answer?,3. The morbidity of idiopathic nephrotic syndrome is due to     a) Any relapse after the first flare     b) Steroid dependency     c) Steroid resistance     d) Exposure to immunosuppressive drugs     e) The need of intravenous methylprednisolone pulses to obtain a full urinary remission,"b, c, d, e"
Treating the idiopathic nephrotic syndrome: are steroids the answer?,4. Long-lasting steroid therapy at low doses     a) Can prevent the occurrence of relapses     b) Is useful in steroid resistant patients     c) Is mandatory after thromboembolism to prevent a further episode     d) Is complicated by steroid intoxication and growth failure     e) Can shorten the duration of the disease,d
Treating the idiopathic nephrotic syndrome: are steroids the answer?,5. Intravenous methylprednisolone pulses allow     a) To stop the disease after the first relapse     b) To prevent end stage renal failure     c) To reduce the prevalence of steroid dependency     d) To reduce the prevalence of steroid resistance     e) To treat patients with vomiting and oral intolerance,e
Use of calcimimetics in children with normal kidney function,1. Clinically symptomatic hypercalcemia in familial hypocalciuric hypercalcemia (FHH) can be treated with:     a) Corticosteroids     b) Calcitonin     c) Calcimimetics     d) Furosemide,c
Use of calcimimetics in children with normal kidney function,2. Hypercalciuria caused by calcimimetics is best treated by:     a) Thiazide diuretics     b) Decreased vitamin D supplementation     c) Decreased nutritional calcium intake     d) Simultaneous treatment with potassium citrate,a
Use of calcimimetics in children with normal kidney function,"3. In patients with XLH, compared with acute administration of oral phosphate alone the concomitant administration of cinacalcet results in:     a) Further increase in serum PTH, phosphate and ionized calcium concentration     b) Decrease in serum PTH, phosphate and ionized calcium concentration     c) Decrease in serum PTH, and increase in phosphate and ionized calcium concentration     d) Decrease in serum PTH and ionized calcium, and increase in phosphate concentration",d
Use of calcimimetics in children with normal kidney function,4. The most serious adverse effect to calcimimetics is:     a) Hypercalciuria     b) Hypocalcemia     c) Nausea and vomiting     d) Hypoparathyroidism,b
Use of calcimimetics in children with normal kidney function,"5. Besides by causing hypercalciuria and hypocalcemia, furosemide treatment stimulates the parathyroid glands by:     a) Stimulation of the NKCC1 receptor     b) Creation of hypovolemia     c) Creation of hypophosphatemia     d) Creation of metabolic acidosis",a
Uric acid and progression of chronic kidney disease,1. Uric acid is primarily excreted by which organ?     a) Liver     b) Kidneys     c) Lungs     d) Skin,b
Uric acid and progression of chronic kidney disease,2. What is the main enzyme involved in the production of uric acid?     a) Xanthine oxidoreductase     b) Glucose-6-phosphatase     c) Lactate dehydrogenase     d) Pyruvate kinase,a
Uric acid and progression of chronic kidney disease,3. Which transporter is primarily responsible for the reabsorption of uric acid in the kidneys?     a) GLUT1     b) URAT1     c) SGLT2     d) MCT1,b
Uric acid and progression of chronic kidney disease,4. Hyperuricemia is generally defined at what serum uric acid concentration in adults?     a) 5.0 mg/dl     b) 6.8 mg/dl     c) 8.0 mg/dl     d) 10.0 mg/dl,b
Uric acid and progression of chronic kidney disease,5. What is a potential consequence of hyperuricemia in the kidneys?     a) Nephrotic syndrome     b) Chronic kidney disease     c) Acute glomerulonephritis     d) Polycystic kidney disease,b
Utilisation of small paediatric donor kidneys for transplantation,"1. The correct definition of an Extended Criteria Donor is:     a) Any donor aged ≥ 60 years old, or a donor aged between 50 to 59 years of age with at least two of the following features: history of hypertension, terminal serum creatinine >1.5 mg/dL (133 mmol/L), or cerebrovascular cause of death     b) Any donor aged ≥ 55 years old with at least two of the following features: history of hypertension, terminal serum creatinine >1.5 mg/dL (133 mmol/L), or cerebrovascular cause of death     c) Any donor aged ≥ 60 years old, or a donor aged between 50 to 59 years of age with at least two of the following features: history of diabetes, terminal serum creatinine >1.5 mg/dL (133 mmol/L), or cerebrovascular cause of death     d) Any donor aged ≥ 50 years old with at least two of the following features: history of diabetes, terminal serum creatinine >1.5 mg/dL (133 mmol/L), or cerebrovascular cause of death",a
Utilisation of small paediatric donor kidneys for transplantation,"2. En bloc kidney transplantation refers to:     a) The retrieval of both kidneys, with subsequent anastomoses of each renal artery and vein to the recipient vessels     b) The retrieval of a single kidney and major blood vessels together, with subsequent anastomoses of the donor aorta and inferior cava to the recipient vessels     c) The retrieval of both kidneys and major blood vessels together, with subsequent anastomoses of the donor aorta and inferior cava to the recipient vessels     d) The retrieval of a single kidney with subsequent anastomoses of the renal artery and vein to the recipient aorta and inferior cava",c
Utilisation of small paediatric donor kidneys for transplantation,3. Which of the following donor characteristics is NOT used in determining the Kidney Donor Profile Index (KDPI):     a) Donation after Circulatory Death (DCD) Status     b) Ethnicity     c) Cold ischaemia time     d) Serum creatinine,b
Utilisation of small paediatric donor kidneys for transplantation,4. Which of the following is the most common cause of early graft loss following the transplantation of kidneys from small paediatric donors:     a) Ureteric stenosis     b) Hyperacute rejection     c) Hyperfiltration injury     d) Thrombosis of donor vessels,d
Utilisation of small paediatric donor kidneys for transplantation,5. The Modified Maastricht Classification for Donors after Circulatory Death (DCD) determines the following categories as uncontrolled donation:     a) Maastricht category I and Maastricht category II     b) Maastricht category I and Maastricht category V     c) Maastricht category II and Maastricht category III     d) Maastricht category II and Maastricht category V,a
Vaccinations in pediatric kidney transplant recipients,1. When should vaccinations be ideally completed for pediatric kidney transplant (KT) recipients?     a) Before transplantation     b) Immediately after transplantation     c) During the first year post-transplant     d) During the second year post-transplant,a
Vaccinations in pediatric kidney transplant recipients,2. Which type of vaccines are generally contraindicated in pediatric KT recipients?     a) Inactivated vaccines     b) Live vaccines     c) Toxoid vaccines     d) Subunit vaccines,b
Vaccinations in pediatric kidney transplant recipients,3. What is the recommended waiting period between the administration of live vaccines and kidney transplantation?     a) 1 week     b) 2 weeks     c) 4 weeks     d) 8 weeks,c
Vaccinations in pediatric kidney transplant recipients,4. Which of the following vaccinations should be given priority for KT candidates before transplantation?     a) Influenza     b) HPV     c) MMR     d) Hepatitis B,c
Vaccinations in pediatric kidney transplant recipients,5. What is a common issue with vaccination rates among pediatric KT candidates?     a) Over-vaccination     b) Suboptimal vaccination rates     c) Excessive side effects     d) Unnecessary vaccinations,b
Oxidative stress in autosomal dominant polycystic kidney disease: player and/or early predictor for disease progression,"1. Did researchers find a significant difference in the occurrence of hypertension between male and female ADPKD patients?  a) No, no differences were found  b) Yes, there are differences between them in childhood  c) Yes, between the ages of 20 and 40 years  d) Yes, after they reach ESRD",c
Oxidative stress in autosomal dominant polycystic kidney disease: player and/or early predictor for disease progression,"2. With an average age of diagnosis of 30 years, hypertension affects  a) 5–44% of the young ADPKD adults  b) 90–95% of the young ADPKD adults  c) 0–20% of the young ADPKD adults  d) 60–75% of the young ADPKD adults",d
Oxidative stress in autosomal dominant polycystic kidney disease: player and/or early predictor for disease progression,"3. Which of the following statements about early ADPKD is correct?  a) Plasma and urinary levels of ADMA are increased  b) Plasma levels of ADMA are increased, but urinary levels are decreased  c) Plasma levels of ADMA are decreased, but urinary levels are increased  d) Plasma and urinary levels of ADMA are decreased",b
Oxidative stress in autosomal dominant polycystic kidney disease: player and/or early predictor for disease progression,4. Which of the following markers of OS that are disturbed in CKD has not been elucidated yet in ADPKD?  a) Increased ADMA levels  b) Decreased SOD levels  c) Increased MDA levels  d) Increased NADPH oxidase activity,d
Oxidative stress in autosomal dominant polycystic kidney disease: player and/or early predictor for disease progression,5. Which of the following is associated with an increased serum uric acid in ADPKD patients?  a) Less risk of hypertension but an accelerated progression to ESRD  b) More risk of hypertension and an accelerated progression to ESRD  c) More risk of hypertension but a delayed progression to ESRD  d) Less risk of hypertension and a delayed progression to ESRD,b
Vitamin D and cardiovascular disease in chronic kidney disease,"1. The following are important determinants of 25(OH)D levels in patients with chronic kidney disease, EXCEPT     a) Age     b) Nutritional vitamin D supplement use     c) Gender     d) Proteinuria     e) Race",c
Vitamin D and cardiovascular disease in chronic kidney disease,"2. 1,25-Dihydroxyvitamin D levels in CKD are regulated by which one of the following:     a) FGF23     b) Klotho     c) Sclerostin     d) Osteopontin",a
Vitamin D and cardiovascular disease in chronic kidney disease,"3. The production of 24-hydroxylase enzyme which inactivates both 25(OH)D and 1,25(OH)2D is induced most strongly by:     a) 25(OH)D     b) FGF23     c) PTH     d) 1,25(OH)2D",d
Vitamin D and cardiovascular disease in chronic kidney disease,"4. A bimodal association is seen between 1,25-dihydroxy vitamin D and which of the following:     a) Left ventricular mass index     b) Pulse wave velocity     c) Flow mediated dilation     d) Fibrinogen     e) Carotid intima-media thickness",e
Vitamin D and cardiovascular disease in chronic kidney disease,"5. In adult clinical trials, paricalcitol, a vitamin D receptor agonist, has been shown to do all of the following, EXCEPT:     a) Decrease proteinuria     b) Decrease markers of inflammation (CRP)     c) Decrease left ventricular mass index     d) Decrease cardiovascular-related hospitalizations",c
A brief history of rickets,1. Rickets is characterized by:  a) Brittle bone b) Elevated serum calcium c) Soft and deformed bone d) Elevated serum phosphate,c
A brief history of rickets,2. Nutritional rickets can be caused by all but one of the choices below:  a) Deficient calcium intake b) Vitamin D deficiency c) Lack of sunlight d) Vitamin A deficiency,d
A brief history of rickets,"3. The most active form of vitamin D is  a) 7-dehydrocholesterol b) 1,25-dihydroxy vitamin D c) 25-hydroxy vitaminD d) cholecalciferol",b
A brief history of rickets,4. The irradiation of milk as a treatment for rickets was demonstrated by  a) Steenbock b) McCollum c) Yalow d) Windhaus,a
A brief history of rickets,5. Burosomab targets:  a) Vitamin D receptor b) Parathyroid hormone c) Intestinal calcium absorption d) FGF-23,d
Alport syndrome: deducing the mode of inheritance from the presence of haematuria in family members,"1. A 14-year-old boy has haematuria, proteinuria, renal impairment, hearing loss, and a fleck retinopathy. His mother has haematuria only. Is it possible to make the diagnosis of X-linked Alport syndrome based on this information?  a) Yes b) No",b
Alport syndrome: deducing the mode of inheritance from the presence of haematuria in family members,2. Inheritance of Alport syndrome is autosomal recessive in what % of families?  a) 5% b) 15% c) 25% d) 35%,b
Alport syndrome: deducing the mode of inheritance from the presence of haematuria in family members,"3. Where a person is diagnosed with Alport syndrome (renal failure, hearing loss, lenticonus, and retinopathy) but there is no other family member with these features, this could be due to  a) A de novo mutation and X-linked inheritance b) Autosomal recessive inheritance c) Either a or b d) Neither a nor b",c
Alport syndrome: deducing the mode of inheritance from the presence of haematuria in family members,4. It is important to diagnose autosomal recessive Alport syndrome because  a) The persons’ offspring will not develop Alport syndrome and renal failure b) The person’s parents will not have Alport syndrome with renal failure c) Each of the person’s siblings will have a one in four chance of developing Alport syndrome with renal failure d) All of the above,d
Blood pressure in children with chronic kidney disease lessons learned from the Chronic Kidney Disease in Children Cohort Study,"1. In children with mild-to-moderate chronic kidney disease, what technique for in-office blood pressure measurement is considered the gold standard for classification of blood pressure status? a) Blood pressure measured manually by auscultation b) Blood pressure measured automatically by oscillometry c) Blood pressure measured automatically by ABPM d) Blood pressure measured by auscultation and by oscillometry",a
Blood pressure in children with chronic kidney disease lessons learned from the Chronic Kidney Disease in Children Cohort Study,"2. A 15-year-old girl with stage 3 chronic kidney disease undergoes ambulatory blood pressure monitoring. The study shows normal mean blood pressure while awake, elevated mean blood pressure while asleep and normal nocturnal blood pressure dipping. Based on findings from CKiD, for which of the following patterns of additional findings is the patient at highest risk? a) She would have normal carotid intima-media thickness and abnormal echocardiography b) She would have abnormal carotid intima-media thickness and abnormal pulse wave velocity c) She would have abnormal echocardiography and normal pulse wave velocity d) She would have abnormal echocardiography, abnormal carotid intima-media thickness and abnormal pulse wave velocity",c
Blood pressure in children with chronic kidney disease lessons learned from the Chronic Kidney Disease in Children Cohort Study,3. The chances of rapid progression of chronic kidney disease in children are increased the most when what sequence of events occurs? a) Blood pressure is normal at baseline and hypertension develops two years later b) Blood pressure is elevated at baseline but is controlled with medication c) Blood pressure is normal at baseline and remains normal two years later,a
Blood pressure in children with chronic kidney disease lessons learned from the Chronic Kidney Disease in Children Cohort Study,4. Left ventricular hypertrophy has been associated with what blood pressure pattern in children with chronic kidney disease? a) Nocturnal hypertension b) Masked hypertension c) White coat hypertension d) Pre-hypertension e) All of the above,e
Blood pressure in children with chronic kidney disease lessons learned from the Chronic Kidney Disease in Children Cohort Study,"5. In children with chronic kidney disease, increased carotid intima thickness correlates with what other finding? a) Left ventricular hypertrophy b) Hypertension c) Nephrotic-range proteinuria d) Rapid CKD progression",b
"Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation",1. What is no diagnostic mean for detection of BKPyV replication with risk of nephropathy? A) Decoy cells in the urine B) BKPyV PCR in urine C) BKPyV PCR in blood D) Graft biopsy with SV40 staining E) BKPyV-specific IgG in blood,E
"Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation",2. Name the current recommendation for first-line treatment of BKPyVassociated nephropathy A) Reduction of immunosuppressive therapy B) Switch of immunosuppressive medication to Belatacept-based immunosuppression C) Cidofovir D) Ciprofloxacin E) Leflunoamide,A
"Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation",3. What is NOT true? BKPyV-specific T cells A) represent the cellular immune response to BKPyV. B) predict the ability of the transplanted patient to cope with BKPyV infection. C) have the same predictive value as BKPyV-specific antibodies. D) can be determined by ELISpot-assay or flow cytometry. E) have not yet been implemented in routine care.,C
Does treatment-resistant hypertension exist in children? A review of the evidence,What factors can lead to misclassification of TRH?  a. Medical non-adherence  b. White coat phenomenon  c. Suboptimal drug dosing  d. All of the above,d. All of the above
Does treatment-resistant hypertension exist in children? A review of the evidence,Which of the following medications was shown to be most effective at management TRH in the PATHWAY-2 Trial?  a. Doxazosin  b. Bisoprolol  c. Spironolactone  d. None of the above,c. Spironolactone
Does treatment-resistant hypertension exist in children? A review of the evidence,Which is the following is the best method to evaluate for white coat phenomenon in a child with potential ARHC?  a. Ambulatory blood pressure monitoring  b. Asking the patient about anxiety  c. Medication monitoring  d. Daily blood pressure checks by the school nurse,a. Ambulatory blood pressure monitoring
Does treatment-resistant hypertension exist in children? A review of the evidence,Which of the following should be considered in a child with ARHC?  a. Renovascular hypertension  b. Monogenic hypertension  c. Obstructive sleep apnea  d. All of the above,d. All of the above
Does treatment-resistant hypertension exist in children? A review of the evidence,"A mutation in which of the following genes could lead to hypertension, hyperkalemia, and metabolic acidosis?  a. SCNN1β  b. WNK1  c. HSD11β2  d. CYP11β1/β2",b. WNK1
Dialysis modalities for the management of pediatric acute kidney injury,1. Which of the following statements about peritoneal dialysis is true: a) PD is usually performed in the intensive care unit (ICU) b) The use of appropriate catheter and technique allows a predictable UF in critically ill children c) PD cannot be performed without a well-functioning vascular access d) Providing PD does not require expertise and individual nurses,d
Dialysis modalities for the management of pediatric acute kidney injury,"2. Between the following dialytic indications, in which case would CRRT be the most appropriate treatment approach? a) A 15-year-old female trauma victim with significant myoglobinemia, hyperkalemia, and hyperphosphatemia b) A 3-year-old patient with HUS with oliguria and acute kidney failure c) A 16-year-old oncologic patient with sepsis, a fluid overload of 9%, and hemodynamic instability d) A neonate with hyperammonemia secondary to an inborn error of metabolism without anuria and acute kidney injury",c
Dialysis modalities for the management of pediatric acute kidney injury,3. When starting an acute HD: a) Slow reduction of uremic toxins is required to avoid the disequilibrium syndrome b) The UF rate may exceed 1–2% of patient’s body weight reduction hourly c) An anticoagulation protocol is always recommended d) Set the blood pump rate at 5–8 ml/kg/min for small infants,a
Dialysis modalities for the management of pediatric acute kidney injury,"4. Which of the following statements about the regional anticoagulation with citrate is true: a) A patient’s iCa level monitoring should be performed after 30 min initially, and later on after 12 h b) Calcium gluconate is the recommended supplemental calcium solution for the correction of a patient’s calcium levels c) LMWH is the preferred anticoagulant when the presence of liver failure contraindicates regional citrate d) None",d
End-stage kidney disease in infancy an educational review.,1. The approximate percentage of infants on dialysis with a non-renal comorbidity is: a) 5% b) 10% c) 20% d) 30%,d
End-stage kidney disease in infancy an educational review.,2. The most common reason for peritoneal dialysis catheter revisions in infants on chronic peritoneal dialysis is: a) Peritoneal dialysis fluid leakage b) Peritonitis c) Mechanical dysfunction d) Exit site infection,c
End-stage kidney disease in infancy an educational review.,3. The factor(s) associated with impaired linear growth in infants with ESKD include: a) Inadequate protein intake b) Sodium losses in PD effluent c) Metabolic acidosis d) Bone mineral disease e) All of the above,e
End-stage kidney disease in infancy an educational review.,4. Which outcome is better in infants with ESKD compared to adolescents with ESKD: a) Percent change in BMI on dialysis b) Patient survival rates c) Allograft rejection ratio d) Transplantation rates,c
Growth plate alterations in chronic kidney disease,"1. What is false? a) Prenatal growth depends only on genetics b) Infant growth is predominantly influenced by nutrition c) Thyroid and growth hormones have a significant effect during childhood growth d) The maximum growth rate, called peak height-velocity (PHV), occurs during later stages of puberty at around 12 years in girls and 14 years in boys",a
Growth plate alterations in chronic kidney disease,2. Which one is NOT a stratum of the growth plate? a) Reserve zone b) Degenerative zone c) Hypertrophic zone d) Proliferative zone,b
Growth plate alterations in chronic kidney disease,"3. It is true that children who have advanced CKD, a) Fall below the third percentile during the first 15 months b) Have the pubertal spurt delayed, shortened and associated with a reduced growth velocity c) Children receiving dialysis have higher growth velocity d) Have catch-up growth infrequently after transplantation",d
Growth plate alterations in chronic kidney disease,"4. The growth plate during uremia is NOT characterized by, a) Profound disorganization b) Expansion of the hypertrophic region c) Increased height d) Expansion of the proliferative stratum",d
Growth plate alterations in chronic kidney disease,"5. What is false about the growth plate’s alterations during CKD? a) Chondrocytes of uremic rats achieve a lower final size than those of control rats b) In the growth plate of young uremic rats, reduced expression of GH receptor has been found c) IGF-I expression is not affected d) An elevated expression of SOCs family could partially explain the local insensitivity to GH",c
Malaria and acute kidney injury,1. Renal compromise is most often seen with what plasmodium species? A. Plasmodium malariae B. Plasmodium vivax C. Plasmodium ovale D. Plasmodium falciparum,D
Malaria and acute kidney injury,2. What is the most common cause of acute kidney injury (AKI) in patients with malaria? A. Acute tubular necrosis B. Acute glomerulonephritis C. Renal cystic disease D. Urinary obstruction,A
Malaria and acute kidney injury,3. What are the most frequently encountered electrolyte abnormalities seen in patients with malarial AKI? A. Hyponatremia and hyperkalemia B. Hyponatremia and metabolic alkalosis C. Hypokalemia and metabolic acidosis D. Hypernatremia and hypokalemia,A
Malaria and acute kidney injury,4. Which is true regarding IV bolus fluid resuscitation in patients with severe infection according to results from the FEAST trial? A. A 20 mL/kg bolus of normal saline improved 48-h mortality in patients with severe infection B. A 20 mL/kg bolus of albumin improved 48-h mortality in patients with severe infection C. A 20 mL/kg IV bolus of albumin increased mortality in patients with severe infection but normal saline did not D. Both normal saline and albumin IV fluid boluses increased 48-h mortality in patients with severe infection,D
Malaria and acute kidney injury,5. What disease has been associated with malarial infection itself or certain drugs used for treatment of malaria? A. ANCA vasculitis B. FSGS C. Thrombotic microangiopathy D. Lupus nephritis,C
Management of antenatal hydronephrosis,1. What are the most frequently accepted APRPD thresholds for prenatal diagnosis of AHN? a) ≤ 4 mm in the second and ≤ 10 mm in the third trimester b) ≤ 4 mm in the second and ≤ 7 mm in the third trimester c) ≤ 5 mm in the second and ≤ 10 mm in the third trimester d) ≤ 7 mm in the second and ≤ 12 mm in the third trimester,b
Management of antenatal hydronephrosis,2. What is the optimal time for postnatal US in a male patient with bilateral moderate hydronephrosis and distended bladder? a) Within 24 h b) Within 48 h c) 3–7 days of life d) After 7 days of life,a
Management of antenatal hydronephrosis,"3. Which one of the following is wrong about mild isolated AHN? a) Defined as an APRPD of 7–10 mm diagnosed by fetal US in the third trimester of gestation. b) Majority of them resolve, stabilize, or improve. c) A substantial number of patients in this group require surgical intervention. d) Mild AHN does not necessarily exclude the diagnosis of PUV.",c
Management of antenatal hydronephrosis,4. Which one of the following is wrong about VUR and UPJO? a) The correlation between the severity of AHN and grade of VUR is poor. b) The degree of postnatal hydronephrosis is predictive for the presence of UPJO. c) Length of APRPD and preoperative DRF on DRSc were found to be predictors for surgery. d) DRSc with 99Tc MAG-3 is indicated as an immediate postnatal study for neonates with suspected bladder outlet obstruction.,d
Management of antenatal hydronephrosis,5. What should be recommended to a patient with AHN who had a normal postnatal US which is performed in the 5th day of life? a) No need to perform any other investigation b) A second US should be performed at 4–6 weeks of age c) A second US should be performed at 1 year of age d) Perform US every 3 months in the first year,b
Maternal and gestational influences on childhood blood pressure,The most common high risk maternal condition that has been associated with higher BP in child offspring is: a) Type 2 diabetes b) Obesity c) Preeclampsia d) Air pollution,b
Maternal and gestational influences on childhood blood pressure,The association of maternal obesity and diabetes with higher BP in child offspring is most likely to be: a) Directly due to fetal programing b) Secondary due to development of obesity in childhood c) Directly due to genetic factors d) Directly due to maternal age,b
Maternal and gestational influences on childhood blood pressure,A maternal exposure associated with high BP in childhood that is the result of fetal programing is: a) Gestational hypertension b) Maternal obesity c) Assisted reproductive technology d) All of above,c
Maternal and gestational influences on childhood blood pressure,Maternal and gestational influences on higher BP in child offspring can be due to: a) Fetal programing b) Genetic factors c) Familial lifestyle factors d) All of above,d
Maternal and gestational influences on childhood blood pressure,"A 10-year-old boy is referred for suspected hypertension. His BMI is > 95th%, BP is =90th%, physical exam is otherwise normal. On birth history, birth weight was 3.2 kg and mother has type 2 diabetes before and throughout pregnancy. Additional evaluation should include: a) 24 h ambulatory BP monitoring b) Lipid panel c) Diet history d) No further evaluation needed",a
Mineralized tissues in hypophosphatemic rickets,1. Hypophosphatemic rickets is most commonly a. An acquired disorder b. Inherited as an autosomal dominant disorder c. Inherited as an X-linked dominant disorder d. Inherited as an autosomal recessive disorder,c
Mineralized tissues in hypophosphatemic rickets,2. PHEX mutations lead to a. Decreased levels of circulating FGF23 b. Decreased expression of 1-alpha hydroxylase c. Decreased expression of 24-hydroxylase d. All of the above,b
Mineralized tissues in hypophosphatemic rickets,3. Hypophosphatemic rickets leads to a mineralization defect a. In trabecular bone b. In the growth plate c. In cortical bone d. All of the above,d
Mineralized tissues in hypophosphatemic rickets,4. Disordered mineralization of bone tissue (osteomalacia) is characterized by a. A shortened mineralization lag time b. A lack of alkaline phosphatase c. Accumulation of osteoid d. Accumulation of osteoblasts,c
Mineralized tissues in hypophosphatemic rickets,"5. The conventional treatment of hypophosphatemic rickets includes a. Oral phosphate supplementation b. Low phosphate diet c. High doses of 24, 25 dihydroxy-vitamin D d. Low calcium diet",a
"Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management","1. Which of the following is the next step in the evaluation of a 2-cm × 2-cm incidental adrenal mass noticed on a CT scan of the abdomen in a patient with normal vital signs, kidney function, and serum electrolytes? a) Spot urine for metanephrines b) MIBG scan c) MRI of the abdomen and pelvis d) Plasma metanephrines e) No further testing",d
"Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management",2. Which of the following is the most common germline mutation in patients with PPGL? a) MAX b) NF1 c) RET d) SDHB e) TMEM,d
"Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management",3. Which of the following is a risk factor for malignant PPGL? a) Adrenal incidentalomas b) Adrenal location c) Epinephrine phenotype d) Old age e) SDH mutation,e
"Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management",4. Which of the following is the correct recommendation for a patient receiving antihypertensive treatment with alpha adrenergic blockers for pheochromocytoma? a) 2 L fluid restriction b) High salt diet c) Low calorie diet d) Low salt diet e) Low salt and low potassium diet,b
"Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management",5. Which of the following does not increase plasma metanephrines? a) Acetaminophen b) Amitriptyline c) Phenoxybenzamine d) Supine body position e) Upright body position,d
Psychosocial considerations and recommendations for care of pediatric patients on dialysis,1. Which of these statements regarding depression is most accurate? a. Greater depression and anxiety has been documented for patients on dialysis compared with those with pre-dialysis CKD and healthy controls. b. Adolescent males are at greater risk of developing depression than females. c. The Centers for Medicare and Medicaid Services (CMS) mandates depression screening for pediatric patients on dialysis. d. Dialysis has not been associated with an increased risk for depression. e. Both A and C,e
Psychosocial considerations and recommendations for care of pediatric patients on dialysis,"2. Which of these statements regarding academic performance and cognitive functioning is FALSE? a. Patients on dialysis often experience absences due to dialysis treatment, hospitalizations, and health problems. b. Parents report that academic problems for pediatric dialysis patients increase over time. c. Patients on dialysis tend to perform well above transplant patients on all academic tasks. d. Children with CKD often have higher intellectual and memory deficits than healthy controls. e. Rates of ADHD are higher for pediatric dialysis patients compared with healthy controls.",c
Psychosocial considerations and recommendations for care of pediatric patients on dialysis,3. A neuropsychological evaluation can inform: a. Transition planning b. Medical education approach c. School accommodations d. Psychological intervention e. All of the above,e
Psychosocial considerations and recommendations for care of pediatric patients on dialysis,4. Transfer to adult care is associated with: a. Assurance that all adult providers are competent in working with patients with congenital issues. b. Poor disease outcomes c. Continued medical coverage with no lapses d. Improved disease outcomes e. No insurance concerns,b
Psychosocial considerations and recommendations for care of pediatric patients on dialysis,5. Ideal recommendations for psychosocial care of pediatric patients on dialysis include: a. Psychosocial screening and triage of all patients b. Neuropsychological testing c. Annual depression screening d. Regular QOL assessment e. All of the above,e
Renal aspects of metabolic acid–base disorders in neonates,1. The mechanisms responsible for reduced renal acidification capacity in newborn infants are: a. Low excretion of titratable acids b. Low renal HCO3− threshold c. Low glomerular filtration rate d. Low excretion of ammonium salts e. All of the above,e
Renal aspects of metabolic acid–base disorders in neonates,2. Metabolic acidosis with high serum anion gap can be observed in: a. Severe dehydration b. Drug-induced hypokalemia c. Established chronic renal failure d. dRTA (type 4) e. Excessive chloride intake following resuscitation or parenteral nutrition,c
Renal aspects of metabolic acid–base disorders in neonates,3. Which of the following statements about pRTA is false? a. The serum anion gap is normal b. Severe hypokalemia is present c. Urinary pH remains always higher than 6.2 d. Can be associated with a number of various diseases e. It is caused by an impairment of HCO3− reabsorption with intact distal acidification,c
Renal aspects of metabolic acid–base disorders in neonates,"4. Which of the following statements about dRTA is true? a. The treatment of hyperkalemia is mandatory b. Urinary pH may decrease below 6.2 following severe metabolic acidosis c. Dehydration and salt wasting are very common d. It is associated with juxtaglomerular apparatus hyperplasia e. Treatment by alkali should be administered by caution, due to the risk of hypertension",c
Should we abandon GFR in the decision to initiate chronic dialysis,"1. The two validated equations providing help in estimating time to ESKD take into consideration: a) Age, sex, primary renal disease and eGFR b) Age, sex, primary renal disease and proteinuria c) Age, sex, BP, proteinuria and eGFR d) Age, sex, eGFR, proteinuria or eGFR, proteinuria and primary renal disease",d
Should we abandon GFR in the decision to initiate chronic dialysis,"2. After the only randomized control trial in adults and the two largest paediatric registry observational studies, what is the main conclusion regards the optimal time to start maintenance dialysis? a) “The earlier the better” b) “The later the better” c) There is no evidence supporting benefit from early initiation of dialysis; however in children large prospective randomized trials are required. Until then decisions should be made on a case-by-case basis. d) When eGFR is between 5 and 7 ml/min/1.73m2, dialysis should always be started.",c
Should we abandon GFR in the decision to initiate chronic dialysis,"3. A clinician should base the decision to initiate maintenance dialysis on the presence of: a) Biochemical abnormalities difficult to control by medications, diuresis-resistant fluid overload and growth, but not eGFR b) Biochemical abnormalities difficult to control by medications, diuresis-resistant fluid overload, hypertension, eGFR and growth, but not primary renal disease c) Biochemical abnormalities difficult to control by medications, diuresis-resistant fluid overload, primary renal disease (glomerular vs. non-glomerular), but not eGFR d) Biochemical abnormalities difficult to control by medications, diuresis-resistant fluid overload, primary renal disease (glomerular vs. non-glomerular), growth, HTN, eGFR, patient-related quality of life issues and a shared decision making with parents/family",d
Should we abandon GFR in the decision to initiate chronic dialysis,"4. After all other conservative treatment efforts have been tried, there is some evidence that early initiation of dialysis in children might improve: a) Hypertension b) Growth c) Metabolic bone disease d) Morbidity",b
Should we abandon GFR in the decision to initiate chronic dialysis,"5. Based on the up-to-date literature, there is some evidence that late initiation of dialysis in children might increase the prevalence of: a) Hypertension and anemia b) Slow decline in urinary output c) Anemia alone d) Hypertension alone",a
The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children,"1. A 6-year-old girl with five non-febrile UTIs over the past year. Infections always present with dysuria, frequency, and daytime incontinence. All episodes have been confirmed with urinalysis and midstream urine culture, which is always positive for Escherichia coli. Renal and bladder ultrasound is normal, except for significant fecal load in the rectum. What would be the most appropriate next step? a. VCUG b. DMSA c. Bladder retraining and constipation treatment ± short-term CAP d. Cystoscopy e. Watchful waiting",c
The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children,2. A 7-year-old girl with recurrent UTIs has been investigated in the community and found to have bilateral grade 2 VUR. Infections presented with LUTS and were not associated with fever. A voiding diary reveals 3–4 voids per day and bowel movement every 2–3 days. Appropriate management includes: a. DMSA scan b. Cystoscopy and injection of bulking agent c. CAP d. Aggressive management of constipation and bladder retraining e. Ureteral reimplantation,d
The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children,3. A 4-year-old girl with history of 3 confirmed febrile UTIs has completed toilet training and diary demonstrates 5–6 voids daily and a daily bowel movement reported as Bristol type 2. Appropriate next steps include: a. Renal bladder ultrasound b. Management of constipation c. Bladder training d. CAP e. All of the above,e
The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children,"4. For the same patient in the above question, a renal bladder ultrasound was obtained and demonstrated bilateral hydroureteronephrosis and right kidney 1.5 cm smaller than the left. The best next step to determine renal reserve is: a. VCUG b. DMSA scan c. Cystoscopy d. Renal scan with Lasix e. Observation",b
The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children,5. A 7-year-old boy presents with recurrent UTIs for the past several months. The main symptoms of the infections are frequency and urgency with dysuria. Physical examination reveals physiologic phimosis with erythema noted around the tip of his foreskin. Voiding diary demonstrates 10–12 voids per day and daily Bristol type 1 bowel movements. Your next steps should be: a. Bladder retraining and management of constipation b. Renal ultrasound c. Management of phimosis d. CAP e. a) and c),e
Twin gestation and the burden of adult cardio-renal disease,"1. Some twins have been shown to have smaller kidney size, reduced creatinine clearance, and hypertension. Which additional individual factors may play an important role in these findings: a. Low birth weight b. Preterm birth c. Other maternal factors such as pre-eclampsia d. All of the above",d
Twin gestation and the burden of adult cardio-renal disease,"2. TTTS is a condition characterized by the following: a. Donor twin develops hypervolemia, cardiomyopathy, and acute kidney injury b. Donor twin develops hypovolemia, oliguria, and acute kidney injury c. Recipient twin develops hypervolemia, hypertension, and cardiomyopathy d. Both b and c",d
Twin gestation and the burden of adult cardio-renal disease,3. The RAAS is implicated in the pathogenesis of TTTS as evidenced by: a. A similarly increased level of renin in both the donor and recipient twins b. Downregulation of RAAS activators in the recipient twin kidney c. Upregulation of RAAS activators in the donor twin kidney d. All of the above,d
Twin gestation and the burden of adult cardio-renal disease,4. Renal tubular dysgenesis is characterized by undifferentiated proximal convoluted tubular cells in the kidney and is a histological manifestation of: a. A primary condition associated with a mutation in RAAS genes b. A secondary condition associated with TTTS or ACE fetopathy c. Both a and b d. Neither a or b,c
Twin gestation and the burden of adult cardio-renal disease,5. Abnormal vascular programming and increased arterial stiffness in TTTS is seen in: a. The recipient twin b. The donor and recipient twin c. The donor twin unless a complete laser fetoscopic surgery is done d. None of the above,c
Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction,1. Congenital lower urinary tract obstruction occurs: a) In 1 per 3000 births b) More often in Caucasians c) More often in females d) With more complex anomalies in males,a
Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction,2. Amniotic fluid volume in a pregnancy with fetal cLUTO is: a) Not associated with long-term renal failure when normal b) Not significant when low during the canalicular phase of lung development c) More predictive of poor kidney function when considering the parent’s subjective sense of risk d) More predictive of poor kidney function when low later in gestation,c
Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction,3. Renal parenchymal echogenicity and cystic change in the setting of cLUTO: a) Are not surrogates of renal reserve b) Are predictors of renal dysfunction when assessed subjectively c) Are less reliable on fetal than postnatal imaging d) Can be objectively described by ultrasound or magnetic resonance,d
Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction,4. Fetal urine should: a) Increase in tonicity along gestation b) Decrease in sodium concentration along gestation c) Contain the digestive enzyme gamma-glutamyl transpeptidase (GGTP) d) Be most indicative of renal dysfunction in cLUTO on the first bladder aspiration,b
Clinical predictors of chronic kidney disease in congenital lower urinary tract obstruction,5. β-2 microglobulin levels in the fetus: a) Correlate with inflammatory markers implicated in renal dysplasia of cLUTO b) Reflect glomerular filtration when measured in the urine c) Reflect tubular dysfunction when measured in the serum d) Are easier to obtain from the serum than the urine,a
Endurance training during maintenance hemodialysis in pediatric and adolescent patients—theory and best practice suggestions,1. Leveling off means a) plateau formation in O2-uptake b) plateau formation in CO2-emission c) stop of maximum load at spiroergometry d) early termination of spiroergometry,a
Endurance training during maintenance hemodialysis in pediatric and adolescent patients—theory and best practice suggestions,2. Which measure does not lead to an increase in training adherence? a) always the same routine procedure b) support patient motivation c) adjust solid coach d) media,d
Endurance training during maintenance hemodialysis in pediatric and adolescent patients—theory and best practice suggestions,3. Which parameter does not influence endurance capacity during dialysis? a) stable blood pressure measurements b) timing of training c) fluid overload d) motivation,a
Endurance training during maintenance hemodialysis in pediatric and adolescent patients—theory and best practice suggestions,4. Exercise testing should always be done at a) day of dialysis and at the same time before dialysis b) day of dialysis and in the morning before dialysis c) dialysis-free days d) after the dialysis,a
Endurance training during maintenance hemodialysis in pediatric and adolescent patients—theory and best practice suggestions,5. Reasons for not achieving the aerobic ventilatory threshold could be a) high motivation b) low muscle strength c) good exercise capacity d) active lifestyle,b
Inherited glomerular diseases in the gilded age of genomic advancements,1. Choose the factor(s) likely to improve the yield and clinical usefulness of a genetic evaluation such as a genetic panel or whole exome sequencing (WES): A. A high suspicion of a genetic condition based on the clinical presentation and family history obtained by the ordering physician B. Detailed phenotype information made available to the genetic testing laboratory C. Availability of DNA from parents or other affected family members D. All the above,D
Inherited glomerular diseases in the gilded age of genomic advancements,2. Whole Exome Sequencing results reported by a clinical laboratory may miss which of the following types of genetic variants A. A large structural DNA variation or Copy Number Variation B. Deep intronic variants C. Common variants in complex disease genes D. Variants in genes not known to be causative of the clinical phenotype at the time of the study. E. All the above,E
Inherited glomerular diseases in the gilded age of genomic advancements,"3. A 14 years old male has nephrotic range proteinuria and CKD, mild craniofacial asymmetry and hearing loss, his renal biopsy shows FSGS. Genetic evaluation may reveal: A. COL4A5 mutation (X-linked Alport syndrome) B. EYA1 heterozygous mutation (BOR syndrome) C. COL4A4 heterozygous mutation (COL4-associated FSGS) D. NPHS2 mutation (AR FSGS) E. A) and B)",E
Inherited glomerular diseases in the gilded age of genomic advancements,4. What genetic evaluation approach would be most suitable to obtain a genetic diagnosis in the patient described above? A. Karyotype B. WES C. Gene panel D. WGS,B
Inherited glomerular diseases in the gilded age of genomic advancements,"5. A 19 years old female has borderline hypertension and a history of hematuria and low-grade proteinuria. Multiple family members have microscopic hematuria and/or renal insufficiency. You consider ordering either genetic testing of COL4A3, COL4A4, and COL4A5, which consists of sequencing and deletion testing for the 3 genes, or WES for microscopic hematuria. What are the likely benefits of WES in this case? A. Identification of a variant of unknown significance (VUS) in COL4A3, COL4A4, or COL4A5 B. Detection of a deletion mutation in COL4A3, COL4A4, or COL4A5 C. Identification of a mutation in the coding sequence of another gene responsible for microscopic hematuria D. Coverage by insurance E. Reveal epigenetic factors leading to disease variability.",C
Innate immunity and urinary tract infection,1. Which of the following secreted proteins directly promotes neutrophil chemotaxis across the urothelium during UTI? a) IL-12 b) TNF-α c) IL-8 d) IL-6 e) IL-1β,c
Innate immunity and urinary tract infection,2. Which of the following cell types is NOT a source of TNF-α during UTI? a) Neutrophils b) Resident macrophages c) Mast cells d) Natural killer cells,a
Innate immunity and urinary tract infection,"3. What are the roles of mast cells during UTI? a) Promote exfoliation of bladder umbrella cells b) Secrete TNF-α, which promotes recruitment of circulating neutrophils c) Neither a nor b is correct. d) Both a and b are correct.",d
Innate immunity and urinary tract infection,"4. How do intercalated cells contribute to host defense against ascending UTI? a) Secrete TLR4 and TLR5, which bind to bacterial ligands and prevent kidney invasion b) Release antimicrobial peptides in an insulin dependent manner c) Exfoliate into the collecting duct lumen following UPEC binding d) Release chemokines that promote recruitment of circulating T and B lymphocytes",b
Innate immunity and urinary tract infection,5. Which of the following is a form of innate immunity? a) Biological shielding through use of local microbiota b) Induction of AMP expression in the urinary stream c) Production of chemokines and chemokines d) Toll-like receptors e) All of the above,e
Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones,1. Which one of the following amino acids is not increased in urine in patients with cystinuria? a) Cystine b) Ornithine c) Lysine d) Arginine e) Glutamine,e
Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones,2. Which of the following statements is TRUE? a) The diagnosis of hyperoxaluria does not necessitate a 24-h urine collection. b) Most urinary solutes have age-dependent reference intervals. c) Higher muscle mass can cause overestimation of solute to creatinine ratios in urine. d) A single spot urine at the time of presentation will suffice for the work-up of nephrolithiasis.,b
Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones,"3. Which of the following statements is NOT TRUE? a) Kidney stone formation can be multifactorial, including urinary tract infections, stasis, and metabolic reasons. b) Hypercalciuria is a monogenetic disorder. c) Increased urinary sodium excretion leads to urinary calcium wasting. d) A urinary sodium/potassium ratio should be less than 2.5 in children with a propensity for kidney stones.",b
Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones,"4. Please select the FALSE statement: a) To date, we know of three different forms of primary hyperoxaluria. b) In primary hyperoxaluria type I, the genetic defect results in reduced or absent alanine-glyoxylate aminotransferase. c) In primary hyperoxaluria type III, progression to end-stage renal disease is rare. d) In primary hyperoxaluria type III, the genetic defect results in deficiency or absence of the enzyme glyoxylate reductase/hydroxy pyruvate reductase.",d
Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones,5. Please select the FALSE statement: a) The incidence of nephro- and urolithiasis in children and adolescents is increasing due to dietary changes and increasing ambient temperature. b) The incidence of kidney stones in children is higher in arid climates. c) The increase of kidney stones among children and adolescents was not observed in countries with laws promoting lower salt content in processed food. d) Boys are always more affected than girls across all ages.,d
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?,1. Which of the following are currently hampering our ability to identify the prevalence of ARC in critically ill children? a) A lack of consensus about ARC thresholds adapted to age-specific GFR reference values for the pediatric population. b) A lack of consensus about appropriate methods for the bedside determination of renal function in critically ill children. c) Limited research on ARC in pediatric patients. d) All of the above.,d
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?,2. What is the most reliable method currently available to detect ARC in critically ill patients? a) Serum creatinine levels. b) Estimated GFR equations. c) Cystatin C levels. d) Urinary creatinine clearance.,d
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?,3. What is a significant risk associated with ARC in critically ill children? a) Increased risk of kidney injury. b) Increased fluid retention. c) Subtherapeutic antimicrobial concentrations and therapeutic failure. d) Higher rates of hypertension.,c
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?,4. Which factor is NOT mentioned as potentially contributing to the development of ARC in critically ill children? a) Systemic inflammation. b) Decreased cardiac output. c) Fluid resuscitation. d) Inotropic support.,b
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?,5. Why are standard GFR estimating equations less suitable for use in critically ill patients? a) They are too complicated to use at the bedside. b) They tend to underestimate true GFR in patients with acutely changing renal function. c) They overestimate GFR in patients with ARC. d) They require invasive procedures to calculate.,b
Practical application of ABPM in the pediatric nephrology clinic,1. The 2017 Clinical Practice Guideline for Elevated BP in Children recommends regular use of ABPM in screening for hypertension in which of the follow high-risk populations? a) Solid organ transplant recipients b) CKD c) History of prematurity d) Diabetes e) All of the above,e
Practical application of ABPM in the pediatric nephrology clinic,2. A 17-year-old female patient with CKD is undergoing ABPM for the first time. She is not currently taking any antihypertensive medications. Which of the following thresholds should be applied when interpreting the results of the monitor? a) 50th percentile MAP b) 140/85 while awake and 120/70 when asleep c) 95th percentile SBP and DBP from the 2014 AHA ABPM Guidelines d) 90th percentile SBP and DBP from the 2017 AAP Clinical Practice Guideline e) 95th percentile SBP and DBP from the 2017 AAP Clinical Practice Guideline,c
Practical application of ABPM in the pediatric nephrology clinic,"3. A 12-year-old male returns to clinic to review results from a 24-h ABPM placed at his prior clinic visit. His office BPs have been in the stage 1 hypertension range and he is not taking antihypertensive medications. The results show awake and sleeping mean BPs below the threshold for his sex and height and BP loads as follows: awake SBP 16%, awake DBP 8%, sleeping SBP 22%, and sleeping DBP 15%. Based on the above information, his ABPM classification would be which of the following: a) Pre-hypertension b) Elevated BP c) Ambulatory hypertension d) White-coat hypertension e) Blunted nocturnal dipping",d
Practical application of ABPM in the pediatric nephrology clinic,4. A 10-year-old boy with CKD and transplant is on 5 mg daily of lisinopril. All of the following are potential benefits of managing hypertension by performing ABPM at regular intervals except: a) Assessment of adequacy of hypertension treatment b) Slow or prevent the development of hypertensive target organ damage c) Slow progression of CKD d) Assess medication adherence e) Assess diurnal BP patterns,d
Practical application of ABPM in the pediatric nephrology clinic,"5. A 15-year-old female with height 160 cm is referred for evaluation of persistently elevated BPs in the primary care clinic. A history and physical exam do not reveal an obvious cause of secondary hypertension. An ABPM is placed and later returned for analysis. Threshold BPs are 129/82 (awake) and 114/66 (asleep). The mean awake BP is 124/78 and mean sleeping BP is 116/64. BP loads are awake SBP 26%, awake DBP 12%, sleeping SBP 33%, and sleeping DBP 28%. Dipping is normal. Based on this information, what is the patient’s diagnosis? a) Sustained hypertension b) Pre-hypertension c) White-coat hypertension d) Secondary hypertension e) Blunted nocturnal dipping",a
2020 update on the renin–angiotensin–aldosterone system in pediatric kidney disease and its interactions with coronavirus,Which of the following mechanisms lead to renin release? a) Increased concentration of sodium in the macula densa b) Reduced renal blood flow to the afferent arteriole c) Alpha adrenergic stimulation d) Vasoconstriction of the efferent arteriole,b
2020 update on the renin–angiotensin–aldosterone system in pediatric kidney disease and its interactions with coronavirus,Binding of Ang II to the AT1 receptor causes which of the following responses? a) Reduction of endothelial dysfunction b) Release of nitric oxide and prostaglandins c) Vasodilation of efferent arteriole d) Stimulation of renal sodium reabsorption,d
2020 update on the renin–angiotensin–aldosterone system in pediatric kidney disease and its interactions with coronavirus,SARS-CoV-2 binding to ACE-2 leads to a) Viral entry to the target cell b) Apoptosis of intestinal epithelial cells c) Systemic inflammation d) Viral replication,a
2020 update on the renin–angiotensin–aldosterone system in pediatric kidney disease and its interactions with coronavirus,Use of ACE inhibitors in hypertensive children with CKD a) Accelerates loss of kidney function over time b) Increases the risk of kidney disease progression c) Decreases the rate of kidney disease progression d) Worsens blood pressure control,c
2020 update on the renin–angiotensin–aldosterone system in pediatric kidney disease and its interactions with coronavirus,"Compared with the classical arm of the RAAS, effects of the alternative arm include a) Increase in proteinuria and reduction of fibrosis b) Stimulation of fibrosis and increased proteinuria c) Stimulation of fibrosis and reduction in proteinuria d) Reduction in fibrosis and decreased proteinuria",d
Adult survivors of idiopathic childhood onset nephrotic syndrome,The potential late effects of cytotoxic therapies administered in childhood include: a) Delayed puberty b) Short stature c) Oligospermia d) Chronic kidney disease,c
Adult survivors of idiopathic childhood onset nephrotic syndrome,Chronic kidney disease in adult survivors of idiopathic childhood onset nephrotic syndrome a) Occurs only in FSGS b) Is associated with APOL1 high-risk genotype c) Is common in steroid-responsive patients d) Is associated with younger age at nephrotic syndrome presentation,b
Adult survivors of idiopathic childhood onset nephrotic syndrome,"Following idiopathic childhood onset nephrotic syndrome, relapses in adults a) Occur in 60% of steroid-sensitive patients b) Occur only in steroid-resistant patients c) Are a harbinger of kidney failure d) Are associated with hypertension",d
Adult survivors of idiopathic childhood onset nephrotic syndrome,The late effects of anti-CD 20 monoclonal antibody therapy in adult survivors of idiopathic childhood onset nephrotic syndrome a) Include pulmonary fibrosis b) Include malignancy c) Are largely unknown d) All of the above,c
Adult survivors of idiopathic childhood onset nephrotic syndrome,"Adult survivors of steroid-sensitive, idiopathic childhood onset nephrotic syndrome a) Are more likely to have short stature than the general population b) Are more likely to be obese than the general population c) Are as likely to be of healthy weight and height as the general population d) Are more likely to be underweight than the general population",c
Biomarkers in pediatric glomerulonephritis and nephrotic syndrome,1. Which of the following tests predicts outcomes and helps to guide therapy at the time of diagnosis of a glomerular disease?  a) Proteinuria b) eGFR c) Serum creatinine d) Kidney pathology e) None of the above,e
Biomarkers in pediatric glomerulonephritis and nephrotic syndrome,2. What are the key features required for a biomarker to be successful?  a) Sensitive b) Specific c) Non-invasive d) Reproducible e) All the above,e
Biomarkers in pediatric glomerulonephritis and nephrotic syndrome,3. Which of the biomarkers below has been fully validated and widely used in clinical practice? Select all correct answers:  a) PLA2R b) suPAR c) Angptl4 d) CD80 e) c-mip,a
Biomarkers in pediatric glomerulonephritis and nephrotic syndrome,4. Which of the biomarkers below has the potential to discriminate MCD from other forms of nephrotic syndrome?  a) Urinary Angptl4 b) Urinary CD80 c) Serum suPAR d) Podocyte c-mip e) Serum Hemopexin,b
Biomarkers in pediatric glomerulonephritis and nephrotic syndrome,5. Which of the following approaches can help make biomarker development more successful?  a) Combining biased with unbiased approaches and evaluating candidate biomarkers in large and well-characterized populations b) Using a biased approach and investigating a single biomarker in a homogeneous group of patients. c) Increasing rigor by validating candidate biomarkers with multiple approaches d) a and c e) b and c,d
CKD-MBD post kidney transplantation,1. What is a typical clinical feature of post-transplant CKD-MBD?  a. Bone pain b. Delayed sexual maturation c. Increased bone mineral density d. Low bone turnover,a
CKD-MBD post kidney transplantation,2. Post-transplant CKD-MBD is often due to  a. Mycophenolate mofetil treatment b. Decreased FGF23 levels c. Glucocorticoid treatment d. Preemptive renal transplantation,c
CKD-MBD post kidney transplantation,3. Management of post-transplant CKD-MBD does focus on  a. Maintenance of regular physical activity b. High sodium intake c. High dose treatment with active vitamin D d. Treatment with bisphosphonates,a
CKD-MBD post kidney transplantation,4. Treatment with recombinant human growth hormone should be considered  a. Within 12 months post transplantation b. If height velocity is below the 30th percentile for age and gender c. If eGFR is above 50 mL/min/1.73 m2 d. If height is below the 3rd percentile for age and gender e. In case of concomitant glucocorticoid therapy,d
CKD-MBD post kidney transplantation,5. Which statement regarding control of PTH levels is right?  a. Correction of vitamin D deficiency should be done before starting active vitamin D b. Active vitamin D should be started within the first three months after transplantation c. Hypercalcemia stimulates PTH levels d. PTH levels should be above 2 times the upper limit of normal,a
Does HLA matching matter in the modern era of renal transplantation?,"1. Which of the following is true regarding living donation (choose one)?  a) Overall, living donors last longer than deceased donors. b) A living donor with 4MM is better than a deceased donor with 1 MM of the same age. c) A living donor with haplotype MM including 1 DR MM has worse outcomes in the second transplant compared to a 0 HLA-DR MM deceased donor at the time of first transplant. d) A healthy 60 year old living donor with 3 HLA MM has worse allograft survival compared to an equivalently matched 40 year old living donor.",a
Does HLA matching matter in the modern era of renal transplantation?,"2. Which of the following is true regarding deceased donation (choose one)?  a) There is no effect of HLA matching in young donors (<35 years of age) for 5 year allograft survival. b) Donors less than <5 years have similar survival to older donors. c) Class I HLA MM does not affect kidney transplant outcome. d) When deciding whether to accept deceased donors, one should always wait for a favourable (≤3) HLA MM.",a
Does HLA matching matter in the modern era of renal transplantation?,3. Which of the following is true regarding long term allograft survival (choose one)?  a) Class II HLA MM is associated with antibody mediated rejection. b) Patients who are matched for HLA-DR will always be matched for HLA-DQ. c) Median allograft survival for a 0 MM transplant is 15 years. d) 0 MM deceased donors do not reject.,a
Does HLA matching matter in the modern era of renal transplantation?,4. Which of the following is true regarding long-term patient morbidity (choose one)?  a) Results of registry studies can be readily applied to populations in different countries. b) MMF is a risk factor for developing cancer in transplant recipients. c) HLA-DR MM is a large risk factor for developing post-transplant lymphoproliferative disease. d) HLA MM increases risk of sensitisation after allograft loss and increases waiting times for subsequent transplants.,d
Does HLA matching matter in the modern era of renal transplantation?,5. Choose the transplant with the best expected allograft survival.  a) LD from 60 year old grandmother who is a 4 HLA MM b) LD from 30 year old father who is 3 HLA MM c) DD from a 30 year old 3 HLA MM who died from a road traffic accident d) DD from a 50 year old 1 HLA MM who was hypertensive and died of a cerebral vascular accident,b
Early clinical management of autosomal recessive polycystic kidney disease,1. Which of the following statements is true?  a) ARPKD is mainly caused by variants in the PKHD1 gene. b) Variants in DZIP1L are more common than variants in PKHD1. c) Specific variants in DZIP1L are always associated with specific variants in PKHD1. d) PKHD1 encodes polycystin-1. e) DZIP1L encodes the ARPKD protein fibrocystin.,a
Early clinical management of autosomal recessive polycystic kidney disease,"2. Which of the following statements is true?  a) With the knowledge of the genotype, clear-cut prediction of the clinical course of an ARPKD patient is possible. b) Two missense variants in PKHD1 always result in a mild phenotype. c) Two truncating variants in PKHD1 typically result in a severe phenotype that may not be compatible with life. d) A missense and a null variant in PKHD1 result in an intermediate phenotype. e) With the knowledge of the clinical course of a sibling, clear-cut prediction of the clinical course of an ARPKD patient is possible.",c
Early clinical management of autosomal recessive polycystic kidney disease,"3. Which of the following statements is true?  a) In ARPKD kidney function determines survival in the first days of life. b) Liver disease typically shows the earliest symptoms compared to other affected organs. c) Kidney disease in ARPKD results in a need of kidney replacement therapy in the first year of life in 80% of affected children. d) Patients with prenatal manifestation and oligohydramnios cannot survive. e) Kidney enlargement, kidney cysts, and oligo-/anhydramnios may be helpful to estimate a risk for early postnatal dialysis dependency.",e
Early clinical management of autosomal recessive polycystic kidney disease,4. Which of the following statements is true?  a) Peritoneal dialysis is not possible in ARPKD. b) Peritoneal dialysis is not possible in ARPKD without obligatory nephrectomies. c) Peritoneal dialysis should only be offered to ARPKD children without liver disease. d) Peritoneal dialysis can be applied in ARPKD but may require adaptations. e) Peritoneal dialysis is not needed in ARPKD as kidney function can be preserved through targeted pharmacological intervention.,d
Early clinical management of autosomal recessive polycystic kidney disease,5. Which of the following statements is true?  a) Hypertension is not an issue in ARPKD. b) Hypertension can be very pronounced in ARPKD requiring treatment with multiple pharmacological classes. c) Hypertension is only an issue in adult patients with ARPKD. d) Hypertension in ARPKD should be treated by nephrectomy. e) Hypertension in ARPKD results in obligatory variceal bleeding.,b
Emerging monitoring technologies in kidney transplantation,1. Which of the following tissue typing methodologies is used to determine the degree of eplet mismatch in a kidney transplant donor–recipient pair?  a) Complement dependent cytotoxicity cross-match b) Flow cytometry–based cross-match c) Software-based HLA matching algorithms d) CRISPR technology,c
Emerging monitoring technologies in kidney transplantation,2. Which of the following is the most common type of donor-specific antibodies post-kidney transplantation?  a) HLA-Cw antibodies b) HLA-DQ antibodies c) HLA-DR antibodies d) HLA-DP antibodies,b
Emerging monitoring technologies in kidney transplantation,3. Which of the following histological lesions is most often associated with angiotensin II type 1 receptor antibody-mediated rejection?  a) Transplant glomerulopathy b) Interstitial fibrosis and tubular atrophy c) Severe microvascular inflammation d) Positive C4d staining,c
Emerging monitoring technologies in kidney transplantation,"4. Based on the available evidence, a cut-off threshold of > 1% donor-derived cell-free DNA is most strongly associated with which of the following patterns of allograft injury?  a) Borderline cell-mediated rejection b) Banff 1A T cell–mediated rejection c) Antibody-mediated rejection d) Calcineurin inhibitor toxicity",c
Emerging monitoring technologies in kidney transplantation,5. Which of the following molecules is measured in the blood and/or urine of kidney transplant recipients using transcriptomic assays?  a) Cell-free DNA b) Messenger RNA c) Small peptides d) Enzyme substrates,b
Familial hypomagnesemia with hypercalciuria and nephrocalcinosis,1. What clinical manifestations are common in FHHNC?  a) Polyuria-polydipsia b) Urinary tract infections c) Failure to thrive d) All the above,d
Familial hypomagnesemia with hypercalciuria and nephrocalcinosis,2. Identify which clinical finding that may be absent in FHHNC.  a) Increased fractional excretion of magnesium in urine b) Hypomagnesemia c) Hypercalciuria d) Nephrocalcinosis,b
Familial hypomagnesemia with hypercalciuria and nephrocalcinosis,3. Magnesium tubular transport is characterized by the fact that:  a) Most tubular Mg reabsorption occurs at TAL b) Tight junction proteins claudin-16 and claudin-19 form a selective divalent cation pore. c) Loss of lumen-positive potential difference at the TAL explains Mg renal wasting in different tubulopathies d) All the above,d
Familial hypomagnesemia with hypercalciuria and nephrocalcinosis,4. Which of the following factors is not helpful for differential diagnosis between FHHNC type 1 and type 2?  a) Kidney disease manifestations b) Geographic origin c) Ocular symptoms d) Genetic testing,a
Familial hypomagnesemia with hypercalciuria and nephrocalcinosis,5. Treatment of FHHNC may include:  a) Oral Citrate b) Thiazides c) Mg supplements d) All the above,d
Growth in children on kidney replacement therapy: a review of data from patient registries,1. Which statement about growth in pediatric KRT patients is correct?  a) Improvements in height are mainly obtained during the pre-CKD 5 period b) rhGH should not be initiated during infancy c) Enteral feeding is only advised in dialysis patients d) Height is not associated with increased hospitalization rates,a
Growth in children on kidney replacement therapy: a review of data from patient registries,2. Which factors are associated with better growth in pediatric patients treated with dialysis?  a) Biocompatible PD fluids b) Hemodiafiltration c) Residual kidney function d) All of the above,d
Growth in children on kidney replacement therapy: a review of data from patient registries,3. Which patient group showed the poorest catch-up growth after kidney transplantation?  a) Infants b) Pre-school children (2–5 years) c) 6–12-year-old patients d) Adolescents,d
Growth in children on kidney replacement therapy: a review of data from patient registries,"4. How many pediatric KRT patients roughly grow up as stunted adults (i.e., have a reduced final height)?  a) 30% b) 40% c) 50% d) 60%",b
Growth in children on kidney replacement therapy: a review of data from patient registries,"5. According to the recent ESPN clinical practice guidelines on rhGH which patients would be eligible for rhGH therapy?  a) Dialysis patients with growth failure b) All children with CKD, on dialysis and after kidney transplantation with growth failure c) CKD and dialysis patients with growth failure d) All children with CKD stage 3–5D with growth failure once other potentially treatable risk factors for growth failure are adequately addressed, and there is growth potential, as well as KT patients without spontaneous catch-up growth 1-year post-KT and if steroid-free immunosuppression is not possible.",d
Hypertension and childhood stroke,"1. Which of the following is a TRUE statement in regard to the etiology of stroke in pediatric patients?  a) In most cases, an etiology is not identified b) Hypertension is the most common cause c) Arteriopathies are a frequent cause of childhood stroke d) Infection is not a cause of stroke in children",c
Hypertension and childhood stroke,"2. Which of the following statements is evidence that there may be a link between stroke and hypertension in children?  a) Hypertension has been identified as a risk factor for recurrent strokes in childhood cancer survivors b) An increase in the prevalence of classic cardiovascular risk factors, including hypertension, among US adolescents and young adults hospitalized for ischemic stroke c) Hypertension was associated with increased mortality after adjusting for multiple covariates, including renal failure d) All of the above",d
Hypertension and childhood stroke,"3. Of the following, which is the MOST FREQUENT disease that can cause strokes in children?  a) Moyamoya disease b) Sickle cell disease c) Fibromuscular dysplasia d) Neurofibromatosis type 1",b
Hypertension and childhood stroke,"4. Which of the following has been identified as a BARRIER to recognize a possible link between hypertension and stroke in children?  a) No predetermined field on data entry sheet for modifiable adult risk factors, including hypertension, in the International Pediatric Stroke Study database b) Both elevated blood pressure and hypertension are well-recognized in the general pediatric population c) Stroke studies always specify how BP is obtained and interpreted d) BP is always measured and plotted on percentile charts.",a
Hypertension and childhood stroke,5. Effects of hypertension on the pediatric brain may include one of the following:  a) Cognition deficits b) Encephalopathy c) Cerebrovascular events d) All of the above,d
Kidney disease in children with heart or liver transplant,1. Which of the following is TRUE with regard to calcineurin inhibitor toxicity?  a. The most common presentation is gross hematuria and edema. b. Interstitial “striped fibrosis” and tubular atrophy are considered pathognomonic histological findings. c. CNI nephrotoxicity decreases with duration of exposure. d. It is a clinical diagnosis.,b
Kidney disease in children with heart or liver transplant,2. Which of the following statements is TRUE regarding CKD in children with heart transplant?  a. CNI exposure is the most common risk factor for CKD post-heart transplant. b. The risk of CKD decreases with increasing post-heart transplant survival. c. There is no relationship between AKI and the risk of developing CKD. d. BK nephropathy is a common cause of CKD in this population.,a
Kidney disease in children with heart or liver transplant,3. Which of the following statements is FALSE related to the risk of kidney injury in children undergoing liver transplantation?  a. Cirrhosis pre-transplant may compromise kidney blood flow and result in kidney injury. b. Infections such as hepatitis C can cause kidney disease. c. Intraoperative basiliximab for induction immunosuppression is associated with kidney injury. d. Increased intraoperative bleeding can lead to AKI.,c
Kidney disease in children with heart or liver transplant,4. Which of these medications is LEAST likely to contribute to hypertension in a child with a solid organ transplant?  a. Tacrolimus b. Cyclosporin A c. Prednisone d. Mycophenolate mofetil,d
Kidney disease in children with heart or liver transplant,5. All of the following statements are appropriate measures of nephroprotection in pediatric recipients of heart or liver transplant EXCEPT:  a. Avoiding nonsteroidal anti-inflammatory drugs b. Avoiding episodes of dehydration c. Monitoring for and reducing proteinuria d. Avoiding the use of induction immunosuppression at the time of transplant surgery,d
Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist,1. Which is a correct reason for VAD implantation?  a) To provide cardiac support for patients as a bridge to heart transplantation or to recovery b) To be used as destination therapy for patients who are not candidates for heart transplantation c) Both of the above,c
Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist,"2. In recent years, pediatric patients discharged with VAD has increased.  a) True b) False",a
Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist,3. Which method is preferred to measure blood pressure in patients with CF-VAD?  a) Standard oscillometric devices b) Radial arterial BP c) Doppler ultrasound probe,c
Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist,"4. In patients with CF-VAD, which signs correlate with hypovolemia during KRT?  a) Low CVP, low MAP, low pulsatility, and high flow b) Low CVP, low MAP, high pulsatility, and low flow c) Low CVP, low MAP, low pulsatility, and low flow",c
Kidney replacement therapy in pediatric patients on mechanical circulatory support: challenges for the pediatric nephrologist,"5. In patients with CF-VAD, which signs can correlate with suction during KRT?  a) Low CVP, low MAP, low pulsatility, and high flow b) Low CVP, low MAP, high pulsatility, and low flow c) Low CVP, high MAP, low pulsatility, and low flow",b
Malignancies after pediatric solid organ transplantation,1. Which is the most common overall cancer type among pediatric SOTRs?  a) Non-melanoma skin cancer b) PTLD c) Renal cell carcinoma d) Melanoma e) Leukemia,b
Malignancies after pediatric solid organ transplantation,2. Which induction agent has not been demonstrated to increase the risk of PTLD?  a) Basiliximab b) Anti-lymphocyte globulin (ALG) c) Monoclonal anti-CD3 antibody (OKT3) d) Anti-thymocyte globulin (ATG),a
Malignancies after pediatric solid organ transplantation,3. Which immunosuppressive agent has been shown to decrease the risk of skin cancers?  a) Prednisone b) Tacrolimus c) Sirolimus d) Mycophenolate mofetil (MMF) e) Azathioprine,c
Malignancies after pediatric solid organ transplantation,4. Which of the following features would be a poor prognostic factor for PTLD?  a) T cell lineage b) Early-onset PTLD c) Lower International Prognostic Index score d) CD20-positive status,a
Malignancies after pediatric solid organ transplantation,"5. Which cancer type has the highest standardized incidence ratio among pediatric SOTRs, compared with age-matched general populations?  a) Leukemia b) Brain c) Melanoma d) Breast e) Renal",e
Maturation of glomerular filtration rate in neonates and infants: an overview,"1. After birth, the increase in GFR is largely dependent upon:  a) Number of nephrons b) Arterial blood pressure c) Increased glucocorticoids levels d) Sympathetic nerve stimulation of the afferent arteriole e) All of the above",b
Maturation of glomerular filtration rate in neonates and infants: an overview,"2. Which of the following statements concerning the measurement of GFR is false?  a) The U · V/P clearance of the gold standard inulin has never been used in preterm infant. b) The plasma clearance (single injection) of inulin overestimates GFR during the first week of life. c) The clearance of inulin after short-term (3 h) infusion overestimates GFR in neonates. d) The exogenous markers iothalamate, iohexol, and EDTA have not been validated against the gold standard in neonates. e) All the above",a
Maturation of glomerular filtration rate in neonates and infants: an overview,"3. In newborn premature infants, the estimation of GFR based on the plasma creatinine concentration can be affected by:  a. Catabolism b. Creatinine tubular back diffusion c. High-protein intake d. Maternal creatinine e. All the above",e
Maturation of glomerular filtration rate in neonates and infants: an overview,"4. Which of the following statements about aminoglycosides is true?  a. Aminogycosides are eliminated mostly by tubular secretion. b. They may induce renal vasodilation. c. Their clearance correlates with the urinary creatinine clearance. d. Being nephrotoxic, aminoglycosides are contraindicated in premature neonates. e. All the above",c
Mechanisms and management of edema in pediatric nephrotic syndrome,"1. A 12-year-old male with SRNS presented to the ER with worsening edema. Exam showed facial and leg edema with ascites and he looked uncomfortable. Vital signs: heart rate 75/min, respiratory rate 24/min, BP 138/76 with no orthostatic hypotension. Work up showed: serum albumin 2.2 g/dl, serum Cr 0.5 mg/dl, urine protein > 300 mg/dl and negative for blood. Of the following, the most likely pathophysiologic mechanism of edema in this child:  a) Lack of hematuria makes overfill more likely than underfill as the dominant mechanism b) Underfill is the most likely mechanism with his serum albumin > 2 g/dl c) The absence of hypotension makes overfill the more likely dominant mechanism d) We cannot determine his most likely mechanism since we do not have the urine Na measured.",c
Mechanisms and management of edema in pediatric nephrotic syndrome,"2. In the previous case, the best initial plan to treat his edema is:  a) Furosemide b) Albumin 25% followed by Furosemide c) Amiloride d) Hydrochlorothiazide.",a
Mechanisms and management of edema in pediatric nephrotic syndrome,"3. A 9-year-old male with SRNS presented for a routine clinic visit. You noticed that he gained 12 lbs. since his last clinic visit six weeks ago and he complains of discomfort with his feet. He appeared comfortable otherwise and denied any pain. His physical examination showed pitting edema in his feet and legs and mild abdominal distention. His BP was 90/55, heart rate 90 /min. When approaching edema management in this child, of the following options, the best one to pursue is to:  a) Avoid the outpatient use of loop diuretics as these agents are associated with increased risk of acute kidney injury b) Initiate diuretics since reducing edema has been shown to improve quality of life in subjects with NS c) Initiate a small dose of Lisinopril and follow up his weight in 1 week d) There is no indication to initiate diuretics since he has minimal symptoms.",b
Mechanisms and management of edema in pediatric nephrotic syndrome,"4. A 7-year-old female with NS was admitted to the hospital for management of severe edema. Physical examination showed significant edema overall, abdominal distention and mild abdominal pain with palpation. Her BP was 132/85 and heart rate 90/min. Serum albumin was 2.3 g/dl. After 36 h of diuresis with furosemide, her fluid balance was negative for 560 ml and she continued to complain of abdominal discomfort. Of the following factors, this poor response to diuretics may best be explained by:  a) Decreased kidney function b) Decreased distribution of furosemide in extracellular space with edema c) Increased excretion of furosemide into the urinary filtrate in NS d) Lack of binding of furosemide to albumin in the intratubular space",a
Management of dyslipidemia in pediatric renal transplant recipients,"1. According to the North American Pediatric Renal Trials and Collaborative Studies 2014 Annual Report, the most common cause of death in pediatric kidney transplant recipients is: a. Trauma b. Malignancy c. Cardiovascular disease d. Infection",d
Management of dyslipidemia in pediatric renal transplant recipients,"2. Of the following immunosuppressants, the one with the LEAST potential to contribute to dyslipidemia is: a. Mycophenolate b. Prednisone c. Sirolimus d. Cyclosporine",a
Management of dyslipidemia in pediatric renal transplant recipients,"3. According to existing guidelines, pediatric kidney transplant recipients should: a. Practice therapeutic lifestyle changes if they have hypertriglyceridemia b. Be treated with a statin as early as 6 years of age if they have hypercholesterolemia c. Discontinue immunosuppression if they have dyslipidemia d. All of the above",a
Management of dyslipidemia in pediatric renal transplant recipients,4. Many HMG CoA reductase inhibitors (statins) significantly interact with: a. Mycophenolate b. Prednisone c. Sirolimus d. Cyclosporine,d
Management of dyslipidemia in pediatric renal transplant recipients,"5. According to existing guidelines, a healthy amount of daily screen time (television + computer + video games) not only for pediatric kidney transplant recipients is no more than: a. 1 h b. 2 h c. 3 h d. 4 h",b
Monitoring dialysis adequacy history and current practice,"1. In the original NCDS study, the following cohort had the lowest overall morbidity: a) Lowest in short treatment time vs. long treatment time b) Lowest in long treatment time vs. short treatment time c) Lowest in low TACurea vs. high TACurea d) Lowest in high TACurea vs. low TACurea e) The study was underpowered to detect differences in morbidity",d
Monitoring dialysis adequacy history and current practice,2. Daugirdas’ single-pool Kt/V accounts for the following two factors: a) The use of a high versus low flux dialyzer and intra-session urea generation b) Ultrafiltration and intra-session urea generation c) Hemodiafiltration and serum albumin d) Ultrafiltration and serum albumin e) The use of a high versus low flux dialyzer and ultrafiltration,b
Monitoring dialysis adequacy history and current practice,3. The “rebound effect” that forms part of equilibrated Kt/V calculations is due to: a) Urea movement from the extravascular compartment to the intravascular compartment b) Blood return to the patient at the end of a hemodialysis session c) The number of missed dialysis sessions a patient experiences per week d) Decrease in urea removed with progressively smaller volume of distribution e) Drawing the post-dialysis urea sample from an arterial vs venous port.,a
Monitoring dialysis adequacy history and current practice,4. A limitation of urea as a marker of dialysis adequacy is: a) It is an economical test b) It is a commonly available test c) It correlates with total body water d) It relates linearly to mortality e) It is a protein-breakdown product,d
Monitoring dialysis adequacy history and current practice,5. What is the best way to compare the efficacy of different dialysis doses for nonstandard dialysis regimens? a) Single-pool Kt/V b) Double-pool Kt/V c) UV spectrophotometry Kt/V d) Ionic dialysance Kt/V e) Standard Kt/V,e
Neonatal acute kidney injury: a case-based approach,1) Which of the following is not part of the typical initial evaluation of a neonate with acute kidney injury? a. BUN and creatinine b. Urinalysis c. Careful history d. Kidney ultrasound e. PTH,e
Neonatal acute kidney injury: a case-based approach,2) Factors that increase the risk of AKI in neonates include all except: a. Low birth weight b. Maternal exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) c. Spontaneous vaginal delivery d. Congenital heart disease in the baby,c
Neonatal acute kidney injury: a case-based approach,3) Which is a true statement regarding limitations of serum creatinine? a. Serum creatinine is a marker of tubular injury. b. It is affected by the volume status and may be diluted in conditions of fluid overload. c. Baseline serum creatinine is established in neonates by day of life 7. d. All neonates have the same baseline.,b
Neonatal acute kidney injury: a case-based approach,4) What is the most common long-term outcome of acute kidney injury? a. Normal kidney function throughout childhood without kidney-related complications b. Ongoing CKD at NICU discharge requiring outpatient management c. Stage 5 chronic kidney disease during childhood d. Improvement in serum creatinine to baseline during hospitalization but mild chronic kidney disease and/or hypertension during childhood,a
Neonatal acute kidney injury: a case-based approach,5) Which of the following is not commonly used for severe acute kidney injury with fluid overload in neonates? a. Peritoneal dialysis b. Continuous renal replacement therapy c. Diuretics d. Hemodialysis,d
Nephron number and its determinants: a 2020 update,1) Which of the following statements regarding human nephrogenesis is true? a) Postnatal nephrogenesis is common and can occur for several weeks after full-term gestation. b) Nephrogenesis can be initiated after injury. c) There is a wide range of nephron number within and among various healthy populations. d) The population-wide variability in nephron number is only influenced by aging factors.,c
Nephron number and its determinants: a 2020 update,2) Nephron number inversely correlates with aging in which populations? a) Males b) Females c) Hypertensive d) Renal disease e) b and c f) a and d,e
Nephron number and its determinants: a 2020 update,3) Which of the following nephron number counting techniques has been used to estimate or whole count whole kidney nephron number in living patients? a) Acid maceration method b) Fractionator–disector technique c) Cationic ferritin-enhanced MRI d) Glomerular density by biopsy and cortical volume e) None of the above,d
Nephron number and its determinants: a 2020 update,4) Infants born at 24 weeks are at risk for decreased nephron number due to: a) Exposure to nephrotoxic medications b) Hyperglycemia c) Oxygen alterations d) All of the above,d
Nephron number and its determinants: a 2020 update,5) The parents of a 1-year-old child born with 2 copies of the high-risk APOL1 genes ask about preserving his nephrons and decreasing their son’s long-term risk of chronic kidney disease. Each of the following would be sound recommendations EXCEPT: a) Avoid nephrotoxic medications b) Begin vitamin A supplementation c) Encourage appropriate postnatal weight gain and avoidance of obesity d) Treat hypertension,b
Non-immunosuppressive therapies for childhood IgA nephropathy,"1. What are the components of the RAAS? a) angiotensinogen, angiotensin I, bradykinin b) angiotensinogen, anigiotensin I, angiotensin II c) bradykinin, angiotensin II, chymase d) angiotensin II, chymase, aldosterone e) chymase, angiotensin II, angiotensinogen",b
Non-immunosuppressive therapies for childhood IgA nephropathy,"2. Which factors are believed to be involved in the aldosterone breakthrough phenomenon? a) adrenocorticotropic hormone, potassium, sodium b) potassium, sodium, genetics c) potassium, genetics, endothelin-1 d) sodium, endothelin-1, angiotensin II receptor e) angiotensin II receptor, adrenocorticotropic hormone, sodium",c
Non-immunosuppressive therapies for childhood IgA nephropathy,3. What is the first-line treatment recommended for childhood IgAN according to 2012 KDIGO guidelines? a) corticosteroids b) immunosuppressant c) fish oil d) RAAS inhibitors e) Chinese herbal medicine,d
Non-immunosuppressive therapies for childhood IgA nephropathy,4. What are the clinical features of children with IgAN? a) prominent mesangial hypercellularity during early onset of the disease b) mesangial matrix expansion over time c) prominent mesangial matrix expansion during the chronic phase of the disease d) active and acute pathological lesions e) all of the above,e
Non-immunosuppressive therapies for childhood IgA nephropathy,"5. What is the best prediction model for progression in childhood IgAN? a) clinical features (proteinuria, hematuria, eGFR) at kidney biopsy b) pathological features (MEST-C, C4d) c) genetic risk factors d) history e) all of the above",e
"Obesity, metabolic syndrome, and primary hypertension",1. The prevalence of primary hypertension and of obesity-related hypertension among children and adolescents: a) Is the same in boys and girls b) Is higher in girls in comparison with boys c) Is higher in boys than in girls and increases with growth spurt d) Is higher in prepubertal girls than in pubertal boys,c
"Obesity, metabolic syndrome, and primary hypertension","2. The phenotypic features of primary hypertension include: a) Slower biological maturation, metabolic abnormalities typical of metabolic syndrome, increased parasympathetic activity, disturbed body composition b) Accelerated biological maturation, hyperoestrogenism, metabolic abnormalities typical of metabolic syndrome, disturbed body composition c) Accelerated biological maturation, metabolic abnormalities typical of metabolic syndrome, tendency to lower serum uric acid levels, disturbed body composition d) Accelerated biological maturation, metabolic abnormalities typical of metabolic syndrome, tendency to elevated serum uric acid, disturbed body composition, increased sympathetic activity",d
"Obesity, metabolic syndrome, and primary hypertension",3. Serum uric acid levels in adolescents with primary hypertension are: a) Normal and do not differ from normotensive individuals b) Lower than in normotensive children c) Elevated in secondary hypertension and lowered in primary hypertension d) Tend to be higher in primary hypertension and treatment with allopurinol lowered both serum uric levels and blood pressure,d
"Obesity, metabolic syndrome, and primary hypertension","4. Pharmacological antihypertensive treatment in adolescents with primary hypertension and metabolic syndrome should be based on: a) ACEi/ARBs and, when contraindicated, dihydropyridine calcium channel blockers b) Beta-adrenolytics c) Beta-adrenolytics and thiazides/thiazide-like diuretics d) Centrally acting agents",a
"Obesity, metabolic syndrome, and primary hypertension",5. Non-pharmacological treatment of primary hypertension and obesity-related hypertension: a) Is the most important part of treatment and should be started in all patients with stage 1 hypertension and should accompany pharmacological therapy in patients with stage 2 hypertension b) Should be used only in patients with stage 1 hypertension c) Dietary treatment alone has the same efficacy as diet plus physical activity d) Physical activity should be increased to 3 days a week for 60 min,a
Oral health in children with chronic kidney disease,"1. What is the etiology of dental enamel defects found in children with chronic kidney disease? a) Disruption of enamel mineralization due to growth hormone deficiency. b) Disruption of enamel mineralization due to hypocalcemia, decreased serum levels of 1,25-dihydroxycholecalciferol, and elevated serum phosphate, parathyroid, and fluoride levels. c) Disruption of enamel mineralization due to impaired function of the polycystin 2 (Pkd2) mechanoreceptor. d) Disruption of enamel mineralization due to hypocalcemia, decreased serum levels of 1,25-dihydroxycholecalciferol, decreased serum phosphate, and increased parathyroid, and fluoride levels.",b
Oral health in children with chronic kidney disease,"2. What are common variations of craniofacial features reported in growing patients with CKD? a) Longer length of the cranial base, short mandibular length, increased lower facial height, retrusive mandible position, and obtuse mandibular angle. b) Long length of the cranial base, long mandibular length, increased lower facial height, protrusive mandible position, and obtuse mandibular angle. c) Short length of the cranial base, short mandibular length, increased lower facial height, retrusive mandible position, and obtuse mandibular angle. d) Short length of the cranial base, short mandibular length, decreased lower facial height, protrusive mandible position, and obtuse mandibular angle.",c
Oral health in children with chronic kidney disease,"3. Which factors promote caries in children and adolescents with CKD? a) Neutral salivary pH, developmental enamel defects, xerostomia, and a high fat diet/low protein diet. b) Neutral salivary pH, developmental enamel defects, xerostomia, and high carbohydrate/low protein diet. c) Low salivary pH, developmental enamel defects, xerostomia, and a high fat diet/low protein diet. d) Low salivary pH, developmental enamel defects, xerostomia, and high carbohydrate/low protein diet.",d
Oral health in children with chronic kidney disease,4. Which statement best describes dental calculus accumulation in children with CKD? a) Calculus accumulation is increased due to decreased salivary pH and high levels of salivary urea and phosphorus. b) Calculus accumulation is increased due to elevated salivary pH and high levels of salivary urea and phosphorus. c) Calculus accumulation is decreased due to elevated salivary pH and low levels of salivary urea and phosphorus. d) Calculus accumulation is increased due to decreased salivary pH and low levels of salivary urea and phosphorus.,b
Oral health in children with chronic kidney disease,5. What is true about intraoral soft tissue health of children and adolescents with CKD? a) Gingival hypertrophy is uncommon in medically managed patients with CKD (pre-transplant) and timing of tooth eruption is unaffected. b) Gingival hypertrophy is uncommon in medically managed patients with CKD (pre-transplant) and delay of tooth eruption is common. c) Gingival hypertrophy is common in patients following kidney transplant and does not affect timing of tooth eruption. d) Gingival hypertrophy is uncommon in patients following kidney transplant and timing of tooth eruption is unaffected.,b
Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients,Which of the following statements about AKI is false? a. Patients with hematologic malignancies such as leukemias are at higher risk for developing AKI compared with patients with solid tumors. b. AKI is a risk factor for development of CKD in pediatric cancer survivors. c. Many chemotherapy agents require dose adjustments with initiation of dialysis. d. Sepsis is an uncommon cause of AKI in pediatric cancer and HCT patients.,d
Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients,Which subset of pediatric cancer survivors are at highest risk for CKD? a. Acute lymphoblastic leukemia b. Wilms tumor c. Hodgkin lymphoma d. Neuroblastoma e. Rhabdomyosarcoma,b
Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients,Which of the following chemotherapy agents is strongly associated with late CKD? a. Ifosfamide b. Methotrexate c. Mercaptopurine d. VEGF inhibitors e. BRAF inhibitors,a
Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients,"Which of the following statements is true? a. Oncology and HCT patients should be given additional fluids to achieve a positive fluid balance to decrease morbidity and mortality. b. The electrolyte derangements in tumor lysis syndrome includes hypokalemia, hypercalcemia, and hyperuricemia. c. All pediatric cancer patients who undergo nephrectomy will develop kidney failure. d. Additional causes of kidney injury in HCT survivors include sinusoidal obstructive syndrome and thrombotic microangiopathy.",d
Outcomes of kidney injury including dialysis and kidney transplantation in pediatric oncology and hematopoietic cell transplant patients,Which of the following should not be a consideration for enrollment on the kidney transplant waitlist? a. Age of patient b. Weight and height of patient c. Duration of cancer remission d. Likelihood of cancer recurrence e. Chemotherapy received,e
Predictors of progression in autosomal dominant and autosomal recessive polycystic kidney disease,1. Which of the following is considered an FDA-qualified prognostic biomarker for clinical trials to help identify patients with ADPKD at high risk of progression? a. Urine albumin excretion b. Diastolic blood pressure load c. Total kidney volume d. Kidney cyst size e. Neutrophil gelatinase-associated lipocalin (NGAL),c
Predictors of progression in autosomal dominant and autosomal recessive polycystic kidney disease,2. Which of the following clinical factors is associated with higher risk of progression to kidney failure in the PROPKD scoring algorithm for ADPKD? a. Female sex b. PKD2 mutation c. Proteinuria before age 35 years d. Gross hematuria before age 35 years e. Low urine osmolarity,d
Predictors of progression in autosomal dominant and autosomal recessive polycystic kidney disease,"3. Which of the following prenatal ultrasound findings is most predictive of the need for dialysis within the first year of life in infants with ARPKD? a. Intrauterine growth retardation b. Enlarged kidneys c. Kidney cysts d. Oligohydramnios and echogenic kidneys e. Oligohydramnios, enlarged kidneys, and kidney cysts",e
Predictors of progression in autosomal dominant and autosomal recessive polycystic kidney disease,4. Which of the following clinical findings is NOT typical of ARPKD-associated liver disease? a. Transaminitis b. Portal hypertension c. Biliary duct dilatation d. Congenital hepatic fibrosis e. Esophageal varices,a
Predictors of progression in autosomal dominant and autosomal recessive polycystic kidney disease,5. Which of the following factors is associated with earlier onset of kidney failure in patients with ARPKD? a. Lack of liver involvement b. Younger age at diagnosis c. PKHD1 missense mutations d. Proteinuria e. High water intake,b
Protein energy wasting; what is it and what can we do to prevent it,1. Malnutrition differs from PEW because (one is true): a) Malnutrition is more common in younger children b) Appetite is lost in malnutrition but not PEW c) Body fat is preserved in malnutrition d) Loss of lean body mass occurs late in PEW e) Resting energy expenditure is high in PEW,e
Protein energy wasting; what is it and what can we do to prevent it,2. Children with PEW have one of the following: a) Decreased fat mass b) Normal height velocity c) Reduced upper mid arm circumference d) Normal serum albumin e) Normal CRP,c
Protein energy wasting; what is it and what can we do to prevent it,3. PEW is associated with one of the following: a) Muscle wasting but normal height velocity b) Increased risk of CVD c) No increased mortality risk d) Hospitalisation rate not increased e) Infection rate not increased,b
Protein energy wasting; what is it and what can we do to prevent it,4. All but one of the following contributes to poor nutrition in PEW: a) Abnormal taste sensation b) high leptin levels c) Inadequate dialysis d) Gastro-oesophageal reflux e) Dialysate losses of fatty acids and triglycerides,e
Protein energy wasting; what is it and what can we do to prevent it,5. All but one of the following contributes to inflammation in PEW: a) Decreased response to anabolic hormones b) Metabolic alkalosis c) Oxidative stress d) Fluid overload e) Increased levels of inflammatory cytokines as CKD progresses,b
Renal involvement in paediatric inflammatory bowel disease,1. Renal disease as extraintestinal manifestation of IBD can be caused by: a.) Genetic predisposition to immune deficiency disorders. b.) Medications adverse effects. c.) Deposition of immune complexes in the kidneys. d.) Crohn’s disease more than ulcerative colitis. e.) Duration of intestinal inflammation is a leading factor.,c
Renal involvement in paediatric inflammatory bowel disease,2. In an adolescent with an oxalate renal stone secondary to IBD: a.) The likely cause is GI bicarbonate loss and acidic urine. b.) Low-fat diet and bile salt chelating agents can prevent recurrence. c.) Alkalinisation of urine can prevent recurrence. d.) Calcium phosphate stones are more common that oxalate stones. e.) Renal stones are very common in children with IBD.,b
Renal involvement in paediatric inflammatory bowel disease,3. A child with Crohn’s disease well controlled on azathioprine for the last 3 years developed glomerulonephritis and renal insufficiency: a.) IgA nephropathy is the most common type in children with IBD. b.) Stopping azathioprine is recommended. c.) Long-term outcome in children is better than in adults. d.) HLA DQ2 and DQ8 are common in IgA nephropathy and IBD. e.) Renal replacement therapy should be considered early.,a
Renal involvement in paediatric inflammatory bowel disease,4. Mesalazine is commonly used in children with IBD and can lead to renal impairment: a.) Drug dose and duration of therapy are major factors in mesalazine nephrotoxic effect. b.) Concomitant steroid use can increase the risk of renal damage. c.) Immune modulators can improve intestinal inflammation and renal function. d.) 2 monthly blood test is routinely recommended. e.) Concomitant use of azathioprine at IBD diagnosis increases the risk of renal damage.,c
Renal involvement in paediatric inflammatory bowel disease,5. Infliximab (an anti TNFα) is recommended for treatment of moderate to severe cases of IBD: a.) Prolonged use of infliximab can worsen renal amyloidosis. b.) Anti-infliximab antibodies can cause direct glomerular damage. c.) Renal stones are common during treatment with infliximab. d.) Renal tubules can produce TNF receptors. e.) Infliximab can cause reversible renal vasoconstriction.,b
Renal tumors in tuberous sclerosis complex,"1. Which of the following statements about the genetics of tuberous sclerosis complex (TSC) is correct? A) TSC is inherited in an autosomal recessive fashion. B) If a family has a child with TSC, there is at least a 50% chance their next child will have TSC. C) The expression of TSC within affected families is very variable. D) Most children with TSC have a mutation affecting the TSC1 gene. E) A positive genetic test is required to make the diagnosis of TSC.",C
Renal tumors in tuberous sclerosis complex,2. Which one of the following statements about the renal manifestations of TSC is correct? A) Angiomyolipomas are visible on kidney imaging in 50% of newborns with TSC. B) Kidney cysts are an uncommon finding in TSC except when there is a contiguous gene mutation of TSC2 and PKD1. C) Lipid-poor renal lesions are typically malignant. D) The prevalence of renal cell carcinoma is higher in children with TSC than in the general age-matched population. E) Hypoplastic kidneys are a cardinal feature of TSC.,D
Renal tumors in tuberous sclerosis complex,3. Which one of the following statements about mTOR inhibitors in TSC is correct? A) Angiomyolipomas may regrow if treatment with an mTOR inhibitor is withdrawn. B) Everolimus has been shown to be more effective than sirolimus in management of renal angiomyolipomas. C) Low-dose tacrolimus has a synergistic effect with everolimus to prevent growth of renal angiomyolipomas in TSC. D) Antiepileptic drugs typically inhibit the cytochrome P450 pathway. E) Oral mTOR inhibitors have not been approved for use in children with TSC.,A
Renal tumors in tuberous sclerosis complex,4. Which of the following statements about kidney screening in TSC best represents the current international consensus guidelines? A) An abdominal CT scan should be performed when TSC is suspected. B) Kidney MRI should be performed every 5 years during childhood. C) Kidney imaging should occur every 1 to 3 years throughout life. D) Serum creatinine should be measured annually. E) DMSA kidney scan should be used if a lipid poor lesion is suspected.,C
Renal tumors in tuberous sclerosis complex,5. A kidney ultrasound has been performed in a 15-year-old girl with TSC. The ultrasound shows an echogenic lesion in the upper pole of the right kidney measuring 6.5 × 4 cm. The patient has not had flank pain or hematuria. Which of the following statements is most correct? A) Spontaneous hemorrhage occurs in more than 60% of renal angiomyolipomas that are greater than 3 cm in diameter. B) Therapy with everolimus would be expected to lead to a reduction in size of the lesion over 6 to 12 months. C) A CT angiogram is indicated to screen for intralesional aneurysms. D) A biopsy of the lesion is indicated to exclude a renal cell carcinoma. E) Intervention is not indicated as there is a low risk that this lesion will continue to grow.,B
Renovascular hypertension in pediatric patients: update on diagnosis and management,1. What is the main mechanism that leads to RVH? a) Increased cardiac output due to an amplified sympathetic tone b) Increased nitric oxide release c) Increased plasma volume if intact contralateral kidney d) Increased renin release by the hypoperfused nephrons,d
Renovascular hypertension in pediatric patients: update on diagnosis and management,"2. Which of these explains the abrupt fall in GFR after the administration of ACE-I or ARB in patients with bilateral renal stenosis? a) These medications impair the vasoconstriction of the efferent arteriole elicited by Ang II, which maintains the GFR in the hypoperfused nephrons. b) These medications increase vasoconstriction of the afferent arteriole, decreasing the GFR. c) These medications increase vasoconstriction of the efferent arteriole, decreasing the GFR. d) These medications decrease renal sodium reabsorption, decreasing the GFR.",a
Renovascular hypertension in pediatric patients: update on diagnosis and management,3. Which of these imaging tests makes possible a therapeutic intervention at the same time as the exam performance? a) Magnetic Resonance Angiography b) Renal Scintigraphy c) Digital Subtraction Angiography d) Doppler Renal Ultrasonography,c
Renovascular hypertension in pediatric patients: update on diagnosis and management,4. Why is angioplasty often favored over surgical procedures in the treatment of RVH? a) Angioplasty usually has a lower restenosis rate. b) Angioplasty is less invasive and has a smaller risk of complications. c) Surgery has a high mortality rate. d) Angioplasty has a better outcome for all patients.,b
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen,"1. What factors determine the treatment response to rituximab? A. Patient factors, such as disease severity B. Rituximab dose C. Maintenance immunosuppression D. All of the above",D
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen,2. Which of the following regimens has shortest relapse-free survival? A. Low dose (375 mg/m2) alone B. Medium dose (750 mg/m2) alone C. Low dose (375 mg/m2) with maintenance therapy D. High dose (750 mg/m2) with maintenance therapy,A
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen,3. Which of the following B cell subsets is more relevant to relapse after rituximab? A. Transitional B cells B. Mature B cells C. IgM Memory B cells D. Switched Memory B cells,D
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen,4. How many patients develop persistent hypogammaglobulinemia following rituximab? A. Less than 5% B. 5% to 10% C. 10% to 15% D. More than 15%,D
Seasonal variation of blood pressure in children,1. What is the increased prevalence of hypertension in children according to a study from 1999 to 2008 for boys and girls? a) 9.2% and 5.8% respectively b) 15.8% and 8.2% respectively c) 12.8% and 15.2% respectively d) 19.2% and 12.6% respectively e) 29.1% and 22.6% respectively,d
Seasonal variation of blood pressure in children,2. The prevalence of BP in the hypertensive range in children... a) decreases by 50-75% in the cold season. b) decreases by 5-17% in the warm season. c) increases by 15-17% in the warm season. d) increases by 17-50% in the cold season. e) increases by 50-57% in the cold season.,e
Seasonal variation of blood pressure in children,3. The systolic BP change between winter and summer in children described by Miersch et al. amounts to approximately: a) 2-15 mmHg b) 2-31 mmHg c) 2.4 mmHg d) 4.5 mmHg e) 15-31 mmHg,d
Seasonal variation of blood pressure in children,"4. According to this review, potential mediators of seasonal blood variation in children seem to include… a) sympathetic activation of the nervous system, elevated levels of norepinephrine and hypercoagulability, but not vitamin D nor hydration status. b) sympathetic activation of the nervous system, elevated levels of norepinephrine and hydration status, but not vitamin D nor hypercoagulability. c) vitamin D and hydration status, but not sympathetic activation of the nervous system, elevated levels of norepinephrine nor hypercoagulability. d) sympathetic activation of the nervous system, elevated levels of norepinephrine, hypercoagulability and hydration status but not vitamin D. e) vitamin D and hydration status, but not sympathetic activation of the nervous system, elevated levels of norepinephrine nor hypercoagulability.",a
Seasonal variation of blood pressure in children,"5. What are the main suggestions summarized in this review considering seasonal BP variation in children? a) regular monitoring in healthy children as well as patients treated for hypertension, more research regarding seasonal BP differences b) monthly BP measurement in patients treated for hypertension, more research regarding seasonal BP differences c) monthly BP measurement in patients treated for hypertension, more research regarding pathophysiological mechanisms of seasonal BP differences d) monthly BP measurement in patients treated for hypertension, more research regarding the long-term effects of seasonal BP differences in children e) triple BP measurement for every adolescent in the routine check-up examination, more research regarding the long-term effects of seasonal BP differences in children",a
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension,1. What are the most commonly prescribed antihypertensive drugs in children after renal transplantation? a) ACEI b) ARB c) Beta-blockers d) CCB e) Diuretics,d
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension,2. Which class of antihypertensive drugs was able to increase glomerular filtration rate in transplanted adults? a) ACEI b) ARB c) Beta-blockers d) CCB e) Diuretics,d
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension,3. Which class of antihypertensive drugs was able to reduce proteinuria in transplanted patients? a) ACEI b) Alpha-blockers c) Beta-blockers d) CCB e) Diuretics,a
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension,4. Which class of antihypertensive drugs has the best BP lowering effect in transplanted patients? a) ACEI b) ARB c) CCB d) Diuretics e) The classes have similar BP lowering effect,e
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension,5. Which class of antihypertensive drugs should be avoided in the immediate post-transplant period? a) ACEI b) Alpha-blockers c) Beta-blockers d) CCB e) Diuretics,a
Substance use among adolescents and young adults with chronic kidney disease or kidney failure,1. Which of the following is NOT true regarding electronic nicotine delivery systems (ENDS)? a) Use of ENDS devices has been associated with sleep disturbances. b) Menthol or tobacco flavored e-liquids are less harmful than appealing flavored e-liquids like candy or fruit. c) ENDS have not been proven to be effective smoking cessation tools. d) Elevated blood pressure has been observed in those who use ENDS.,b
Substance use among adolescents and young adults with chronic kidney disease or kidney failure,2. Which of the following is NOT true regarding adolescents with chronic kidney disease who consume alcohol? a) They participate in binge drinking. b) More male than female adolescents consume alcohol. c) Higher medication count per day is associated with less alcohol consumed. d) Alcohol ingestion at the time of sexual activity is not uncommon.,b
Substance use among adolescents and young adults with chronic kidney disease or kidney failure,"3. Regarding the use of cannabinol and recreational marijuana, which of the following is true? a) Optimal dose of cannabinol to alleviate CKD-related nausea has been determined. b) Adolescent patients with CKD have a high-risk perception of marijuana use. c) Age at first use of marijuana is similar between adolescents with CKD and their healthy peers. d) Studies suggest that marijuana use in adolescents is completely benign.",c
Substance use among adolescents and young adults with chronic kidney disease or kidney failure,4. Methamphetamines are known to cause acute kidney injury (AKI). Which of the following best describes the pathophysiology of AKI caused by this illicit substance? a) Tubular injury secondary to rhabdomyolysis b) Vasoconstriction c) Malignant hypertensive nephropathy d) All the above,d
Substance use among adolescents and young adults with chronic kidney disease or kidney failure,"5. Which of the following is accurate regarding opioid use in chronic kidney disease (CKD)? a) Opioids are contraindicated for pain control in patients with chronic kidney disease. b) Illicit use of opioids has been directly associated with membranoproliferative glomerulonephritis. c) Compared to their healthy peers, adolescents with chronic kidney disease use illicit opioids more frequently. d) Inducing systemic inflammation is a pathophysiologic mechanism of illicit IV opioid use.",d
The CKiD study overview and summary of findings related to kidney disease progression,1. The primary aim of the CKiD study is to: a. Identify CKD progression risk factors b. Measure the impact of kidney function on growth c. Describe cardiovascular risk factors in children with CKD d. All of the above,d
The CKiD study overview and summary of findings related to kidney disease progression,2. Which study design describes CKiD? a. Cross-sectional study b. Prospective cohort study c. Case control study d. Clinical trial,b
The CKiD study overview and summary of findings related to kidney disease progression,3. The most unbiased estimate of GFR in 18–26 year olds with CKD can be obtained using: a. The CKiDSCr-Cystatin equation b. The classic Schwartz formula c. The simple mathematical average of the CKiDSCr and CKD-EPI equations d. The CKD-EPI equation,c
The CKiD study overview and summary of findings related to kidney disease progression,4. All of the following have been identified as risk factors for CKD progression in the CKiD cohort EXCEPT: a. Elevated blood pressure b. Income c. Proteinuria d. Glomerular disease,b
The CKiD study overview and summary of findings related to kidney disease progression,5. Short stature in CKiD subjects has been identified with: a. Poorer renal function post-transplant b. Faster CKD progression c. Hypertension d. Glomerular disease,a
The old becomes new advances in imaging techniques to assess nephron mass in children,1. Ex vivo studies have shown that the following imaging modality has been the least accurate determinant of kidney volume: a) CT scan b) 2D ultrasound using an ellipsoid formula c) 3D MRI d) No modality has shown superiority,b
The old becomes new advances in imaging techniques to assess nephron mass in children,2. The use of the ellipsoid formula to calculate total kidney volume is 100% accurate in assessment of nephron mass: a) True b) False,b
The old becomes new advances in imaging techniques to assess nephron mass in children,3. Renal parenchymal area accounting for various degrees of pelvicalyceal dilatation has been studied in bladder outlet obstruction and has shown the following: a) Increased RPA prenatally can predict progression to ESKD b) Decreased RPA prenatally can predict progression to ESKD c) Decreased RPA postnatally is associated with ESKD d) Both b and c,d
The old becomes new advances in imaging techniques to assess nephron mass in children,4. Indexing TKV by BSA results in the following distribution of values: a) Normally distributed and Gaussian or bell-shaped curve b) Non-normally distributed c) Normally distributed only in certain populations d) None of the above,a
The old becomes new advances in imaging techniques to assess nephron mass in children,5. Contrast-enhanced ultrasound has the following potential applications in renal imaging: a) Renal mass characterization b) Diagnosis of vesicoureteral reflux c) Kidney volume determination d) All of the above,d
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children,"1. Why should an AVF be preferred compared to a CVL when HD is required? a) It is recommended by the European Society of Pediatric Nephrology Dialysis Working Group b) It has been shown that children with an AVF have fewer hospitalizations compared to those with CVLs. c) Creating an AVF promotes the “limb salvage”, whereas when a CVL has been created, this might compromise the future of the vessels in the arm of interest d) Because the “Fistula First Initiative” has been applied already in adults but not in children yet.",b
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children,2. Which are the barriers to AVF formation in children? a) Surgical challenges of placing and maintaining an AVF in young children b) Patients’ preference c) Timing of transplantation (planned transplant in the next 6–12 months) d) Late referral to a pediatric nephrologist or to a dedicated pre-dialysis unit e) All the above,e
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children,3. What are the measures that each pediatric nephrology unit should appraise in order to increase the rate of AVF creation? a) Refer any child with an eGFR < 30 ml/min/1.74 m2 to a dedicated vascular access team b) Educate the child and the parents about vein preservation c) Surgical assessment of the realistic possibilities for creating an AVF d) The type of vascular access for HD should be a multidisciplinary decision alongside with the child’s and parent’s preferences e) All the above,e
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children,4. Which is the best cannulation technique of an AVF in children? a) Area puncture b) Rope ladder c) Buttonhole technique d) Rope ladder or buttonhole technique depending on an individualized risk-assessment for each patient e) Rope ladder if the AVF is more than 2 cm long,d
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children,"5. In terms of surveillance, which is the optimal way of assessing an AVF in children? a) A 3 to 6 monthly imaging by venography. b) The ultrasound dilution method (UDM) is the only accurate way of assessing an AVF in children. c) A systematic ‘ABCDE’ assessment is recommended at every HD session. d) A systematic clinical assessment is recommended at every HD session with diagnostic ultrasound imaging every 3–6 monthly provided there are no concerns identified on clinical examination. e) Both a, b and c.",d
Use of diuretics in the neonatal period,1. Which of the following is not a therapeutic indication of loop diuretics? a) Sodium-retaining states b) Hyperkalemic states c) Hypercalcemic states d) Nephrogenic diabetes insipidus e) Assessment of distal acidification,d
Use of diuretics in the neonatal period,2. Which of the following is not a side effect of loop diuretics? a) Ototoxicity b) Hyperglycemia c) Hyperuricemia d) Gynecomastia e) Nephrocalcinosis,d
Use of diuretics in the neonatal period,3. Which of the following is a possible side effect of inhibitors of carbonic anhydrase? a) Metabolic alkalosis b) Hyperkalemia c) Hypercalcemia d) Hypokalemia e) Hirsutism,d
Use of diuretics in the neonatal period,4. Which diuretic among the following inhibits the sodium-potassium-chloride cotransporter NKCC? a) Acetazolamide b) Spironolactone c) Amiloride d) Hydrochlorothiazide e) Furosemide,e
When should we start and stop ACEi/ARB in paediatric chronic kidney disease,1. Which of the following is not predictive for kidney disease progression in both glomerular and non-glomerular CKD? A. High blood pressure B. Significant proteinuria C. Age D. Hypoalbuminaemia,C
When should we start and stop ACEi/ARB in paediatric chronic kidney disease,2. Which of the following is not preferred in the management of paediatric CKD? A. ACEi monotherapy B. ACEi and ARB combination therapy C. Normal protein intake D. Attaining a normal vitamin D level,B
When should we start and stop ACEi/ARB in paediatric chronic kidney disease,3. Which of the following predicts good kidney outcomes after RAAS blockade? A. Significant initial reduction in proteinuria B. Acute changes of GFR C. Hyperkalaemia D. Hypotension,A
When should we start and stop ACEi/ARB in paediatric chronic kidney disease,"4. What factors should be considered when one decides on the use of RAASi in advanced CKD? A. Baseline patient characteristics e.g. underlying renal diagnosis B. Treatment response, e.g. proteinuria reduction C. Side effect profiles, e.g. hyperkalaemia D. All of the above",D
Pediatric onco-nephrology: time to spread the word,"You were consulted for evaluation of proteinuria in a 15-month-old boy with urine protein-creatinine ratio of 10. Upon exam, you noticed that he has ambiguous genitalia, and the kidney US that you ordered just came back and showed unilateral kidney mass. The underlying genetic defect mostly involves:  a TRIM37 b PTCH1 c WT1 d PIK3CA",c
Pediatric onco-nephrology: time to spread the word,The mechanism of AKI in the setting of methotrexate therapy is:  a Oxidative stress b Increase peritubular capillary pressure c Interstitial nephritis d Crystal deposition,d
Pediatric onco-nephrology: time to spread the word,"The mechanism of kidney injury in children receiving CAR-T therapy includes  a Decreased effective renal blood flow due to increased capillary leakage and third spacing b CRS c TLS d a and b e a, b, and c",e
Pediatric onco-nephrology: time to spread the word,"You were called by your oncology colleague to discuss the plan to decrease the risk of AKI following CT with IV contrast for a 5-year-old patient with abdominal mass. The patient weight at admission was 34 kg, and his current weight is 30 kg. The laboratory results from 2 h ago showed Na 152 mEq L−1, K 5.9 mEq L−1, BUN 55 mg dL−1, and serum osmolality 320 mOsm kg−1 H2O.  Which of the following is the most crucial intervention to decrease the risk of development of CI-AKI?  a Give the patient D5W + 45 mEq L−1 NaCl for 12 h before and after the CT at a rate of 30 mL h−1. b Use diatrizoate contrast media with osmolality of 1570 mOsm kg−1 H2O c Give the patient a bolus of 20 mL kg−1 of 0.9% NS and postpone the CT until he is fully hydrated d Stop the night dose of amlodipine the day before the CT is done and use the ICM agent iodixanol 320 (Visipaque) 290 mOsm kg−1 H2O",c
Pediatric onco-nephrology: time to spread the word,"You discussed with your fellow that the most appropriate initial management for a 6-year-old girl who was recently diagnosed with Burkitt’s lymphoblastic B-ALL and has a uric acid of 10 mg dL−1, is:  a Daily laboratory tests, IV fluids, and initiation of allopurinol immediately b Start IV fluids, close cardiac monitoring, start rasburicase, and check laboratory tests every 6 h",b
A clinical approach to tubulopathies in children and young adults,The following is not a cause of a generalised proximal tubulopathy: a) Galactosaemia b) Cystinosis c) Wilson’s disease d) Proximal RTA (type 2 RTA) e) Mitochondrial ciliopathy,d
A clinical approach to tubulopathies in children and young adults,Genetic testing is important in the tubulopathies as it can: a) Provide a definitive diagnosis b) Allow the commencement of disease-specific therapy c) Facilitate family planning d) All of the above,d
A clinical approach to tubulopathies in children and young adults,Which statement is incorrect when reviewing proximal and distal RTA? a) Both present with a hypokalaemic metabolic acidosis b) Both are associated with nephrocalcinosis c) Proximal RTA is secondary to an inability to reabsorb bicarbonate d) Distal RTA is secondary to an inability to secrete protons,b
A clinical approach to tubulopathies in children and young adults,"Which statement is incorrect when reviewing tubulopathies that affect magnesium handling of the kidney? a) When assessing hypomagnesaemia, urinary calcium is an important tool to guide diagnosis b) Individuals with variants in CLDN10 present with a salt wasting tubulopathy with hypomagnesaemia c) Individuals with variants in CLDN16/19 present with a salt wasting tubulopathy with hypomagnesaemia d) Familial hypomagnesaemia with hypocalcaemia results from variants in TRMP6",b
A clinical approach to children with C3 glomerulopathy,A kidney biopsy performed in a child with C3 glomerulopathy can show: a) Intramembranous dense deposits b) Mesangial proliferation c) Subepithelial humps d) All of the above e) None of the above,d
A clinical approach to children with C3 glomerulopathy,"Membranoproliferative glomerulonephritis is a histological pattern which may be secondary to alternative pathway of complement dysregulation a) Very rarely b) Frequently, especially in children c) Only in adults d) Only if there is C3 predominance by IF e) In all cases",b
A clinical approach to children with C3 glomerulopathy,The complement system is involved in the pathogenesis of C3G. Which of the following serological tests does not fit in the pattern of increased C3 turnover? a) low C3 levels b) normal C3 levels c) normal factor B d) auto-antibodies against AP convertase C3bBb e) all of the above,c
A clinical approach to children with C3 glomerulopathy,Optimal treatment of C3 glomerulopathy requires a) Supportive care with RAAS inhibition and low-salt diet b) Mycophenolate mofetil when proteinuria is ≤ 0.5 g/day c) Eculizumab d) Therapy targeting the alternative pathway of complement e) All of the above,e
A clinical approach to children with C3 glomerulopathy,"Among therapeutic agents targeting complement, which of the following statements is true? a) Eculizumab is the only agent approved for use in C3G b) ACH4471 targets Factor B c) CCX168 is a C5aR1 antagonist d) APL-2 is orally administered e) LNP023 targets the C5 convertase",c
Acute kidney injury in pediatrics an overview focusing on pathophysiology,"What is the GFR change in each AKI pathophysiological phase? a) Initiation (slow GFR decrease), extension (fast GFR decrease), maintenance (GFR stabilization), recovery (GFR increase). b) Initiation (slow GFR decrease), extension (fast GFR decrease), maintenance (slow GFR increase), recovery (fast GFR increase). c) Initiation (fast GFR decrease), extension (slow GFR decrease), maintenance (GFR stabilization), recovery (GFR increase). d) Initiation (fast GFR decrease), extension (slow GFR decrease), maintenance (GFR increase), recovery (GFR stabilization).",c
Acute kidney injury in pediatrics an overview focusing on pathophysiology,"Considering the pathophysiology of Sepsis-associated Acute Kidney Injury (SA-AKI), choose the correct answer: a) SA-AKI’s pathophysiology is similar to other AKI etiologies, with hypoperfusion and ischemic injury being the main mechanisms. b) The most accepted mechanism associated with SA-AKI is a decrease in global kidney blood flow, but differently from other AKI causes, it does not lead to Acute Tubular Necrosis. c) There is more than one pathway for the development of SA-AKI, including ischemia–reperfusion injury, inflammation, alterations in microcirculation and metabolic reprogramming. d) Microcirculatory dysfunction is one of the mechanisms associated with SA-AKI, through endothelial injury, thrombotic microangiopathy and alteration of the kidney blood flow with preserved capillary density.",c
Acute kidney injury in pediatrics an overview focusing on pathophysiology,Which of the following causes of intrinsic kidney disease is not associated with drug-induced nephrotoxicity? a) Acute Tubular Necrosis. b) Acute Interstitial Nephritis. c) Tumor Lysis Syndrome. d) Rapidly Progressive Glomerulonephritis,c
Acute kidney injury in pediatrics an overview focusing on pathophysiology,Which pregnancy-related event favours AKI onset in neonatology? a) Late term delivery. b) Antenatal glucocorticoid administration. c) Placental abruption. d) Use of centrally-acting anti-hypertensive agents.,c
Acute kidney injury in pediatrics an overview focusing on pathophysiology,Which parameter/condition is most widely used to determine AKI in hospitalized patients? a) Reduction of urine output or anuria. b) Increase in baseline serum creatinine (SCr). c) Reduction of glomerular filtration rate (GFR). d) Need for kidney replacement therapy.,b
Acute and chronic kidney complications in children with type 1 diabetes mellitus,Acute kidney injury in children at T1DM onset… a) … could manifest in about 2/3 of children with DKA b) … is extremely rare c) … is usually not reversible d) … could manifest in about of 2/3 of children without DKA,a
Acute and chronic kidney complications in children with type 1 diabetes mellitus,"In AKI pathophysiology for patients at the onset of T1DM, all of the following factors are involved with the exception of: a) Osmotic polyuria b) Delayed T1DM diagnosis c) Acidosis d) Older age at T1DM onset",d
Acute and chronic kidney complications in children with type 1 diabetes mellitus,The presence of diabetic kidney disease may be indicated by all the following parameters with the exception of: a) Urine albumin to creatinine ratio > 30 mg/g creatinine b) eGFR < 60 mL/min/1.73 m² c) Urine albumin to creatinine ratio > 300 mg/g creatinine d) Glycosuria,d
Acute and chronic kidney complications in children with type 1 diabetes mellitus,The first-choice pharmacological treatment for hypertension in children with T1DM is: a) Angiotensin-converting enzyme inhibitors b) Calcium channel blockers c) Diuretics d) Beta-blockers,a
Acute and chronic kidney complications in children with type 1 diabetes mellitus,The risk of developing DKD increases in case of: a) Poor glycemic control b) Previous AKI episode c) Untreated hypertension d) All of the above,d
Anemia after kidney transplantation,Early post-transplant anemia is defined as anemia diagnosed: a) Within 12 months after kidney transplant b) Within 6 months after kidney transplant c) Within the first month after kidney transplant d) At the 3 month post-transplant visit e) Any time after transplant,b
Anemia after kidney transplantation,Which of the following is NOT a risk factor for post-transplant anemia? a) Pre-transplant anemia b) Delayed graft function c) Iron deficiency d) Corticosteroids e) Viral infections,d
Anemia after kidney transplantation,Post-transplant anemia has been associated with a variety of clinical outcomes in adults including: a) All-cause mortality b) Allograft dysfunction c) Left ventricular hypertrophy d) Congestive heart failure e) All of the above,e
Anemia after kidney transplantation,The initial diagnostic evaluation for PTA in children should include all of the following EXCEPT: a) Measurement of biomarkers of iron status including ferritin and transferrin saturation b) Review of medications to identify those associated with increased risk for anemia c) Measurement of reticulocyte count d) Ultrasound to assess for intra-abdominal hematoma e) Testing for the presence of hemolysis if clinical suspicion is high,d
Anemia after kidney transplantation,The optimal post-transplant hemoglobin level in children: a) Has not been defined b) Is the same as the optimal hemoglobin level in adult kidney transplant recipients c) Depends on the dose of erythropoiesis stimulating agent they are treated with d) Is lower for those receiving iron supplementation e) Is > 11 g/dl,a
An update on lipid apheresis for familial hypercholesterolemia,"Which of the statements below is wrong? a) It is recommended to check plasma lipid levels in children if there is a 1st and 2nd degree relative before the age of 55 (men) or 60 years (women) with early cardiovascular disease. b) An affected parent should undergo genetic testing first and when the diagnosis has been confirmed, genetic testing in the potentially affected child should be performed. c) It is recommended to check plasma lipid levels in every child once, regardless of anamnestic hints or clinical features. d) It is only recommended to look for secondary reasons for elevated lipid levels if no pathogenic mutation can be found.",d
An update on lipid apheresis for familial hypercholesterolemia,Which of the statements below is correct? a) Serum lipid levels are age dependent. b) LDL-target levels are the same in children and adults. c) LDL-target levels can only be reached with a multimodal treatment of medication and lipid apheresis. d) LDL-target levels can only be reached with a multimodal treatment of medication and lipid apheresis twice a week.,a
An update on lipid apheresis for familial hypercholesterolemia,"Which of the statements below is wrong? a) A mutation in the PCSK9 gene decreases LDL receptors and subsequently causes hypercholesterolemia. b) LDL receptor mutations can result in medication resistance. c) LDLR gene mutations are causative in 60–80% of genetically diagnosed cases of hypercholesteronemia. d) If an underlying mutation can be identified, the treatment should always be a multimodal intense therapy because all mutations cause LDL plasma values elevated to a comparable level.",d
An update on lipid apheresis for familial hypercholesterolemia,"Which is the correct next step in diagnostics or therapy when a child . . . a) is newly diagnosed and has no medication yet? Start with a combination of statins, intestinal cholesterol uptake inhibitors and PCSK9 inhibitors to lower the burden of LDL as fast as possible. b) is on statins, intestinal cholesterol uptake inhibitors and PCSK9 inhibitors, and does not show a satisfactory decrease in LDL levels? Check underlying mutation and eventually terminate statins and PCSK9 inhibitors. c) is on lipid apheresis and does not show a satisfactory decrease in LDL levels? Increase the plasma volume to treat, because more treated plasma in a session results in a long-lasting decrease in mean LDL. d) is on lipid apheresis and does not show a satisfactory decrease in LDL levels? Check eluted liquids for co-eliminated factors, because they can be washed out completely.",b
An update on lipid apheresis for familial hypercholesterolemia,"Which of the statements below is correct? a) Endothelial dysfunction and thickening of the arterial vessel wall in hypercholesterolemia can already be present in children. b) Severe atherosclerotic lesions like aortic valve stenosis and supravalvular aortic stenosis cannot be present before adolescence. c) Lipid apheresis does not influence coagulation and rheological pathways, adhesive proteins, immunological/inflammatory properties and vessel compliance. d) Other substances besides LDL can only be found in the DALI column",a
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation,Which of the following is not associated with an increased risk for new-onset diabetes after transplant (NODAT)? a) High dosage of corticosteroids b) Younger age c) Obesity d) Tacrolimus use,b
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation,Which of the following foods is not consistent with the Dietary Approaches to Stop Hypertension (DASH) diet? a) 4-5 servings of fruits per day b) 4-5 servings of vegetables per day c) 2-3 servings of dairy per day d) > 8 oz of red meat per day,d
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation,"Which of the following is recommended by the American Heart Association for children with high-risk health conditions, including kidney transplant recipients? a) At least 5 hours of physical activity weekly b) More than 8 servings of fruits and vegetables daily c) Less than 180 minutes of screen time daily d) At least two servings of red meat daily",a
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation,Therapeutic lifestyle changes that may be associated with benefit on cardiometabolic parameters among pediatric kidney transplant recipients include: a) Reducing sugar-sweetened beverage intake b) Reducing sodium intake to < 2.3 g daily c) Increasing full-fat dairy intake d) A and B e) All of the above,d
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation,"Which of the following is a reasonable first step for lowering cholesterol levels in pediatric kidney transplant recipients? a) Switching from tacrolimus to sirolimus b) Blood pressure reduction c) Starting a statin empirically, regardless of the age of the patient d) Increasing consumption of plant-based foods",d
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy,Citrate toxicity involves which of the following manifestations?a. High anion gap metabolic acidosis.b. High anion gap metabolic alkalosis.c. High total serum calcium to ionized calcium ratio (> 2.5). d.All of the above.,d
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy,"If heparin-induced thrombocytopenia (HIT) is suspected in a dialysis patient, which of the available alternative anticoagulants might be a more appropriate option? a. Enoxaparin b. Nadroparin c. Hirudin d. Dalteparin e. Reviparin ",c
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy,"In a patient with acute kidney injury on intermittent hemodialysis, which anticoagulant does NOT require dose adjustment? a. Danaparoid b. Fondaparinux c. Argatroban d. Enoxaparin e. Hirudin",c
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy,"What is the mechanism of action of prostacyclin as potential anticoagulant to prolong CKRT circuit life? a. Irreversibly inhibits thrombin. b. Reversibly inhibits platelet function and decreases aggregation by inhibiting GP IIb-IIIa receptor activation. c. Inhibits serine protease and targets protein factors IXa, Xa, Xia, VIIa, and thrombin (IIa). d. Chelation of calcium and decreases adhesions between platelets and red blood cells. e. None of the above.",b
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes,"Identified risk factors for the development of chronic kidney disease in children with CAKUT include: a) the underlying CAKUT diagnosis b) kidney size c) baseline eGFR d) family history of CAKUT e) a, b, and c f) all of the above",e
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes,The specific CAKUT category most likely associated with the long-term outcome of kidney failure is: a) multicystic dysplastic kidney b) unilateral renal agenesis c) renal hypodysplasia d) posterior urethral valve e) none of the above,d
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes,A term newborn in the level 1 nursery was found to have antenatal hydronephrosis on a third-trimester ultrasound with an APD of 12 mm. What is the next best step in management? a) Refer to Nephrology for appointment within the first month of life b) Monitor urine output prior to discharge home c) Obtain kidney bladder ultrasound at 48 h of life d) Schedule patient for VCUG e) Urgent referral to Urology,c
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes,Essential components of a successful multidisciplinary pediatric CAKUT care team include: a) pediatric nephrologist b) specialty nurse c) social worker d) dietitian e) pharmacist f) geneticist g) psychologist h) all of the above,h
Care of the pediatric patient on chronic peritoneal dialysis,Which of the following are advantages of PD compared with HD?\na. Improved preservation of residual kidney function\nb. Fewer dietary restrictions\nc. Fewer fluid restrictions\nd. Avoidance of systemic anticoagulation\ne. All of the above,e
Care of the pediatric patient on chronic peritoneal dialysis,Which of the following is NOT an absolute contraindication to PD?\na. Omphalocele\nb. Diaphragmatic hernia\nc. Colostomy\nd. Gastroschisis\ne. Bladder exstrophy,c
Care of the pediatric patient on chronic peritoneal dialysis,Which of the following is one strategy to reduce PD catheter-related infections?\na. Intraoperative antibiotic prophylaxis administration within 30 min prior to incision for PD catheter placement\nb. Downward or lateral-facing exit site\nc. Use of sutures in securing the PD catheter\nd. Avoidance of dressing changes for 2 weeks after catheter placement\ne. Placement of g-tube after PD catheter placement,b
Care of the pediatric patient on chronic peritoneal dialysis,"Low transporters are characterized by:\na. High membrane permeability, rapid solute clearance, poor ultrafiltration, high protein loss\nb. Low membrane permeability, slow solute clearance, good ultrafiltration, low protein loss\nc. Low membrane permeability, rapid solute clearance, good ultrafiltration, high protein loss\nd. High membrane permeability, slow solute clearance, poor ultrafiltration, low protein loss",b
Care of the pediatric patient on chronic peritoneal dialysis,Which of the following are healthcare disparities in children receiving maintenance PD in lower-income countries?\na. Higher mortality risk\nb. Higher cardiovascular-related death\nc. Smaller height\nd. High mineral bone disease\ne. All of the above,e
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions,"A 14-year-old girl was evaluated by the ED trauma team after a motor vehicle accident. She was referred to pediatric nephrology for an incidental CT finding of five simple kidney cysts. Noticing a pale macule on her arm, the astute nephrologist entertains the possibility of TSC. Which of the following would make this diagnosis? a) Finding additional hypomelanotic macules on her torso b) Finding additional hypomelanotic macules on her torso and eliciting a history of febrile seizure c) Finding additional hypomelanotic macules on her torso and noticing that the CT reports sclerotic lesions in the thoracic vertebrae d) Realizing her acne might be facial angiofibroma",c
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions,"Which of the following statements about renal imaging is true for patients with TSC? a) Infants do not need renal imaging at the time of diagnosis. b) Imaging is recommended at least every one to three years in all patients, regardless of kidney findings. c) Kidney ultrasound is preferable to MRI or CT scan in patients unable to cooperate. d) CT scan without iv contrast is the preferred imaging modality for patients already known to have kidney lesions.",b
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions,"Regarding cystic kidney disease in pediatric TSC, which of the following is true? a) Large symptomatic cysts have the highest risk of undergoing malignant transformation. b) Mutations in TSC1 confer a higher risk of kidney failure due to severe polycystic disease and requiring more aggressive therapeutic interventions. c) The Bosniak classification is helpful to stratify cystic kidney masses according to their malignant potential and determine the need and timing of follow-up imaging. d) Temporal changes in cyst morphology are the best indicators of their malignant potential.",d
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions,"Which of the following statements about mTOR inhibitors (mTORi) is false? a) Tacrolimus, sirolimus, and everolimus all inhibit mTOR activity. b) mTORi is often used to treat the kidney manifestations of TSC. c) It is unclear if TSC-associated kidney cysts respond to mTORi treatment. d) Pharmacologic levels of mTORi only partly replace the normal function of the TSC1 and TSC2 proteins.",a
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions,"In a 7-year-old boy with a clinical diagnosis of TSC based on brain and skin findings, which of the following is most consistent with a diagnosis of TSC/PKD contiguous gene syndrome? a) Bilateral kidney cysts, hypertension, and a disease-associated point mutation in exon 8 of the TSC2 gene b) Bilateral kidney cysts, hypertension, and a paternal grandfather on dialysis for ADPKD c) Bilateral kidney cysts, hypertension, and deletion of multiple exons at the 3’ end of the TSC2 gene d) Bilateral kidney cysts, hypertension, and deletion of multiple exons at the 3’ end of the TSC1 gene",c
Diabetic kidney disease in children and adolescents: an update,1. Which of the following statements is correct about diabetic kidney disease? a) It is always associated with proteinuria. b) It never progresses to end-stage renal disease. c) It can be slowed with appropriate glycemic control. d) It is reversible with medication.c2. What is a common early marker of diabetic kidney disease? a) Microalbuminuria b) Hyperglycemia c) Hypoglycemia d) Polyuriaa3. Which medication is commonly used to treat diabetic kidney disease? a) ACE inhibitors b) Beta-blockers c) Calcium channel blockers d) Diureticsa4. What lifestyle modification is recommended to prevent diabetic kidney disease progression? a) Increased protein intake b) Decreased physical activity c) Smoking cessation d) Increased sodium intakec5. Which of the following is a risk factor for developing diabetic kidney disease in children? a) Low blood pressure b) Type 1 diabetes c) Non-diabetic parents d) Normal weightb,c
Diabetic kidney disease in children and adolescents: an update,2. What is a common early marker of diabetic kidney disease? a) Microalbuminuria b) Hyperglycemia c) Hypoglycemia d) Polyuria,a
Diabetic kidney disease in children and adolescents: an update,3. Which medication is commonly used to treat diabetic kidney disease? a) ACE inhibitors b) Beta-blockers c) Calcium channel blockers d) Diuretics,a
Diabetic kidney disease in children and adolescents: an update,4. What lifestyle modification is recommended to prevent diabetic kidney disease progression? a) Increased protein intake b) Decreased physical activity c) Smoking cessation d) Increased sodium intake,c
Diabetic kidney disease in children and adolescents: an update,5. Which of the following is a risk factor for developing diabetic kidney disease in children? a) Low blood pressure b) Type 1 diabetes c) Non-diabetic parents d) Normal weight,b
Early microvascular complications in type 1 and type 2 diabetes,You are seeing a 14-year-old female patient who has had type 1 diabetes for a total of 5 years in diabetes clinic. Your patient and her family are interested in learning more about the complications of diabetes. Which of the following do you advise the family is the most common microvascular complication of diabetes?\na. Diabetic kidney disease\nb. Diabetic eye disease\nc. Diabetic nerve disease\nd. Cardiovascular disease,b
Early microvascular complications in type 1 and type 2 diabetes,"Which of the following most accurately describes the onset and progression of diabetic kidney disease in children with type 2 diabetes compared to children with type 1 diabetes?\na. Diabetic kidney disease is more prevalent at onset in type 2 diabetes, but available evidence suggests it progresses at a slower rate.\nb. Diabetic kidney disease is more prevalent at onset in type 2 diabetes, and available evidence suggests it progresses at a faster rate.\nc. Although early diabetic kidney disease may exist at diagnosis in type 2 diabetes, the long-term risk of chronic kidney disease progression is similar to type 1 diabetes.\nd. It is extremely rare for early diabetic kidney disease to be present at diagnosis in either type 1 or type 2 diabetes, and the risk of long-term progression of chronic kidney disease is similar for both conditions.",b
Early microvascular complications in type 1 and type 2 diabetes,"You are caring for an 18-year-old male patient with type 2 diabetes who has recently developed worsening albuminuria, which has now progressed to macroalbuminuria. He is currently receiving treatment with metformin and lisinopril. His HbA1c is above target at 7.5% and he has a normal serum creatinine. Which of the following is the best option to improve his long-term kidney outcome?\na. Initiation of long-acting insulin\nb. Addition of an angiotensin-receptor blocker (ARB)\nc. Initiation of a glucagon-like peptide 1 receptor agonist (GLP-1 RA)\nd. Initiation of a sodium-glucose co-transporter 2 (SGLT2) inhibitor",d
Early microvascular complications in type 1 and type 2 diabetes,Which of the following most accurately describes the patient that is at highest risk for developing retinopathy?\na. A 16-year-old male patient with type 1 diabetes diagnosed at 15 years of age with an HbA1c of 7.5% and no microalbuminuria.\nb. An 8-year-old male patient with type 1 diabetes diagnosed at 2 years of age with an HbA1c of 8% and no microalbuminuria.\nc. A 16-year-old female patient with type 1 diabetes diagnosed at age 7 years with an HbA1c of 11% and microalbuminuria.\nd. An 18-year-old female patient with type 1 diabetes diagnosed at age 15 years with an HbA1c of 9% and microalbuminuria.,c
Early microvascular complications in type 1 and type 2 diabetes,You are evaluating a 16-year-old male with a 4-year history of very poorly controlled type 2 diabetes (HbA1c > 14% now) on combination therapy with metformin and long-acting insulin who presents with numbness and tingling in his bilateral lower extremities. What is your next step for further evaluation and/or treatment of this finding?\na. Order cardiovascular reflex testing including heart rate variability and an EKG to evaluate the QT interval.\nb. Start treatment with gabapentin.\nc. Recommend improved glycemic control and increase the patient’s long-acting insulin by 20%.\nd. Start treatment with a glucagon-like peptide 1 receptor agonist (GLP-1 RA).,a
Endothelial dysfunction as a factor leading to arterial hypertension,"Indicate incorrect answer for nitric oxide (NO): a) NO is the main endothelium-derived vasodilatator b) Potassium has an opposite function to NO c) The main substrate to produce NO is arginine d) NO inhibits platelet aggregation and adhesion, smooth muscle cell proliferation, and leucocyte adhesion e) NO inhibits vascular permeability and inflammatory mechanisms",b
Endothelial dysfunction as a factor leading to arterial hypertension,Which antihypertensive drug has no beneficial effect on endothelial cells: a) Valsartan b) Amlodipine c) Ramipril d) Metoprolol e) Nebivolol,d
Endothelial dysfunction as a factor leading to arterial hypertension,What is the biomarker of glycocalyx damage? a) Syndecan-1 b) Angiopoietin-2 c) Angiotensin II d) A + B e) A + C,d
Endothelial dysfunction as a factor leading to arterial hypertension,Which of the following statements about glycocalyx (GCX) is true: a) It has only a mechanical function b) Injury to the GCX increases the risk of atherosclerosis c) Decreased heparanase activity leads to GCX damage d) Loss of GCX decreases transcapillary albumin transport e) GCX damage does not affect vascular permeability,b
Endothelial dysfunction as a factor leading to arterial hypertension,Which of the following methods is not used to evaluate endothelial function in children in studies? a) FMD b) Albuminuria c) Endocan level d) Thrombomodulin level e) Quantitative coronary angiography,e
Fabry disease and kidney involvement,"What are the clinical manifestations in patients with FD? a) only gastrointestinal symptoms and neuropathic pain b) symptoms and signs are heterogeneous c) kidney failure d) heart failure e) gastrointestinal symptoms, neuropathic pain, angiokeratoma, hypohidrosis, acroparesthesia and discomfort during adulthood",b
Fabry disease and kidney involvement,When does Gb-3 deposition occur in the kidney? a) as early as during fetal development b) only after the age of 10 c) in adulthood d) during fetal development only in female patients e) in old age,a
Fabry disease and kidney involvement,Kidney involvement is: a) a positive prognostic indicator b) an early sign of Fabry disease c) a sure predictor of therapy failure d) a significant cause of morbidity and reduced life expectancy in patients with Fabry’s disease e) present only in the elderly,d
Fabry disease and kidney involvement,What is the main therapy? a) diet and exercise b) enzyme replacement therapy (ERT) with glucocerebrosidase c) dialysis d) enzyme replacement therapy (ERT) with agalsidase alfa and agalsidase beta e) lifestyle change,d
Fabry disease and kidney involvement,What are the initial manifestations of kidney impairment? a) shortness of breath b) decreased urine output c) fatigue and confusion d) an increase in microalbuminuria and proteinuria e) a decrease in creatinine clearance,d
Erythropoiesis-independent effects of iron in chronic kidney disease,"In children with CKD, serum ferritin INVERSELY correlates with:\na) CKD stage\nb) Serum hepcidin\nc) Hemoglobin\nd) Inflammatory markers\ne) Iron sequestration",c
Erythropoiesis-independent effects of iron in chronic kidney disease,Hepcidin regulates cellular iron transport by binding to:\na) Ferritin heavy chain\nb) Ferritin light chain\nc) Transferrin receptor 1\nd) Ferroportin\ne) Erythroferron,d
Erythropoiesis-independent effects of iron in chronic kidney disease,Ferroportin is…:\na) …iron importer highly expressed on the apical aspect of enterocytes.\nb) …not expressed in tubular epithelial cells.\nc) …a transcription factor regulating intracellular iron balance.\nd) …regulated exclusively by systemic hepcidin in all cell types.\ne) …the only known iron exporter.,e
Erythropoiesis-independent effects of iron in chronic kidney disease,Which of the following statements about physiologic renal iron handling is correct?\na) Iron is not filtered by healthy glomeruli but may be filtered in nephrotic syndrome.\nb) Iron is filtered by the glomeruli and the majority of filtered iron is reabsorbed.\nc) Tubular secretion of iron is critically important for maintaining iron balance.\nd) Iron is reabsorbed in the proximal tubule primarily via brush border ferroportin.\ne) Transferrin-bound iron cannot be reabsorbed because tubular epithelial cells do not express transferrin receptor 1.,b
Erythropoiesis-independent effects of iron in chronic kidney disease,"Choose the correct statement about the relationship between iron, mineral homeostasis, and bone health:\na) In clinical trials, ferric citrate coordination complex improved hyperphosphatemia in adult dialysis patients.\nb) All iron preparations stimulate FGF23 production in patients with CKD.\nc) Hypophosphatemia has been reported as a complication of oral, but not parenteral, iron administration.\nd) In the general population, similar to children with thalassemia, total body iron stores are directly associated with improved bone mineral density.\ne) Iron typically stimulates the function of osteoblasts and inhibits the function of osteoclasts.",a
Genetic causes of neonatal and infantile hypercalcaemia,"Neonatal severe hyperparathyroidism (NSHPT) and familial hypocalciuric hypercalcaemia (FHH) are: a) Both caused by inactivating mutations in the CaSR gene only. b) NSHPT is caused by inactivating mutations in the CaSR only; FHH is caused by inactivating mutations in the CaSR, Gα11 and AP2σ genes. c) NSHPT is caused by inactivating mutations in the CaSR, Gα11 and AP2σ genes; FHH is caused by inactivating mutations in the CaSR gene only. d) Both are caused by inactivating mutations in the CaSR, Gα11 and AP2σ genes.",b
Genetic causes of neonatal and infantile hypercalcaemia,"Jansen’s metaphyseal chondrodysplasia is characterised by: a) Short-limbed short stature, deformed, under-mineralised bones, chronic hypercalcaemia and hypophosphaturia with elevated serum PTH levels and elevated serum markers of bone turnover. b) Short-limbed short stature, deformed, under-mineralised bones, chronic hypercalcaemia and hypophosphaturia with normal serum PTH levels and elevated serum markers of bone turnover. c) Short-limbed short stature, deformed, under-mineralised bones, transient hypercalcaemia and hyperphosphaturia with normal serum PTH levels and elevated serum markers of bone turnover. d) Short-limbed short stature, deformed, under-mineralised bones, chronic hypercalcaemia and hypophosphaturia with normal serum PTH levels and elevated serum markers of bone turnover.",d
Genetic causes of neonatal and infantile hypercalcaemia,"Idiopathic infantile hypercalcaemia (IIH) is caused by mutations in: a) The CYP27B1 gene, encoding 1α-hydroxylase, which converts 25-hydroxyvitamin D3 to active 1,25(OH)2D3. b) The CYP24A1 gene, encoding 24-hydroxylase, which inactivates 1,25(OH)2D3. c) The CYP2R1 gene, encoding 25-hydroxylase, which converts vitamin D to 25-hydroxyvitamin D3. d) The CYP24A1 and CYP27B1 genes. e) The CYP2R1, CYP24A1 and CYP27B1 genes.",b
Genetic causes of neonatal and infantile hypercalcaemia,"In Williams syndrome the reported frequency of hypercalcaemia is: a) >50%, is often symptomatic, may resolve within the first few years, but may recur during puberty. b) <50%, is often symptomatic, may resolve within the first few years, but may recur during puberty. c) <50%, is often asymptomatic, and always resolves within the first few years, with no recurrence. d) >50%, is often asymptomatic, and always resolves within the first few years, with no recurrence.",b
Genetic causes of neonatal and infantile hypercalcaemia,"Which of these causes of hypercalcaemia is characterised by poor feeding, rachitic deformities that can result in respiratory complications, persistent rickets, bony craniosynostosis and is associated with mutations in the ALPL gene: a) Jansen’s metaphyseal chondrodysplasia b) William’s syndrome c) Hypophosphatasia d) Blue diaper syndrome e) Subcutaneous fat necrosis of the newborn",c
Gutted constipation in children with chronic kidney disease and on dialysis,Factors contributing to constipation in children with CKD include:<br>a) Reduced fluid intake as kidney function deteriorates<br>b) Toileting behaviors<br>c) Reduction in physical activity<br>d) Medications used in the management of CKD<br>e) All of the above,e
Gutted constipation in children with chronic kidney disease and on dialysis,The understanding of gut dysbiosis is important in CKD because:<br>a) There is evidence that it directly leads to disease progression<br>b) Evidence suggests some increased cardiovascular risk<br>c) Dysregulation leads to worsening uremia<br>d) b and c<br>e) All of the above,e
Gutted constipation in children with chronic kidney disease and on dialysis,"Children on dialysis who are constipated, can have hyperkalemia. This can be due to:<br>a) CKD leads to an intracellular accumulation of potassium<br>b) Constipation reduces intestinal transit time, leading to increased potassium absorption<br>c) In healthy individuals up to 80% of potassium is excreted through the gastrointestinal tract<br>d) All laxatives contain potassium salts<br>e) All of the above",b
Gutted constipation in children with chronic kidney disease and on dialysis,Which of these laxatives has the highest sodium content?<br>a) Isotonic Polyethylene Glycol (PEG)<br>b) Ispaghula husk<br>c) Docusate sodium<br>d) Bisacodyl<br>e) Sodium picosulphate,a
Gutted constipation in children with chronic kidney disease and on dialysis,Children with CKD requiring pharmacological management of constipation:<br>a) Are more often on peritoneal dialysis than hemodialysis<br>b) Often require one agent for optimal management<br>c) Require care to be taken when prescribing multiple agents as they may contain sodium and potassium salts<br>d) Require large volumes of laxatives for optimal management<br>e) Require large volumes of fluid for optimal management,c
How to define and assess the clinically significant causes of hematuria in childhood,"What is the most common cause of macroscopic post-glomerular hematuria in childhood? a) IgA nephropathy b) Nutcracker syndrome, arteriovenous malformations c) Nephrolithiasis, hypercalciuria d) Bladder tumor",c
How to define and assess the clinically significant causes of hematuria in childhood,"What is the prognosis of IgA nephropathy in childhood? a) It usually leads to rapidly progressive glomerulonephritis b) It is commonly a benign condition, but a considerable percentage of patients will develop chronic kidney disease c) Is always a benign self-limiting condition d) Its prognosis depends on the number of acquired infections in childhood",b
How to define and assess the clinically significant causes of hematuria in childhood,When would you indicate a kidney biopsy in childhood in the process of evaluating hematuria? a) Hematuria cases with persisting acute kidney injury or chronic kidney injury with unknown origin b) In every case of nephrotic syndrome c) To verify Alport syndrome with a positive family background d) In every case of persisting microscopic hematuria,a
How to define and assess the clinically significant causes of hematuria in childhood,What is the cornerstone of radiological imaging in suspected childhood nephrolithiasis? a) Magnetic resonance imaging b) Low-dose computed tomography c) Ultrasound with the combination of cystoscopy d) Ultrasound,d
How to define and assess the clinically significant causes of hematuria in childhood,Which of the following statements is true for hematuria in childhood? a) Hematuria is a common finding in idiopathic nephrotic syndrome in childhood. b) Macroscopic hematuria found in Henoch-Schönlein purpura always has an origin of bladder hemorrhage. c) The combination of hematuria and proteinuria can be a sign of progressive kidney disease. d) Hematuria during urinary tract infection is a hallmark of glomerular damage.,c
How to take advantage of easily available biomarkers in patients with IgA nephropathy: IgA and C3 in serum and kidney biopsies,"1. IgA nephropathy: a. is the most common nephropathy in the world b. can lead to kidney failure in 20–40% of patients within 20 years c. is most prevalent in Asians, followed by Caucasians, and relatively rare in Africans d. kidney biopsy is the gold standard diagnostic method e. the diagnosis is made based on elevated serum IgA level","a, b, c, d"
How to take advantage of easily available biomarkers in patients with IgA nephropathy: IgA and C3 in serum and kidney biopsies,2. Clinical manifestations of IgA nephropathy include: a. erythrocyturia or hematuria b. proteinuria c. asymptomatic leukocyturia d. hypertension e. kidney failure,"a, b, d, e"
How to take advantage of easily available biomarkers in patients with IgA nephropathy: IgA and C3 in serum and kidney biopsies,3. Factors important in the pathogenesis of IgA nephropathy include: a. formation of oligoglycosylated IgA1 b. formation of anti-glycan antibodies c. genetic predisposition d. complement activation by the classical pathway e. complement activation by the alternative pathway,"a, b, c, e"
How to take advantage of easily available biomarkers in patients with IgA nephropathy: IgA and C3 in serum and kidney biopsies,4. Serum IgA level: a. may be elevated in about 50% of patients with IgA nephropathy b. has no prognostic significance c. indicates GDIgA1 d. is related to creatinine level e. is associated with lower proteinuria,"a, b"
How to take advantage of easily available biomarkers in patients with IgA nephropathy: IgA and C3 in serum and kidney biopsies,5. C3 complement component: a. serum C3 level < 90 mg/dL in adults is an adverse prognostic factor b. serum C3 level correlates positively with the severity of C3 deposits in kidney biopsy c. elevated C3 level is present in patients with the protective CFHR1/CFHR3 deletion d. severe C3 deposits in kidney biopsy are associated with better kidney survival e. may be a component of IgA/C3 and have prognostic significance,"a, c, e"
Hypogammaglobulinemia in pediatric kidney transplant recipients,Which of the following is an accurate statement pertaining to the epidemiology of hypogammaglobulinemia after kidney transplantation? a) Hypogammaglobulinemia is more common in children than adults after Tx b) The prevalence of hypogammaglobulinemia peaks at 12 months after Tx c) MMF is associated with a higher risk of Ig abnormalities compared to Aza d) Ig abnormalities are rare after Tx in the absence of an underlying primary immunodeficiency,c
Hypogammaglobulinemia in pediatric kidney transplant recipients,Which of the following complications have been associated with post-Tx hypogammaglobulinemia? a) Pneumocystis jirovecii infections b) Secondary malignancies c) Bacterial sepsis d) Rotaviral gastroenteritis,c
Hypogammaglobulinemia in pediatric kidney transplant recipients,"Of the following immunosuppressive strategies, which has been shown to be useful in patients who develop post-Tx hypo-IgG and experience recurrent infections, while receiving an MMF-based immunosuppressive regimen? a) Substitute MMF with azathioprine b) Add an IL-2 receptor blocker to the regimen c) Replace MMF with methotrexate d) Start a short course of IV thymoglobulin",a
Hypogammaglobulinemia in pediatric kidney transplant recipients,Which of the following statements pertaining to the treatment of hypogammaglobulinemia after Tx is true? a) Data support the use of IVIG replacement for all patients post-Tx with Ig abnormalities b) More frequent IVIG replacement therapy is required in post-Tx patients compared to those with primary immunodeficiencies c) IVIG therapy is contraindicated after kidney Tx d) There are no controlled trials assessing the role and indication for IVIG after kidney Tx,d
Hypogammaglobulinemia in pediatric kidney transplant recipients,Which of the following statements is true about post-Tx bronchiectasis? a) The use of MMF has been linked to the development of bronchiectasis b) Data clearly support a causal link between Ig abnormalities and post-Tx bronchiectasis c) Post-Tx bronchiectasis is an indication for starting IVIG therapy d) The severity of hypogammaglobulinemia is a strong predictor for the development of bronchiectasis,a
Non-Hodgkin lymphoma after pediatric kidney transplantation,"Non-Hodgkin lymphoma (NHL) in patients after kidney transplantation: a) Is a unique and very rare malignancy, seen mainly in adults b) Is a common type of PTLD c) Develops only >10 years after transplantation d) Presents incidence comparable with normal age-matched population e) Is diagnosed only in adolescents after transplantation",b
Non-Hodgkin lymphoma after pediatric kidney transplantation,Non-Hodgkin lymphoma (NHL) after kidney transplantation: a) Is EBV-negative in all cases b) Never develops in CMV-negative patients c) Develops only in EBV-seronegative patients before transplantation d) Is EBV-positive in the majority of pediatric patients e) Never develops in patients presenting EBV reactivation,d
Non-Hodgkin lymphoma after pediatric kidney transplantation,"Confirmed associations between immunosuppression and risk of developing NHL include: a) Importance of high exposure to steroids, which must be withdrawn after diagnosis b) Use of anti-IL2R-based blocking induction c) Use of rituximab in the treatment of primary nephrotic syndrome in case-history before transplantation d) Use of belatacept in EBV-negative (at transplant) patients e) Use of moderate doses of rabbit thymoglobulin for induction in EBV-positive patients",d
Non-Hodgkin lymphoma after pediatric kidney transplantation,"Therapeutic approach in post-transplant NHL includes: a) Immediate radiation of the malignant lesion, regardless of its localization b) Use of rituximab monotherapy in all cases c) Immediate use of interferon together with rituximab d) Reduction of immunosuppression plus rituximab in B cell-positive cases and specific oncologic protocol, adjusted to the defined staging of the disease and morphology of the malignant lesion e) Intensive antiviral treatment (ganciclovir for 6 months) and with IVIG pulses (2 g/kg) in EBV-positive cases, combined with rituximab",d
Non-Hodgkin lymphoma after pediatric kidney transplantation,"In patients who survived NHL and lost the kidney graft: a) Re-transplantation is not possible due to unacceptable, high risk of malignancy recurrence b) Re-transplantation must be postponed >10 years after malignancy c) Immunosuppression in re-transplantation must be reduced and never include biological agents d) Re-transplantation is possible after 2–3 years of malignancy-free period and after gaining immunity against EBV (in previously negative patients) e) Re-transplantation must be performed with prophylactic use of rituximab",d
Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study,"In the CKiD study, a relatively high percentage of children with mild to moderate CKD can manifest mild neurocognitive difficulties in: a) Impulsivity b) Verbal IQ c) Parent ratings of executive functions d) Anxiety",c
Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study,"From the CKiD study, there are a variety of factors that have been associated with neurocognitive functioning including: a) Low bicarbonate and low blood pressure variability b) High bicarbonate and high blood pressure variability c) Low bicarbonate and high blood pressure d) High bicarbonate and low blood pressure",b
Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study,Children with mild to moderate CKD show: a) Rates of depression that are slightly higher than that found in the normal population b) Extremely high rates of depression c) Extremely high rates of behavior problems d) Extremely low rates of depression,a
Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study,"On quality of life ratings, parents and youth reported: a) Ratings in the physical and emotional domains to be significantly more impaired when compared to similar reports from healthy children. b) Ratings in the physical domain to be significantly more impaired when compared to similar reports from healthy children. c) Ratings in the physical, school, social, and emotional domains to be equivalent to those from healthy children. d) Ratings in the school and social domains to be significantly higher when compared to similar reports from healthy children.",a
Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study,"From the CKiD study, best practices would dictate: a) The need for annual comprehensive assessments. b) No need for any comprehensive assessments in this population. c) Appreciation for the various factors contributing to neurocognitive and psychosocial outcomes, including increased consideration for brain imaging and genetic testing strategies, and consideration for routine monitoring of neurocognitive and psychosocial functioning. d) A focus on neurocognitive assessments at more frequent intervals than emotional-behavioral assessments.",c
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis,"1. Which of the following statements is true? a) The infant’s weight, length and weight-for-length need only be measured when there are concerns about growth. b) The infant’s euvolemic weight, length and head circumference should be measured frequently and plotted on WHO growth charts. c) True gain in body weight in infants on peritoneal dialysis cannot be distinguished from fluid retention. d) An infant’s failure to gain weight is not a signal for nutritional intervention.",b
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis,2. Which of the following statements is true? a) The energy and protein intake for the conservatively managed infant with CKD should approximate that of the healthy infant. b) The energy and protein intake for the conservatively managed infant with CKD should be 150% higher than the requirements of the healthy infant. c) Infants with CKD on peritoneal dialysis require a lower protein intake than infants managed conservatively. d) The energy derived from glucose in the dialysate should not be included in the energy intake for the infant on peritoneal dialysis.,a
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis,3. Which of the following statements is true? a) Infants with CKD should be fed a renal-specific low potassium formula from birth. b) Infants with CKD can have cow’s milk as their main drink from 6 months of age. c) Breast milk or whey-dominant infant formula are the preferred feeds for infants with CKD throughout the first year. d) Casein-dominant infant formulas have a nutritional profile closest to breast milk.,c
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis,"4. Which of the following statements is true? a) Infants with CKD should have a healthy balanced diet avoiding sugars, fats and salt. b) Infants with CKD should avoid foods high in calcium, phosphate and potassium. c) Modification of the calcium, phosphate and potassium content of the diet of the infant with CKD can help maintain normal serum ranges. d) The introduction of solid foods should be delayed in the infant with CKD.",c
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis,"5. Which of the following statements is true? a) As soon as the infant’s weight starts to falter, start enteral tube feeding. b) As soon as the infant’s weight starts to falter restrict the intake of phosphate and potassium. c) As soon as the infant’s weight starts to falter, start peritoneal dialysis. d) As soon as the infant’s weight starts to falter, start nutritional supplementation of oral feeds and solid foods.",d
Palliative care for children and young people with stage 5 chronic kidney disease,Advance care planning discussions: a) Should result in an agreement regarding resuscitation and limitations of treatment. b) Are often a series of conversations over a period of time and decisions may change. c) Must be led by a palliative care physician. d) Should only involve the CYP in exceptional circumstances.,b
Palliative care for children and young people with stage 5 chronic kidney disease,"When involving CYP in decision-making: a) Child/young person’s age is the most important consideration. b) Clinician should meet with the child/young person alone. c) Child/young person’s wishes should take precedence over the wishes of parents. d) Child/young person should determine degree and timing of disclosure of information about care, treatment, condition, and prognosis.",d
Palliative care for children and young people with stage 5 chronic kidney disease,When selecting an opioid for pain management in CKD 5: a) Morphine should be avoided due to accumulation. b) Oxycodone is a good option for a long-acting opioid. c) Fentanyl or alfentanyl are the preferred option for a continuous infusion. d) The opioid dosing interval should generally be reduced.,c
Palliative care for children and young people with stage 5 chronic kidney disease,"When treating neuropathic pain in CKD 5: a) Ketamine should be used cautiously, with dose reduction. b) Gabapentin is safe to use without dose reduction. c) Tricyclics can be used cautiously. d) Pregabalin can be used but with dose reduction and a long dosing interval.",d
Palliative care for children and young people with stage 5 chronic kidney disease,"1. An 18-year-old Caucasian male with CKD secondary to dysplastic kidneys has been on maintenance hemodialysis for over 6 years. He was noted to have valvular calcifications on recent echocardiogram but has no cardiac symptoms. At the time of the study, he was on calcium carbonate (3.5 g/d) and received calcitriol in the past for elevated PTH. Laboratory studies revealed: serum calcium, 9.4 mg/dl; phosphate, 7.6 mg/dl; and immunoreactive PTH, 230 pg/ml (normal: 10–65 pg/ml). Of the following statements about this patient’s condition, the most accurate is. a) The finding of vascular calcification can be associated with the history of hyperparathyroidism, poor control of hyperphosphatemia, and previous use of calcium-based phosphate binders. b) The echocardiogram findings more likely reflect effects of high LDL and low HDL levels than abnormalities in calcium and phosphate metabolism. c) Vascular calcifications are related to present or the previous hypoparathyroidism in children and adolescents with CKD-MBD. d) In CKD, vascular calcifications are associated with an increased risk of cardiovascular mortality later in life but not at this age.",a
Pediatric CKD-MBD: existing and emerging treatment approaches,"2. You are consulted on a 10-year-old boy with newly diagnosed CKD. By history, the patient voids several times each night. On examination, he is pale. His height and weight are both below the third percentile. He has normal blood pressure and Tanner 1 pubertal development. Laboratory tests: Sodium mEq/L (mmol/L) 136 (136), Potassium mEq/L (mmol/L) 3.8 (3.8), Chloride mEq/L (mmol/L) 108 (108), Total carbon dioxide mEq/L (mmol/L) 18 (18), Serum urea nitrogen mg/dL (mmol/L) 40 (14.3), Creatinine mg/dL (µmol/L) 1.8 (159), Calcium mg/dL (mmol/L) 9.9 (2.5), Phosphorus mg/dL (mmol/L) 4.0 (1.3), Intact parathyroid hormone pg/mL (ng/L)170 (18), 25-OH-vitamin D ng/mL (nmol/L) 12 (30). The next most appropriate step in the treatment of his CKD-MBD is to initiate. a) calcitriol. b) vitamin D supplementation. c) paricalcitol. d) sevelamer carbonate.",b
Pediatric CKD-MBD: existing and emerging treatment approaches,"3. A 16-year-old boy who has been on chronic PD for 2 years presents with lower extremity pain. He reports nonadherence with his prescribed diet, phosphate binders, and calcitriol but has not missed any dialysis treatments. His laboratory data are as follows: Laboratory test: Calcium mg/dL (mmol/L) 8.3 (2.0), Phosphorus mg/dL (mmol/L) 7.7 (2.4), Intact parathyroid hormone pg/mL (ng/L) 928 (97.7), Alkaline phosphatase IU/L (µkat/L) 345 (5.7). Based on the laboratory data, the child’s renal osteodystrophy findings could best be postulated as. a) adynamic bone. b) high bone turnover. c) low bone turnover. d) low bone volume.",b
Pediatric CKD-MBD: existing and emerging treatment approaches,"4. A 7-year-old boy on chronic PD for 2 years secondary to dysplastic kidneys presents to the clinic. When he started treatment, his height was decreased for age (height Z-score = − 2.4 SD), and his height improvement on dialysis has been minimal (Δ height Z-score = + 0.1 SD). In addition, he recently developed bilateral hip pain on ambulation and reduced exercise capacity. His medications include calcium carbonate, calcitriol, and sodium bicarbonate. His laboratory findings are as follows: Sodium mEq/L (mmol/L) 135 (135), Potassium mEq/L (mmol/L) 3.9 (3.9), Bicarbonate mEq/L (mmol/L) 16 (16), Calcium mg/dL (mmol/L) 8.5 (2.1), Phosphorus mg/dL (mmol/L) 7.4 (2.3), Serum urea nitrogen mg/dL (mmol/L) 65 (23.3), Creatinine mg/dL (µmol/L) 5 (442). Of the following, the most reliable and definitive test to assess the type and severity of his CKD-MBD is: a) bone biopsy b) combination of parathyroid hormone level and 25 hydroxyvitamin D c) serum osteocalcin and urine bone turnover markers d) 1,25 dihydroxyvitamin D level",a
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease,"What is the effect of the plant-based diet on bioavailability of nutrients and production of trimethylamine-N-oxide? a) Plant-based diet has increased bioavailability of protein, phosphorus, and potassium content compared to animal-based diet and decreases production of trimethylamine-N-oxide. b) Plant-based diet has increased bioavailability of protein, phosphorus, and potassium content as compared to animal-based diet and decreases production of trimethylamine-N-oxide. c) Plant-based diet has decreased bioavailability of protein, phosphorus, and potassium content compared to animal-based diet and decreases production of trimethylamine-N-oxide. d) Plant-based diet has decreased bioavailability of protein, phosphorus, and potassium content compared to animal-based diet and increases production of trimethylamine-N-oxide.",c
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease,Which of the below statements regarding fat sources in plant-based diets is true? a) Fat from animal origin is high in saturated fats and low in unsaturated fats. b) Fat from plant-based diet is high in saturated fats and low in unsaturated fats. c) Vegetarian diets are high in lecithin compared to animal-based diets. d) Omega-3 and omega-6 fatty acids are types of monounsaturated fatty acids found in the plant-based diet.,a
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease,"Choose the best answer: a) Plant-based diet is known to help with obesity, hypertension, and dyslipidemia. b) Plant-based diet improves gut microbiota. c) Plant-based diet increases production of short-chain fatty acids. d) Fiber in the plant-based diet decreases gut motility. e) A, B, and C are true.",e
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease,Which of the following options would be the best snack choice for a child with CKD: a) Packaged cheese and crackers b) Carrot sticks with homemade hummus c) Artificially fruit-flavored gummy snacks d) Baked low-sodium potato chips,b
Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease,Choose the best answer. Non-dairy almond milk alternative beverages: a) Are a better source of calories and protein compared to cow’s milk. b) Can be used as a plant-based substitute for breastmilk in infants with CKD. c) Is lower in potassium and phosphorus compared to cow’s milk and soy milk. d) All of the above.,c
Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents,"Which endothelin activates endothelinA receptors? a) Only endothelin-1 b) Only endothelin-2 c) Only endothelin-3 d) Both endothelin-1 and endothelin-2 e) Endothelin-1, endothelin-2 and endothelin-3 all activate endothelinA receptors",d
Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents,Which of these substances does not stimulate the synthesis of endothelin-1? a) Thrombin b) TNF-α c) Heparin d) Insulin e) Vasopressin,c
Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents,"Which of these statements is incorrect? a) To be active, the nitric oxide synthase enzyme requires all these cofactors: NADH, FAD, FMN, BH4. b) The nitric oxide synthase enzyme is stimulated by endothelin-3. c) Endothelin-3 stimulates vasodilation through cyclic GMP and endothelium-derived hyperpolarizing factors. d) The nitric oxide synthase enzyme is always active in the central nervous system. e) Estrogen stimulates the production of nitric oxide synthase enzyme.",d
Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents,How is endothelial dysfunction defined? a) An imbalance between vasodilating and vasoconstricting substances produced by muscle cells b) An imbalance between vasodilating and vasoconstricting substances produced by endothelial cells c) An increase in vasodilation capacity d) A decrease of pro-inflammatory and pro-thrombotic state e) An increase of nitric oxide bioavailability and a decrease of endothelin-1 plasma values,b
Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents,The balance of nitric oxide and endothelin-1 in hypertensive children: a) is similar to that described in hypertensive adults b) is similar to that described in hypertensive adults only regarding the bioavailability of nitric oxide c) is influenced by the presence of excess weight d) is always characterized by an increase in plasma endothelin-1 values e) has been studied predominantly in prepubescent children and there is a lack of evidence in adolescents,c
Post-transplant education for kidney recipients and their caregivers,Which of the following combinations represents an age-appropriate educational strategy? A) Adolescence – focus education on caregivers to prevent loss of follow-up during transition B) Early childhood – start patient-centered education C) Middle childhood – allow time for the patient to ask independent questions D) Infancy/ Toddler – explain things simply and briefly in a way the child can understand,c
Post-transplant education for kidney recipients and their caregivers,Which of the following strategies has been shown to improve patient understanding of disease processes? A) Individualization of education B) Making material understandable to those with low health literacy C) Culturally competent education D) Providing resources to help patients navigate complex healthcare systems E) All of the above,e
Post-transplant education for kidney recipients and their caregivers,"Discussion of dietary recommendations in the post-transplant period should include all but one of the following: A) Weight gain and obesity are uncommon complications after transplantation, as physical activity generally increases B) Fluid intake goals are likely to change in the post-transplant period, shifting from a restrictive to a permissive fluid goal C) Sodium may need to be restricted to prevent hypertension in the post-transplant period D) Patients should avoid taking grapefruit juice with their immunosuppressive medications",a
Post-transplant education for kidney recipients and their caregivers,"Which of the following statements regarding post-transplant management is inaccurate? A) Live vaccines are preferred to be given prior to transplantation; however, in some situations, a risk–benefit analysis may favor post-transplant administration B) Estrogen-containing contraceptive methods have been shown to be safe in female transplant recipients and therefore can be used in any post-transplant recipient of reproductive age C) Transplant recipients should adhere to age-appropriate USPSTF STI screening recommendations at least as often as healthy children D) Most sports have a low risk of kidney injury and can be performed by transplant recipients with appropriate modifications as needed",b
Rickets guidance part II—management,"Which of the following statements is true? a) The cause of nutritional rickets is always a deficiency of vitamin D. b) Nutritional rickets can be excluded if the 1,25(OH)2D is highly normal or even outside the upper normal range. c) Therapy of nutritional rickets is exclusively done with high vitamin D supplementation. d) During monitoring of nutritional rickets, the drop in PTH is the earliest and most important indicator of response to therapy. e) In case of tetany due to nutritional rickets, rapid initiation of vitamin D supplementation is sufficient.",d
Rickets guidance part II—management,Which of the following statements is true? a) The marked hypophosphatemia which may be present in nutritional rickets requires oral supplementation with phosphate salts. b) The diagnosis of vitamin D-dependent rickets type 1B should be considered if high-dose therapy with native vitamin D does not lead to a normalization of 25-OHD and a concomitant decrease in PTH levels. c) Intramuscular injection of vitamin D is the treatment of choice in nutritional rickets. d) Vitamin D-dependent rickets type 2a and 2b differ with respect to response to calcitriol therapy. e) Administration of intravenous calcium is the therapy of choice in vitamin D-dependent rickets type 1B in the first months of life.,b
Rickets guidance part II—management,"Which of the following statements is true? a) Monitoring of children with hypophosphatemic rickets treated with phosphate salts and active vitamin D includes the assessment of serum phosphate, calcium, alkaline phosphatase, creatinine, 1,25(OH)2 vitamin D, and calculation of maximum rate of tubular reabsorption of phosphate per glomerular filtration rate (TmP/GFR). b) Children with hypophosphatemic rickets should undergo yearly X-ray examinations of the left wrist and/or lower limbs. c) Patients with hypophosphatemic rickets due to defects in sodium-dependent tubular phosphate transporters should undergo yearly hearing tests. d) Calculation of maximum rate of tubular reabsorption of phosphate per glomerular filtration rate (TmP/GFR) is recommended to assess renal phosphate wasting in children on burosumab treatment. e) Assessment of PTH levels is not helpful in the management of children with hypophosphatemic rickets treated with burosumab.",d
Rickets guidance part II—management,Which of the following statements is true? a) Children with hypophosphatemic rickets are usually treated with phosphate salts and active vitamin D. b) Burosumab is the treatment of choice in infants aged less than 6 months with X-linked hypophosphatemia. c) Patients with hypophosphatemic rickets due to defects in sodium-dependent tubular phosphate transporters require no treatment with active vitamin D. d) Conventional treatment with phosphate salts and active vitamin D is more effective than burosumab treatment in patients with X-linked hypophosphatemia. e) Phosphate should be given in two divided doses in patients with X-linked hypophosphatemia.,c
Rickets guidance part II—management,Which of the following statements is true? a) High doses of phosphate and/or active vitamin D are associated with the development of nephrocalcinosis in children with hypophosphatemic rickets. b) The starting dose of burosumab in children with X-linked hypophosphatemia amounts to 0.4 mg/kg given every two weeks subcutaneously. c) The starting dose of burosumab in children with tumor-induced osteomalacia amounts to 0.8 mg/kg given every two weeks subcutaneously. d) Active vitamin D may be combined with burosumab for treatment of X-linked hypophosphatemia. e) Burosumab should be tailored in 0.4 mg/kg increments every two weeks to raise fasting serum phosphate levels to within the lower end of the normal reference range.,a
Role of therapeutic apheresis in the treatment of pediatric kidney diseases,1. Which of the following statements is not correct about the principles of TPE? a) A pathogenic molecule has to be identified which is large enough to be amenable to removal only by TPE. b) Use of TPE is associated with improvement in disease. c) Pathogenic molecules are mostly distributed intracellularly. d) The half-life of the molecule should be long enough such that it does not re-accumulate quickly after TPE.,c
Role of therapeutic apheresis in the treatment of pediatric kidney diseases,2. Which of the following statements about TPE use in pediatric kidney disorder is false? a) TPE has been used as successful adjunctive therapy for anti-glomerular basement membrane disease that has become dialysis-dependent. b) There is not much of a role for TPE in lupus nephritis. c) TPE is used for FSGS recurrence after kidney transplant in children with other immunosuppressive therapy. d) TPE is not used in ANCA vasculitis with mild kidney disease.,a
Role of therapeutic apheresis in the treatment of pediatric kidney diseases,3. TPE is the standard of care in which of the following thrombotic microangiopathy (TMA)? a) TTP b) Transplantation-associated TMA c) Quinine-associated TMA d) Shiga toxin-associated HUS,a
Role of therapeutic apheresis in the treatment of pediatric kidney diseases,4. TPE is a useful adjunct in all the following diseases affecting kidney transplantation except? a) Antibody-mediated rejection of kidney transplant b) Cellular rejection of kidney transplant c) Recurrence of FSGS in kidney transplantation d) ABO-incompatible kidney transplantation,b
Role of therapeutic apheresis in the treatment of pediatric kidney diseases,5. Which of the following statements is true regarding complications associated with apheresis? a) Hypocalcemia is more common with heparin-based anticoagulation. b) The use of FFP is associated with higher rates of allergic reactions. c) Tandem TPE requires less intensive monitoring for complications. d) Critically ill children who are getting TPE are at lower risk of complications.,b
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease?,What gene contributes to the majority of ADPKD cases? a) PKD1 b) PKD2 c) PKD3 d) CYS1 e) CYS2,a
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease?,What is the average age of ICA rupture in those with ADPKD? a) 12 years b) 20 years c) 34 years d) 40 years e) 52 years,d
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease?,What is the true prevalence of ICA in the ADPKD paediatric population? a) 0.1% b) 1% c) 2% d) 5% e) unknown,e
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease?,What is the imaging tool of choice for investigations for an ICA in children? a) CT b) X-ray c) TOF MRA d) Cranial ultrasound e) PET scan,c
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease?,Which of the following statistical measures are affected by the prevalence of a disorder? (2 correct) a) Sensitivity b) Specificity c) Positive predictive value d) Negative predictive value,c and d
Serum osmolality and hyperosmolar states,"1. A 5-year-old female patient was admitted to the pediatric emergency room with complaints of irritability, nausea, vomiting, and abdominal pain. Blood gas analysis showed pH 7.28, HCO3 18 mmol/dL; serum biochemistry revealed sodium 143 mEq/L, potassium 4.3 mEq/L, chloride 102 mEq/L, glucose 96 mg/dL, blood urea nitrogen 26 mg/dL, and creatinine 0.8 mg/dL. Fractional excretion of sodium was 0.8%. Serum osmolality was measured as 305 mOsm/kg with osmolal gap 22 mOsm/kg. What is the most probable diagnosis?\na. Renal tubular acidosis\nb. Hypernatremic dehydration\nc. Ethylene glycol poisoning\nd. Acute tubular necrosis\ne. Septic shock",c
Serum osmolality and hyperosmolar states,2. Which of the below conditions is not associated with an increased osmolal gap? a) Radiocontrast medium use b) Methanol intoxication c) Mannitol treatment d) Severe hyperproteinemia e) Sodium chloride administration,e
Serum osmolality and hyperosmolar states,3. Please select the false statement. a) Serum tonicity increases in cases of diabetic ketoacidosis. b) Serum tonicity increases in cases of acute hyperkalemia due to crush injury. c) An increase in serum tonicity is responded to by arginine vasopressin release and stimulation of thirst. d) Organic osmolytes are slowly removed during restoring serum osmolality. e) Rapid hemodialysis in the initiation of kidney replacement treatment can cause brain edema due to water shift into the brain cells with relatively higher urea concentrations.,b
Serum osmolality and hyperosmolar states,4. Which of the substances given below is not considered an organic osmolyte? a) Glutamate b) Aspartate c) Taurine d) Oxalate e) Glycine,d
Sociodemographic determinants of chronic kidney disease in Indigenous children,Which of the following is the most important risk factor for CKD in Indigenous children? a) Genetic predisposition. b) Post-infectious glomerulonephritis. c) Type 1 diabetes. d) Impacts of colonization including sociodemographic disadvantage.,d
Sociodemographic determinants of chronic kidney disease in Indigenous children,Which of the following statements about the developmental origins of health is most accurate? a) In utero exposures are only relevant to kidney development in the 1st and 2nd trimesters of pregnancy. b) Prenatal exposure to diabetes in pregnancy increases the risk of diabetes and kidney disease in offspring. c) Prenatal exposure to CKD in pregnancy increases the risk of diabetes and kidney disease in offspring. d) Indigenous individuals have glomeruli that are smaller than non-Indigenous individuals.,b
Sociodemographic determinants of chronic kidney disease in Indigenous children,"What prevention strategies would best address the high rates of CKD in Indigenous peoples? a) Exercise-based interventions. b) Multifaceted interventions that include screening for early risk factors, intensive follow-up and care that is culturally appropriate. c) Dialysis education. d) Prenatal vitamins.",b
Sociodemographic determinants of chronic kidney disease in Indigenous children,"What standard work-up should be considered for an asymptomatic Indigenous adolescent in the primary care setting? a) None—screening tests are not useful. b) BMI assessment only. c) Thyroid studies. d) Blood pressure, BMI assessment, creatinine for eGFR, HbA1c, and urine for assessment of albuminuria.",d
Sociodemographic determinants of chronic kidney disease in Indigenous children,What is the best argument for screening Indigenous children for metabolic and kidney disease? a) Early metabolic disease and CKD risk factors are modifiable with treatment. b) Screening for CKD is cost effective in children. c) There are none—screening is irrelevant in children. d) There are none—diabetes and CKD usually are associated with symptoms in children.,a
Monogenic forms of low-renin hypertension: clinical and molecular insights,"1. Monogenic hypertension can be excluded in a patient if: a) Patient’s mother has hypertension diagnosed at 40 years of age b) Blood pressure in a 15-year-old girl does not exceed 140/80, and there is no target organ damage c) Plasma aldosterone concentration is normal d) Blood potassium and acid–base balance is normal e) None of the above",e
Monogenic forms of low-renin hypertension: clinical and molecular insights,2. Which of the following abnormalities is NOT inherited as autosomal dominant: a) Intronic WNK1 mutation in pseudohypoaldosteronism type 2 b) Chimeric CYP11B1/CYP11B2 c) Deficiency of 11β-hydroxysteroid dehydrogenase-2 d) p.Ser810Leu mutation in NR3C2 e) SCNN1B defect in Liddle syndrome,c
Monogenic forms of low-renin hypertension: clinical and molecular insights,"3. Match the disorders with appropriate primary treatment: 1. Apparent mineralocorticoid excess A. Amiloride 2. Pseudohypoaldosteronism type 2 B. Low-dose dexamethasone 3. Liddle syndrome C. Hydrocortisone replacement 4. 17α-Hydroxylase deficiency D. Spironolactone E. Thiazide a) 1-A, 2-E, 3-D, 4-C b) 1-D, 2-E, 3-A, 4-C c) 1-E, 2-C, 3-D, 4-B d) 1-D, 2-B, 3-A, 4-C e) 1-D, 2-E, 3-A, 4-B",b
Monogenic forms of low-renin hypertension: clinical and molecular insights,"4. A 12-year-old boy presented with short stature (height −2.5 standard deviation) and blood pressure of 150/100. Father had hypertension diagnosed at 30 years of age and died following an intracranial bleed. Cardiac and abdominal examinations were unremarkable. Investigations showed Na 143 mEq/L, K 6.2 mEq/L, HCO3 18 mEq/L, and creatinine 0.48 mg/dl. The gene implicated for this condition most likely is: a) KCNJ5 b) HSD11B2 c) KCNJ1 d) CUL3 e) SCNN1G",d
Monogenic forms of low-renin hypertension: clinical and molecular insights,"5. A 3-year-old girl presented with poor weight gain, polyuria, and polydipsia since infancy. She was born at term weighing 2.1 kg. Family history was unremarkable. Blood pressure was 140/90 mmHg. Investigations were creatinine of 0.6 mg/dL, sodium of 144 mEq/L, potassium of 2.4 mEq/L, and bicarbonate 25 mEq/L. Ultrasound showed normal sized kidneys with medullary nephrocalcinosis, and Doppler showed normal renal vasculature. Plasma renin activity was 0.3 ng/mL/h (normal for age 3.0–9.0 ng/mL/h). Which is the next best approach for diagnosis? a) Urinary free cortisol:cortisone and sequencing of HSD11B2 b) Long PCR technique for CYP11B1/CYP11B2 c) Thiazide trial d) Overnight dexamethasone suppression test e) Plasma metanephrines and MIBG scan",a
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program,"1. In which situations might an extracorporeal KST be preferable over PD? a) Infants with congenital kidney failure b) Infants with extreme prematurity and low birthweight c) Infants with inborn errors of metabolism, e.g., hyperammonemia d) Infants with hemodynamic instability e) None of the above",c
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program,"2. All of the following are advantages of newer KST modalities (CVVH with Aquadex, CARPDIEM™) compared to traditional CKST (Prismaflex, NxStage), except a) Designed or adopted for the needs of smaller neonates and infants b) Do not require central venous access c) Smaller ECV which minimizes hemodynamic instability during treatment d) Precise control of clearance and ultrafiltration e) Fewer complications at initiation of therapy",b
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program,"3. Which of the following are essential members of the multidisciplinary team that cares for a neonate or infant with complicated AKI or CKF requiring KST: a) Nursing: bedside, dialysis, KST-trained b) Providers: nephrologists, advanced practitioners, neonatologists, and pharmacists c) Maternal fetal medicine, ethics, and palliative care d) Surgeons, interventional radiologists, hospital administrators and data team e) All of the above",e
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program,"4. When choosing the best KST modality for a particular infant: a) PD is always preferred over other KST modalities b) Newer KST platforms (CVVH with Aquadex, CARPEDIEM™) are preferred over PD c) The ideal modality varies depending on patient characteristics, indication, goals of therapy and local resources d) Extracorporeal KST cannot be performed in neonates and small infants e) None of the above",c
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program,5. Which of the following are effective approaches to KST team education? Choose all that apply. a) High-fidelity simulation b) Bedside clinical coaching and just-in-time teaching c) Didactics and online modules only d) Multidisciplinary neonatal KST educational programs e) None of the above,"a, b, d"
Kidney disease and thyroid dysfunction: the chicken or egg problem,1. Which of the following statements is true? a) Hypothyroidism is found less frequently in CKD patients than in the general population. b) Low T3 syndrome is rarely observed in DD-CKD patients. c) The prevalence of hyperthyroidism does not seem to be associated with CKD. d) The prevalence of hypothyroidism seems to decrease with CKD progression. e) The prevalence of thyroid disorders in NDD-CKD and DD-CKD patients has not been assessed so far.,c
Kidney disease and thyroid dysfunction: the chicken or egg problem,2. Which of the following statements is false? a) Hypothyroidism results in increased tubuloglomerular feedback with a sequential reduction in eGFR. b) The effects of hypothyroidism on glomerular filtration have only been shown indirectly using creatinine-based equations. c) Hypothyroidism affects the renin–angiotensin–aldosterone system which results in reduced autoregulation of the kidneys. d) Hypothyroidism reduces myocardial contractility. e) Hypothyroidism causes reduced expression of renal vasodilators such as nitric oxide.,b
Kidney disease and thyroid dysfunction: the chicken or egg problem,3. Which of the following statements is false? a) Uraemia is a frequent trigger of Graves’ disease. b) Children with congenital nephrotic syndrome often develop primary hypothyroidism. c) DD-CKD and its associated metabolic changes may be a cause of non-thyroidal illness. d) Metabolic acidosis seems to affect thyroid hormone and TSH levels. e) Nephrotic syndrome may result in depletion of thyroid hormones.,a
Kidney disease and thyroid dysfunction: the chicken or egg problem,4. Which of the following statements is true? a) Hypothyroidism leads to decreased serum creatinine levels. b) Assessment of thyroid function should not be taken into account when evaluating serial serum creatinine measurement in individual patients over time. c) Reduced activity of deiodinating enzymes has not been established as a potential cause of low T3 syndrome in DD-CKD patients. d) Hypothyroidism results in decreased serum cystatin C levels. e) Hyperthyroidism appears to result in an increase in serum creatinine levels.,d
Kidney disease and thyroid dysfunction: the chicken or egg problem,5. Which of the following statements is false? a) Hypothyroidism has been associated with an increased mortality in DD-CKD patients. b) Thyroid replacement therapy in NDD-CKD patients with subclinical hypothyroidism may attenuate the decline of kidney function. c) Low T3 syndrome has been associated with an increased mortality in DD-CKD patients. d) The optimal TSH range in NDD-CKD and DD-CKD patients remains to be established. e) The effect of hypothyroidism on the mortality of NDD-CKD and DD-CKD patients has not been assessed so far.,e
Pediatric Onco-Nephrology Time to Spread the Word-Part II,1. All the following post kidney transplant malignancies could be attributed to viral infections except: a) PTLD b) Anorectal cancer c) Lung cancer d) Skin cancer,c
Pediatric Onco-Nephrology Time to Spread the Word-Part II,2. Which of the following group of children are at highest risk of developing deterioration of kidney function on follow-up: a) Children with ALL b) Children with unilateral Wilms tumor who had partial nephrectomy and chemotherapy c) Children with unilateral Wilms tumor who had unilateral total nephrectomy and chemotherapy d) Children with unilateral Wilms tumor who had unilateral total nephrectomy and radiation therapy,d
Pediatric Onco-Nephrology Time to Spread the Word-Part II,"3. In children with PTLD, select one correct answer: a) Most cases diagnosed during the first year can be attributed to CMV infection. b) Most cases after the first post-transplant year are due to EBV infection in EBV-naïve children. c) Valganciclovir has proven activity against EBV in vivo. d) Chronic, low-grade EBV viremia in transplant recipients without development of PTLD is not uncommon.",d
Pediatric Onco-Nephrology Time to Spread the Word-Part II,4. You are taking care of a 4-year-old boy with stage 5 CKD. He has a history of Wilms tumor. He completed therapy when he was 3.5 years old. The earliest he can receive kidney transplant is when he is: a) 5 years old b) 6 years old c) 7 years old d) 8.5 years old e) 11 years old,d
Use of extracorporeal therapies to treat life-threatening intoxications,Which of the following is not a property of an ideally hemodialyzable drug? a) Small molecule size b) Small volume of distribution c) Lipophilic and non-polarity nature d) Low protein binding,c
Use of extracorporeal therapies to treat life-threatening intoxications,"A 10-kg child is admitted to your ICU with a salicylate overdose (VD = 0.2 l/kg, molecular weight = 180 Da, 30% protein bound in overdose setting). The salicylate level is 136 mg/dl, and the patient has developed respiratory failure requiring intubation. Which of the following is the next best step, following initial medical therapy with alkalinization? a) Perform pheresis with a 1.5 plasma volume exchange b) CKST with standard (20–30 cc/kg or 2000 cc/m2) clearance c) Continue medical therapy and recheck level in 4 h d) Hemodialysis with blood flow of 75 ml/min and dialysate flow of 500 ml/min for 3 h",d
Use of extracorporeal therapies to treat life-threatening intoxications,True or false: Diffusive clearance on CKST can achieve removal of larger “middle” molecules/toxins (15–30 kDa)? True False,False
Use of extracorporeal therapies to treat life-threatening intoxications,"You are called regarding a patient who accidentally received 10 times the intended dose of IV rituximab (144 kDa, volume of distribution < 0.2 l/kg, protein binding: negligible). Extracorporeal therapeutic removal is desired. Which is the best option? a) High-dose CKST with 4–5 times standard clearance b) Plasma exchange c) Hemofiltration using convective mode d) Standard hemodialysis",b
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d,"1. Which of the following statements is true? a) Dialysis patients are at risk for micronutrient deficiency but not excess due to the increased loss from dialytic clearance. b) Pediatric dialysis patients lose significant amounts of vitamin B12 in dialysate. c) Human body storage of thiamine is large and can last for several months despite deficient intake. d) Children with CKD might not meet the RDA intake for several water-soluble vitamins, but those who depend on enteral nutrition with formula often meet the RDA for water-soluble vitamins.",d
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d,2. Which of the following statements is true? a) Pediatric dialysis patients are spared from vitamin C toxicity due to their inadequate vitamin C intake and the dialyzability of vitamin C. b) Zinc toxicity manifests as copper deficiency as their levels are inversely related. c) Riboflavin toxicity can present as peripheral sensory neuropathy. d) Niacin is considered safe without toxicity even if consumed in large dosage.,b
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d,"3. Which of the following statements is true? a) There is a plethora of research on micronutrient disorders among children with CKD stage 5d. b) Patients who are on HD vs. PD are at similar risk for micronutrient deficiencies. c) Underlying CKD diagnosis (such as congenital nephrotic syndrome), residual urine output, diet/feeding, and other comorbidities (such as oncologic diagnoses or bowel surgeries) can all affect pediatric dialysis patients’ micronutrient status. d) Water-soluble multivitamin should be prescribed to all pediatric dialysis patients regardless of their diet.",c
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know,"Which of the following is untrue regarding proactive management of neurogenic bladder? a) CIC initiated at birth b) Urodynamics delayed until potty training age c) Anticholinergic medication initiated with findings of poor bladder compliance without hydronephrosis d) Kidney function studies (i.e. Creatinine, Cystatin- C) are regularly performed",b
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know,"The management of recurrent UTIs in children who perform CIC includes all of the following, except: a) Intravesical antibiotic administration b) Prophylactic oral antibiotics c) Optimization of bladder dynamics d) Retrograde colonic irrigation",d
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know,"Several medications can be used to treat poor compliant, high-pressure bladders, except: a) Oxybutynin b) Mirabegron c) Solifenacin d) Tamsulosin",d
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know,Intravesical injections of Botulinum toxin-A are effective to manage: a) High post void residual b) UTIs c) High pressure bladder d) Detrusor sphincter dyssynergia,c
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know,"The following are true regarding urological surgeries for neurogenic bladder except: a) Mitrofanoff is a continent catheterizable channel that facilitates CIC b) Urinary diversions should be done for all infants with high grade VUR c) Bladder augmentation comes with significant short- and long-term risks including stones, cancer, metabolic changes, UTIs, and mucus production d) VUR due to neurogenic bladder is usually secondary and management should be focused on improving bladder dynamics",b
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review,1. Which of the following statements is correct? a) TDM is useful in the monitoring of drugs with wide therapeutic window. b) Patients with nephrotic syndrome who received rituximab should have regular checks of serum drug levels to predict response. c) Equations validated in similar patient populations should be used to estimate drug AUC. d) Free drug level is often used to monitor treatment effectiveness in clinical practice. e) Pharmacodynamic monitoring is a cost-effective tool to aid dose titration.,c
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review,2. Which of the following factors does not contribute to the variability in drug levels in nephrotic syndrome? a) Hypoalbuminemia b) Nephrotic-range proteinuria c) Hypercholesterolemia d) Change in prednisolone dose e) Capillary refill time,e
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review,3. Which of the following scenarios is most indicated for pharmacokinetic TDM? a) A 4-year-old girl who received prednisolone at 60 mg/m2/day for newly diagnosed nephrotic syndrome b) A 10-year-old boy who received rituximab 2 weeks ago c) A 5-year-old boy who was started on MMF 1 week ago and is currently in disease remission d) A 5-year-old boy who was started on MMF 2 weeks ago and is admitted to the hospital due to a disease relapse e) A 4-year-old girl who is receiving tacrolimus on a stable dose. Her last blood level check was 2 weeks ago.,c
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review,4. Which of the following statements regarding mycophenolate-based therapy is incorrect? a) The use of a proton pump inhibitor may reduce the efficacy of MMF. b) TDM is not recommended during therapy of MMF or EC-MPS. c) A higher range of MPA AUC is recommended in NS as compared to kidney transplantation. d) The measured total MPA level is reduced during the time of NS relapse with a serum albumin level of 10 g/dl. e) A low trough MPA level is associated with a higher risk of NS relapse.,b
The impact of rural status on pediatric chronic kidney disease,"1. What is the universal definition of rurality? a) Living outside of a city b) There is no universal definition of rurality c) Residing more than 30 km from a town d) Areas with less than 10,000 people per square mile",b
The impact of rural status on pediatric chronic kidney disease,2. Which of the following domains of care from Levesque et al.’s model of access to care would best encompass issues with having very few pediatric nephrologists in a rural state? a) Acceptability b) Appropriateness c) Availability and accommodation d) Affordability,c
The impact of rural status on pediatric chronic kidney disease,3. How is the current pediatric care capacity in the United States changing? a) Fewer hospitals that provide pediatric inpatient care b) Rural hospitals are admitting more pediatric patients c) Creation of regionalized tiered systems of pediatric inpatient care based on acuity d) Development of long-term telemedicine programs to deliver pediatric inpatient care in rural hospitals,a
The impact of rural status on pediatric chronic kidney disease,4. What was unique about the screening programs presented in Guatemala and Canada? a) Use of a novel technique to measure blood pressure and estimate GFR b) Implementation of population-based screening programs in high-risk rural communities c) Employing telehealth strategies to connect with rural populations from existing medical centers d) Integration of CKD care into a primary care clinic visit,b
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services,1. Which of the following statements is true regarding the transition period for AYA and young adults with chronic health conditions? <br> a) It is associated with improved adherence to medications. <br> b) The added responsibility of navigating the health care system is good for development. <br> c) It is associated with poor health outcomes and increased hospital visits. <br> d) Risk of graft loss is the same regardless of the type of support received during transition.,c
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services,2. Select the true statement regarding the primary care medical home model. <br> a) The specialist serves as the hub to coordinate patient care. <br> b) Coordinates care and communication for smooth transitions. <br> c) Relies on the caregiver and families to coordinate care and transition. <br> d) Does not focus on prevention and wellness.,b
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services,3. Barriers to maintaining continuity of care include all of the following except: <br> a) Lack of clearly defined roles and responsibilities of primary care providers. <br> b) Inadequate education and training of primary care providers around complex care and coordination of care. <br> c) Lack of communication between primary care providers and specialists. <br> d) Guidelines and frameworks to allow effective and smooth transition.,d
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services,4. Adolescents and young adults with chronic kidney disease will benefit from multidisciplinary care and special transition of care services. All of the below responses are true except: <br> a) They may have developmental and cognitive delays. <br> b) They frequently take multiple medications. <br> c) There is an increased risk of kidney failure and kidney transplant graft loss during transition. <br> d) Specialized transition care services can replace primary care services.,d
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services,5. Continuity of care has a critical role in transitioning from pediatric to adult care. Which of the following statements is true? <br> a) Management continuation involves the use of information and past events to make decisions. <br> b) Relational continuity is an ongoing therapeutic relationship between the patient and health care provider(s). <br> c) Informational continuity is a cohesive management approach to caring for a patient’s changing needs. <br> d) Continuity of care is illness-specific and does not exceed beyond that illness period.,b
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury,1. What is the safe threshold of priming volume for an extracorporeal dialysis treatment (as a percentage of the patient’s blood volume)? <br> a) 3% <br> b) 5% <br> c) 10% <br> d) 20%,c
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury,"2. What is one of the greatest technical innovations of the CARPEDIEM dialysis machine? <br> a) the three-roller pump, which allows for controlled flows even in small-sized catheters <br> b) the ability to perform CVVHD <br> c) the possibility of using the device with catheters of different sizes <br> d) the possibility to use three different filters",a
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury,"3. What makes a device, specifically designed for neonatal dialysis, safe and reliable? <br> a) the small size of the hardware <br> b) the accuracy of the scales and alarms <br> c) the ability to perform multiple types of extracorporeal treatments <br> d) the possibility of performing blood priming",b
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury,4. What is one of the biggest challenges of neonatal CKRT when performed with adult dialysis machines? <br> a) the patient’s lack of compliance <br> b) the requested size of the vascular access and the need for circuit priming <br> c) the inadequate warming system for dialysis fluids <br> d) the absence of a dedicated fluid management monitoring tool,b
Hypertension in diabetes,"1. Which of the following statements regarding hypertension and diabetes in the adult population is false?<br>a. Hypertension is approximately twice as prevalent in those with diabetes compared to the general population.<br>b. There is a two-fold higher risk of hypertension in prediabetic patients compared to those with normoglycemia.<br>c. In the US adult population, hypertension affects 30% of patients with type 2 diabetes and up to 80% of patients with T1D.<br>d. In the setting of diabetes, hypertension often requires several anti-hypertensive medications to achieve BP targets.<br>e. In the setting of diabetes, hypertension serves to accelerate the rate of adverse macrovascular and microvascular outcomes.",c
Hypertension in diabetes,"2. Which of the following regarding the epidemiology of hypertension and diabetes in the paediatric population is false?<br>a. Studies suggest poor self-awareness of hypertension in youths with T1D and T2D.<br>b. Hypertension is often over-diagnosed and over-treated in paediatric patients with diabetes.<br>c. In children with T1D, hypertension has a prevalence of 6%.<br>d. In adolescents with T2D, hypertension may occur with a prevalence of 12–31%.<br>e. Appropriate management of hypertension in adolescent patients with evidence of target organ damage can lead to reversal of these findings.",b
Hypertension in diabetes,"3. Which of the following is true regarding the interplay of hyperglycemia, inflammation, and hypertension?<br>a. Hyperglycemia is associated with increased ROS production, which can uncouple eNOS from NO production.<br>b. Hyperglycemia induces increased plasma concentrations of inflammatory cytokines when the effect of insulin is blocked by octreotide, and this effect is potentiated in those with hypertension.<br>c. Hyperglycemia accelerates the formation of AGEs, which lead to vascular inflammation and cross-linking of elastin, collagen, and other ECM components, resulting in decreased arterial wall elasticity.<br>d. Sympathetic kidney denervation has been demonstrated to improve fasting glucose levels and glucose tolerance in humans subjects with treatment-resistant hypertension.<br>e. All are true.",e
Hypertension in diabetes,"4. With respect to the renin–angiotensin–aldosterone system (RAAS) in diabetes, the following statements are correct except for?<br>a. In vitro and animal studies suggest that hyperglycemia can trigger RAAS activation.<br>b. ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) have also been shown to improve insulin sensitivity and reduce diabetic complications in animal models.<br>c. Angiotensin II (AngII) increases sodium retention by increasing activity of the Na–H exchanger in the proximal convoluted tubule and by directly stimulating the release of aldosterone from the adrenal medulla, which in turn increases the expression of the epithelial Na channel in the principal cell of the distal convoluted tubule.<br>d. AngII can decrease systemic vascular resistance by mediating systemic arteriolar vasodilation by increasing endothelin-1 and the production of reactive oxygen species.<br>e. AngII may contribute to insulin resistance in T2D as evidenced by rodent studies.",d
Hypertension in diabetes,"5. Which of the following regarding the use of RAAS blockers in the setting of diabetes is false?<br>a. RAAS blockers are thought to have a particular therapeutic advantage in the setting of diabetes due to improving the hemodynamics in the glomerulus and protecting against maladaptive processes.<br>b. Several studies have demonstrated a clinically significant role for RAAS blockers in delaying the onset and progression of albuminuria and diabetic nephropathy.<br>c. RAAS blockers are recommended in most guidelines as first-line therapy in the treatment of hypertension in the setting of diabetes.<br>d. When compared to other antihypertensive medications, RAAS blockers consistently have been demonstrated to improve all cardiovascular and kidney outcomes.<br>e. C and D.",d
Hypertension in diabetes,"6. Regarding the differences in defining and managing hypertension and diabetes between adult and paediatric populations, which of the following is true?<br>a. Blood pressure targets in adults are based on normative distributions in healthy individuals.<br>b. Blood pressure targets in children are based on outcome data regarding BP limits above which there is a higher risk of morbidity and mortality.<br>c. Anti-hypertensive medications are generally as easily accessible for paediatric patients as they are for adult patients.<br>d. More paediatric-specific studies of hypertension and diabetes are needed, and the inclusion of paediatric patients in future trials is important.",d
Hypertension in diabetes,"7. Regarding the third generation mineralocorticoid receptor antagonist finerenone, which of the following statements is true?<br>a. Finerenone has a higher affinity for the mineralocorticoid receptor than spironolactone.<br>b. Finerenone is approved in North America for use in adult patients with chronic kidney disease and T2D.<br>c. The main adverse event experienced by the participants of the FiGARO and FIDELIO trials in adults was hyperkalemia.<br>d. All of the above.<br>e. None of the above.",d
Holistic care and symptom management for pediatric kidney transplant recipients,"Symptom management includes which three domains? a) Social work, psychology, nephrology b) Therapy, medications, exercise c) Personal, environmental, and health and illness factors d) Mental, emotional, physical",c
Holistic care and symptom management for pediatric kidney transplant recipients,The USPSTF recommends that all children what age and older be routinely screened for anxiety? a) 8 years b) 10 years c) 12 years d) 13 years,a
Holistic care and symptom management for pediatric kidney transplant recipients,Which of the following factors have been shown to have an association with non-adherence? a) Poor body image b) Depression c) Increased experience of side effects d) All of the above,d
Fluid management in children with volume depletion,1. Which of the following statements reflects the relationship between change of serum osmolality and release of AVP?<br>a. Decreased serum osmolality detected by osmoreceptors in proximal nephron results in release of AVP.<br>b. Decreased serum osmolality detected by osmoreceptors in hypothalamus results in release of AVP.<br>c. Increased serum osmolality detected by osmoreceptors in proximal nephron results in release of AVP.<br>d. Increased serum osmolality detected by osmoreceptors in hypothalamus results in release of AVP.,d
Fluid management in children with volume depletion,2. Which of the following statements is true?<br>a. Oral or enteral rehydration therapy is only used in mildly dehydrated children.<br>b. Enteral rehydration is associated with fewer major adverse events and shorter hospital stay in children compared to parenteral therapy.<br>c. Children with hyponatremic dehydration should always receive hypertonic saline to prevent development of cerebral edema.<br>d. The optimal correction rate of serum sodium in children with hyponatremic encephalopathy is 10–15 meq/l increase over 24 h.,b
Fluid management in children with volume depletion,"3. A 20-kg boy presents with vomiting and diarrhea and a 10% volume loss. On admission he is somnolent, with blood pressure of 70/30 mm Hg and has clinical signs of dehydration. His plasma sodium is 144 mmol/l and creatinine is 32 µmol/l (0.36 mg/dl). His total body water is 0.6 × 20 kg = 12 l. His water maintenance requirements are 1500 ml/day. His fluid deficit is 10% of 12 l = 1.2 l. Of the following treatment courses, which would be the most preferable?<br>a. 0.9% NaCl 20 ml/kg (400 ml/h) should be administered initially and repeated as necessary after reassessment of the child to cover the fluid deficit followed by 0.9% NaCl solution at 70 ml/h. The rate of the infusion should be decreased when oral fluid intake is restored.<br>b. 0.45% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>c. 3% NaCl 2 ml/kg for 10-min infusion should be administered initially to prevent the development of brain edema followed by a 0.45% NaCl solution 70 ml/h.<br>d. 5% glucose 20 ml/kg (400 ml/h) for 3 h should be administered initially to replace the fluid deficit followed by 0.9% NaCl solution 70 ml/h. The infusion rate should be decreased when oral fluid intake is restored.",a
Fluid management in children with volume depletion,"4. A 10-kg girl presents with generalized convulsions. She has a history of 3 days of severe diarrhea. The parents noticed her reduced urine output over the last 2 days. She lost approximately 1 kg of weight. She was able to drink tea and water despite the weight loss. Her physical examination is consistent with severe dehydration. Her blood pressure is 80/40 mm Hg. Laboratory examination shows plasma osmolality of 240 mmol/l, plasma sodium 115 mmol/l, plasma potassium 5 mmol/l, and plasma creatinine 60 µmol/l (0.68 mg/dl). Her FENa is 0.3%. Her total body water is 0.6 × 10 kg = 6 l. Her water maintenance requirements are 1000 ml/day. Her fluid deficit is 10% of 6 l = 600 ml. Her sodium deficit is 0.6 × 6 l × (125 − 115) = 36 mmol. Of the following treatment courses, which would be the most preferable?<br>a. 0.9% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>b. 0.45% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>c. Administration of 3% NaCl is indicated (2 ml/kg) over 10 minutes. It may be repeated until symptoms resolve.<br>d. Administration of 3% NaCl is indicated (10 ml/kg) over 15 minutes. It may be repeated until symptoms resolve.",c
"Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families",By what week is fetal urine the major contributor to amniotic fluid?a) 8 weeks b) 14 weeks c) 20 weeks d) 24 weeks,e
"Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families",What is the 50th centile for renal pelvis size at term? a) 4 mm b) 7 mm c) 12 mm d) 15 mm,b
"Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families",Variants in HNF1β have been associated with which of the following prenatal phenotypes? a) Bilateral multicystic dysplastic kidneys b) Bilateral hyperechogenic kidneys c) Unilateral kidney hypoplasia d) Isolated upper urinary tract dilation e) All of the above,b
"Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families",True or false: prenatal diagnosis of a congenital anomaly can be considered a traumatic experience. a) True b) False,e
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding,"1. Which statement is correct: a) The process of bone formation, resorption and remodelling is known as bone turnover b) Cortical bone is more metabolically active than trabecular bone c) The trabecular compartment is the mineral rich, dense bone compartment d) There are only 2 cell types in the bone; osteoblasts and osteoclasts e) The predominant driving force in bone in adults is bone formation",a
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding,2. Clinical manifestation of mineral bone disease includes: a) Bone pain b) Limb deformities c) Fractures d) Slipped epiphyses e) All of the above,e
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding,3. Calcium balance is: a) Positive until around 30 years of age b) Positive until around 15 years of age c) Positive until around 50 years of age d) Negative after 60 years of age e) Neutral throughout life,a
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding,4. The predominant abnormality found in bone biopsies of children with CKD is: a) Low bone turnover b) High bone turnover c) Abnormal mineralization d) Osteitis fibrosa e) Aluminium staining,c
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding,5. Which statement is correct: a) Vascular calcification is associated with an increased morbidity and mortality in people with CKD b) Coronary artery calcification is only seen in older adults with CKD c) Dialysis attenuates the progression of vascular calcification d) Vascular calcification involves dumping of excess calcium and phosphate from calcium-containing medications in blood vessels,a
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities,What is the spontaneous process of activation of the alternative pathway (AP) of complement called? a) Tickover b) Autocleavage c) Hydrosilation d) Dehydration,a
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities,"What are the components of complement called ""anaphylatoxins""? a) C1q, C2a b) C3b, C5b c) C3a, C5a d) C5B-9",c
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities,Which of the following complement inhibitors act on the LP? a) Iptacopan b) Danicopan c) Narsoplimab d) Pegcetacoplan,c
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities,Which bioengineering innovations prolong the half-life of ravulizumab compared to eculizumab? a) Complete humanization of the molecule b) Amino acid substitutions c) Pegylation of the molecule d) Greater dissociative capacity from C5,b
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities,What is currently the only complement inhibitor indicated for AAV? a) Pegcetacoplan b) Eculizumab c) Narsoplimab d) Avacopan,d
Kidney manifestations of pediatric Sjögren’s syndrome,Which of the following statements is true about pediatric Sjögren’s syndrome? A) Sicca syndrome is the most significant feature. B) Kidney involvement is not relevant in affected patients. C) Kidney failure has been observed due to severe kidney involvement. D) Current classification criteria are accurate enough for the pediatric population.,C
Kidney manifestations of pediatric Sjögren’s syndrome,What percentage of children with Sjögren’s syndrome has kidney manifestations? A) 5–20.5% B) 1–5% C) 45–70% D) 0.5–2%,A
Kidney manifestations of pediatric Sjögren’s syndrome,Which of the following manifestations of tubulointerstitial nephritis is the most feared in children? A) Macroscopic hematuria B) Mild impaired urinary concentrating ability C) Periodic hypokalemic paralysis D) Severe proteinuria,C
Kidney manifestations of pediatric Sjögren’s syndrome,What is the most serious long-term complication in pediatric Sjögren’s syndrome with kidney involvement? A) Recurrent nephrolithiasis B) Persistent proteinuria C) Diabetes insipidus D) Extranodal marginal zone lymphomas,D
Kidney manifestations of pediatric Sjögren’s syndrome,Which of the following classification criteria for Sjögren’s syndrome includes kidney manifestation? A) The 2016 ACR/EULAR criteria for all patients with Sjögren’s syndrome B) The 1999 criteria for children and adolescents with Sjögren’s syndrome C) The 2002 AECG criteria for all patients with Sjögren’s syndrome D) None of these,B