MCQs on Chronic Kidney Disease

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

James, a 62-year-old man with a history of type 2 diabetes and hypertension, presents for routine follow-up. His serum creatinine is 1.4 mg/dL (normal: 0.6–1.2 mg/dL). Estimated glomerular filtration rate (eGFR) is calculated as 58 mL/min/1.73 m². Urinalysis shows albumin-to-creatinine ratio (ACR) of 45 mg/mmol. He has no symptoms and physical examination is unremarkable.

Which of the following is the correct classification of his chronic kidney disease?

A) G1A1 – Normal kidney function
B) G2A2 – Mildly decreased eGFR with moderately increased albuminuria
C) G3aA2 – Mild-to-moderate eGFR reduction with moderately increased albuminuria
D) G3bA3 – Moderate-to-severe eGFR reduction with severely increased albuminuria
E) G4A2 – Severely decreased eGFR with moderately increased albuminuria

Correct Answer: C) G3aA2 – Mild-to-moderate eGFR reduction with moderately increased albuminuria

Explanation:
Chronic Kidney Disease is staged by two key parameters: eGFR (G stage) and albuminuria (A stage) according to KDIGO guidelines.

James has an eGFR of 58, which classifies as G3a (45–59 mL/min/1.73 m²).
His albumin-to-creatinine ratio is 45 mg/mmol, equivalent to 400 mg/g, which falls in the A2 category (30–300 mg/g or 3–30 mg/mmol).
Therefore, he is classified as G3aA2.

Why the other options are incorrect:

A) G1A1: Would require normal eGFR (≥90) and normal ACR (<3 mg/mmol), which James does not have.
B) G2A2: G2 requires eGFR 60–89, but James is at 58.
D) G3bA3: G3b is eGFR 30–44 and A3 is ACR >30 mg/mmol. James does not meet either criterion.
E) G4A2: G4 is eGFR 15–29; his eGFR is higher.

Question 2

Linda, a 54-year-old woman, presents for evaluation of mildly elevated serum creatinine found on routine blood testing. Her creatinine is 1.3 mg/dL, and estimated GFR is 62 mL/min/1.73 m². She has no urinary symptoms. Her medical history includes long-standing poorly controlled type 2 diabetes mellitus, hypertension, and obesity. She takes metformin and amlodipine. Urinalysis shows microalbuminuria (ACR 5 mg/mmol). Fundoscopy reveals background diabetic retinopathy.

Which of the following is the most likely cause of her chronic kidney disease?

A) Hypertensive nephrosclerosis
B) Diabetic nephropathy
C) Polycystic kidney disease
D) Chronic glomerulonephritis
E) Obstructive uropathy

Correct Answer: B) Diabetic nephropathy

Explanation:
The most likely cause of CKD in this patient is diabetic nephropathy, given:

History of long-standing diabetes with poor control
Presence of microalbuminuria, a hallmark of early diabetic kidney disease
Diabetic retinopathy, which strongly supports diabetic nephropathy over other causes

Diabetic nephropathy is the most common cause of CKD and end-stage renal disease worldwide.

Why the other options are incorrect:

A) Hypertensive nephrosclerosis is possible, but usually occurs later and without albuminuria or retinopathy.
C) Polycystic kidney disease usually presents with enlarged kidneys and positive family history.
D) Chronic glomerulonephritis would be more likely with hematuria or red cell casts.
E) Obstructive uropathy would usually present with symptoms like hesitancy, weak stream, or a history of stones or prostate disease.

Question 3

Mark, a 68-year-old man with stage 4 chronic kidney disease, presents with increasing fatigue and shortness of breath. He also reports generalized itching and poor appetite. His blood pressure is 160/95 mmHg. Physical examination reveals pallor and bilateral ankle oedema. Laboratory investigations show:

Hemoglobin: 87 g/L
Serum calcium: 2.00 mmol/L (low)
Serum phosphate: 1.9 mmol/L (high)
Parathyroid hormone (PTH): Elevated
eGFR: 22 mL/min/1.73 m²

Which of the following is the most likely explanation for his anemia?

A) Chronic blood loss from the gastrointestinal tract
B) Iron deficiency
C) Anemia of chronic disease
D) Erythropoietin deficiency
E) Vitamin B12 deficiency

Correct Answer: D) Erythropoietin deficiency

Explanation:
In chronic kidney disease, especially at stage 4 or 5, anemia is common due to reduced production of erythropoietin by the failing kidneys. This hormone is essential for stimulating red blood cell production in the bone marrow.

Additional features supporting advanced CKD in this patient include secondary hyperparathyroidism, electrolyte disturbances, and uremic symptoms like pruritus and fatigue.

Why the other options are incorrect:

A) Chronic GI blood loss typically presents with microcytic anemia and positive occult blood; not suggested here.
B) Iron deficiency can contribute but is not the primary issue in CKD-related anemia without supportive iron studies.
C) Anemia of chronic disease may coexist, but erythropoietin deficiency is more specific and common in CKD.
E) Vitamin B12 deficiency would usually present with macrocytic anemia and neurologic findings.

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4. Nephrology & Urology Module

4.1 Hematuria

4.2 Chronic Kidney Disease

4.3 Urinary Incontinence

4.4 Prostate

4.5 Renal Tumors

4.6 Other Renal Disorders

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