CLINICAL ANNUAL COMPETENCY FRESENIUS
FINAL PAPER 2026 FULL STUDY GUIDE
◉ Urinary excretion is . Answer: Excretion = filtration - reabsorbtion
= secretion
◉ What is the function of erythropoietin. Answer: Erythropoietin
stimulates the bone marrow to produce red blood cells.
◉ What is the synthetic form of erythropoietin ?. Answer:
Recombiant Epoetin Alfa ( Epogen) - or- Mircera both are drugs
given by licensed nursing staff to dialysis patients to treat anemia
◉ Why must the kidney activate Vitamin D ?. Answer: The kidney
converts Vitamin D to Calcitrol, its activated form. This activated
form of Vitamin D helps to maintain good bone health by helping to
absorb calcium from foods eaten.
◉ What are synthetic forms of activated Vitamin D ?. Answer:
Calcijex, Zemplar, and Hectorol ( synthetic calcitriol) are medications
used in treating bone disease for hemodialysis patients.
,◉ acute renal failure. Answer: sudden onset, severe, usually
reversible, Drug toxicity, motor vehicle accident, dehydration
◉ Chronic renal failure. Answer: slow onset, progressive,
permanent, diabetes - diabetic nephropathy or glomerulosclerosis,
Hypertension causing nephrolosclerosis, glomerulonephtitis
◉ other causes of renal failure include ?. Answer: Polycystic kidney
disease, Interstitial Nephritis, Goodpasture syndrome, Wilm's tumor,
Systemic Lupus Erythematosus, Alport's disease, Sickle Cell disease,
Acquired Immune Deficiency (AIDS), obstructions, Scleroderma,
Drug toxicity ( heroin, cocaine, non-steroidal anti-inflammatory
drugs, acetaminophen)
◉ What are signs of renal failure or uremia ?. Answer: Elevated
levels of - BUN / Creatinine - phosphorus - potassium, Anemia ,
Nerve damage, Yellow-gray appearance of the skin, fluid overload,
shortness of breath and edema, hypertension, proteinuria
◉ What are symptoms of renal failure or uremia ?. Answer: Uremia,
lethargy, weakness, headache, itching, fatigue, nausea, restlessness,
mental status changes, loss of appetite
◉ What organ systems are affected by kidney disease ?. Answer: All
organ systems are affected, musculoskeletal, integumentary,
,cardiovascular, gastrointestinal, respiratory, immune, neurological,
hematologic, reproductive, endocrine
◉ What are the signs and symptoms of uremia ?. Answer: Yellow-
gray skin tone, peripheral edema, high blood pressure, itching, loss
of appetite, nausea, fatigue, restlessness, mental status changes,
shortness of breath, immune system changes, proteinuria
◉ How is uremia treated ?. Answer: Dialysis, diffusion allows for
uremic toxin removal, dialusate contains no urea levels, urea moves
from the patient to the dialysate
◉ What is uremia ?. Answer: Caused by impaired kidney function.
Build up of harmful waste products in the bloodstream
◉ What is the Glomerular Filtration Rate ( GFR) in the five stages of
kidney disease ?. Answer: 1- normal kidney function 2- mildly
reduced kidney function 3- moderately reduced kidney function 4-
severely reduced kidney function 5- very severely reduced kidney
fuction ( also called chronic kidney disease )
◉ What services are availabel from the socials services department
?. Answer: Provides emotional support, psychological counseling,
patient advocate, also resource and referral services
, ◉ What adjustments do patients encounter when transitioning to
dialysis ?. Answer: Loss of control, dietary restrictions, Loss of
mobility, sexual dysfunction, financial concerns, depression,
unwanted dependency on the dialysis machine and staff, altered
body image concerns due to the apperarance of the access and
redistribution of weight
◉ What causes renal osteodystrophy ( bone disease ) ?. Answer:
patients with kidney disease no longer produce calcitriol - the active
form of Vitamin D ( inadequate or lacking calcitriol causes
demineralization of the bone- bone begins to break down to release
calcium needed for body functioning)
No longer excrete phosphorus ( phosphorus is found in most foods
and beverages. Increased phosphorus levels cause further calcium
bone loss)
◉ What does Calcitriol do ?. Answer: directs the gut to absorb
calcium into the bloodstream.
If calcitriol levels drop too low, parathyroid hormone (PTH) is
increased. Increased PTH levels direct osteoclast activity - bone
breakdown to increase serum calcium levels.
Calcitriol and PTH work together to maintain serum calcium levels.
Diminished or lacking calcitriol levels decrease gut absorption of
calcium, so the body takes the needed calcium from bones.
FINAL PAPER 2026 FULL STUDY GUIDE
◉ Urinary excretion is . Answer: Excretion = filtration - reabsorbtion
= secretion
◉ What is the function of erythropoietin. Answer: Erythropoietin
stimulates the bone marrow to produce red blood cells.
◉ What is the synthetic form of erythropoietin ?. Answer:
Recombiant Epoetin Alfa ( Epogen) - or- Mircera both are drugs
given by licensed nursing staff to dialysis patients to treat anemia
◉ Why must the kidney activate Vitamin D ?. Answer: The kidney
converts Vitamin D to Calcitrol, its activated form. This activated
form of Vitamin D helps to maintain good bone health by helping to
absorb calcium from foods eaten.
◉ What are synthetic forms of activated Vitamin D ?. Answer:
Calcijex, Zemplar, and Hectorol ( synthetic calcitriol) are medications
used in treating bone disease for hemodialysis patients.
,◉ acute renal failure. Answer: sudden onset, severe, usually
reversible, Drug toxicity, motor vehicle accident, dehydration
◉ Chronic renal failure. Answer: slow onset, progressive,
permanent, diabetes - diabetic nephropathy or glomerulosclerosis,
Hypertension causing nephrolosclerosis, glomerulonephtitis
◉ other causes of renal failure include ?. Answer: Polycystic kidney
disease, Interstitial Nephritis, Goodpasture syndrome, Wilm's tumor,
Systemic Lupus Erythematosus, Alport's disease, Sickle Cell disease,
Acquired Immune Deficiency (AIDS), obstructions, Scleroderma,
Drug toxicity ( heroin, cocaine, non-steroidal anti-inflammatory
drugs, acetaminophen)
◉ What are signs of renal failure or uremia ?. Answer: Elevated
levels of - BUN / Creatinine - phosphorus - potassium, Anemia ,
Nerve damage, Yellow-gray appearance of the skin, fluid overload,
shortness of breath and edema, hypertension, proteinuria
◉ What are symptoms of renal failure or uremia ?. Answer: Uremia,
lethargy, weakness, headache, itching, fatigue, nausea, restlessness,
mental status changes, loss of appetite
◉ What organ systems are affected by kidney disease ?. Answer: All
organ systems are affected, musculoskeletal, integumentary,
,cardiovascular, gastrointestinal, respiratory, immune, neurological,
hematologic, reproductive, endocrine
◉ What are the signs and symptoms of uremia ?. Answer: Yellow-
gray skin tone, peripheral edema, high blood pressure, itching, loss
of appetite, nausea, fatigue, restlessness, mental status changes,
shortness of breath, immune system changes, proteinuria
◉ How is uremia treated ?. Answer: Dialysis, diffusion allows for
uremic toxin removal, dialusate contains no urea levels, urea moves
from the patient to the dialysate
◉ What is uremia ?. Answer: Caused by impaired kidney function.
Build up of harmful waste products in the bloodstream
◉ What is the Glomerular Filtration Rate ( GFR) in the five stages of
kidney disease ?. Answer: 1- normal kidney function 2- mildly
reduced kidney function 3- moderately reduced kidney function 4-
severely reduced kidney function 5- very severely reduced kidney
fuction ( also called chronic kidney disease )
◉ What services are availabel from the socials services department
?. Answer: Provides emotional support, psychological counseling,
patient advocate, also resource and referral services
, ◉ What adjustments do patients encounter when transitioning to
dialysis ?. Answer: Loss of control, dietary restrictions, Loss of
mobility, sexual dysfunction, financial concerns, depression,
unwanted dependency on the dialysis machine and staff, altered
body image concerns due to the apperarance of the access and
redistribution of weight
◉ What causes renal osteodystrophy ( bone disease ) ?. Answer:
patients with kidney disease no longer produce calcitriol - the active
form of Vitamin D ( inadequate or lacking calcitriol causes
demineralization of the bone- bone begins to break down to release
calcium needed for body functioning)
No longer excrete phosphorus ( phosphorus is found in most foods
and beverages. Increased phosphorus levels cause further calcium
bone loss)
◉ What does Calcitriol do ?. Answer: directs the gut to absorb
calcium into the bloodstream.
If calcitriol levels drop too low, parathyroid hormone (PTH) is
increased. Increased PTH levels direct osteoclast activity - bone
breakdown to increase serum calcium levels.
Calcitriol and PTH work together to maintain serum calcium levels.
Diminished or lacking calcitriol levels decrease gut absorption of
calcium, so the body takes the needed calcium from bones.
