BCPS – Nephrology Practice Questions 2026 – Study Guide and Review Material
Nephron SA 1
A 75-year-old man (height 73 inches, weight 92.5
kg) presents to your institution with abdominal
pain and dizziness. He has a brief history of gastroenteritis and has had nothing to eat or drink
for
24 hours. His blood pressure reading while sitting
is 120/80 mm Hg, which decreases to 90/60 mm Hg
when standing. His heart rate is 90 beats/minute.
His basic metabolic panel shows sodium (Na) 135
mEq/L, chloride (Cl) 108 mEq/L, potassium (K)
4.7 mEq/L, carbon dioxide (CO2) 26 mEq/L, blood
urea nitrogen (BUN) 40 mg/dL, serum creatinine
(SCr) 1.5 mg/dL, and glucose 188 mg/dL. He has
no known drug allergies. Which is best for treating
this patient?
A. Administer furosemide 40 mg intravenously ×
1 dose.
B. Insert Foley catheter to check for residual
urine.
C. Administer fluid bolus (500 mL of normal
saline solution).
D. Administer insulin lispro 3 units
subcutaneously. - ANS✔✔ Answer: C
,Initial treatment of AKI requires identifying and reversing (if possible) the insult to the kidney.
This patient's symptoms and presentation are consistent with prerenal azotemia because of
volume depletion, so fluid administration would be the best choice (Answer C is correct).
Nephro SA 2
A 44-year-old man is admitted with gram-negative
bacteremia. He receives 4 days of parenteral aminoglycoside therapy and develops acute
tubular necrosis (ATN). Antibiotic therapy is adjusted on the basis of culture and sensitivity
results. Which laboratory value is most consistent with this
presentation?
A. BUN/SCr ratio greater than 20:1.
B. Urinalysis with no casts visible.
C. Fractional excretion of sodium (FENa) more
than 2%.
D. Urinary sodium less than 20 mEq/L. - ANS✔✔ Answer C:
Fractional excretion of sodium also distinguishes prerenal and intrinsic renal damage. A low
FENa (less than 1%) in an oliguric patient suggests that tubular function is still intact, whereas a
FENa greater than 2% is common in intrinsic renal failure (Answer C is correct).
Nephro SA 3
A patient with chronic kidney disease (CKD) category
G4 (estimated glomerular filtration rate [eGFR] 25 mL/minute/1.73 m2) has received a diagnosis
of gram-positive bacteremia, which is susceptible only to drug X. There are no published reports
on how to adjust the dose of drug X in patients with impaired kidney function. Review of the
drug X package insert shows that drug X has significant renal elimination, with 40% excreted
unchanged in the urine. The usual dose for drug X is 600 mg/day intravenously and is provided
as 100 mg/mL in a 6-mL vial. Which is the best dose
(in milliliters of drug X) for this patient?
A. 3.6.
, B. 4.1.
C. 4.5.
D. 5.5. - ANS✔✔ Answer: B
Information regarding the fraction of drug excreted in
the urine (Fe) can help determine the proper dose of
a drug when specific dosing guidelines are not available. The Rowland-Tozer equation can
determine the percentage of the usual dose to give a patient with known kidney disease (Q),
considering the ratio of the patient's renal function to normal (KF). For a patient with an
estimated CrCl of 25 mL/minute/1.73 m2, Q = 1 − [Fe(1 − KF)] = 1 − [0.4(1 − 25/120)] = 1 − 0.32 =
0.68, or 68% of the usual dose. If the usual dose is 600
mg, the adjusted dose would be 410 mg (600 mg × 0.68). Thus, the patient should receive 4.1
mL of the 100-mg/mL preparation (410 mg/100 mg/mL) (Answer B is correct; Answers A, C, and
D are incorrect).
Nephro SA 4
A 45-year-old man (weight 59 kg, height 70 inches)
has a long history of cancer and malnutrition. His
SCr is 0.5 mg/dL. Carboplatin will be initiated,
for which an accurate estimate of kidney function
is critical. Which is the best method for assessing
kidney function in this patient?
A. Cockcroft-Gault equation.
B. Modification of Diet in Renal Disease
(MDRD) study equation.
C. 24-hour urine collection.
D. Iothalamate study. - ANS✔✔ Answer: C
Nephron SA 1
A 75-year-old man (height 73 inches, weight 92.5
kg) presents to your institution with abdominal
pain and dizziness. He has a brief history of gastroenteritis and has had nothing to eat or drink
for
24 hours. His blood pressure reading while sitting
is 120/80 mm Hg, which decreases to 90/60 mm Hg
when standing. His heart rate is 90 beats/minute.
His basic metabolic panel shows sodium (Na) 135
mEq/L, chloride (Cl) 108 mEq/L, potassium (K)
4.7 mEq/L, carbon dioxide (CO2) 26 mEq/L, blood
urea nitrogen (BUN) 40 mg/dL, serum creatinine
(SCr) 1.5 mg/dL, and glucose 188 mg/dL. He has
no known drug allergies. Which is best for treating
this patient?
A. Administer furosemide 40 mg intravenously ×
1 dose.
B. Insert Foley catheter to check for residual
urine.
C. Administer fluid bolus (500 mL of normal
saline solution).
D. Administer insulin lispro 3 units
subcutaneously. - ANS✔✔ Answer: C
,Initial treatment of AKI requires identifying and reversing (if possible) the insult to the kidney.
This patient's symptoms and presentation are consistent with prerenal azotemia because of
volume depletion, so fluid administration would be the best choice (Answer C is correct).
Nephro SA 2
A 44-year-old man is admitted with gram-negative
bacteremia. He receives 4 days of parenteral aminoglycoside therapy and develops acute
tubular necrosis (ATN). Antibiotic therapy is adjusted on the basis of culture and sensitivity
results. Which laboratory value is most consistent with this
presentation?
A. BUN/SCr ratio greater than 20:1.
B. Urinalysis with no casts visible.
C. Fractional excretion of sodium (FENa) more
than 2%.
D. Urinary sodium less than 20 mEq/L. - ANS✔✔ Answer C:
Fractional excretion of sodium also distinguishes prerenal and intrinsic renal damage. A low
FENa (less than 1%) in an oliguric patient suggests that tubular function is still intact, whereas a
FENa greater than 2% is common in intrinsic renal failure (Answer C is correct).
Nephro SA 3
A patient with chronic kidney disease (CKD) category
G4 (estimated glomerular filtration rate [eGFR] 25 mL/minute/1.73 m2) has received a diagnosis
of gram-positive bacteremia, which is susceptible only to drug X. There are no published reports
on how to adjust the dose of drug X in patients with impaired kidney function. Review of the
drug X package insert shows that drug X has significant renal elimination, with 40% excreted
unchanged in the urine. The usual dose for drug X is 600 mg/day intravenously and is provided
as 100 mg/mL in a 6-mL vial. Which is the best dose
(in milliliters of drug X) for this patient?
A. 3.6.
, B. 4.1.
C. 4.5.
D. 5.5. - ANS✔✔ Answer: B
Information regarding the fraction of drug excreted in
the urine (Fe) can help determine the proper dose of
a drug when specific dosing guidelines are not available. The Rowland-Tozer equation can
determine the percentage of the usual dose to give a patient with known kidney disease (Q),
considering the ratio of the patient's renal function to normal (KF). For a patient with an
estimated CrCl of 25 mL/minute/1.73 m2, Q = 1 − [Fe(1 − KF)] = 1 − [0.4(1 − 25/120)] = 1 − 0.32 =
0.68, or 68% of the usual dose. If the usual dose is 600
mg, the adjusted dose would be 410 mg (600 mg × 0.68). Thus, the patient should receive 4.1
mL of the 100-mg/mL preparation (410 mg/100 mg/mL) (Answer B is correct; Answers A, C, and
D are incorrect).
Nephro SA 4
A 45-year-old man (weight 59 kg, height 70 inches)
has a long history of cancer and malnutrition. His
SCr is 0.5 mg/dL. Carboplatin will be initiated,
for which an accurate estimate of kidney function
is critical. Which is the best method for assessing
kidney function in this patient?
A. Cockcroft-Gault equation.
B. Modification of Diet in Renal Disease
(MDRD) study equation.
C. 24-hour urine collection.
D. Iothalamate study. - ANS✔✔ Answer: C
