AFRAN Monthly Quiz - October 2021 - English Version
Quiz developed by:
Mohammed Abdel Gawad (Egypt), Niakhaleen Keita (Senegal)

AFRAN Web and Media Committee

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Q1- A 56-year-old African-American woman with ahistory of type 2 diabetes mellitus and ESRD isevaluated during weekly hemodialysis rounds. Herinterdialytic weight gains average 2.2 kg and shehas minimal residual kidney function. She toleratesultrafiltration to the prescribed dry weight withonly occasional fatigue for several hours after dialysis.Over the last six treatments, you have receivedcalls fromthe hemodialysis unit concerning persistentelevations in BP during dialysis treatments. Today, herpredialysis BP is 142/76 mmHg and increases to188/100 mmHg during dialysis. Home BP readingsaverage 140–150/80–90 mmHg. Her antihypertensivemedications are amlodipine 5 mg daily andlisinopril 40 mg daily. On physical examination, thelungs are clear and there is no peripheral edema.Which ONE of the following is the MOSTappropriate next step in management? *
1 point
Q2- A 66-year-old woman who had been undergoing regular haemodialysis for 2 years experienced repeated episodes of hypotension during dialysis. She usually arrived for dialysis approximately 1.5 kg over her dry weight and, during the second hour of each dialysis, her BP fell to <80 mmHg systolic. She was otherwise well and was not taking any antihypertensive drugs.On examination, there was no oedema.Investigations (performed before a mid-week dialysis session):serum sodium134 mmol/L (137–144)serum potassium4.3 mmol/L (3.5–4.9)serum corrected calcium2.50 mmol/L (2.20–2.60)serum phosphate1.40 mmol/L (0.80–1.45)serum albumin31 g/L (37–49)What intervention is most likely to be helpful? *
1 point
Q3- A 48-year-old man with diabetic nephropathy was reviewed during a haemodialysis session. His dialysate calcium concentration was 1.25 mmol/L, and the dialysate temperature was 35.0°C. He achieved maximal blood flow rates of 280 mL/min against a dialysate flow rate of 600 mL/min. He was dialysed using a low-flux membrane with a surface area of 1.2 m2. Intradialytic hypotension was reported frequently and often resulted in early cessation of therapy.On examination, he had pedal oedema and his BP was 166/88 mmHg. He had an aneurysmal left radiocephalic fistula.Investigations:serum sodium143 mmol/L (137–144)serum potassium3.4 mmol/L (3.5–4.9)serum corrected calcium2.18 mmol/L (2.20–2.60)urea reduction ratio74%single pool Kt/V1.36What is the most appropriate next step in management? *
1 point
Q4- A 56-year-old man complained of bruising over his arms. He had presented with AKI resulting from interstitial nephritis 2 weeks previously, and had initially been treated with continuous haemofiltration in the intensive care unit for 10 days before being switched to haemodialysis three times per week. He was taking prednisolone 40 mg daily and omeprazole 20 mg daily.Investigations:haemoglobin91 g/L (130–180)white cell count7.2 × 109/L (4.0–11.0)platelet count12 × 109/L (150–400)serum sodium134 mmol/L (137–144)serum potassium4.3 mmol/L (3.5–4.9)serum creatinine513 µmol/L (60–110)A diagnosis of heparin-induced thrombocytopenia was made.What is the most appropriate anticoagulation to use for his dialysis? *
1 point
Q5- A 57-year-old man with ESRD maintained onthrice weekly in–center hemodialysis is evaluatedfor recurrent intradialytic hypotension.His prescribed dry weight is 90 kg, and hetypically requires 6 L of volume removalduring dialysis. He frequently cannot achievehis dry weight because his systolic BP decreasesby an average of 40 mmHg, with intradialyticsystolic BPs as low as 85 mmHg.He receives dialysis three times weekly for4 hours. The dialysate sodium concentration is138 mEq/L.Which ONE of the following ultrafiltrationgoal targets is MOST appropriate to decreasehis risk of intradialytic hypotension? *
1 point
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