Assignment Level: Intermediate

1-A 68-year-old male with a history of alcoholic cirrhosis (MELD score 25), ascites, and spontaneous bacterial peritonitis is admitted with a serum creatinine (SCr) of 2.5 mg/dL, up from a baseline of 1.0 mg/dL three months ago. His mean arterial pressure is 75 mmHg, and his urine output is 400 mL in the past 24 hours. After a 1 L albumin 25% bolus, his SCr is 2.8 mg/dL. Which of the following is the most appropriate next step in management?

2- A 55-year-old female with a history of hypertension and type 2 diabetes undergoes coronary angiography with contrast. Her baseline SCr is 1.8 mg/dL. Two days later, her SCr is 2.4 mg/dL. Which of the following statements regarding the prevention of contrast-induced AKI (CI-AKI) is most accurate?

3- A 42-year-old male is admitted to the ICU with septic shock. His SCr has increased from 0.9 mg/dL to 2.1 mg/dL in 24 hours, and his urine output is 0.4 mL/kg/h for the past 12 hours. A urine sample is sent for biomarker analysis. Which of the following biomarker profiles would be most consistent with intrinsic AKI due to acute tubular necrosis (ATN)?

4- A 72-year-old female with acute decompensated heart failure (ADHF) develops worsening renal function (SCr increase from 2.0 to 3.0 mg/dL). Her central venous pressure (CVP) is 18 mmHg. Which of the following interventions is most likely to improve her renal function?

5- A 60-year-old male with a history of CKD stage 3 (eGFR 45 mL/min/1.73m2) is scheduled for a non-urgent CT scan with contrast. Which of the following is the most appropriate strategy to minimize the risk of CI-AKI?

6. A 35-year-old female with lupus nephritis is admitted with AKI (SCr 3.5 mg/dL). A kidney biopsy shows diffuse proliferative glomerulonephritis with cellular crescents in 60% of glomeruli. Which of the following is the most appropriate initial treatment?

7. A 58-year-old male with AKI is on continuous renal replacement therapy (CRRT). His pre-filter ionized calcium is 1.25 mmol/L, and his post-filter ionized calcium is 0.25 mmol/L. He is receiving a standard citrate-based replacement fluid. Which of the following complications is he at highest risk for?

8. A 45-year-old patient with a history of rhabdomyolysis develops AKI with a peak SCr of 5.0 mg/dL. His urine output improves, and his SCr starts to decline. During the recovery phase of AKI, which of the following electrolyte abnormalities is most likely to occur?

9. A 65-year-old male with a history of prostate cancer treated with radiation therapy presents with a SCr of 4.0 mg/dL. A renal ultrasound shows bilateral hydronephrosis. Which of the following is the most appropriate initial management?

10. A 28-year-old pregnant woman at 32 weeks gestation presents with a blood pressure of 160/110 mmHg, proteinuria (3+), and a SCr of 1.5 mg/dL. Her platelet count is 80,000/mm3, and her liver enzymes are elevated. Which of the following is the most definitive treatment for her AKI?