Chronic renal failure MCQs With Answer

Chronic renal failure MCQs With Answer are essential for B.Pharm students preparing for exams and clinical practice. This focused set covers pathophysiology, staging (eGFR, KDIGO), pharmacokinetics in CKD, dose adjustments, renoprotective drugs, dialysis modalities, and common complications like anemia, mineral bone disorder, and hyperkalemia. Each question emphasizes drug selection, safety, and therapeutic monitoring in chronic kidney disease (CKD), helping students master renal pharmacotherapy and clinical decision-making. The questions are tailored to deepen understanding beyond basics and improve exam readiness. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which criterion best defines chronic kidney disease (CKD)?

• Acute rise in serum creatinine over 48 hours
• Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 for 3 months
• Proteinuria for 2 weeks
• Transient hematuria with normal renal function

Correct Answer: Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 for 3 months

Q2. Which of the following equations is commonly used to estimate eGFR in adults for CKD staging?

• Henderson-Hasselbalch equation
• Cockcroft-Gault formula
• MDRD or CKD-EPI equations
• Fick principle

Correct Answer: MDRD or CKD-EPI equations

Q3. In CKD, which marker rises due to decreased renal clearance and is commonly used to monitor renal function?

• Serum albumin
• Serum creatinine
• Serum sodium
• Alkaline phosphatase

Correct Answer: Serum creatinine

Q4. Which electrolyte disturbance is most characteristic and dangerous in advanced CKD?

• Hyponatremia
• Hypocalcemia
• Hyperkalemia
• Hypomagnesemia

Correct Answer: Hyperkalemia

Q5. Which class of antihypertensive drugs has proven renoprotective effects in many CKD patients?

• Beta blockers
• ACE inhibitors
• Calcium channel blockers (non-dihydropyridine)
• Alpha-1 blockers

Correct Answer: ACE inhibitors

Q6. For dose adjustment in CKD, which parameter is most appropriate to estimate renal drug clearance?

• Serum potassium
• Body mass index
• Estimated creatinine clearance (CrCl) or eGFR
• Serum albumin only

Correct Answer: Estimated creatinine clearance (CrCl) or eGFR

Q7. Which phosphate binder is calcium-free and preferred in hyperphosphatemia when hypercalcemia is a concern?

• Calcium carbonate
• Sevelamer
• Calcium acetate
• Aluminum hydroxide

Correct Answer: Sevelamer

Q8. In CKD-related anemia, which therapy is primarily used to stimulate erythropoiesis?

• Intravenous iron only
• Vitamin B12 supplementation
• Erythropoiesis-stimulating agents (ESAs) such as erythropoietin
• Folic acid alone

Correct Answer: Erythropoiesis-stimulating agents (ESAs) such as erythropoietin

Q9. Which vitamin D form is commonly given to CKD patients to manage secondary hyperparathyroidism?

• Cholecalciferol (vitamin D3) only
• Calcitriol (active 1,25-dihydroxyvitamin D)
• Vitamin K
• Ergocalciferol (vitamin D2) never used

Correct Answer: Calcitriol (active 1,25-dihydroxyvitamin D)

Q10. Which diuretic class is most effective for fluid overload in severe CKD with low GFR?

• Thiazide diuretics
• Loop diuretics (e.g., furosemide)
• Carbonic anhydrase inhibitors
• Potassium-sparing diuretics

Correct Answer: Loop diuretics (e.g., furosemide)

Q11. Which antibiotic requires dose adjustment and monitoring due to primarily renal elimination and nephrotoxicity risk?

• Ceftriaxone
• Aminoglycosides (e.g., gentamicin)
• Doxycycline
• Azithromycin

Correct Answer: Aminoglycosides (e.g., gentamicin)

Q12. Metformin must be used cautiously or avoided in advanced CKD primarily because of the risk of:

• Hyperkalemia
• Lactic acidosis
• Hypoglycemia
• Kidney stone formation

Correct Answer: Lactic acidosis

Q13. Which statement about drug protein binding in CKD is correct?

• CKD always increases protein binding of all drugs
• Hypoalbuminemia in CKD can increase free fraction of highly albumin-bound drugs
• Protein binding changes are clinically irrelevant
• CKD converts all drugs to polar forms

Correct Answer: Hypoalbuminemia in CKD can increase free fraction of highly albumin-bound drugs

Q14. The most appropriate initial treatment for acute severe hyperkalemia in a CKD patient with ECG changes is:

• Oral sodium polystyrene sulfonate only
• Intravenous calcium gluconate to stabilize cardiac membranes
• Loop diuretic only
• Oral potassium supplements

Correct Answer: Intravenous calcium gluconate to stabilize cardiac membranes

Q15. Which of the following drugs is contraindicated or should be avoided in CKD due to decreased renal clearance and increased toxicity risk?

• Warfarin without monitoring
• NSAIDs (e.g., ibuprofen)
• Topical acetaminophen
• Insulin with dose adjustment

Correct Answer: NSAIDs (e.g., ibuprofen)

Q16. Peritoneal dialysis differs from hemodialysis in that:

• It requires vascular access and a dialyzer machine
• It uses the peritoneum as the dialysis membrane and allows continuous therapy
• It removes large molecules more rapidly than hemodialysis
• It is only used for acute kidney injury

Correct Answer: It uses the peritoneum as the dialysis membrane and allows continuous therapy

Q17. Which laboratory change is characteristic of CKD-mineral and bone disorder (CKD-MBD)?

• Low phosphate and high calcium
• High phosphate, low vitamin D activity, and secondary hyperparathyroidism
• Isolated elevated alkaline phosphatase with normal PTH
• Low PTH due to increased vitamin D activation

Correct Answer: High phosphate, low vitamin D activity, and secondary hyperparathyroidism

Q18. Which agent is used to treat severe hyperphosphatemia in CKD and has aluminum toxicity risk with long-term use?

• Sevelamer
• Aluminum hydroxide
• Calcium carbonate
• Lanthanum carbonate

Correct Answer: Aluminum hydroxide

Q19. Which is the primary mechanism of progression for most chronic kidney diseases?

• Acute tubular necrosis
• Glomerular hyperfiltration and subsequent nephron loss leading to fibrosis
• Ureteric obstruction alone
• Primary infection of the kidney parenchyma

Correct Answer: Glomerular hyperfiltration and subsequent nephron loss leading to fibrosis

Q20. In drug dosing for CKD patients, which approach is generally recommended?

• Reduce dose or extend dosing interval based on renal function and drug characteristics
• Always double the dose to overcome reduced clearance
• No adjustment is ever necessary for oral drugs
• Stop all drugs regardless of benefit

Correct Answer: Reduce dose or extend dosing interval based on renal function and drug characteristics

Q21. Which laboratory parameter is used to monitor effectiveness of erythropoiesis-stimulating agents (ESAs) in CKD anemia?

• Serum ferritin only
• Hemoglobin concentration
• Serum potassium
• Urine protein

Correct Answer: Hemoglobin concentration

Q22. Which measure helps prevent contrast-induced nephropathy in patients with CKD?

• High dose NSAIDs before procedure
• Hydration with isotonic saline and minimizing contrast volume
• Administration of aminoglycosides
• Fasting for 24 hours

Correct Answer: Hydration with isotonic saline and minimizing contrast volume

Q23. Uremic encephalopathy in advanced CKD is primarily due to accumulation of:

• Glucose
• Uremic toxins and metabolic disturbances
• Excess insulin
• Albumin

Correct Answer: Uremic toxins and metabolic disturbances

Q24. Which antihyperkalemic therapy shifts potassium intracellularly but does not remove potassium from the body?

• Sodium polystyrene sulfonate
• Insulin with glucose
• Loop diuretic causing urinary excretion
• Hemodialysis

Correct Answer: Insulin with glucose

Q25. Which imaging finding is commonly seen in chronic kidney disease of long duration?

• Enlarged kidneys with increased cortical thickness
• Small, shrunken kidneys with cortical thinning
• Normal-sized kidneys always
• Single large cyst in each kidney

Correct Answer: Small, shrunken kidneys with cortical thinning

Q26. Which medication requires extra caution because it is dialyzable and may need supplemental dosing after hemodialysis?

• Warfarin
• Vancomycin and certain beta-lactam antibiotics
• Oral digoxin always unaffected by dialysis
• Long-acting benzodiazepines only

Correct Answer: Vancomycin and certain beta-lactam antibiotics

Q27. Secondary hyperparathyroidism in CKD is primarily driven by:

• Excess renal activation of vitamin D
• Hypophosphatemia and hypercalcemia
• Phosphate retention, hypocalcemia, and reduced calcitriol production
• Excess dietary calcium intake alone

Correct Answer: Phosphate retention, hypocalcemia, and reduced calcitriol production

Q28. Which oral agent is commonly used for chronic management of hyperkalemia by exchanging potassium in the gut?

• Furosemide
• Sodium polystyrene sulfonate (kayexalate)
• Calcium gluconate
• Insulin

Correct Answer: Sodium polystyrene sulfonate (kayexalate)

Q29. In CKD, metabolic acidosis is often present. Which medication is commonly used to correct chronic metabolic acidosis?

• Sodium bicarbonate
• Ammonium chloride
• Calcium carbonate only
• Proton pump inhibitors

Correct Answer: Sodium bicarbonate

Q30. Which of the following is an indication for initiating renal replacement therapy (dialysis) in CKD?

• Asymptomatic mild proteinuria only
• Refractory hyperkalemia, severe uremic symptoms, or volume overload not responsive to medical therapy
• Controlled hypertension on medications
• Stable eGFR of 55 mL/min/1.73 m2

Correct Answer: Refractory hyperkalemia, severe uremic symptoms, or volume overload not responsive to medical therapy

Q31. Which medication used to treat CKD bone disease works by binding phosphate in the gastrointestinal tract?

• Calcitriol
• Phosphate binders like sevelamer or calcium acetate
• Loop diuretics
• Bisphosphonates

Correct Answer: Phosphate binders like sevelamer or calcium acetate

Q32. Which renal replacement modality is preferred for hemodynamically unstable patients in intensive care?

• Intermittent hemodialysis only
• Continuous renal replacement therapy (CRRT)
• Peritoneal dialysis exclusively
• No dialysis is allowed in ICU

Correct Answer: Continuous renal replacement therapy (CRRT)

Q33. In CKD patients, which blood pressure target is generally recommended to slow progression (individualized by comorbidities)?

• Always >160/100 mmHg
• Lower than 130/80 mmHg in many patients, individualized
• Target systolic BP above 150 mmHg
• No control necessary

Correct Answer: Lower than 130/80 mmHg in many patients, individualized

Q34. Which statement about NSAIDs and CKD is true?

• NSAIDs are renoprotective in CKD
• NSAIDs inhibit prostaglandin synthesis and can reduce renal blood flow, worsening CKD
• All NSAIDs improve eGFR
• NSAIDs are safe in all stages of CKD without monitoring

Correct Answer: NSAIDs inhibit prostaglandin synthesis and can reduce renal blood flow, worsening CKD

Q35. Gentamicin toxicity in CKD is primarily due to which mechanism?

• Hepatotoxic metabolites
• Accumulation causing proximal tubular injury and ototoxicity
• Enhanced protein synthesis
• Inhibition of renin release

Correct Answer: Accumulation causing proximal tubular injury and ototoxicity

Q36. Which laboratory test helps assess iron stores before starting intravenous iron therapy in CKD anemia?

• Serum sodium
• Serum ferritin and transferrin saturation (TSAT)
• Urine albumin only
• Serum magnesium

Correct Answer: Serum ferritin and transferrin saturation (TSAT)

Q37. Which electrolyte abnormality often accompanies acidosis in CKD and requires careful management?

• Hypokalemia only
• Hyperkalemia due to decreased renal excretion
• Hyponatremia due to increased sodium retention
• Hypercalcemia always

Correct Answer: Hyperkalemia due to decreased renal excretion

Q38. Which class of drugs used in diabetes has demonstrated cardiovascular and renal benefits and may be considered in CKD with appropriate eGFR thresholds?

• Sulfonylureas
• SGLT2 inhibitors (with eGFR considerations)
• Alpha-glucosidase inhibitors only
• Meglitinides without monitoring

Correct Answer: SGLT2 inhibitors (with eGFR considerations)

Q39. Which complication is commonly seen after initiation of dialysis therapy?

• Improved potassium retention immediately
• Hypotension during hemodialysis sessions
• Permanent cure of CKD
• Increased bone density instantly

Correct Answer: Hypotension during hemodialysis sessions

Q40. In CKD patients, which analgesic is generally considered safer when pain control is needed?

• High-dose ibuprofen regularly
• Acetaminophen (paracetamol) with appropriate dosing
• Combination NSAID-opioid daily
• Topical NSAIDs taken orally

Correct Answer: Acetaminophen (paracetamol) with appropriate dosing

Q41. When managing drug therapy in CKD, which pharmacokinetic parameter is most affected and often necessitates adjustment?

• Oral bioavailability for all drugs
• Renal clearance and elimination half-life
• Volume of distribution only for lipophilic drugs
• Hepatic metabolism always increases

Correct Answer: Renal clearance and elimination half-life

Q42. Which parenteral iron formulation is preferred in many CKD patients on dialysis due to fewer dosing sessions and good efficacy?

• Oral ferrous sulfate only
• IV iron sucrose or ferric carboxymaltose depending on protocol
• Intramuscular gold injections
• Topical iron creams

Correct Answer: IV iron sucrose or ferric carboxymaltose depending on protocol

Q43. Which of the following is a common cardiovascular risk in CKD that pharmacists must monitor and manage?

• Decreased risk of atherosclerosis
• Increased risk of hypertension, left ventricular hypertrophy, and cardiovascular mortality
• Complete protection from myocardial infarction
• Reduced need for lipid-lowering therapy

Correct Answer: Increased risk of hypertension, left ventricular hypertrophy, and cardiovascular mortality

Q44. In CKD patients, why is monitoring drug serum levels (e.g., vancomycin, digoxin) important?

• Levels are irrelevant in renal impairment
• To avoid toxicity and ensure therapeutic efficacy due to altered clearance
• To ensure the drug is completely protein bound
• Because levels always decrease in CKD

Correct Answer: To avoid toxicity and ensure therapeutic efficacy due to altered clearance

Q45. Which nutritional recommendation is commonly advised for patients with progressive CKD to slow progression?

• High-protein diet unrestricted
• Moderate protein restriction with individualized caloric intake
• Unlimited phosphate-rich foods
• Severe sodium restriction to zero grams per day

Correct Answer: Moderate protein restriction with individualized caloric intake

Q46. Which immunosuppressive drug used post-renal transplant requires therapeutic drug monitoring and has nephrotoxic potential?

• Mycophenolate mofetil without monitoring
• Ciclosporin or tacrolimus requiring monitoring due to nephrotoxicity
• Prednisone only
• Topical corticosteroids

Correct Answer: Ciclosporin or tacrolimus requiring monitoring due to nephrotoxicity

Q47. Which process explains why a drug with high molecular weight is less efficiently removed by conventional hemodialysis?

• High molecular weight increases renal tubular secretion
• Dialysis membrane pore size limits clearance of large molecules
• Large molecules are always lipid-soluble and easily cleared
• High molecular weight drugs bind irreversibly to dialyzer surfaces

Correct Answer: Dialysis membrane pore size limits clearance of large molecules

Q48. Which of the following is an advantage of peritoneal dialysis compared to hemodialysis?

• Requires frequent hospital visits for each session
• Provides continuous gentle clearance and more lifestyle flexibility
• Removes toxins more quickly in emergencies
• Has no risk of peritonitis

Correct Answer: Provides continuous gentle clearance and more lifestyle flexibility

Q49. Which lab abnormality suggests poor adherence to phosphate binder therapy in CKD?

• Low serum phosphate
• Persistently elevated serum phosphate despite therapy
• Normal PTH and calcium always
• Low serum calcium only

Correct Answer: Persistently elevated serum phosphate despite therapy

Q50. Which counseling point is most important when dispensing renally-cleared medications to B.Pharm students practicing patient counseling?

• Advise patients to stop all medications when creatinine rises
• Explain the need for dose adjustments, monitoring renal function, and reporting symptoms of toxicity
• Tell patients that over-the-counter NSAIDs are always safe
• No counseling is necessary for renal patients

Correct Answer: Explain the need for dose adjustments, monitoring renal function, and reporting symptoms of toxicity

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