American Board of Internal Medicine (ABIM) Certification Practice Exam

All patients with stage 4 or 5 chronic kidney disease should be referred to a nephrologist for what purpose?

1. Management of diabetes

2. Management of heart failure

3. Management of chronic kidney disease

4. Management of hypertension

The correct answer is: Management of chronic kidney disease

Referring patients with stage 4 or 5 chronic kidney disease to a nephrologist is essential for the management of chronic kidney disease itself. At these advanced stages, the kidneys are significantly impaired, and specialized care is crucial to address the complexities of the condition. Nephrologists have expertise in several critical areas, including the progression of kidney disease, the initiation and timing of dialysis, and the management of complications associated with advanced kidney disease, such as electrolyte imbalances, anemia, and bone mineral disorders. Furthermore, nephrologists play a pivotal role in educating patients about their condition and discussing options for renal replacement therapy, whether that involves dialysis or potential kidney transplantation. Their involvement can help ensure that patients receive optimal, tailored management strategies that improve outcomes and quality of life. While diabetes, heart failure, and hypertension management are important considerations in patients with advanced chronic kidney disease, these conditions can often be managed by primary care physicians or cardiologists without necessitating a nephrology referral, unless there are specific complications directly related to the kidney disease. Hence, the primary purpose of referring patients in advanced stages of chronic kidney disease is indeed focused on the comprehensive management of the kidney disease itself.