American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the estimated glomerular filtration rate below which a patient should be evaluated for transplant?

1. 25 mL/min/1.73 m2

2. 15 mL/min/1.73 m2

3. 20 mL/min/1.73 m2

4. 10 mL/min/1.73 m2

The correct answer is: 20 mL/min/1.73 m2

The correct threshold for evaluating a patient for kidney transplant is commonly established at an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73 m². At this level of kidney function, patients are usually in stage 4 chronic kidney disease (CKD), which indicates that they are nearing end-stage renal disease. Patients with eGFR below this threshold are at higher risk of complications from kidney failure and may benefit from a transplant evaluation. Transplant eligibility assessments typically consider factors such as overall health, presence of comorbidities, and the potential for improvement in quality of life after transplantation. The rationale for setting this specific threshold stems from the recognition that patients with very low kidney function often experience significant morbidity, limited treatment options, and have a much clearer pathway for intervention through transplant or dialysis. Evaluating patients at this level ensures timely referrals to transplant centers, allowing for necessary assessments and planning. While thresholds can vary slightly based on regional practices or specific patient circumstances, the 20 mL/min/1.73 m² mark is widely accepted in clinical guidelines for initiating discussions around renal replacement therapy and possible transplantation.