Question

question 38
1 pts
a nurse practitioner sees a new patient who reports having a diagnosis of chronic kidney
disease for several years. the patient is taking one medication for hypertension which has
been prescribed since the diagnosis was made. the np orders laboratory tests to evaluate the
status of this patient. which laboratory finding indicates a need to refer the patient to a
nephrologist?
o albumin/creatinine ratio (acr) of 325 mg/g
o blood pressure of 145/85 mm h
o glomerular filtration rate (egfr) of 35
o urine red blood cell (rbc) count of 15/hpf
previous

Explanation:

• Albumin/creatinine ratio (ACR): An ACR of 325 mg/g indicates albuminuria. While it is a concern in chronic kidney disease (CKD), it may not immediately warrant referral to a nephrologist without considering other factors like eGFR trends over time.
• Blood pressure: A blood pressure of 145/85 mm Hg is elevated. In CKD, blood pressure control is crucial. However, it is a modifiable risk factor that the nurse practitioner can address initially (e.g., adjusting antihypertensive medications, lifestyle counseling) before referral.
• Glomerular filtration rate (eGFR): An eGFR of 35 mL/min/1.73m² indicates stage 3b CKD. According to CKD guidelines, patients with eGFR <45 mL/min/1.73m² (stage 3b - 5) should be referred to a nephrologist for specialized management, including evaluation of progression, management of complications (e.g., anemia, mineral - bone disorder), and preparation for renal replacement therapy (if needed).
• Urine red blood cell (RBC) count: A urine RBC count of 15/hpf (high - power field) may indicate hematuria. While hematuria in CKD can be a sign of underlying pathology (e.g., glomerulonephritis), it is not as specific an indication for immediate nephrology referral as a severely reduced eGFR.

Answer:

Glomerular filtration rate (eGFR) of 35