American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a clinical indicator for referring a patient to a nephrologist with chronic kidney disease?

1. Stage 1 CKD

2. Stage 2 CKD

3. Stage 3 CKD

4. Stage 4 CKD

The correct answer is: Stage 4 CKD

Referring a patient with chronic kidney disease (CKD) to a nephrologist is often indicated based on the severity of the disease as demonstrated by the stage of CKD. Stage 4 CKD represents a significant decline in kidney function, typically with an estimated glomerular filtration rate (eGFR) of 15-29 mL/min. At this stage, patients are at a higher risk for complications associated with kidney failure, such as electrolyte imbalances, hypertension, and the need for potential kidney replacement therapy (dialysis or transplantation). In this context, a referral to a nephrologist would be essential for the management of advanced kidney disease which may involve planning for dialysis, addressing complications of CKD, and managing comorbidities. Interventions at this stage can help in optimizing the patient's quality of life and preparing for future renal replacement therapy. In contrast, earlier stages of CKD (Stages 1-3) typically involve ongoing monitoring and management by primary care providers or general internists, provided there are no significant complications or comorbidities that warrant specialized nephrological input. While patients in these stages may require attention, they usually do not require referral unless specific criteria or complications arise.