MCQ-Pregnancy-Related Acute Kidney Injury (Pr-AKI)

MCQ-Pregnancy-Related Acute Kidney Injury (PR-AKI)

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1. A 32-week primigravida has a serum creatinine rise from 0.6 mg/dL to 1.4 mg/dL over 24 hours. Which statement best explains why this meets KDIGO Stage 2 AKI?

A. Pregnancy-specific AKI criteria define AKI at creatinine >1.5 mg/dL

B. Creatinine is unreliable in pregnancy and should be ignored

C. Pregnancy lowers baseline creatinine due to increased GFR, so this rise reflects >2× baseline

D. Oliguria alone defines AKI in pregnancy regardless of creatinine

E. Dilutional effects of pregnancy falsely elevate creatinine

2. Which feature most strongly argues against TTP in this patient?

A. Third-trimester presentation

B. Presence of haemolysis and thrombocytopenia

C. Severe renal dysfunction

D. Elevated LDH

E. Hypertension

3. A patient with suspected HELLP-related AKI undergoes delivery. Which post-delivery course would most strongly suggest aHUS rather than HELLP?

A. Rapid platelet recovery within 24 hours

B. Resolution of AKI within 48–72 hours

C. Persistent AKI beyond 72 hours postpartum

D. Normal coagulation parameters

E. Elevated liver enzymes

4. In preeclampsia-associated AKI, why is reliance on FeNa <1% potentially dangerous?

A. It falsely indicates intrinsic renal injury

B. It overestimates renal perfusion

C. It may prompt inappropriate fluid loading despite endothelial injury

D. It correlates poorly with lactate levels

E. It is invalid once vasopressors are started

5. Which combination provides the most reliable assessment of true intravascular volume in this patient?

A. Central venous pressure and urine sodium

B. Pulse pressure variation alone

C. Clinical exam + lactate + POCUS (IVC, lungs, VeXUS, FOCUS)

D. Daily weight change

E. Serum albumin and hematocrit

6. Which statement regarding NGAL in pregnancy AKI is most accurate?

A. It is pregnancy-specific and diagnostic of preeclampsia

B. It rises earlier than creatinine but lacks specificity

C. It replaces serum creatinine for clinical decision-making

D. It is unaffected by infection or inflammation

E. It is validated for guiding RRT initiation

7. A hypotensive, vasopressor-dependent pregnant patient develops refractory acidosis and pulmonary edema. Which RRT strategy is most appropriate?

A. Intermittent hemodialysis with rapid ultrafiltration

B. No RRT until after delivery

C. CRRT or SLEDD with cautious fluid removal

D. Peritoneal dialysis

E. Plasma exchange

8. In a 32-week pregnancy with HELLP, worsening AKI, and fetal heart decelerations, the most appropriate next step is:

A. Delay delivery to complete two steroid doses

B. Initiate dialysis before obstetric decision-making

C. Immediate delivery despite incomplete steroid course

D. Expectant management until 34 weeks

E. Tocolysis to prolong pregnancy

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MCQ-Pregnancy-Related Acute Kidney Injury (PR-AKI)

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