Chronic Kidney Disease

A 62-year-old woman with CKD stage 4 (eGFR 18 mL/min/1.73m²) secondary to chronic glomerulonephritis presents for routine follow-up. She is asymptomatic, hemoglobin is 9.2 g/dL, serum phosphate is 5.8 mg/dL, serum calcium is 8.1 mg/dL, and intact PTH is 285 pg/mL (normal 15–65 pg/mL). She is not yet on any renal replacement therapy. What is the most appropriate next step in management?

What is the most common cause of chronic kidney disease in India?

A 58-year-old man from rural India presents with progressive renal insufficiency. He has a 15-year history of poorly controlled hypertension and type 2 diabetes mellitus. Serum creatinine is 3.2 mg/dL, and urinalysis shows 3+ proteinuria with no active urinary sediment. What is the most common histopathological finding in his kidneys?

A 52-year-old man with a 10-year history of type 2 diabetes mellitus presents to the nephrology clinic. His blood pressure is 148/92 mmHg despite amlodipine 5 mg daily. Serum creatinine is 2.8 mg/dL (baseline 1.2 mg/dL 2 years ago), eGFR is 28 mL/min/1.73m², and urine albumin-to-creatinine ratio (UACR) is 450 mg/g. Urinalysis shows 2+ proteinuria. Renal ultrasound shows normal-sized kidneys with increased echogenicity. Which of the following is the most appropriate next step in management to slow progression of his chronic kidney disease?

A 48-year-old woman with CKD Stage 4 (eGFR 18 mL/min/1.73m²) and hypertension is evaluated for bone-mineral metabolism disturbances. Which investigation is most appropriate to assess secondary hyperparathyroidism and guide management?