Chronic Kidney Disease USMLE Step 1 Practice Question
A 62-year-old woman with stage 3b CKD on lisinopril presents with volume depletion following aggressive diuresis. Vitals show BP 98/62, HR 102, RR 18, temp 37°C. Serum creatinine is 2.1 mg/dL with eGFR 28 mL/min/1.73m². The macula densa senses reduced tubular sodium chloride delivery. No orthostatic hypotension is documented. Which compensatory renal mechanism is most likely activated in response?
Answer choices
- AIncreased atrial natriuretic peptide release
- BSuppressed sympathetic tone to the afferent arteriole
- CIncreased renin release from juxtaglomerular cellsCorrect answer
- DReduced angiotensin II production
- EDecreased prostaglandin synthesis with afferent constriction
- FIncreased nitric oxide production causing afferent arteriolar vasodilation
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