Ch58: Disorders of the Kidneys and Ureters
A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? Inform the health care provider and assess the client for signs of infection. Administer a bolus of IV normal saline as prescribed. Flush the peritoneal catheter with normal saline. Remove the catheter promptly and have the catheter tip cultured.
Correct response: Inform the health care provider and assess the client for signs of infection. Explanation: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the health care provider would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.
A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response? Administer exogenous antidiuretic hormone as ordered. Assess the patient for further signs or symptoms of rejection. Inform the primary care provider of this finding. Recognize this as an expected finding.
Correct response: Recognize this as an expected finding. Explanation: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? Osmotic dieresis. Dysrhythmias Acute pyelonephritis Renal calculi
Correct response: Renal calculi Explanation: Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Activity intolerance Impaired urinary elimination Toileting self-care deficit Risk for infection
Correct response: Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? Serum glucose Urine protein Blood pressure pH and HCO3
Correct response: Serum glucose Explanation: The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
What is used to decrease potassium level seen in acute renal failure? IV dextrose 50% Sodium polystyrene sulfonate Calcium supplements Sorbitol
Correct response: Sodium polystyrene sulfonate Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spiked P waves Prolonged ST segment
Correct response: Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex
A nurse is assessing a client with acute renal failure. What medications should the nurse identify as a nephrotoxic drug? Select all that apply. Neomycin Ceftriaxone Tobramycin Gentamycin Penicillin
Correct Response: Gentamycin Tobramycin Neomycin Explanation: The kidneys are sensitive to the metabolic byproducts from aminoglycosides such as gentamycin, tobramycin, and neomycin. Penicillin and ceftriaxone are not known to be nephrotoxic.
A client with chronic kidney disease weighs 209 lbs (95 kg) and is prescribed 1.2 grams of protein per kg per day. Which amount of protein will the client ingest per day? ___________grams/day
Correct Response: 114 grams/day Explanation: To calculate the amount of protein the client is to ingest per day, first determine the client's weight in kg by dividing the weight in lbs by 2.2 or 209/2.2 = 95 kg. Then multiply the client's weight in kg by 1.2 or 95 x 1.2 = 114 grams. The client is to ingest 114 grams of protein per day.
The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? Enter your response as a whole number. _______mL
Correct response: 4000 Explanation: A 1-kg weight gain is equal to 1,000 mL of retained fluid. 4 kg × 1,000 = 4,000. The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded.
The renal diet includes limiting protein. A nurse understands that a patient who weighs 198 pounds should be limited to the minimum amount of daily protein. What is that amount? 83 grams 50 grams 70 grams 63 grams
Correct response: 63 grams Explanation: The minimum amount of daily protein is 0.7 g/kg. Therefore, a patient who weighs 198 lbs (90 kg) would require a minimum protein intake of 63 g (90 × 0.7).
The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary care provider? Increased urine output Absence of drain output Blood-tinged serosanguineous drain output Increased pain on movement
Correct response: Absence of drain output Explanation: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.
The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? Administration of sodium polystyrene sulfonate [Kayexalate]) Administration of a loop diuretic Administration of an insulin drip Administration of sodium bicarbonate
Correct response: Administration of sodium polystyrene sulfonate [Kayexalate]) Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur? Hypercalcemia Hypokalemia Metabolic alkalosis Hyperphosphatemia
Correct response: Hyperphosphatemia Explanation: Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.
A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply. 1) The cuffs will absorb the dialysate. 2) The cuffs are constructed of Dacron polyester material. 3) The cuffs provide a barrier against microorganisms. 4) The cuffs will help stabilize the catheter. 5) The cuffs prevent the dialysate from leaking.
Correct Response: The cuffs are constructed of Dacron polyester material. The cuffs will help stabilize the catheter. The cuffs prevent the dialysate from leaking. The cuffs provide a barrier against microorganisms. Explanation: Most catheters used for peritoneal dialysis have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.
The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? "A vein and an artery in your arm will be attached surgically." "One needle will be inserted into the fistula for each dialysis treatment." "The fistula can be used 5 to 7 days after the surgery for dialysis treatment." "The arm should be immobilized for 4 to 6 days."
Correct response: "A vein and an artery in your arm will be attached surgically." Explanation: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need several weeks to "mature" before it can be used. The client is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.
A female patient undergoes dialysis as a part of treatment for kidney failure. The patient is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the patient? Avoid administering injections for 2 to 4 hours after heparin administration. Provide periods of rest throughout the day and uninterrupted sleep at night. Use dialysate solutions after 2 hours. Puncture the same site used previously.
Correct response: Avoid administering injections for 2 to 4 hours after heparin administration. Explanation: When heparin is administered to a patient during dialysis, it is very important not to administer injections for the next 2 to 4 hours. This restriction allows heparin to be metabolized and excreted. While caring for patients with chronic glomerulonephritis, the nurse should provide periods of rest throughout the day, with uninterrupted sleep at night. When obtaining vascular access, the nurse should avoid puncturing the same site used previously. Using dialysate solutions after 2 hours of dialysis will not allow heparin to be metabolized and excreted.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate? Pyuria Left upper quadrant pain Cola-colored urine Low blood pressure
Correct response: Cola-colored urine Explanation: Cola-colored urine is a typical symptom of glomerulonephritis. Flank pain on the affected side, not left upper quadrant pain, would be present. Pyuria is a symptom of pyelonephritis, not glomerulonephritis. Blood pressure typically elevates in glomerulonephritis.
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? Donors must be relatives. The client is placed on a transplant list at the local hospital. Donors are selected from compatible living or deceased donors. Donors with hypertension may qualify.
Correct response: Donors are selected from compatible living or deceased donors. Explanation: Donors are selected from compatible living donors. Donors do not have to be relatives as long as they are compatible. Potential donors with a history of hypertension, malignant disease, or diabetes are excluded from donation. Each local hospital does not have its own transplant list, instead the client will be placed on a national computerized transplant waiting list.
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure? Ureteral calculus Hypovolemia Dysrhythmia Glomerulonephritis
Correct response: Glomerulonephritis Explanation: Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.
The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate? Hypercalcemia Hypernatremia Hyperkalemia Hypomagnesemia
Correct response: Hyperkalemia Explanation: Hyperkalemia (high potassium) is a common complication of AKI. If the client's potassium is elevated but does not cause ECG (electrocardiography) changes, then polystyrene sulfonate may be administered since it reduces serum potassium levels. It is not recommended for emergency treatment since it takes more than 6 hours to work. Polystyrene sulfonate does not treat low (hypo) magnesium, high sodium (hypernatremia), or high calcium (hypercalcemia).
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Pneumonia caused by shallow breathing because of severe incisional pain Paralytic ileus caused by manipulation of the colon during surgery Hypovolemic shock caused by hemorrhage Abdominal distention owing to reflex cessation of intestinal peristalsis
Correct response: Hypovolemic shock caused by hemorrhage Explanation: If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Decreased urine sodium Decreased creatinine Increased BUN High specific gravity
Correct response: Increased BUN Explanation: The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.
The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? Level of consciousness Oral intake Radiation of pain Pain intensity
Correct response: Level of consciousness Explanation: Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.
A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? Increasing oral intake Increasing mobility Managing dialysis Managing postoperative pain
Correct response: Managing postoperative pain Explanation: The client requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this client. Dialysis is not necessary following kidney surgery.
Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? Palpate the abdominal wall for rebound tenderness. Inspect the catheter site for leakage of dialysate. Observe for evidence of bleeding. Measure fluid drainage to estimate incomplete recovery of fluid.
Correct response: Palpate the abdominal wall for rebound tenderness. Explanation: Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.
When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic? Penicillin Gentamicin Tobramycin Neomycin
Correct response: Penicillin Explanation: The three nephrotoxic drugs are aminoglycerides.
What is a hallmark of the diagnosis of nephrotic syndrome? Proteinuria Hyperalbuminemia Hyponatremia Hypokalemia
Correct response: Proteinuria Explanation: Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? Infuse 50 mL of additional dialysate. Advance the catheter 2 to 4 cm further into the peritoneal cavity. Aspirate from the catheter using a 60-mL syringe. Reposition the client to facilitate drainage.
Correct response: Reposition the client to facilitate drainage. Explanation: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.
Which clinical finding should a nurse look for in a client with chronic renal failure? Hypotension Uremia Metabolic alkalosis Polycythemia
Correct response: Uremia Explanation: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? Serum potassium level of 4.9 mEq/L Serum sodium level of 135 mEq/L Temperature of 99.2° F (37.3° C) Urine output of 20 ml/hour
Correct response: Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure. Wear a mask while handling any dialysate solutions. Clean the catheter insertion site daily with soap.
Correct response: Use an aseptic technique during the procedure. Explanation: The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine). A mask is generally worn only while performing exchanges, especially when a client has an upper respiratory infection. The catheter insertion site should be cleaned daily with an antiseptic such as povidone-iodine, not with soap. In addition, the catheter should be stabilized to the abdomen above the belt line, not below the belt line, to avoid constant rubbing.
Which of the following is the most accurate indicator of fluid loss or gain? Urine output Weight Caloric intake Body temperature
Correct response: Weight Explanation: The most accurate indicator of fluid loss or gain in an acutely ill patient is weight, as accurate intake and output and assessment of insensible losses may be difficult. Urine output, caloric intake, and body temperature would not be the most reliable indicator of fluid loss or gain.
The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? With each meal Only when needed First thing in the morning Daily at bedtime
Correct response: With each meal Explanation: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be given with food to be effective.
The nurse is administering calcium acetate (PhosLo) to a patient with end-stage renal disease. When is the best time for the nurse to administer this medication? At bedtime with 8 ounces of fluid With food 2 hours after meals 2 hours before meals
Correct response: With food Explanation: Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for: fatigue and weakness. thrush and circumoral pallor. nausea and vomiting. dyspnea and cyanosis.
Correct response: fatigue and weakness. Explanation: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspnea and cyanosis are associated with fluid excess, not CRF. Thrush, which signals fungal infection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.
The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response? Increase the frequency of taking vital signs, monitor urine output, and notify the provider. Assess the client for signs of bleeding and inform the primary provider. Palpate the client's torso bilaterally for flank pain and notify the primary care provider. Perform a full neurological assessment and notify the primary care provider.
Correct response: Assess the client for signs of bleeding and inform the primary provider. Explanation: Bleeding is a major complication of kidney surgery, and if missed can lead to hypovolemic (decreased volume of circulating blood) and hemorrhagic shock. Bleeding can be suspected when the client experiences fatigue, shortness of breath, and urine output of less than 400 mL within 24 hours. The postoperative client is monitored closely and these findings should be reported to the primary care provider. Ruling out the complication of the life-threatening condition of bleeding is the priority decision for this client. Performing a full neurological assessment will be warranted after the priority complications of surgery are ruled out. Increasing the monitoring of vital signs and urine output are just small parts of assessing the client for bleeding. Palpating the client's torso for flank pain may increase the client's pain and does not (in itself) address the most common cause of the client's signs and symptoms.
A client has been diagnosed with acute glomerulonephritis. This condition causes: pyuria. No option is correct. proteinuria. polyuria.
Correct response: proteinuria. Explanation: The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? 1) A GFR of 30-59 mL/min/1.73 m2 2) A GFR of 85 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 4) A GFR of 90 mL/min/1.73 m2
Correct response: A GFR of 30-59 mL/min/1.73 m2 Explanation: Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? Hyperkalemia Pericarditis Anemia Acidosis
Correct response: Anemia Explanation: Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what priority topic? Typical diet Psychosocial stressors Current medication use Allergy status
Correct response: Current medication use Explanation: The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.
What is a characteristic of the intrarenal category of acute renal failure? High specific gravity Increased BUN Decreased urine sodium Decreased creatinine
Correct response: Increased BUN Explanation: The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? The client is unable to initiate voiding for 2 days. Average urine output has been 10 mL/hr for several hours. The client reports left-sided flank pain. The urine is cloudy and has visible sediment with a foul odor.
Correct response: Average urine output has been 10 mL/hr for several hours. Explanation: Oliguria (<400 mL/day of urine or 0.5 mL/kg an hour over 6 hours) is the most common clinical situation seen in AKI. The client's inability to void and/or urine hesitancy is typically seen with kidney stones, prostate problems, and/or a urinary tract infection (UTI). Urine that has visible sediment and is cloudy and foul smelling is more suggestive of a UTI. Acute flank pain is sometimes seen in AKI. Generally, flank pain has some connection to a variety of kidney diseases like acute glomerular inflammation and polycystic kidney disease.
