CHAPTER 21: KIDNEY DISEASE

Glomerulonephritis or nephritic syndrome is one of the causes of a. stage 5 chronic kidney disease (CKD) or end-stage renal disease (ESRD). b. stage 1 CKD. c. kidney stones. d. heart failure

ANS: A Glomerulonephritis is one of the three most common causes of stage 5 CKD.

Disease conditions that can interfere with normal kidney function include a. obstruction and infection. b. chronic caffeine intake. c. chronic alcohol abuse. d. anemia

ANS: A Obstruction and infection can interfere with normal nephron function.

When patients with chronic kidney disease begin dialysis, they can increase their intake of a. protein. b. phosphorus. c. energy. d. fat.

ANS: A Patients treated using dialysis can increase protein intake from 1.1 to 1.5 g/kg body weight because of a more liberal diet. This helps maintain muscle mass.

Patients with chronic renal disease may need to restrict their intake of foods high in phosphorus, such as a. milk, nuts, and legumes. b. meat, chicken, and fish. c. bread, cereal, rice, and pasta. d. fruit and potatoes..

ANS: A Phosphorus-containing foods include milk, nuts, and legumes

Symptoms of chronic kidney failure include a. nitrogen retention. b. euphoria. c. jaundice. d. the inability to sleep.

ANS: A Symptoms of chronic kidney disease include fluid imbalances, electrolyte imbalances, nitrogen retention, anemia, hypertension, and azotemia.

The most common type of kidney stone is composed of a. calcium. b. uric acid. c. cystine. d. magnesium.

ANS: A The most common type of kidney stone (approximately 80%) is composed of calcium oxalate or calcium phosphate

The microscopic functional units of the kidney are called a. nephrons. b. glomeruli. c. tubules. d. loops of Henle.

ANS: A The nephron is the functional unit of the kidney. It performs functions such as filtration, reabsorption, secretion, and excretion.

Carbohydrates and fats are important in the diets of patients with kidney disease because they a. prevent fatigue. b. spare protein for tissue synthesis. c. are low in sodium. d. are metabolized before they reach the kidney.

ANS: B Carbohydrate and fat must supply sufficient nonprotein kilocalories to supply energy and spare protein for tissue synthesis.

Classic symptoms of acute glomerulonephritis include a. azotemia. b. proteinuria. c. ascites. d. anemia.

ANS: B Classic symptoms of acute glomerulonephritis include hematuria and proteinuria, although edema and hypertension also may occur.

Clinical symptoms associated with chronic kidney disease do not include a. anemia. b. diabetes mellitus. c. hypertension. d. bone pain.

ANS: B Complications of chronic kidney disease do not include diabetes mellitus.

The type of diet recommended for a person with a calcium stone depends on a. body weight. b. the composition of the stone. c. fiber intake d. fluid intake

ANS: B Medical nutrition therapy for calcium stones depends on the composition of the stone. If a stone is composed of calcium phosphate, additional sources of phosphorus should be controlled. If a stone is calcium oxalate, foods high in oxalate should be avoided.

Medical nutrition therapy for nephrotic syndrome includes a. high protein intake. b. moderate protein intake. c. high potassium intake. d. fluid restriction.

ANS: B Medical nutrition therapy for nephrotic syndrome includes moderate protein intake at 0.8 g/kg/day, which is sufficient to meet nutritional and growth needs without adding to the burden on the kidney to excrete waste products formed from the breakdown of extra protein.

Nephrotic syndrome, or nephrosis, is a disease that a. is caused by chronic hypertension. b. allows large amounts of protein to escape into the tubule. c. causes the buildup of toxic wastes in the blood. d. results in the formation of kidney stones.

ANS: B Nephrotic syndrome, or nephrosis, results from nephron tissue damage to both the glomerulus and tubule. The primary damage is to the major filtering membrane of the glomerulus, which allows large amounts of protein to pass into the tubule.

The bone disease osteodystrophy develops because of the kidneys' inability to a. excrete calcium. b. activate vitamin D. c. absorb vitamin D. d. excrete urea.

ANS: B The disturbed metabolism of calcium and phosphate from lack of vitamin D activation, a process that occurs in the kidneys, leads to bone pain from osteodystrophy.

One of the first recommendations for any type of kidney stone is to a. increase the fiber in the diet. b. reduce calcium intake. c. increase fluid intake. d. decrease protein intake.

ANS: C A large fluid intake is the primary therapy that helps produce more dilute urine and prevent accumulation of materials that form stones.

A major clinical symptom of acute kidney failure is a. hematuria. b. proteinuria. c. oliguria. d. massive edema.

ANS: C A major symptom of acute kidney failure is oliguria, which is caused when the cellular debris from the tissue damage blocks the renal tubules.

A progressive increase in serum urea levels occurs in a. acute renal failure. b. glomerulonephritis. c. chronic kidney failure. d. nephrotic syndrome.

ANS: C A progressive increase in serum urea levels occurs in chronic kidney failure. Increasing loss of nephron function results in elevated amounts of nitrogenous metabolites, such as urea.

The sudden shutdown of kidney function as the result of traumatic injury is called a. nephrosis. b. glomerulonephritis. c. acute kidney failure. d. chronic kidney failure.

ANS: C Acute kidney failure results when renal function in healthy kidneys shuts down suddenly after some metabolic insult or traumatic injury, causing a life-threatening situation. This is a medical emergency.

Mr. Jones has chronic kidney disease. He is 55 years of age, weighs 165 lbs, and has a glomerular filtration rate (GFR) of 22 mL/min. His estimated energy needs per day are approximately a. 1125 to 2200 kcal/day. b. 1500 to 2350 kcal/day. c. 1875 to 2625 kcal/day. d. 2250 to 2850 kcal/day.

ANS: C Carbohydrate and fat must provide enough energy to spare protein and maintain body weight (BW). A GFR of 22 mL/min is consistent with stage 4 chronic kidney disease (CKD). Recommended energy intake is 25 to 35 kcal/kg of BW/day. In this case, 165 lb = 75 kg; 75 kg x 25 kcal/kg/day = 1875 kcal; 75 kg x 35 kcal/kg/day = 2625 kcal.

For patients treated with dialysis, a good source of protein could be a. sherbet. b. green beans. c. a scrambled egg. d. apple crisp.

ANS: C Eggs are a high-biologic value protein for patients on dialysis.

For patients with uric acid stones, health practitioners may recommend a diet low in a. calcium. b. vegetable protein. c. purines. d. fat.

ANS: C Excess excretion of uric acid may be caused by some impairment with the metabolism of purine, a nitrogen end product of dietary protein from which uric acid is formed.

The massive edema of nephrotic syndrome is caused by a. blockage in the nephron tubules. b. excessive fluid intake. c. large protein losses in the urine. d. a diet too high in sodium.

ANS: C In nephrotic syndrome, large amounts of protein pass into the tubule. The large protein loss leads to massive edema and ascites as well as proteinuria.

The method of dialysis that allows patients to be mobile is a. hemodialysis. b. renal dialysis. c. peritoneal dialysis. d. continuous dialysis.

ANS: C Peritoneal dialysis is an alternative form of treatment for dialysis that allows patients to be mobile. In this process, the patient introduces the dialysate solution directly into the peritoneal cavity 4 or 5 times a day, where it can be exchanged for fluids that contain the metabolic waste products.

The presence of protein in the urine is called a. hematuria. b. oliguria. c. proteinuria. d. anuria.

ANS: C Proteinuria results from an abnormal excess of serum proteins in the urine.

The bone disease osteodystrophy is associated with a. glomerulonephritis. b. acute renal failure. c. chronic renal failure. d. nephrotic syndrome.

ANS: C The disturbed metabolism of calcium and phosphate from lack of vitamin D, a process that occurs in the kidneys, leads to bone pain from osteodystrophy in patients with chronic renal failure.

Ms. Jones comes to the emergency department with a severe drug reaction to penicillin. She may be at risk for a. diabetes or heart disease. b. high sodium intake. c. protein-energy malnutrition. d. acute kidney failure.

ANS: D Acute kidney failure can result from drug reactions in allergic or sensitive persons, such as a reaction to antibiotics (such as penicillin) or antimicrobial agents.

The hormone that causes the kidneys to reabsorb water and decrease urine production is a. renin. b. vitamin D. c. erythropoietin. d. antidiuretic hormone.

ANS: D Antidiuretic hormone (ADH) works on the distal nephron tubule to conserve water by reabsorption.

The classic symptoms of chronic kidney failure result from a. a diet high in sodium. b. a diet chronically low in fluid intake. c. severe trauma to the body. d. the progressive loss of nephrons.

ANS: D Chronic kidney failure, or chronic renal insufficiency, is caused by the progressive breakdown of renal tissues, which impairs all renal function. Few functioning nephrons remain, and they gradually deteriorate.

8. Azotemia refers to elevated blood levels of a. glucose. b. cholesterol. c. amines d. urea

ANS: D Elevated blood levels of urea nitrogen and other nitrogenous products are reflected in the characteristic laboratory finding of azotemia.

The "cleaning solution" used in hemodialysis is called the a. filtrate. b. plasma. c. urine. d. dialysate.

ANS: D The "cleaning solution" used in hemodialysis is called the dialysate.

The structure responsible for filtering the blood is the a. loop of Henle. b. proximal tubule. c. distal tubule. d. glomerulus.

ANS: D The glomerulus filters the blood. Only the larger blood proteins and cells remain behind in the circulating blood as it leaves the glomerulus.