Chapter 25: Disorders of Renal Function

A patient is concerned that medication may damage his kidneys. Which factor(s) place the patient at most risk for developing a drug-related nephropathy? Select all that apply. a. Age/elderly b. Prescription methicillin and other synthetic antibiotics c. Nonsteroidal anti-inflammatory drugs (NSAIDs) d. Diuretics e. Age/young adult f. Procedures involving radiocontrast media

a. Age/elderly b. Prescription methicillin and other synthetic antibiotics c. Nonsteroidal anti-inflammatory drugs (NSAIDs) d. Diuretics f. Procedures involving radiocontrast media (Explanation: Elderly persons are particularly susceptible to kidney damage caused by drugs and toxins. The dangers of nephrotoxicity are increased when two or more drugs capable of producing kidney damage are given at the same time. Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the nonsteroidal anti-inflammatory drugs [NSAIDs], can cause acute kidney injury by decreasing renal blood flow.)

The most important information for a nurse to give a patient who has been diagnosed and treated for a calcium oxalate stone would be to: a. Avoid spinach and peanuts b. Avoid milk and dairy products c. Take a thiazide diuretic d. Increase intake of citrus juices

a. Avoid spinach and peanuts (Explanation: Persons who form calcium oxalate stones may need to decrease their intake of foods that are high in oxalate [e.g., spinach, Swiss chard, cocoa, chocolate, pecans, and peanuts]. Taking a thiazide diuretic helps to prevent calcium stone redevelopment but it not a dietary change.)

A nurse is caring for a patient diagnosed with nephrotic syndrome. The nurse is aware that the patient may manifest which of the following? Select all that apply. a. Generalized edema b. Lipiduria c. Hyperlipidemia d. Hyperalbuminemia e. Massive proteinuria (>3.5 g/day)

a. Generalized edema b. Lipiduria c. Hyperlipidemia e. Massive proteinuria (>3.5 g/day) (Explanation: Nephrotic syndrome is characterized by massive proteinuria [>3.5 g/day in adults] and lipiduria [e.g., free fat, oval bodies, fatty casts), along with an associated hypoalbuminemia [<3 g/dL], generalized edema, and hyperlipidemia. The nephrotic syndrome is not a specific glomerular disease but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine.)

A patient had been diagnosed with a simple cyst of the kidney and is presenting with symptoms. Which does the nurse anticipate the patient will display? Select all that apply. a. Hypertension b. Compromised renal function c. Hematuria d. Less than 50 years of age e. Infection

a. Hypertension c. Hematuria e. Infection (Explanation: Most simple cysts do not produce signs or symptoms or compromise renal function. When symptomatic, they may cause flank pain, hematuria, infection, and hypertension related to ischemia-produced stimulation of the renin-angiotensin system. They are most common in persons older than 50 years.)

Which stresses can cause injury to the kidney glomerulus? Select all that apply. a. Nonimmunologic b. Hereditary c. Asthma d. Arthritis e. Diabetes f. Immunologic

a. Nonimmunologic b. Hereditary e. Diabetes f. Immunologic (Explanation: Most cases of primary and many cases of secondary glomerular disease probably have an immune origin. Although many glomerular diseases are driven by immunologic events, a variety of metabolic [e.g., diabetes], hemodynamic [e.g., hypertension], and toxic [e.g., drugs, chemicals] stresses can induce glomerular injury, either alone or in concert with immunologic mechanisms. Arthritis and asthma would not affect the glomerulus.)

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: a. Prolonged blockage of the ureter with a stone b. A streptococcal infection 7 to 12 days prior to onset c. Uncontrolled diabetes with increased proteinuria d. Drug-induced damage to the renal glomeruli

b. A streptococcal infection 7 to 12 days prior to onset (Explanation: Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A B-hemolytic streptococci and is caused by deposition of immune complexes. It also may occur after infections by other organisms, including staphylococci and a number of viral agents, such as those responsible for mumps, measles, and chickenpox.)

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor? a. Presence of a palpable flank mass b. Anomalies of the genitourinary system c. Massive generalized edema d. A visible fine red rash on the body

b. Anomalies of the genitourinary system (Explanation: An important feature of Wilms tumor is its association with other congenital anomalies, aniridia [absence of the iris], hemihypertrophy [enlargement of one side of the face or body], and other congenital anomalies, usually of the genitourinary system. Wilms tumor usually is a solitary mass that occurs in any part of the kidney. The common presenting signs are a large asymptomatic abdominal mass and hypertension.)

What clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)? a. Elevated systemic blood pressure and severe pain b. Bilateral flank masses and impaired lung development c. Ascending urinary tract infection and vomiting d. Gross hematuria and massive generalized edema

b. Bilateral flank masses and impaired lung development (Explanation: Clinical manifestations of the typical infant with ARPKD include bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Potter facies and other defects associated with oligohydramnios may be present. Hypertension is usually noted within the first few weeks of life and is often severe.)

Which factor has been implicated in the progression of diabetic nephropathy? a. Elevated cholesterol b. Cigarette smoking c. Increased sodium intake d. Decreased blood pressure

b. Cigarette smoking (Explanation: Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy. The control of blood pressure [to levels of 130/80 mm Hg or less] and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes. Increased sodium intake would result in increased volume and additional stress on the kidneys. Elevated glucose levels would contribute to disease progression.)

What signs and symptoms would you expect to see in a patient diagnosed with acute nephritic syndrome? a. Generalized edema and hypotension b. Hematuria and azotemia c. Hypoalbuminemia and lipiduria d. Proteinuria and hyperlipidemia

b. Hematuria and azotemia (Explanation: The acute nephritic syndromes evoke an inflammatory response in the glomeruli and are characterized by hematuria with red cell casts in the urine, diminished GFR, azotemia, oliguria, and hypertension. Nephrotic syndrome, also due to glomerular disease, is characterized by heavy proteinuria, hypoalbuminemia, and severe edema.)

Which factor contributes to the development of polycystic kidney disease? a. A reduction in prerenal blood flow to the kidneys b. Hereditary mutations in polycystin I and II c. Enlargement in the basement membrane of the kidney d. Multiple recurrent urinary tract infections

b. Hereditary mutations in polycystin I and II (Explanation: Polycystic kidney disease is typically related to dominant or recessive hereditary mutations in polycystin. The other options are related to urinary tract infections. Some drugs, such as diuretics, high molecular weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the NSAIDs can cause acute prerenal failure by decreasing renal blood flow.)

The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop: a. Increased urine output b. Increase in blood pressure c. Inability to control urination d. Excretion of dilute urine

b. Increase in blood pressure (Explanation: Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.)

Which condition increases a patient's chance of developing an ascending urinary tract infection? a. Seeding of the kidney in the course of infective endocarditis b. Obstruction of urine outflow from the kidney c. The presence of high levels of glucose in the urine d. Transfer of pathogens in the course of septicemia

b. Obstruction of urine outflow from the kidney (Explanation: Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder. A common complication of urinary tract obstruction is infection. Stagnation of urine predisposes to infection, which may spread throughout the urinary tract. There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream [hematogenous spread]. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney. The hematogenous route results from seeding of the kidneys by bacteria from distant loci in the course of septicemia or infective endocarditis.)

Select the manifestations of renal cell carcinoma. Select all that apply. a. Does not metastasize b. Palpable flank mass c. Hematuria d. Often silent in the early stages

b. Palpable flank mass c. Hematuria d. Often silent in the early stages (Explanation: Kidney cancer is largely a silent disorder during its early stages, and symptoms usually denote advanced disease. Presenting features include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. It is, however, intermittent and may be microscopic; as a result, the tumor may reach considerable size before it is detected. One of the features of renal cell carcinoma is its ability to metastasize.)

A patient who developed acute pyelonephritis asks the nurse what caused the infection. Which should be included in the nurse's response? Select all that apply. a. Reflux is the most common cause. b. Severe hypertension often is a contributing factor in the progress of the disease. c. Acute pyelonephritis is caused by bacterial infection. d. Outflow obstruction, catheterization, and urinary instrumentation. e. Escherichia coli is the causative agent in about 80% of cases.

c. Acute pyelonephritis is caused by bacterial infection. d. Outflow obstruction, catheterization, and urinary instrumentation. e. Escherichia coli is the causative agent in about 80% of cases. (Explanation: Acute pyelonephritis is an acute suppurative inflammation of the kidney caused by bacterial infection. Escherichia coli is the causative agent in about 80% of cases, also Enterobacteriaceae, Pseudomonas species, group B Streptococcus, Staphylococcus, and enterococci. Factors that contribute to the development of complicated acute pyelonephritis are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder. Reflux is the most common cause of chronic pyelonephritis. Severe hypertension is a contributing factor in the progression of chronic pyelonephritis.)

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome? a. Abnormal blood clotting and elevated blood pressure b. Decreased high-density lipoproteins and increased iron levels c. Elevated urine protein and hypoalbuminemia d. Low triglycerides and elevated sodium levels

c. Elevated urine protein and hypoalbuminemia (Explanation: The nephritic syndrome is due to glomerular disease that is usually of acute onset and is accompanied by grossly visible hematuria, mild to moderate proteinuria, and hypertension. The nephrotic syndrome, also due to glomerular disease, is characterized by heavy proteinuria, hypoalbuminemia, and severe edema.)

Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)? a. Percutaneous nephrolithotomy b. Retrograde ureteroscopy c. Extracorporeal shock wave lithotripsy (ESWL) d. Percutaneous ureterolithotomy

c. Extracorporeal shock wave lithotripsy (ESWL) (Explanation: ESWL is a nonsurgical treatment that uses sound waves, laster, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.)

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a patient. Which would be the most important information for the nurse to provide? a. It is not necessary to stop smoking. b. A decrease in GFR will occur with early alterations. c. Microalbuminuria is a predictor of future nephropathies. d. Blood glucose control has no impact on GFR.

c. Microalbuminuria is a predictor of future nephropathies. (Explanation: The increased GFR that occurs in persons with early alterations in renal function is associated with microalbuminuria, defined as urinary albumin excretion of 30 to 300 mg in 24 hours. Microalbuminuria is an important predictor of future diabetic nephropathies. In many cases, these early changes in glomerular function can be reversed by careful control of blood glucose levels. [Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy.] Thus, control of blood pressure [to levels of 130/80 mm Hg or less] and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes.)

Which are contributing factors of acute postinfectious glomerulonephritis? Select all that apply. a. Polyuria is the first symptom. b. Antibodies develop in 2 to 5 days after infection. c. Primarily infects the pharynx. d. Increased GFR. e. May result from impetigo. f. Occurs after infection of group A B-hemolytic streptococci.

c. Primarily infects the pharynx. e. May result from impetigo. f. Occurs after infection of group A B-hemolytic streptococci. (Explanation: The classic case of poststreptococcal infection by approximately 7 to 12 days - the time needed for the development of antibodies. The primary infection usually involves the pharynx [pharyngitis] but can also result from a skin infection [impetigo]. Oliguria, which develops as the GFR decreases, is one of the first symptoms. Proteinuria and hematuria follow because of increased glomerular capillary wall permeability.)

A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest: a. A visible abdominal mass and abdominal pain b. Elevation in systemic blood pressure and frequent urination c. Increased thirst and increased urinary output d. Acute onset of colicky or dull and achy intermittent flank pain

d. Acute onset of colicky or dull and achy intermittent flank pain (Explanation: One of the major manifestations of kidney stones in pain. Depending on the location, there are two types of pain associated with kidney stones - colicky or non colicky. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in men. Stones are not externally visible or palpable. Obstruction by a stone may result in urinary retention and increased fluid volume.)