Urinary/Nephrology Quizzes Pathophysiology
All of the following patients are at risk for acute renal failure of the pre-renal type EXCEPT
A) A 22-year-old male who has lost 40% of his blood volume following a workplace injury B) A 41-year-old female admitted for intravenous antibiotic treatment for pyelonephritis C) A 75-year-old male with diagnoses of biventricular heart failure D) An 80-year-old female, in a nursing home, admitted to the ER for treatment of dehydration and malnutrition E) A 20-year-old who just completed a grueling triathlon in the middle of the summer season Correct Answer: B) A 41-year-old female admitted for intravenous antibiotic treatment for pyelonephritis Why? Prerenal AKI represents the most common form of kidney injury and often leads to intrinsic AKI if it is not promptly corrected. Volume loss can provoke this syndrome; the source of the loss may be GI, renal, or cutaneous (eg, burns) or from internal or external hemorrhage. Prerenal AKI can also result from decreased renal perfusion in patients with heart failure or shock (eg, sepsis, anaphylaxis).
One of the complications of renal failure is anemia. Which of the following is indicated to treat the patient with anemia secondary to renal dysfunction or failure?
A) Arrange for frequent blood transfusions in an outpatient clinic B) Administer iron dextran, intravenously C) Administer subcutaneous injection of erythropoietin D) Administer prenatal vitamins twice a day E) Loading dose of iron follow by oral multivitamin with iron supplement Correct Answer: C) Administer subcutaneous injection of erythropoietin Why? Chronic renal failure leads to anemia because of declining erythropoietin production
Nephrotic syndrome involves loss of large amounts of ________ in the urine.
A) Blood B) Sodium C) Potassium D) Calcium E) Protein Correct Answer: E) Protein Why? Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
A 55-year-old male with a history of gout complained of left flank pain. Which of the following renal calculi will most likely develop in this patient?
A) Calcium oxalate B) Uric acid C) Cysteine D) Struvite E) Calcium phosphate Correct Answer: B) Uric acid Why? Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia
A 21-year-old male was admitted to the renal ward for acute glomerulonephritis? As the admitting resident, which of the following question is most appropriate to ask the patient?
A) Do you have a history of heart failure? B) Have you had any type of infection, e.g., strep-throat, within the last 2 weeks? C) Have you recently had kidney stones? D) Have you been diagnosed with diabetes type II? E) Are you sexually active and does not wear condoms? Correct Answer: B) Have you had any type of infection, e.g., strep-throat, within the last 2 weeks? Why? glomerulonephritis can be caused by a streptococcal infection
A 42-year-old is diagnosed with chronic renal failure. Which dietary restriction will the nurse discuss with the patient?
A) Fats B) Complex carbohydrates C) Proteins D) Sugars Correct Answer: C) Proteins Why? For people with kidney disease who are not on dialysis, a diet lower in protein is recommended. Many studies suggest that limiting the amount of protein and including more plant-based foods in the diet may help slow the loss of kidney function. High-protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration. This can cause damage to a glomerular structure leading to or aggravating chronic kidney disease (CKD). Hence, a low-protein diet (LPD) of 0.6-0.8 g/kg/day is often recommended for the management of CKD.
A 54-year-old female is diagnosed with nephritic syndrome. Which of the following is a common symptom of this disease?
A) Hematuria B) Dysuria C) Oliguria D) Proteinuria Correct Answer: A) Hematuria Why? S/s of nephritic syndrome include Hematuria - dysmorphic red blood cells, red blood cell casts, Azotemia, Oliguria, Hypertension, Variable proteinuria (usually < 3 g/day) Nephritic syndrome is a syndrome comprising signs of nephritis, which is kidney disease involving inflammation. It often occurs in the glomerulus, where it is called glomerulonephritis.
The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is
A) Hematuria B) Proteinuria C) Glycosuria D) Bacteruria E) Pyuria Correct Answer: B) Proteinuria Why? Kidneys that are not working properly by spilling protein will cause fluid to leak into your body's tissue causing swelling. This is usually seen around the eyes, in hands and feet, and in your belly (abdomen). This swelling is called "edema" and is a common symptom associated with proteinuria.
A young female was referred to a nephrologist for suspected glomerular disease - nephritic disease. Which of the following are signs of nephritic syndrome?
A) Hematuria B) Proteinuria C) Mild edema D) All of the above Correct Answer: D) All of the above Why? Nephritic syndrome is the name given to a collection of different signs and symptoms that occur as a result of inflammation in the kidneys. This inflammation causes the kidneys to work less effectively. It also causes protein and red blood cells to leak from the bloodstream into the urine. S/s include Edema in the face and legs, Low urine volume (oliguria), Hematuria, High blood pressure/Hypertension (results from the disruption of kidney function, may also occur), Fever, weakness and fatigue, Appetite loss, vomiting, and abdominal pain, Malaise (a feeling of general unwellness) and nausea may also be present.
Nephrotic syndrome does not usually cause
A) Hyperlipidemia B) Proteinuria C) Hematuria D) Generalized edema Correct Answer: C) Hematuria
A 42-year-old male is involved in a motor vehicle accident that has resulted in prerenal failure. What is the most likely cause of this patient's condition?
A) Kidney stones B) Immune complex deposition in the glomerulus C) Inadequate renal blood flow D) Obstruction of the proximal tubule Correct Answer: C) Inadequate renal blood flow Why? Prerenal is the Most common cause of acute renal failure (ARF). Caused by impaired renal blood flow. GFR declines because of the decrease in filtration pressure Acute kidney injury: prerenal decreased renal blood flow --> hypoperfusion (reduced amount of blood flow) --> decreased GFR --> increased proximal tubule Na and H2O reabsorption --> increased aldosterone and ADH secretion --> increased distal tubule Na and H2O reabsorption --> oliguria (small amount of urine)
What causes polyuria during the stage of renal insufficiency?
A) Loss of tubule function B) Increased blood pressure C) Decreased aldosterone secretion D) Increased GFR Correct Answer: A) Loss of tubule function Why? Polyuria caused by solute diuresis results from the delivery of a high load of solute through the nephron, either as a result of filtration of a poorly reabsorbed solute, or of blunted reabsorption of a solute normally transported out of the tubular fluid
What intervention do you plan to include in patient who has renal calculi?
A) Maintain bedrest B) Increase dietary purines C) Restrict fluids D) Strain all urine E) Increase narcotic dose to alleviate renal colic Correct Answer: D) Strain all urine Why? Straining the first urine specimen of the morning is important, because a stone may pass into your bladder during the night. Collecting any passed kidney stones is extremely important in the evaluation of a patient with nephrolithiasis for stone-preventive therapy.
The most common sign/symptom of renal calculi (kidney stone) is
A) Pain B) Vomiting C) Hematuria D) Oliguria Correct Answer: A) Pain
A 35-year-old who was severely burned is now demonstrating symptomology associated with acute tubular necrosis (ATN). Which form of renal failure is this patient experiencing?
A) Prerenal B) Intrarenal C) Postrenal D) Extrarenal Correct Answer: B) Intrarenal Why? Intrarenal is caused by acute tubular necrosis (ATN) (the most common cause of intrarenal renal failure). It can be Postischemic or nephrotoxic. Oliguria Acute kidney injury: intrarenal renal tubular injury (necrosis, apoptosis) --> cast formation --> increased intratubular obstruction --> increased intratubular pressure --> tubular backleak --> decreased GFR --> oliguria
An older male presents with flank pain and polyuria. Tests reveal that he has an enlarged prostate. Which type of renal failure is this patient at risk for?
A) Prerenal B) Intrarenal C) Postrenal D) Extrarenal Correct Answer: C) Postrenal Why? Postrenal occurs with urinary tract obstructions that affect the kidneys bilaterally. Acute kidney injury: postrenal bilateral obstruction to urine flow --> increased intraluminal pressure --> release of inflammatory mediators and vascular endothelial cell injury --> renal vasoconstriction --> cellular/interstitial edema --> decreased glomerular filtration pressure --> oliguria
Glomerular disorders include
A) Pyelonephritis B) Cystitis C) Obstructive urapathy D) Nephrotic syndrome Correct Answer: D) Nephrotic syndrome Why? When the glomeruli become damaged and cannot do their job, it is called glomerular disease. Glomerular disease may be caused by an infection or a drug that is harmful to your kidneys. These include nephrotic syndrome, nephritic syndrome, and glomerulonephritis.
A 45-year-old present with hypertension, anorexia, nausea, and vomiting, and anemia and is diagnosed with chronic renal failure. What is the cause of this patient's anemia?
A) Red blood cells being lost in the urine B) Inadequate production of erythropoietin C) Inadequate iron absorption in the gut D) Red blood cells being injured as they pass through the glomerulus Correct Answer: B) Inadequate production of eryhtropoietin Why? Chronic renal failure leads to anemia because of declining erythropoietin production
A 25-year-old male was involved in a motor vehicle accident. He was transported to UMC in stable condition. Abdominal CT scan showed intra-abdominal bleeding from liver laceration. The patient was prepped for emergency surgery to repair the laceration. Resulting from this traumatic event, blood flow to the kidneys decreased. Which of the following may/will occur?
A) Sodium reabsorption will be inhibited B) There is systemic vasodilation C) The renin-angiotensin system will be activated D) Obligatory water reabsorption will decrease E) The amount of ADH in the blood will decrease Correct Answer: C) The renin-angiotensin system will be activated Why? The renin-angiotensin system (RAS) is a hormone system that regulates blood pressure and fluid balance. Ang II increases blood pressure, stimulates drinking, and increases sodium reabsorption in kidney tubules, to restore blood volume.
A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be
A) Struvite B) Cystine C) Calcium D) Uric acid Correct Answer: D) Uric acid Why? kidney disease can cause gout. However, gout may also lead to kidney disease. Since uric acid is filtered through the kidneys, the two diseases are related. Individuals with gout have a higher risk for uric acid stone formation due to the low urine pH, which creates an environment favorable for uric acid precipitation. Gout may also increase the risk for calcium oxalate stone formation, the most common type of kidney stones
What is the most common type of renal stone composed of?
A) Struvite B) Cystine C) Uric acid D) Calcium E) Cholesterol Correct Answer: D) Calcium Why? The most common components of renal stone are calcium, accounting for 70% to 80%. They are usually made of calcium and oxalate (a natural chemical found in most foods) but are sometimes made of calcium and phosphate. Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium. Dietary factors, high doses of vitamin D, intestinal bypass surgery, and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
As the chief resident of the nephrology service, you are tasked to educate 4th year medical students rotating through the nephrology clinic. On the first day of the rotation, a medical student was involved in the admission of a patient with pre-renal failure. Which of the following is a teaching point to the medical student to ensure he understands the disease process?
A) The cardinal signs of pre-renal failure is polyuria B) Ureteral and bladder outlet obstruction are common contributors to pre-renal failure C) Trauma with blood lost, burns, and cardiogenic shock are precursors to pre-renal failure D) All of the above Correct Answer: C) Trauma with blood lost, burns, and cardiogenic shock are precursors to pre-renal failure Why? Prerenal acute renal failure (ARF) occurs when a sudden reduction in blood flow to the kidney. (renal hypoperfusion) causes a loss of kidney function. In prerenal acute renal failure, there is nothing wrong with the kidney itself. Causes include A sudden, serious drop in blood flow to the kidneys. Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.
While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is:
A) Urine pH B) Gender C) Serum mineral concentrations D) Lifestyle Correct Answer: A) Urine pH Why? Acidic urine promotes Uric Acid and cystine stones, whereas alkaline urine promotes calcium phosphate and struvite stones.
A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3-5 grams per day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is:
A) cystitis. B) chronic pyelonephritis. C) acute glomerulonephritis. D) renal calculi. Correct Answer: C) acute glomerulonephritis Why? Acute glomerulonephritis is defined as inflammation and subsequent damage of the glomeruli leading to hematuria, proteinuria, and azotemia; it may be caused by primary renal disease or systemic conditions. Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes, and waste from your bloodstream and pass them into your urine. S/s include Pink or cola-colored urine from red blood cells in your urine (hematuria), Foamy urine due to excess protein (proteinuria), High blood pressure (hypertension), Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because
A) hepatocyte failure decreases albumin synthesis. B) albumin is excreted in the urine. C) albumin leaks into the interstitial spaces. D) malnutrition is part of nephrotic syndrome. Correct Answer: B) albumin is excreted in the urine Why? Nephrotic syndrome can produce hypoalbuminemia by massive proteinuria, with 3.5 g or more of protein lost within 24 hours. Albumin is filtered by the glomerulus and catabolized by the renal tubules into amino acids that are recycled. In patients with chronic renal disease, in whom both glomerular and tubular diseases are present, excessive protein filtration may lead to both increased protein loss and increased degradation. Only at higher rates of albuminuria (>100 mg/kg/d) and only when the diet is adequate is albumin synthesis increased.
The major cause of glomerulonephritis is an
A) infection of the glomerular capsule secondary to a urinary tract infection. B) hydronephrosis resulting from kidney stones. C) Streptococcus infection that migrates from the bloodstream to the glomerulus. D) immune system damage to the glomeruli. Correct Answer: D) immune system damage to the glomeruli Why? The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure. The chronic glomerulonephritis Sometimes runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.
Signs consistent with a diagnosis of glomerulonephritis include
A) oliguria. B) red blood cell casts in the urine. C) proteinuria. D) all the above. Correct Answer: D) all the above Why? Glomerulonephritis is inflammation of the glomerulus. Caused by Immunologic abnormalities (most common) (Deposition of circulating soluble antigen-antibody complexes, often with complement fragments (type III hypersensitivity). Antibodies reacting in situ against planted antigens within the glomerulus (type II hypersensitivity-cytotoxic)), Drugs or toxins, Vascular disorders, Systemic diseases (secondary), and Viral causes S/s include Two major symptoms if severe (Hematuria with red blood cell casts (dark urine) and Proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein), Oliguria, Hypertension, Edema: generalized, facial, periorbital, Flank or back pain (Edema and stretching of renal capsule), and General signs of inflammation
The pathophysiologic basis of acute glomerulonephritis is
A) renal ischemia. B) bacterial invasion of the glomerulus. C) an anaphylactic reaction. D) an immune complex reaction. Correct Answer: D) an immune complex reaction
Acute post streptococcal glomerulonephritis is primarily caused by:
A) swelling of mesangial cells in the Bowman space in response to the presence of bacteria. B) immune complex deposition in the glomerular capillaries and inflammatory damage. C) inflammatory factors that stimulate cellular proliferation of epithelial cells. D) accumulation of anti-glomerular basement membrane antibodies. Correct Answer: B) immune complex deposition in the glomerular capillaries and inflammatory damage Why? Antigen-antibody complex deposition in the glomerular capillaries and inflammatory damage (Acute post-streptococcal glomerulonephritis is caused by an antigen-antibody complex)
In acute post-streptococcal glomerulonephritis, the glomerular inflammation results from:
A) toxins produced by the bacteria. B) a type III hypersensitivity reaction. C) an ascending infection from the bladder. D) spread of infection from the tubules. Correct Answer: B) a type III hypersensitivity reaction Why? Poststreptococcal glomerulonephritis (PSGN) is characterized by rapid deterioration of kidney functions due to an inflammatory response (type III hypersensitivity reaction) following streptococcal infection Type III hypersensitivity reactions are also termed immune complex reactions. Complexes of antigen and antibody form in the circulation and are then deposited in susceptible tissues; they may also form directly in the tissue. The clinical manifestations of type III hypersensitivity reactions relate to tissue deposition, for example vasculitic (skin), serum sickness (systemic), nephritis (kidneys), and extrinsic allergic alveolitis (lungs).
