Porth's Patho: Disorders of Renal Fx, Chapter 33

A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed: -Autosomal recessive polycystic kidney disease (ARPKD) -Acute postinfectious glomerulonephritis -Adult-onset medullary cystic disease -Acute nephritic syndrome

Acute postinfectious glomerulonephritis The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days—the time needed for the development of antibodies. Oliguria, which develops as the GFR decreases, is one of the first symptoms. Proteinuria and hematuria follow because of increased glomerular capillary wall permeability. Sodium and water retention gives rise to edema (particularly of the face and hands) and hypertension. Adults with medullary cystic kidney disease present first with polyuria, polydipsia, and enuresis (bed-wetting), which reflect impaired ability of the kidneys to concentrate urine. The typical infant with ARPKD presents with bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function.

A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis? -Acute renal failure -Acute pyelonephritis -Renal cell carcinoma -Renal calculi

Acute pyelonephritis Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations.

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

-Occurs after infection of group A-hemolytic streptococci. -Primarily infects the pharynx. -May result from impetigo. The classic case of poststreptococcal glomerulonephritis follows a streptococcal 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 9-year-old boy has just been diagnosed with the nephritic syndrome. The first stage of his disease will result in: -hypoproteinemia. -decreased plasma oncotic pressure. -increased permeability to proteins. -glomerular damage.

-glomerular damage. The pathophysiology of the nephritic syndrome involves damaged glomeruli becoming increasingly permeable to protein, allowing more protein into the filtrate. The blood is consequently proteinemic, decreasing plasma oncotic pressure and resulting in edema.

A pregnant woman who is beginning her third trimester has been diagnosed with a urinary tract infection (UTI). Which factors most likely predisposed this client to the development of a UTI? -Dilation of the upper urinary structures -Increased urine alkalinity during pregnancy -Spastic peristalsis of the ureters -Hypertrophy of the bladder wall

Dilation of the upper urinary structures Normal changes in the functioning of the urinary tract that occur during pregnancy predispose to UTIs. These changes involve the collecting system of the kidneys and include dilation of the renal calyces, pelves, and ureters that begin during the first trimester and become most pronounced during the third trimester. Bladder hypertrophy, spastic peristalsis, and increased urine pH are not phenomena that are common accompaniments to pregnancy.

A young child has been diagnosed with Wilms tumor after the parent discovered an unusual mass, prompting a diagnostic workup. Which tumor characteristic is typical of Wilms tumor? -Self-limiting -A secondary neoplasm -Encapsulated -Asymptomatic

Encapsulated Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. It is not a self-limiting health problem, and chemotherapy, radiotherapy, and/or surgery may be utilized. Symptoms include hypertension, abdominal pain, and vomiting.

Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and: -Hyperalbuminemia -Hyperkalemia -Hypoalbuminemia -Hypokalemia

Hypoalbuminemia An increase in glomerular membrane permeability allows proteins to escape from the plasma into the glomerular filtrate. Massive proteinuria results, leading to hypoalbuminemia.

Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation? -Decreased heart rate -Decreased sodium retention -Increased urinary output -Increased blood pressure

Increased blood pressure In cases of unilateral obstruction of the kidney, renin secretion is enhanced, probably secondary to impaired renal blood flow. This would result in increased sodium retention, and increased blood pressure. Urine output would be decreased, and heart rate would not necessarily be affected.

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema? -Lower extremities -Eyelids -Abdomen -Hands

Lower extremities Initially, the edema caused by nephritic syndrome presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized as the disease progresses.

What is the most common cancer of the kidney? -Lymphoma -Transitional cell carcinoma -Renal cell carcinoma -Wilms tumor

Renal cell carcinoma Renal cell carcinoma accounts for 80% to 90% of all kidney tumors.

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte? -Sodium -Hydrogen -Potassium -Glucose

Sodium One type of RTA results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of sodium ions with decreased elimination of hydrogen and potassium ions. Glucose is not an electrolyte.

Drug-related nephropathies involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on? -Vesicoureteral reflux -State of hydration -Medication class -Proteinuria

State of hydration The tolerance to drugs varies with age and depends on renal function, state of hydration, blood pressure, and the pH of the urine.

A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client? -Strain the urine. -Restrict fluid intake. -Administer acetaminophen every 4 hours for pain. -Have the client take cool baths.

Strain the urine. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. This information, along with a careful history and laboratory tests, provides the basis for long-term preventive measures. The client will require an increase in fluid intake. The client will also require an opioid analgesic to control the pain.

One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease includes which diagnostic procedure? -Serum creatinine levels -Urine specific gravity -Urine albumin excretion (UAE) -Blood urea nitrogen (BUN) level

Urine albumin excretion (UAE) Serum creatinine levels have not been found to be an effective predictor marker for worsening ADPKD, but urine albumin excretion (UAE) has been determined to be a reliable predictor, as have increased electrolytes and hematuria.

The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include: -decreased triglycerides. -protein in the urine. -abnormal blood clotting factors. -serum hyperalbuminemia. -decreased low-density lipoproteins.

protein in the urine In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema, and hyperlipidemia.

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: -does not have a kidney stone obstructing the urethra. -is not allergic to shell fish or iodine. -will not undergo an acute kidney injury by decreasing renal blood flow. -is in good enough health to withstand a walking on a treadmill.

will not undergo an acute kidney injury by decreasing renal blood flow. Some drugs (diuretics, high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and nonsteroidal anti-inflammatory drugs) can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels does not predict the client's allergies, a kidney stone, or tolerance for stress testing.

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds: -"All glomeruli and all parts of the glomeruli are involved." -"The mesangial cells are being affected." -"Only one segment of each glomerulus is involved." -"Only some of the glomeruli are affected."

"All glomeruli and all parts of the glomeruli are involved." Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells.

An adult client has been diagnosed with polycystic kidney disease. Which statement by the client demonstrates an accurate understanding of this diagnosis? -"I've always been prone to getting urinary tract infections, and now I know why." -"I suppose I should be tested to see if my children might inherit this." -"I suppose I really should have paid more attention to my blood pressure." -"I had a feeling that I was taking too many medications, and now I know the damage they can do."

"I suppose I should be tested to see if my children might inherit this." Autosomal dominant polycystic kidney disease is the most common of all inherited kidney diseases. The disorder is characterized by multiple expanding cysts of both kidneys that ultimately destroy the surrounding kidney structures and cause renal failure. The etiology of polycystic kidney disease (PKD) is not infective, and it is not caused by nephrotoxic drugs or uncontrolled hypertension.

A nurse's neighbor is experiencing some odd symptoms, and asks the nurse about them. The neighbor states having blood in the urine intermittently and thinks there is a lump in the back (where kidney is located). What advice is most appropriate for the nurse to relay to this neighbor? -"Do you think you might have a kidney infection?" -"See if your health care provider will prescribe some antibiotics for you." -"Make an appointment with your health care provider immediately." -"Try drinking more water and see if the symptoms go away."

"Make an appointment with your health care provider immediately." Kidney cancer is largely a silent disorder during the early states. Presenting features include hematuria, flank pain, and presence of a palpable flank mass. The tumor may reach considerable size before it is detected. Urinary tract infections may cause hematuria and drinking more water may help along with antibiotics. However, palpable lumps must always be checked by the health care provider.

A nurse is caring for a client with hematuria. The nurse understands this may be a clinical manifestation of which renal conditions? Select all that apply. -Acquired renal cyst -Unilateral hydronephrosis -Renal calculi -Renal cell carcinoma

-Acquired renal cyst -Renal calculi -Renal cell carcinoma Hematuria is a possible manifestation of acquired renal cysts, renal cell carcinoma, and renal calculi. Unilateral hydronephrosis may remain silent for long periods because the unaffected kidney can maintain adequate kidney function.

A client has recently been diagnosed with systemic lupus erythematosus (SLE) glomerulonephritis. Knowing the treatment options, the nurse should anticipate educating the client (who has a positive renal biopsy result) on which medications usually prescribed? Select all that apply. -Furosemide, a diuretic -Captopril, an ACE inhibitor -Ampicillin, an antibiotic -Prednisone, a corticosteroid

-Captopril, an ACE inhibitor -Prednisone, a corticosteroid Treatment depends on the extent of glomerular involvement. Oral corticosteroids and angiotensin-converting enzyme (ACE) inhibitors are the mainstays of treatment. Diuretics and antibiotics are not part of the treatment protocol.

An adult client presents to the emergency department with manifestations of acute cystitis. For which sign/symptom would the nurse assess the client? Select all that apply. -Fever -Cloudy urine -Urinary infrequency -Chest pain -Back discomfort -Burning on urination

-Cloudy urine -Back discomfort -Burning on urination An acute episode of cystitis (bladder infection) is characterized by frequency of urination, lower abdominal or back discomfort, and burning and pain on urination (i.e., dysuria). Occasionally, the urine is cloudy and foul smelling. In adults, fever and other signs of infection usually are absent. If there are no complications, the symptoms disappear within 48 hours of treatment.

A client with suspected kidney cancer asks the nurse, "What testing procedures will be ordered to confirm the diagnosis?" How should the nurse respond? Select all that apply. -Computerized tomography (CT) scan looking for lesions and metastasis -Magnetic resonance imaging (MRI) to identify if the inferior vena cava is involved -24-hour urine testing to estimate the amount of blood loss per day -Ultrasound of the kidney looking for masses -Renal arteriogram looking for blockages

-Computerized tomography (CT) scan looking for lesions and metastasis -Magnetic resonance imaging (MRI) to identify if the inferior vena cava is involved -Ultrasound of the kidney looking for masses Ultrasonography and CT scanning are used to confirm the diagnosis of kidney cancer. MRI may be used when involvement of the inferior vena cava is suspected. A 24-hour urine test will not assist with the diagnosis of renal cancer. A renal arteriogram is used to assess patency of the arteries going to the kidney for possible blockages.

An newborn has been diagnosed with renal agenesis. Which characteristics should the nurse mention to the parents as it correlates to this diagnosis? Select all that apply. -Epicanthic folds (skin of the upper eyelid) are present -Low-set ears -Long, narrow nose -Receding chin -Eyes are situated very close together

-Epicanthic folds (skin of the upper eyelid) are present -Low-set ears -Receding chin Newborns with renal agenesis often have characteristic facial features, called Potter syndrome, that are caused by fetal compression due to a marked reduction in amniotic fluid levels. The eyes are widely separated and have epicanthic folds, the ears are set low, the nose is broad and flat, and the chin is receding. Limb defects often are present.

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

-Escherichia coli is the causative agent in about 80% of cases. -Acute pyelonephritis is caused by bacterial infection. -Outflow obstruction, catheterization, and urinary instrumentation 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

Several clients in clinic today are reporting urinary signs/symptoms. Which reported manifestation(s) leads the health care provider to suspect acute pyelonephritis? Select all that apply. -Flank pain in the back -Heart palpitations -Abrupt onset of fever and chills -Urinary urgency and frequency -Shortness of breath

-Flank pain in the back -Abrupt onset of fever and chills -Urinary urgency and frequency Acute pyelonephritis tends to present with an abrupt onset of chills, high fever, and an ache or tenderness in the flank area of the back. Lower urinary tract symptoms--dysuria, frequency, and urgency--also are common. Nausea and vomiting may occur along with abdominal pain. Chest pain and shortness of breath is not associated with acute pyelonephritis.

A client admitted with acute pyelonephritis has shaking chills and acute pain. What other clinical manifestations will the nurse likely assess for this diagnosis? Select all that apply. -Change in level of consciousness and hallucinations -Pale skin and dry mucous membranes -Shallow breathing and expiratory wheezes -Frequency, urgency, and dysuria -Moderate to high fever

-Frequency, urgency, and dysuria -Moderate to high fever The onset of acute pyelonephritis is usually abrupt, with shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency, also are common. It is not associated with expiratory wheezes, hallucinations, or dry mucous membranes.

Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis? -E. coli -Group A β-hemolytic streptococci -P. aeruginosa -S. aureus

-Group A β-hemolytic streptococci Group A β-hemolytic streptococci have the ability to seed from one area of the body to another. One area it seeds to is the kidney, where it causes acute postinfectious glomerulonephritis. Other organisms can cause acute postinfectious glomerulonephritis, but they are not the most common cause of the disease.

Which clients would be considered at a higher risk for developing Goodpasture syndrome, an aggressive form of glomerulonephritis? Select all that apply. -Hair stylist expert who specializes in coloring (dying) hair -Painter working with a busy construction crew who finishes all the house painting, indoor and outdoor -Electrician who wires homes and businesses for high-definition Internet -Older adult with a recent influenza infection -Middle-aged, over-the-road truck driver

-Hair stylist expert who specializes in coloring (dying) hair -Painter working with a busy construction crew who finishes all the house painting, indoor and outdoor -Older adult with a recent influenza infection The cause of Goodpasture syndrome is unknown, although influenza infection and exposure to hydrocarbon solvent (found in paints and dyes) have been implicated in some persons, as have various drugs and cancers. There is not a greater risk associated with truck drivers or electricians.

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

-Hyperlipidemia -Massive proteinuria (>3.5 g/day) -Lipiduria -Generalized edema 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 [30 g/L]), 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.

Which can be said about acute, drug-induced interstitial nephritis? Select all that apply. -It may result in acute renal failure. -It may be related to a sensitivity to sulfonamide drugs. -It is an autoimmune disease. -It manifests as a fever, hematuria, mild proteinuria, and possibly a rash. -It is an infectious disease

-It may result in acute renal failure. -It may be related to a sensitivity to sulfonamide drugs. -It manifests as a fever, hematuria, mild proteinuria, and possibly a rash. Acute drug-related hypersensitivity reactions produce tubulointerstitial nephritis, with damage to the tubules and interstitium. This condition was observed initially in persons who were sensitive to sulfonamide drugs. At the onset, there is fever, eosinophilia, hematuria, mild proteinuria, and in approximately 25% of cases, a rash. In approximately 50% of cases, signs and symptoms of acute renal failure develop.

Which statements are true regarding a Wilms tumor? Select all that apply. -Long term survival rate is low for stage II-III. -It presents with an abdominal mass. -It is the most common childhood malignant tumor. -Treatment includes chemotherapy, radiation and surgery.

-It presents with an abdominal mass. -It is the most common childhood malignant tumor. -Treatment includes chemotherapy, radiation and surgery. Wilms tumor is one of the most common malignant tumors of children. The most common presenting signs are a large abdominal mass and hypertension. Treatment is surgery, chemotherapy, and sometimes radiation therapy. The long-term survival rate for children with Wilms tumor is approximately 90% for stages I-III, with an aggressive plan of treatment.

What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply. -Inserting a Foley catheter -Keeping track of intake and output -Addressing the client's pain -Restricting the client's oral fluid intake -Straining the client's urine

-Keeping track of intake and output -Addressing the client's pain -Straining the client's urine One of the major manifestations of kidney stones is pain. Treatment includes relief of pain. All urine should be strained during an attack in the hope of retrieving the stone for chemical analysis and determination of type. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged. Keeping track of intake and output will help to identify poor output possibly due to obstruction by a calculi. A Foley catheter is not indicated when the client is able to urinate.

A client with systemic lupus erythematosus (SLE) glomerulonephritis is experiencing a worsening of the disease and has progressed to the higher classes resulting in renal involvement. Which medication(s) will likely be prescribed by the health care provider to treat the deterioration of the renal function? Select all that apply. -Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor -Oral corticosteroid -Intravenous antimicrobial combination drug trimethoprim and sulfamethoxazole -Spironolactone, a mineralocorticoid-receptor antagonist -Increase in Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)

-Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor -Oral corticosteroid As SLE clients progress to the higher classes of glomerulonephritis, the renal function deteriorates, as seen with rising serum creatinine and decrease in calculated glomerular filtration rate (GFR). Oral corticosteroids and ACE inhibitors are the mainstay of treatment. The combination drug trimethoprim and sulfamethoxazole are prescribed for urinary tract infections. Spironolactone is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, hypertension, or hypokalemia. Ibuprofen is an NSAID. It works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.

Following the diagnosis of nephrotic syndrome, the nurse knows the clinical manifestations occur as a result of a decreased plasma colloidal osmotic pressure. Therefore, the nurse should assess the client for which signs? Select all that apply. -Moist crackles in both lung fields -Increased circumference in the abdomen related to fluid excess -Liver enlargement -Kidneys palpable to deep palpation -Areas of diminished breath sounds due to pleural effusions

-Moist crackles in both lung fields -Increased circumference in the abdomen related to fluid excess -Areas of diminished breath sounds due to pleural effusions Generalized edema, which is a hallmark of the nephrotic syndrome, results from a decrease in the plasma colloidal osmotic pressure due to the hypoalbuminemia that develops as albumin is lost from the vascular compartment. Initially, the edema presents in dependent parts of the body such as the lower extremities, but becomes more generalized as the disease progresses. Dyspnea due to pulmonary edema, pleural effusions, and diaphragmatic compromise due to ascites (increased fluid in the abdominal cavity) can develop in persons with nephrotic syndrome. Liver enlargement is not associated with nephrotic syndrome, but increased synthesis of lipoproteins in the liver secondary to a compensatory increase in albumin production may occur. Palpable kidney mass is associated with cancer.

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

-Often silent in the early stages -Hematuria -Palpable flank mass 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 client who developed acute pyelonephritis asks the nurse what caused the infection. What should be included in the nurse's response? Select all that apply. -Outflow obstruction, catheterization, and urinary instrumentation -Reflux is the most common cause. -Escherichia coli is the causative agent in about 80% of cases. -Severe hypertension often is a contributing factor in the progress of the disease. -Acute pyelonephritis is caused by bacterial infection.

-Outflow obstruction, catheterization, and urinary instrumentation -Escherichia coli is the causative agent in about 80% of cases. -Acute pyelonephritis is caused by bacterial infection. 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.

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

-Prescription methicillin and other synthetic antibiotics -Nonsteroidal anti-inflammatory drugs (NSAIDs) -Diuretics -Age/elderly -Procedures involving radiocontrast media Older adults 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.

Which statement best describes nephronophthisis-medullary cystic kidney disease? -The tubule wall, which is lined by a single layer of tubular cells, expands and then rapidly closes the cyst off from the tubule of origin. -Small, elongated cysts form in the collecting ducts and maintain contact with the nephron of origin. -Cysts develop in the kidney as a consequence of aging, dialysis, or other conditions that affect tubular function. -Presence of a variable number of cysts usually restricted to the corticomedullary border.

-Presence of a variable number of cysts usually restricted to the corticomedullary border. Nephronophthisis and adult-onset medullary cystic kidney disease both produce progressive medullary tubulointerstitial cystic disease. The other conditions described are elsewhere in the renal space.

A nurse is caring for a child with Wilms tumor, stage I. Which statements are true regarding this diagnosis? Select all that apply. Prognosis is poor even with treatment. -Prognosis is good with treatment. -The tumor has undergone hematogenous metastasis, most commonly involving the lung. -The tumor is limited to the kidney and can be excised with the capsular surface intact.

-Prognosis is good with treatment. -The tumor is limited to the kidney and can be excised with the capsular surface intact. Long-term survival rates have increased to 90% for Wilms tumor stages I through III. The tumors usually are staged using the National Wilms' Tumor Study Group classification: stage I tumors are limited to the kidney and can be excised with the capsular surface intact

A parent asks the nurse what signs and symptoms a child would display if the child had a urinary tract infection. Which is the best response by the nurse? -The same symptoms as an adult. -The child's immune system is weak so he or she will not have foul-smelling urine. -The child will not have a fever. -The child does not present with typical symptoms.

-The child does not present with typical symptoms. Unlike adults, children frequently do not present with the typical signs of a UTI. A urinary tract infection should be suspected when the child presents with a fever that has no other cause. The parents should be educated to report any abnormal colored or cloudy urine because this is also an early indication of a urinary tract infection.

A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon? -The higher hydrostatic pressure causes reactive mesangial cell atrophy. -The higher pressures cause muscular growth of the afferent arteriole, resulting in reduced GFR. -The higher volume of blood reaching the kidneys overworks them, and they begin to atrophy. -The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation.

-The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation. The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation. The inflammatory reaction damages the membrane, and the selective permeability is lost. Smooth muscle hypertrophy will not affect GFR. Mesangial cells will undergo hypertrophy and hyperplasia, not atrophy, in glomerular disorders. Increased workloads cause hypertrophy, not atrophy, of the renal structures.

A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply. -Daily tub baths -Wiping from front to back after a bowel movement -Careful hand washing -Avoiding bubble baths

-Wiping from front to back after a bowel movement -Careful hand washing -Avoiding bubble baths Most uncomplicated lower UTIs are caused by Escherichia coli. It is important to wipe from front to back to prevent introducing this pathogen to the urinary tract from the rectal area. It is not necessary to take a daily tub bath. Bubble baths can cause urinary irritation. Careful hand washing helps to reduce the introduction of pathogens to the urinary tract.

If a client with a kidney stone has the "classic" ureteral colic, the client will describe the pain as: Select all that apply. -excruciating. -diffuse over the entire lower back and legs. -acute and intermittent. -in the flank and upper outer quadrant of the abdomen.

-excruciating. -acute and intermittent. -in the flank and upper outer quadrant of the abdomen The symptoms of renal colic are caused by stones 1 to 5 mm in diameter that can move into the ureter and obstruct flow. Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man. The pain is usually not described as diffuse and over the entire low back and legs.

Which client is likely at the greatest risk of developing a urinary tract infection? -A client with a diagnosis of chronic kidney disease who requires regular hemodialysis -A confused, 81-year-old client who is incontinent of urine -A pregnant woman who has been experiencing urinary frequency -A 79-year-old client with an indwelling catheter

A 79-year-old client with an indwelling catheter Indwelling catheters are strongly associated with the development of UTIs, and this risk factor supersedes pregnancy and kidney disease. Frequency and incontinence may be signs and symptoms of UTIs, but they are not causative of the infections.

The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as: -Simple -Autosomal recessive -Autosomal dominant -Acquired

Autosomal recessive Autosomal recessive familial PKD is characterized by cystic dilatation of the cortical and medullary collecting tubules. It is rare compared with autosomal dominant polycystic kidney disease and usually presents as severe renal dysfunction during infancy.

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

Bilateral flank masses and impaired lung development 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.

Hospitalized neonates are at greatest risk of developing septicemia related to which procedure? -Suctioning of tracheostomy -Arterial blood gas measurement -Collection of urine for analysis -Catheter-associated bacteriuria

Catheter-associated bacteriuria Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized neonates. The other procedures can cause bacteremia but are not the primary cause for this.

Which disorder of renal function primarily affects the proximal and distal tubules? -Chronic pyelonephritis -Acute nephritic disease -Polycystic kidney disease -Renal calculi

Chronic pyelonephritis Pyelonephritis is an infection of the renal tubular structures, whereas nephritic disease involves the glomeruli. Polycystic kidney disease does not primarily afflict the tubules. Renal calculi have an obstructive etiology.

Which client would the nurse consider having the highest risk for developing a urinary tract infection? -Client with septicemia -Client with high levels of glucose in the urine -Client with infective endocarditis -Client with obstructed urinary outflow from a kidney stone

Client with obstructed urinary outflow from a kidney stone Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, sexually active women, postmenopausal women, and neurogenic bladder.

A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen? -Take prescribed diuretics early in the day to avoid having to get up during the night. -Force micturition every 2 hours while awake. -Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear. -Increase intake of cranberry juice to 2 L/day.

Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear. Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral (caused by conditions that obstruct bladder outflow) or unilateral (such as occurs with ureteral obstruction). Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis.

Which laboratory findings would the nurse anticipate in a client diagnosed with nephritic syndrome? -Low triglycerides (<150 mg/dL; 1.69 mmol/L]) and elevated sodium levels -Decreased high-density lipoproteins (HDL) and increased iron levels (Hgb >18 g/dL; 180 g/L). -Elevated urine protein level (>3.5 g/day) and hypoalbuminemia -Low platelet level (<20 ×103/µL; 20 ×109/L) and elevated blood pressure

Elevated urine protein level (>3.5 g/day) and hypoalbuminemia 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, lipiduria, hypoalbuminemia, and severe edema.

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra. -Group B Streptococcus -Escherichia coli -Pseudomonas -Staphylococcus aureus

Escherichia coli Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli bacteria that enter through the urethra. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs, and both non-E. coli Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and Gram-positive cocci (Staphylococcus aureus, Group B Streptococcus) in complicated UTIs.

Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)? -Percutaneous nephrolithotomy -Percutaneous ureterolithotomy -Extracorporeal shock wave lithotripsy (ESWL) -Retrograde ureteroscopy

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

The nurse is caring for a client with cystitis. Which sign/symptom is most characteristic of the urine associated with cystitis? -Pale color -Foul smell -Dark color -Oliguria

Foul smell The manifestations of cystitis include urine that is occasionally cloudy and foul smelling.

While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which high-risk factor with the development of this cancer? -Heavy smoking -Adrenal medulla tumors -Inherited renal disease -Gastroesophageal reflux disease (GERD)

Heavy smoking Epidemiologic evidence suggests a correlation between heavy smoking and kidney cancer. Obesity also is a risk factor, particularly in women. The risk of renal cell carcinoma also is increased in persons with acquired cystic kidney disease associated with chronic renal insufficiency. Although the adrenal gland is adjacent to the kidney, primary adrenal tumors are unrelated to renal cell disease. Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. Frequent or constant reflux can lead to gastroesophageal reflux disease (GERD).

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? -Hematuria -Oliguria -Urinary urgency -Cloudy urine

Hematuria Presenting features of renal cancer 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. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma.

Which signs and symptoms would you expect to see in a client diagnosed with acute nephritic syndrome? -Proteinuria and hyperlipidemia -Hematuria and proteinuria -Hypoalbuminemia and lipiduria -Generalized edema and hypotension

Hematuria and proteinuria 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, proteinuria, oliguria, and hypertension. Nephrotic syndrome, also due to glomerular disease, is characterized by hypoalbuminemia, and severe edema.

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

Hereditary mutations in polycystin I and II 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.

Which medication does the nurse administer that will lower urinary calcium by increasing tubular reabsorption to prevent kidney stone formation? -Spironolactone -Hydrochlorothiazide -Furosemide -Bumetanid

Hydrochlorothiazide Thiazide diuretics, such as hydrochlorothiazide, lower urinary calcium by increasing tubular reabsorption so that less remains in the urine. Drugs that bind calcium in the gut may be used to inhibit calcium absorption and urinary excretion.

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely? -Urinary calculi -Papillary necrosis -Prostatic hyperplasia -Hydronephrosis

Hydronephrosis Hydronephrosis refers to urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction of urine outflow.

A client is diagnosed with renal calcium stone formation. Which endocrine imbalances could contribute to this condition? -Cushing disease -Hyperparathyroidism -Hypothyroidism -Pheochromocytoma

Hyperparathyroidism Renal calculi are most commonly made of calcium. Dehydration and elevated blood calcium levels contribute to the condition. Because parathyroid hormone draws calcium from the bones into the bloodstream, hyperparathyroidism is a major contributing factor in calcium kidney stone formation.

The nurse is planning an education seminar on polycystic kidney disease. Which topic should the nurse include as a key indicator of both autosomal dominant and autosomal recessive polycystic kidney disease? -Impaired lung development -Hypertension -Renal colic -Massive proteinuria

Hypertension Hypertension is a clinical manifestation of both autosomal dominant and autosomal recessive polycystic kidney disease. Nephrotic syndrome is characterized by massive proteinuria. Impaired lung development is a sign of autosomal recessive polycystic kidney disease but not autosomal dominant. Renal colic is a symptom of nephrolithiasis and this occurs in only 20% of clients with autosomal dominant polycystic kidney disease.

Manifestations of polycystic kidney disease include which of the following? -Increase in kidney size bilaterally -Reduction in kidney size unilaterally -Reduction in kidney size bilaterally -Increase in kidney size unilaterally

Increase in kidney size bilaterally The kidneys are usually enlarged in people with autosomal dominant polycystic kidney disease and may achieve enormous sizes. The external contours of the kidneys are distorted by numerous cysts. The kidneys are also enlarged in autosomal recessive polycystic kidney disease

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication? -Increased blood pressure -Polyuria -Diluted urine -Decreased blood pressure

Increased blood pressure Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect? -solid formations -positive glucose -specific gravity of 1.025 -increased nitrites

Increased nitrites The nurse would expect the urinalysis of a client with a urinary tract infection to have increased nitrites, because bacteria reduce nitrates in the urine to nitrites. Glucose and protein are not normal findings and would require follow-up. Specific gravity of 1.025 is within normal limits; solid formations in the urine suggest calculi.

What is the usual cause of acute pyelonephritis? -Autoimmunity -Infection -Reflux -Obstruction

Infection Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the most common causative agents for acute pyelonephritis.

Magnesium renal stones are associated with which medical problem? -Infection -Azotemia -Gout -Hypercalcemia

Infection Magnesium ammonium phosphate stones, also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide.

A client presents with sudden onset of hematuria, variable proteinuria, decreased GFR, oliguria, and signs of impaired renal function. Upon taking a history the nurse learns that the client had strep throat 3 weeks ago. Upon renal biopsy the diagnosis of acute glomerulonephritis is confirmed. What mechanism of damage is the most plausible? -Injury resulting from antibodies reacting with fixed glomerular antigens or antigens planted within the glomerulus. -Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. -Direct damage from cytotoxic T-cell activation. -Direct damage for abnormal complement activation.

Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The glomerular injury results from circulating antigen-antibody complexes that originated in the primary infection and now become trapped in the glomerular membrane. Activation of immune and inflammatory components damages the membrane but must be activated by the antibody complex.

What commonly causes chronic pyelonephritis, resulting in renal scarring and atrophy? -Renal hyperplasia -Abscess formation -Intrarenal reflux -Viral organisms

Intrarenal reflux Reflux, the most common cause of chronic pyelonephritis, results from superimposition of infection on congenital vesicoureteral reflux or intrarenal reflux. Reflux may be unilateral with involvement of a single kidney or bilateral, leading to scarring and atrophy of both kidneys with the eventual development of chronic renal insufficiency. Acute pyelonephritis represents a patchy, interstitial, infectious bacterial inflammatory process, with abscess formation and tubular necrosis.

The acute care unit has had an increase in Gram-negative septicemia over the last 6 months. Which of the following would the infection care nurse know might require clinical focus of the most common cause of these types of infections? -Knowledge of aseptic technique when inserting urethral catheters -Knowledge of performing activities of daily living -Knowledge of the administration of subcutaneous insulin -Knowledge of starting IV fluids

Knowledge of aseptic technique when inserting urethral catheters Knowledge of aseptic techniques when inserting urethral catheters is essential when there are incidences of catheter-associated bacteriuria. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized clients. Studies have shown that bacteria adhere to the surface of the catheter and initiate the growth of a biofilm that then covers the surface of the catheter.

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor? -Hypotension and a large abdominal mass -Large asymptomatic abdominal mass and hypertension -Vomiting and oliguria -Abdominal pain and diarrhea

Large asymptomatic abdominal mass and hypertension The common presenting signs of a Wilms tumor are a large asymptomatic abdominal mass and hypertension. The tumor is often discovered inadvertently, and it is not uncommon for the mother to discover it while bathing the child. Some children may present with abdominal pain, vomiting, or both. Hypotension, oliguria, and diarrhea are not common presenting signs of a Wilms tumor.

Staghorn kidney stones, or struvite stones, are usually located in the renal pelvis. These stones are made from: -Calcium oxalate -Magnesium ammonium phosphate -Uric acid -Cystine

Magnesium ammonium phosphate Phosphate levels are increased in alkaline urine and magnesium, always present in the urine, and combine to form struvite stones. These stones can increase in size until they fill an entire renal pelvis. Because of their shape, they often are called staghorn stones. The other minerals can form stones, but not staghorn stones.

The most recent assessment of a client with type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which assessment finding is most suggestive of this increased risk? -Diabetic retinopathy -Microalbuminuria -Hematuria -Orthostatic hypotension

Microalbuminuria The increased glomerular filtration rate (GFR) that occurs in persons with early alterations in renal function is associated with microalbuminuria, which is an important predictor of future diabetic nephropathies. Hematuria is not directly suggestive of diabetic nephropathy, although it is a highly significant assessment finding. Orthostatic hypotension and diabetic retinopathy are not direct indicators of diabetic nephropathy.

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a client. Which statement would be the most important information for the nurse to provide? -A decrease in GFR will occur with early alterations. -Microalbuminuria is a predictor of future nephropathies. -Blood glucose control has no impact on GFR. -Smoking plays no role in the progression of this disease.

Microalbuminuria is a predictor of future nephropathies. 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.

A nurse is caring for a client who is diagnosed with acute poststreptococcal glomerulonephritis. Which renal disorder is most commonly associated with acute post-streptococcal glomerulonephritis? -Nephritic syndrome -Renal colic -Occult hematuria -Nephrotic syndrome

Nephrotic syndrome The acute nephritic syndrome is the clinical correlate of acute glomerular inflammation. The nephritic syndromes produce a proliferative inflammatory response, whereas the nephrotic syndrome produces increased permeability of the glomerulus. The acute nephritic syndrome may occur in such a systemic disease as systemic lupus erythematosus. Typically, however, it is associated with acute proliferative glomerulonephritis such as postinfectious glomerulonephritis. Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens.

Surgical stone removal is indicated for which instance? -Obstruction of urine flow -Stone too small to pass -Mild, intermittent pain for 1 day -Small stone without evidence of size increase

Obstruction of urine flow Open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal. Kidney stones are a major cause of upper urinary tract obstruction.

Surgical stone removal is indicated for which instance? -Small stone without evidence of size increase -Obstruction of urine flow -Mild, intermittent pain for 1 day -Stone too small to pass

Obstruction of urine flow Open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal. Kidney stones are a major cause of upper urinary tract obstruction.

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)? -Male client 2 days postoperative hip fracture repair whose Foley catheter was removed on postoperative day 1 -Woman who has just given birth and had a straight urinary catheter inserted prior to delivery -Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month -Middle-aged male client admitted for dehydration due to strenuous exercise in hot weather

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized clients. A catheter in place for 1 month places the client at greatest risk for a UTI.

A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and autoantibodies from the system? -Intravenous calcium -Plasmapheresis -Renal transplant -Kidney removal

Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies. Renal transplantation would return the kidneys to normal function, but this is the extreme of treatment. The other options would not produce the necessary treatment outcomes

A female client with suspected glomerular disease has been referred to a nephrologist by her family physician. Which finding would help the specialist rule out glomerular disease? -Collagen fibers are deposited in the glomeruli. -Dense noncellular material is deposited on the endothelial and epithelial side of the basement membrane cells. -Podocytes encircle the outer surface of glomerular capillaries and connect to the epithelial cells. -There is a large amount of extracellular material in the mesangial and subendothelial tissue of her glomeruli.

Podocytes encircle the outer surface of glomerular capillaries and connect to the epithelial cells. In the healthy glomerulus, podocytes encircle the capillaries and attach epithelial cells to the basement membrane. Dense noncellular material denotes basement membrane thickening. A large amount of extracellular material in the mesangial and subendothelial tissue characterizes sclerosis. The presence of collagen fibers denotes fibrosis; all are pathologic findings.

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems? -Horseshoe kidney -Unilateral renal agenesis -Polycystic kidney disease -Simple renal cyst

Polycystic kidney disease Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death. Agenesis refers to failure of an organ to develop at all. The other kidney usually undergoes compensatory hypertrophy and performs the function of the missing kidney. Most simple cysts do not produce signs or symptoms or compromise renal function. A horseshoe kidney occurs when the upper and lower poles of the two kidneys are fused, producing a horseshoe-shaped structure. The condition usually does not cause problems.

Which substance would not be found in glomerular filtrate? -Potassium -Protein -Sodium -Water

Protein The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall.

Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome? -Proteinuria and generalized edema -Increased creatinine with normal blood urea nitrogen -Hematuria and anemia -Renal colic and increased serum sodium

Proteinuria and generalized edema The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia. Hematuria and anemia may be associated with a cancer. Renal colic is characteristic of kidney stones. Increased creatinine may be associated with systemic lupus erythematosus.

An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem? -Has peripheral vascular disease -Takes a diuretic and an ACE inhibitor each day for the treatment of hypertension -Recently had a urinary tract infection -Was diagnosed with type 2 diabetes several years earlier

Recently had a urinary tract infection There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis. Diabetes, peripheral vascular disease, and hypertension controlled by a diuretic and an ACE inhibitor and are not associated with acute pyelonephritis.

A woman has sought care because of recurrent urinary tract infections that have been increasing in both frequency and severity. Which factor is likely to contribute to recurrent UTIs? -Fluctuations in urine pH -Reflux flow of urine -Urethral trauma -Inadequate fluid intake

Reflux flow of urine Reflux flow of urine is a significant risk factor for UTIs in general and for recurrent UTIs in particular. Fluctuations in urine pH are not noted to contribute to recurrent UTIs. Urethral trauma and inadequate fluid intake may contribute to the development or prolonging of UTIs, but these risk factors are less significant than the presence of urine reflux.

An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which treatment goal would be considered the priority in the care of this child? -Total parenteral nutrition -Respiratory support -Rehydration therapy -Prophylactic antibiotics

Respiratory support Aggressive ventilatory support is often necessary for neonates with ARPKD due to the presence of pulmonary hypoplasia and hypoventilation. Hydration, nutrition, and infection prevention are relevant aspects of care, but respiratory interventions are the priority.

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle? -Salt and water tubular reabsorption -Obstruction and reflux -Inability to concentrate urine -Decreased glomerular permeability

Salt and water tubular reabsorption Generalized edema, a hallmark of nephrosis, results from salt and water retention and a decrease in plasma colloid osmotic pressure due to loss of albumin in the urine. Glomerulonephritis is characterized by sodium and water retention that causes edema, particularly of the face and hands. Clinical findings of nephrotic syndrome result from increased (rather than decreased) glomerular permeability to the plasma proteins. In renal damage, the inability to concentrate urine causes polyuria and water loss. Outflow obstruction and reflux are associated with microorganisms in the stagnant urine that can ascend along the ureters to infect the kidneys.

The nurse is performing a history and physical on a client with diabetic nephropathy. Findings include BP 124/80; smokes two packs of cigarettes/day; diet high in saturated fats and sodium. Which intervention can help prevent the progression of the diabetic nephropathy? -Walking program -DASH diet with limited caloric intake -Increase dietary sodium intake -Smoking cessation program

Smoking cessation program Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy. The control of blood pressure (the client has a normal BP at this time) and smoking cessation will help prevent the progression of diabetic nephropathy. The other dietary interventions may be recommended; however, there is not a correlation that they will prevent the development of diabetic nephropathy.

A female teenager has experienced three uncomplicated urinary tract infections in the past 3 months. Which action should the nurse include in education for this teenager? -Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus -Taking antimicrobials to treat Escherichia coli while forcing fluids -Proper handwashing to decrease amount of Pseudomonas growing on the hands -Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection

Taking antimicrobials to treat Escherichia coli while forcing fluids Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli that enter through the urethra. Escherichia coli are abundant in fecal matter. Treatment consists of a short course of antimicrobial therapy. Forcing fluids may relieve signs and symptoms and is used as an adjunct to antibiotics. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs and both non-E. coli gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and gram-positive cocci (Staphylococcus aureus, group B Streptococcus) in complicated UTIs.

A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon? -The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation. -The higher volume of blood reaching the kidneys overworks them, and they begin to atrophy. -The higher pressures cause muscular growth of the afferent arteriole, resulting in reduced GFR. -The higher hydrostatic pressure causes reactive mesangial cell atrophy.

The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation. The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation. The inflammatory reaction damages the membrane, and the selective permeability is lost. Smooth muscle hypertrophy will not affect GFR. Mesangial cells will undergo hypertrophy and hyperplasia, not atrophy, in glomerular disorders. Increased workloads cause hypertrophy, not atrophy, of the renal structures.

A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe? -The woman has multiple sexual partners. -There is possible obstruction in the urinary tract. -The woman takes too many bubble baths. -The woman does not clean herself properly.

There is possible obstruction in the urinary tract. Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections.

The family members of a client who has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD) ask the nurse what they should do to find out if they have this disease. The nurse will respond that they should visit with their health care provider and ask about having which lab/diagnostic test to screen for the disease? -Renal biopsy -Red blood cell count -Ultrasound of the kidney -Serum BUN and creatinine level

Ultrasound of the kidney Ultrasonography usually is the preferred technique for the diagnosis of ADPKD in symptomatic clients and for screening of asymptomatic family members. A renal biopsy is very invasive and carries a high risk for bleeding. The BUN, creatinine, and RBC serum levels will monitor for normal kidney function. However, the ultrasound is the preferred technique for the diagnosis of ADPKD.

One of the most damaging effects of urinary obstruction on kidney structures is which effect? -Concentrated urine -Kidney hyperplasia -Renal hypertension -Urinary stasis

Urinary stasis The most damaging effects of urinary obstruction are stasis of urine, which predisposes to infection and stone formation, and progressive dilation of the renal collecting ducts and renal tubular structures. Most commonly, the person has pain, signs and symptoms of urinary tract infection, (UTI) and manifestations of renal dysfunction, such as an impaired ability to concentrate urine. Progressive atrophy of the kidney is caused by obstruction of the outflow of urine. Hypertension is an occasional complication of urinary tract obstruction, since urine flow is obstructed rather than renal blood flow.

The formation of magnesium ammonium phosphate (struvite) kidney stones is directly associated with which cause? -Hydronephrosis -Urinary tract infections -Hyperuricemia -High urine calcium

Urinary tract infections There are four types of kidney stones: calcium (i.e., oxalate and phosphate) stones, which are associated with increased serum calcium levels; magnesium ammonium phosphate (i.e., struvite) stones, which are associated with urinary tract infections (UTIs); uric acid stones, which are related to elevated uric acid levels; and cystine stones, which are seen in cystinuria. Urinary obstructive disorders increase the risk of infection and calculi formation, renal hypertension, and hydronephrosis.

The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change? -Urine cloudy with strong odor -Hearing aid batteries are run down -No bowel movement in 48 hours -Exacerbation of osteoarthritis

Urine cloudy with strong odor Older adults are prone to infections without obvious symptoms of fever and purulent drainage. Approximately 50% of all older adults with infections will develop vague symptoms such as anorexia, fatigue, weakness, or change in mental status. Constipation is not noted for stimulating mental status changes. Loss of hearing from malfunctioning hearing aids is most likely to cause difficulties of communication.

Which diagnoses should be considered in children who present with urinary symptoms without bacteriuria? -Vaginitis, sexual molestation, or pinworms -Acute abdomen, renal stones, or spastic bladder dysfunction -Constipation, irritable bowels, or flaccid bladder -Overflow urge, bladder hypertrophy, or overactive bladder

Vaginitis, sexual molestation, or pinworms Urinary symptoms in the absence of bacteriuria suggest vaginitis, urethritis, use of irritating bubble baths, sexual molestation, pinworms, or viral cystitis. In adolescent girls dysuria and vaginal discharge suggest vaginitis or vulvitis.

A teenager has been admitted with the diagnosis of Alport syndrome. The client has been passing large amounts of blood in the urine. Knowing that this disorder is inherited and associated with other abnormalities, the nurse should focus assessment on which area? -Cardiac problems associated with dysrhythmias -Cognitive imbalance -Liver enlargement and ascites -Visual disturbances and hearing loss

Visual disturbances and hearing loss Children may initially present with heavy microscopic hematuria (large amount of blood on dipstick), followed by the development of proteinuria. Many, but not all, persons with Alport syndrome have sensorineural deafness and various eye disorders, including lens dislocation, posterior cataracts, and corneal dystrophy. The hearing loss is bilateral and often is first detected during adolescence. This hereditary disorder affects the kidney's, eyes, and ears. It is not associated with cardiac, liver, or CNS problems.

The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: -drug-induced damage to the renal glomeruli. -uncontrolled diabetes with increased proteinuria. -a streptococcal infection 7 to 12 days prior to onset. -prolonged blockage of the ureter with a stone.

a streptococcal infection 7 to 12 days prior to onset Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-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.

A 25-year-old man of Asian ancestry arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. He is eventually told that his kidney disease has no known treatment and results in protein deposits accumulating in the glomerulus. The client has likely been diagnosed with: -Kimmelstiel-Wilson syndrome. -Goodpasture syndrome. -membranous glomerulonephritis. -immunoglobulin A nephropathy.

immunoglobulin A nephropathy. Immunoglobulin A (IgA) nephropathy is a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits. It can occur at any age but most commonly occurs with clinical onset in the second and third decades of life. It is more common in men than in women and is the most common cause of glomerular nephritis in Asians. None of the other listed renal diseases have these characteristics.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance? -Inflammatory cells -Red blood cells -Antibody complexes -Plasma proteins

Plasma proteins The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to plasma proteins. Some of nephrotic glomerular injury results from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The nephritic syndromes are characterized by hematuria with red cell casts.

A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize? -Increase washout of urine -Increase immune availability -Decrease acidity of urine -Thin mucus to prevent bacterial adherence

Increase washout of urine The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor? -palpable flank mass -Congenital anomalies, usually of the genitourinary system

Congenital anomalies, usually of the genitourinary system 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.

The nurse reviews the lab results for a client who has advanced autosomal dominant polycystic kidney disease (ADPKD). The client 's hemoglobin is 8.8 g/dL (88 g/L). The nurse suspects this lab value is related to which cause? -Hemorrhage -Poor dietary intake of iron -Low calcium levels -Reduced production of erythropoietin

Reduced production of erythropoietin As ADPKD progresses, the nephrons reduce the production of erythropoietin (EPO). EPO is necessary for red blood cell production by bone marrow, so EPO deficiency causes anemia.

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response? -Antiviral medications -Antibiotics -Corticosteroids -Pain medications

Corticosteroids The disorder usually is treated with corticosteroids. Although kidney transplantation is the preferred treatment for end-stage kidney disease, focal segmental glomerulonephritis occurs in half of these people. Pain medications may help relieve symptoms but will not treat the disease. Antivirals and antibiotics are not effective in FSGS.

What is a common cause of acute pyelonephritis, an infection of the renal parenchyma and renal pelvis? -Candida albicans -Group A β-hemolytic streptococci -Pseudomonas species -Haemophilus influenzae

Pseudomonas species The most common causative agents of acute pyelonephritis are Gram-negative bacteria, including E. coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas. The other answers are not considered common causative agents of acute pyelonephritis.

A client is being treated with colchicine for pain in the big right toe. The client begins to complain of severe right flank pain and is diagnosed with kidney stones. Which type of kidney stone does the nurse recognize this client is most likely affected by? -Cystine -Uric acid -Calcium -Magnesium ammonium phosphate

Uric acid Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine; it accounts for about 7% of all stones.

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop? -Wilms tumor -Alport syndrome -Pyelonephritis -Renal cell carcinoma

Wilms tumor Wilms tumor gene, WT1, which is located on chromosome 11, encodes a transcription factor that is critical for normal kidney development. Roughly 20% of all Wilms tumors carry WT1 mutations. Renal cell carcinoma is a different mutation, as is Alport syndrome. Pyelonephritis is an infection.