(Sherpath) GU Alterations

Glomerulonephritis

refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Infection or a systemic disease process, such as lupus erythematosus or Schönlein-Henoch purpura (an autoimmune vasculitis), can cause glomerular inflammation.

What are some Diagnostic test to determine glomerulonephritis?

-An antistreptolysin (ASO) titer, which indicates presence of antibodies to streptococcal bacteria, or a Streptozyme test, can be elevated -Protein, erythrocytes, leukocytes, and glucose may be found in urine

What are CMs of nephrotic syndrome?

-Frothy urine -Edema -Anorexia -Fatigue -Abdominal pain -Respiratory infection -Increased weight

Acute poststreptococcal glomerulonephritis, the most common type, is characterized by?

-Hematuria -Proteinuria -HTN -Edema -Renal insufficiency

When do CMs of glomerulonephritis usually develop?

1-2 weeks after streptococcal pharyngitis or 3-6 weeks after streptococcal skin infection

Which set of clinical evidence will prompt a nurse to prepare for managing a patient with glomerulonephritis over nephrotic syndrome? Select all that apply. 1. Hematuria 2. Hypotensive 3. Hypertensive 4. Frothy urine 5. Pallor & fatigue 6. Abrupt onset edema

1. Hematuria 3. Hypertensive 6. Abrupt onset edema

Which elements of a dietary regime are helpful in the therapeutic management of a child with CKD? Select all that apply. 1. Include foods with sodium. 2. Limit (regulate) fluid intake. 3. Include foods the child enjoys. 4. Allow the child to consume fluids freely. 5. Individualize plan within restrictive parameters.

2. Limit (regulate) fluid intake. 3. Include foods the child enjoys. 5. Individualize plan within restrictive parameters.

Cause of Wilms tumor is unknown. Has been associated with?

Aniridia (absence of the irises) Hemihypertrophy Cryptorchidism Hypospadias

glomerulonephritis occurs most frequently in what age group?

young children of preschool or early school age

What should be avoided when assessing a child with Wilms Tumor?

The tumor mass should not be palpated during the assessment because of the risk of rupturing the protective capsule. Excessive manipulation can cause seeding of the tumor and spread of cancerous cells.

What is one difference between glomerulonephritis and nephrotic syndrome?

Unlike the child with glomerulonephritis, the child with nephrotic syndrome usually has normal blood pressure. Edema is usually first noted in the periorbital spaces and dependent areas of the body; its onset is often insidious.

A renal parenchymal histological report of a 2-year-old patient confirms evidence of rare bilateral Wilms tumors affecting the kidneys. As the surgeon prepares for surgery, why is palpating or putting pressure on the abdomen avoided? A. Increased pressure on the tumor may cause a significant rise in blood pressure. B. Palpation or pressure near the tumor may cause it to shift and increase the difficulty of removal. C. Only with bilateral Wilms tumors will the surgeon use extra precautions to prevent the tumors from colliding. D. Increased pressure may cause the tumor to rupture and cancer cells may spread throughout the abdominal cavity.

D. Increased pressure may cause the tumor to rupture and cancer cells may spread throughout the abdominal cavity.

An 8-year-old patient comes to the clinic with symptoms of acute kidney injury. While discussing recent events with the patient, the nurse learns that the patient attended a family barbeque the day before. Which statement explains the importance of this information? Select all that apply. 1. Patient may have eaten pasteurized juice. 2. The patient may have eaten improperly cooked meat. 3. The patient may have consumed contaminated dairy products. 4. Patient may have consumed too much water during the meal leading to water intoxication. 5. The patient may have eaten mayonnaise products that were left unrefrigerated for too long.

2. The patient may have eaten improperly cooked meat. 3. The patient may have consumed contaminated dairy products.

Patient 1: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has developed a GFR of 10% over the past two months.Patient 2: Born with grade V VUR that is unresolved; has received conservative treatments to correct the reflux. Patient has a GFR of 50%.How should the nurse classify each patient based on the information provided? Select all that apply. 1. Patient 1: Acute kidney injury 2. Patient 1: Chronic kidney disease 3. Patient 1: End-stage renal disease 4. Patient 2: Acute kidney injury 5. Patient 2: Chronic kidney disease 6. Patient 2: End-stage renal disease

3. Patient 1: End-stage renal disease Patients with end-stage renal disease have irreversible kidney damage, as indicated by significant decrease in estimated GFR ≤10%. 5. Patient 2: Chronic kidney disease Patients with chronic kidney disease have irreversible kidney damage, as indicated by estimated GFR 50%.

A patient with glomerulonephritis is receiving intravenous fluids to regulate hydration but begins to experience pulmonary edema and worsening hypertension. Blood serum analysis shows hyperkalemia and increased BUN. The hyperkalemia does not respond to interventions. These clinical data should be an indication for the nurse to prepare for which steps in the management of acute renal failure? A. Dialysis B. Antibiotics C. Kidney transplant D. Update vaccinations

A. Dialysis In patients with acute renal failure, unresponsive hyperkalemia and increasing BUN, pulmonary edema and worsening hypertension are indications for dialysis.

A common cause of HUS is the bacteria E.coli. Upon infection of the upper gastrointestinal tract, the bacteria secrete a toxin (Shiga toxin) which damages the endothelial walls of the capillaries and causes inflammation. How does this relate to renal function? A. Occlusion of the glomeruli by inflammation can decrease GFR. B. The toxins damage the lining of the ureters and prevent peristalsis into the bladder. C. Occlusion of the glomeruli increases glomerular pressure and increases GFR causing diuresis. D. Damage to the endothelium can result in proteinuria due to decreased size permeability and decreased GFR.

A. Occlusion of the glomeruli by inflammation can decrease GFR.

A patient presents with sudden onset of gross hematuria, proteinuria and hypertension. In assessing this patient, what statement best supports the importance for the nurse to assess the presence of throat discomfort over the past two weeks? A.Streptococcal pharyngitis can induce glomerulonephritis. B. Hemolytic uremic syndrome (HUS) initially presents with pharyngitis. C. Hematuria is the primary indicator that the patient has nephrotic syndrome caused by E. coli. D. Throat discomfort is an indication of edema which is the primary cause of nephrotic syndrome.

A.Streptococcal pharyngitis can induce glomerulonephritis. Acute poststreptococcal glomerulonephritis occurs as an immune reaction to a group A beta-hemolytic streptococcal infection of the throat or skin. Clinical symptoms usually develop 1-2 weeks after a streptococcal pharyngitis.

A family brings their toddler to the clinic because of frothy urine and a swollen face. Serum analysis confirms hypoalbuminemia and elevated hematocrit levels. The child is normotensive. Based on this clinical data, what care measure should the nurse anticipate in managing this patient? A. Hemodialysis to decrease edema B. Immunosuppression with corticosteroids C. Give normal saline IV to decrease hematocrit D. Decrease protein in diet to compensate for hypoalbuminemia

B. Immunosuppression with corticosteroids For the child with nephrotic syndrome, corticosteroids are continued until child is in remission—defined as <1+ urine protein for 3-7 consecutive days. Steroids are typically continued at the same daily dose for 4-6 weeks.

Which statement helps to explain why immunosuppressive therapy is needed for kidney transplantation? A. To increase endogenous cortisol production B. To prevent rejection of the transplanted organ C. To increase the protection generated by antibodies by decreasing the activity of macrophages D. To increase the number of antibodies produced against infectious agents but decrease the antibodies against "self"

B. To prevent rejection of the transplanted organ

What is nephrotic syndrome?

Nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, hypercholesterolemia, and edema. Nephrotic syndrome can be classified as primary or secondary.

What causes glomerulonephritis?

Occurs as immune reaction to group A beta-hemolytic streptococcal infection of throat or skin