Chapter 25: Disorders of Renal Function- Patho level 3 taken from http://thepoint.lww.com

A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations? a) Albumin b) Red blood cells c) Sodium d) Potassium

Albumin The clinical manifestations of diabetic glomerulosclerosis are closely linked to those of diabetes. The increased glomerular filtration rate that occurs in people with early alterations in renal function is associated with microalbuminuria, which is defined as urinary albumin excretion of 30 to 300 mg in 24 hours.

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

Elevated urine protein 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, hypoalbuminemia, and severe edema.

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

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

Which one of the following is the usual cause of acute pyelonephritis? a) Autoimmunity b) Obstruction c) Infection d) Reflux

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

Staghorn kidney stones, or struvite stones, are usually located in the renal pelvis. These stones are made from what? a) Uric acid b) Calcium oxalate c) Magnesium ammonium phosphate d) 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.

Surgical stone removal is indicated for which of the following instances? a) Stone too small to pass b) Mild, intermittent pain for one day c) Obstruction of urine flow d) 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.

A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system? a) Intervenous calcium b) Renal transplant c) Kidney removal d) Plasmapheresis

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

Which of the following is the most common cancer of the kidney? a) Lymphoma b) Renal cell carcinoma c) Wilms tumor d) Transitional cell carcinoma

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

Drug-related nephropathies occur all too often. They involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on? a) Glomerular filtration rate b) State of hydration c) Proteinuria d) Vesicoureteral reflux

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. None of the other answers are correct.

A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason? a) The patient has ingested a dark-colored drink. b) The patient's urine contains material from the degradation of red blood cells. c) The patient has an elevation of urine potassium. d) The patient's urine has a decrease in the specific gravity.

The patient's urine contains material from the degradation of red blood cells. When red blood cells degrade in the urine, urine may appear cola colored.

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed: a) acute renal failure. b) acute postinfectious glomerulonephritis. c) nephrotic syndrome. d) kidney stones.

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. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR (Glomerular filtration rate ) decreases, is one of the first symptoms.

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

• 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 patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause? a) "Have you had any type of infection within the last 2 weeks?" b) "Do you have a history of heart failure?" c) "Have you ever been diagnosed with diabetes?" d) "Have you recently had kidney stones?"

"Have you had any type of infection within the last 2 weeks?" Acute post-infectious Glomerulonephritis usually occurs after infection with certain strains of group A β-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organism can also cause this infection.

Which one of the following would the nurse see as being liable to cause the most serious long-term problems? a) Unilateral renal agenesis b) Polycystic kidney disease c) Simple renal cyst d) Horseshoe kidney

Polycystic kidney disease 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 horeshoe-shaped structure. The condition usually does not cause problems. Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death.

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

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.

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

Anomalies 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 suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which of the following disorders? a) Autosomal recessive polycystic kidney disease (ARPD) b) Simple renal cysts c) Horseshoe kidney abnormality d) Autosomal dominant polycystic kidney disease

Autosomal recessive polycystic kidney disease (ARPD) The typical infant with ARPD presents with bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension.

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

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.

A patient has passed a kidney stone composed of uric acid (urate). Which of the following pathological conditions is a contributing factor for the development of this type of kidney stone? a) Arteriosclerosis b) Atherosclerosis c) Gout d) Sickle-cell disease

Gout Uric acid stones develop in conditions of gout and high concentrations of uric acid in the urine.

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? a) E. coli b) S. aureus c) Group A Β-hemolytic streptococci d) P. aeruginosa

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.

A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media? a) Administering ibuprophen 600 mg prior to the procedure b) Administering one unit of packed red blood cells c) Having the patient take nothing by mouth d) Increasing the normal saline intravenous infusion rate to 125 mL/hour

Increasing the normal saline intravenous infusion rate to 125 mL/hour Some drugs, such as high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus and nonsteroidal anti-inflammatory drugs can cause acute prerenal failure by decreasing renal blood flow. Administering intravenous saline can improve hydration and renal perfusion to decrease the toxic effects of the radiocontrast media.

A patient who has had an intestinal bypass has developed a kidney stone. Which of the following types of kidney stone does the nurse recognize that this patient will most likely be treated for? a) Cystine b) Uric acid c) Calcium d) Magnesium ammonium

Calcium Most kidney stones are calcium stones-calcium oxalate, calcium phosphate, or a combination of the two materials. Patients who have had intestinal bypass surgery are at a higher risk for developing calcium kidney stones.

A 22 year-old female with a history of intermittent flank pain, repeated UTIs and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis? a) She has inherited undersized kidneys that are prone to calculi formation. b) UTIs coupled with an impaired immune response have caused her ADPKD. c) She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. d) Severe hypertension and portal hypertension are likely precursors.

She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. ADPKD is an inherited condition, and the etiology is thought to involve cysts arising in segments of the renal tubules from a few epithelial cells that proliferate abnormally. UTIs are consequent, not causative, of the condition. Severe hypertension and portal hypertension are more commonly associated with ARPKD (autosomal recessive polycystic kidney disease) than ADPKD. Kidneys are typically oversized in ADPKD and renal calculi are not noted sequelae

A nurse is caring for a patient who has been diagnosed with kidney colic and has not yet passed the stone. Which of the following interventions should the nurse be sure to include when planning the care for this patient? a) Have the client take cool baths. b) Administer acetominophen (Tylenol) every 4 hours for pain. c) Restrict fluid intake. d) Strain the urine.

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 preventative measures. The patient will require an increase in fluid intake. The patient will also require an opioid analgesic to control the pain

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: a) Is not allergic to shell fish or iodine b) Does not have a kidney stone obstructing the urethra c) Is in good enough health to withstand a walking on a treadmill d) Will not undergo an acute kidney injury by decreasing renal blood flow

Will not undergo an acute kidney injury by decreasing renal blood flow 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. Checking creatinine levels do not predict the client's allergies, a kidney stone, or tolerance for stress testing.

If a client with a kidney stone has the "classic" ureteral colic, the client will describe his pain as: Select all that apply. a) Excruciating b) In the flank and upper outer quadrant of the abdomen c) Diffuse over the entire lower back and legs d) Acute, intermittent

• Acute, intermittent • Excruciating • 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.

A client is admitted with acute pyelonephritis. As the nurse enters the room, the client has shaking chills and reports acute pain. Other clinical manifestations the nurse will assess includes: Select all that apply. a) frequency, urgency, and dysuria. b) change in level of consciousness and hallucinations. c) shallow breathing and expiratory wheezes. d) moderate to high fever. e) pale skin and dry mucous membranes.

• moderate to high fever. • frequency, urgency, and dysuria. 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. (less)

A nurse is caring for a patient who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this patient? a) Bowel elimination b) Skin care c) Bed rest d) Hydration

Hydration A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.

A 34 year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis, stating, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the man's statement? a) "Your liver does perform most of the detoxifying in your body, but your kidneys can perform this role if the liver is unable to." b) "Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." c) "High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case." d) "It is very rare for someone as young as yourself to have kidney damage like this; usually only older people are vulnerable to kidney damage from drugs."

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." High flow and pressure combined with the metabolic transformative of drugs makes the kidneys vulnerable to drug toxicity. They do not play a backup role to the liver in the metabolism of drugs, and while structural and functional damage may occur with drug overuse, infection is a less likely consequence. The elderly are particularly vulnerable to drug-related nephritis and nephropathies, but it would be incorrect to conclude that younger people are thus immune.

Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate? a) ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history. b) The use of ACE inhibitors will increase the vasopressin levels. c) The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. d) ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. In addition to increasing water intake to decrease vasopressin levels, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to interrupt the renin-angiotensin-aldosterone system as a means of reducing intraglomerular pressure and renal vasoconstriction. Although not approved by the Food and Drug Administration (FDA), there has been recent interest in the use of vasopressin receptor antagonists (vaptans) to decrease cyst development.

A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest:

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

A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds: a) All glomeruli and all parts of the glomeruli are involved. b) Only some of the glomeruli are affected. c) That the mesangial cells are being affected. d) Only one segment of each glomerulus is involved.

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.

A nurse is caring for a patient with systemic lupus erythematosis (SLE). The patient asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which of the following factors was present in the urine? a) Sugar b) Blood or protein c) Cancer cells d) Potassium

Blood or protein Because of the high risk of kidney disease, all people with SLE should undergo routine urinalysis to monitor for the presence of hematuria or proteinuria.

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? a) Increase intake of cranberry juice to 2 L/day. b) Continue taking antibiotics for full 10 to 14 days even if symptoms of infection disappear. c) Take prescribed diuretics early in the day to avoid having to get up during the night. d) Force micturition every 2 hours while awake.

Continue taking antibiotics for full 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 of the following best describes nephronophthisis-medullary cystic kidney disease? a) Small elongated cysts form in the collecting ducts and maintain contact with the nephron of origin. b) Cysts are restricted to the corticomedullary border. c) Cysts develop in the kidney as a consequence of aging, dialysis, or other conditions that affect tubular function. d) 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.

Cysts are 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.

The nurse is reviewing the lab results of a patient with suspected nephrotic syndrome. The nurse anticipates that the results to include: a) Abnormal blood clotting factors b) Serum hyperalbuminemia c) Protein in the urine d) Decreased tryglycerides e) 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.

A nurse is caring for a patient who is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following is the most common clinical presentation of this condition? a) Occult hematuria b) Nephrotic syndrome c) Nephritic syndrome d) Renal colic

Nephritic 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 A beta-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens

Which of the following substances would not be found in glomerular filtrate? a) Water b) Protein c) Potassium d) Sodium

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.

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? a) The woman takes too many bubble baths. b) The woman has multiple sexual partners. c) There is possible obstruction in the urinary tract. d) 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.

Congenital disorders of the kidneys are fairly common, occurring in approximately 1:1000 live births. What is the result to the newborn when bilateral renal dysplasia occurs? (Select all that apply.) a) Oligohydramnios b) Potter facies c) Pulmonary hypoplasia d) Multicystic kidneys e) Renal failure

• Potter facies • Oligohydramnios • Pulmonary hypoplasia • Renal failure Bilateral renal dysplasia causes oligohydramnios and the resultant Potter facies, pulmonary hypoplasia, and renal failure. Multicystic kidneys are a disorder, not the result of a congenital problem.

Which client would be considered at a higher risk for developing Goodpasture Syndrome, an aggressive form of glomerulonephritis? Select all that apply. a) Elderly person with a recent influenza infection b) Painter working with a busy construction crew who finishes all the house painting indoor and out c) Electrician who wires homes and businesses for high-definition Internet d) Hair style expert who specializes in coloring [dyes] hair e) Middle-aged over-the-road truck driver

• Elderly person with a recent influenza infection • Painter working with a busy construction crew who finishes all the house painting indoor and out • Hair style expert who specializes in coloring [dyes] hair The cause of the disorder [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.

The nurse is caring for a patient who has not received prenatal care during her pregnancy. The patient delivers a newborn who dies an hour after birth because of total agenesis of both kidneys. Which of the following physical features does the newborn exhibit that correlates with this diagnosis? Select all that apply. a) Imperforate anus b) Broad and flat nose c) Low-set ears d) Cleft lip e) Eyes widely separated with epicanthic folds

• Eyes widely separated with epicanthic folds • Low-set ears • Broad and flat nose Total agenesis of both kidneys is incompatible with extrauterine life. Infants are stillborn or die shortly after birth of pulmonary hypoplasia. Newborns with renal agenesis often have characteristic facial features, sometimes called Potter syndrome, resulting from the effects of oligohydramnios. The eyes are widely separated and have epicanthic folds, the ears are low set, the nose is broad and flat, the chin is receding, and limb defects are often present.

A client has been recently undergone diagnostic testing for possible Berger disease. The nurse caring for this client would anticipate the primary clinical manifestations include which of the following? Select all that apply. a) Fever, chills, and general body aches b) Gross hematuria c) Recent upper respiratory infection d) Elevated ketone levels in the urine

• Gross hematuria • Recent upper respiratory infection • Fever, chills, and general body aches Early in the disease, many people with the disorder have no obvious symptoms, and the disorder is discovered during screening or examination for another condition. In others, the disorder presents with gross hematuria that is preceded by upper respiratory tract infection, GI tract symptoms, or flulike illness. The hematuria lasts 2 to 6 days. Elevated ketones are usually associated with acidosis, fasting, high-protein diet, or diabetes to name a few.

A client has a tubulointerstitial disorder and is no able to concentrate urine. The nurse will likely assess which manifestations associated with this disorder? Select all that apply. a) Acidic urine b) Nocturia c) Hematuria d) Polyuria

• Polyuria • Nocturia The tubulointerstitial disorders are distinguished clinically from glomerular diseases by the absence, in the early stages, of such hallmarks of nephritis and nephrosis as hematuria and proteinuria, and by the presence of disorders in tubular function. These disorders, which are often subtle, include the inability to concentrate urine, as evidenced by polyuria and nocturia; interference with acidification of urine, resulting in metabolic acidosis; and diminished tubular reabsorption of sodium and other substances.