PATHO CH 27

nephrotic syndrome

group of clinical signs and symptoms caused by excessive protein loss in urine

glomerulonephritis

inflammation of the glomeruli of the kidney

pyelonephritis

inflammation of the renal pelvis and the kidney

renal calculi

kidney stones

In addition to E. coli, a risk factor for development of pyelonephritis is a. urinary retention and reflux. b. nephrotic syndrome. c. respiratory disease. d. glomerulonephritis.

ANS: A When E. coli is present, urinary retention and reflux increase the risk of the infection ascending the ureter to the kidneys, causing pyelonephritis. Nephrotic syndrome, respiratory disease, and glomerulonephritis are not risk factors for pyelonephritis.

glomeruli

site in kidney where filatraion occurs

It is true that polycystic kidney disease is a. always rapidly fatal. b. caused by a streptococcal infection. c. associated with supernumerary kidney. d. genetically transmitted.

ANS: D Polycystic kidney disease is genetically transmitted. Polycystic kidney disease is a chronic disorder that progresses for several years. It is not caused by a streptococcal infection and is not associated with supernumerary kidney.

Acute pyelonephritis

Bacterial infection in the Kidney or Renal Pelvis- (UTI): E. coli, Staphylococcus.

hydronephrosis

abnormal condition of water in the kidney / obstructive uropathy

hematuria

blood in the urine

hyperlipidemia

excessive fat in the blood / high cholestrol

nephralgia

pain in the kidney

A person with acute pyelonephritis would most typically experience a. fever. b. oliguria. c. edema. d. hypertension

ANS: A Acute pyelonephritis often leads to fever. Acute pyelonephritis does not typically lead to oliguria, edema, or hypertension.

Calcium oxylate stone formation is facilitated by a. hypercalciuria. b. hypoparathyroidism. c. low urine pH. d. protein intake.

ANS: A Hypercalciuria facilitates calcium oxylate stone formation. Hyperparathyroidism and high urine pH facilitate calcium stone formation. Protein intake does not facilitate calcium stone formation.

Hyperlipidemia occurs in nephrotic syndrome because a. hepatocytes synthesize excessive lipids. b. lipids are not excreted in the urine. c. body fats are catabolized. d. muscles stop burning triglycerides for energy.

ANS: A Hyperlipidemia in nephrotic syndrome is caused by increased hepatic synthesis of lipids. People who have nephrotic syndrome have both hyperlipidemia and lipiduria. Catabolized body fats and muscles not burning triglycerides for energy are not the causes of hyperlipidemia in nephritic syndrome.

A common component of renal calculi is a. calcium. b. cholesterol. c. creatinine. d. urobilirubin

ANS: A Renal calculi most commonly are formed from calcium oxalate. Cholesterol, creatinine, and urobilirubin are not common components of renal calculi.

The urea-splitting bacteria contribute to the formation of ________ kidney stones. a. struvite b. calcium oxalate c. uric acid d. cystine

ANS: A Struvite kidney stones are caused by the urea-splitting bacteria. Calcium oxalate, uric acid, and cystine stones are not caused by the urea-splitting bacteria.

The most common sign/symptom of renal calculi is a. pain. b. vomiting. c. hematuria. d. oliguria.

ANS: A The most common sign/symptom of renal calculi is pain. Although nausea, vomiting, and hematuria may accompany renal colic, the most common sign/symptom of renal calculi is pain. Oliguria is not a frequent sign/symptom of renal calculi.

The condition characterized by oliguria and hematuria is a. acute glomerulonephritis. b. polycystic kidney disease. c. cystitis. d. renal insufficiency.

ANS: A Acute glomerulonephritis is characterized by oliguria and hematuria. Polycystic kidney disease and renal insufficiency are not characterized by oliguria and hematuria. Cystitis is not characterized by oliguria

Renal stone formation is affected by (Select all that apply.) a. urine concentration. b. urine PH. c. metabolic/congenital conditions. d. dietary intake. e. potassium level

ANS: A, B, C, D Concentrated urine enhances stone formation. Some stones are formed in acidic urine and others are formed in alkaline urine. Metabolic conditions such as gout increase the possibility of stone formation. High dietary intake of calcium enhances stone formation in susceptible people. Potassium level does not affect stone formation.

Risk factors for renal carcinoma include (Select all that apply.) a. genetics. b. hypotension. c. cigarette smoking. d. obesity. e. chemicals.

ANS: A, C, D, E A small number of individuals have a genetic predisposition to renal carcinoma. Cigarette smoking and obesity are risk factors for renal carcinoma. Certain chemicals (e.g., trichloroethylene) may be associated with development of renal carcinoma. Hypertension is a risk factor for renal carcinoma.

The type of glomerulonephritis which is most likely to result in a swift decline in renal function that then progresses to acute kidney injury is a. acute glomerulonephritis. b. crescentic glomerulonephritis. c. post-streptococcal glomerulonephritis. d. chronic glomerulonephritis.

ANS: B Crescentic glomerulonephritis results in a swift decline in renal function that progresses to acute renal injury. Acute glomerulonephritis, post-streptococcal glomerulonephritis, and chronic glomerulonephritis do not develop into acute renal injury

A major modifiable risk factor for nephrolithiasis is a. positive family history. b. dehydration. c. smoking. d. drinking alcohol.

ANS: B Dehydration is a major modifiable risk factor for nephrolithiasis. Family history is not modifiable. Smoking and alcohol consumption are not a major risk factors for nephrolithiasis.

Scrotal pain in males and labial pain in females may accompany renal pain as a result of a. associated infections. b. associated dermatomes. c. muscle tension. d. anxiety

ANS: B Dermatomes in the T10-L1 spinal cord segment can result in scrotal and labial pain in association with renal pain. Scrotal and labial pain in association with renal pain are not as a result of associated infection, muscle tension, or anxiety

The consequence of an upper urinary tract obstruction in a single ureter is a. kidney stone formation. b. hydronephrosis. c. dilation of the urethra. d. anuria.

ANS: B Dilation of the urinary tract occurs proximal to the obstruction. In this case, the proximal ureter and renal pelvis would enlarge, causing hydronephrosis. Kidney stones are causes, rather than consequences, of an upper urinary tract obstruction. Dilation of the urinary tract occurs proximal to the obstruction. Urine production will continue to occur if one ureter is blocked.

The organism most commonly associated with acute pyelonephritis is a. Streptococcus. b. Escherichia coli. c. Klebsiella. d. Enterobacter

ANS: B Escherichia coli is the most common cause of acute pyelonephritis. Streptococcus, Klebsiella, and Enterobacter are not the most common causes of acute pyelonephritis.

Signs consistent with a diagnosis of glomerulonephritis include a. anuria. b. proteinuria. c. red blood cell casts in the urine. d. foul-smelling urine.

ANS: B Glomerulonephritis leads to proteinuria. Glomerulonephritis produces oliguria, not anuria. Glomerulonephritis does not lead to red blood cell casts in the urine and does not produce foul-smelling urine.

The infection frequently associated with development of postinfectious acute glomerulonephritis is a. pneumonia. b. throat infection. c. endocarditis. d. urinary tract infection.

ANS: B Group A B-hemolytic Streptococcus infection of the throat (strep throat) frequently is associated with development of postinfectious acute glomerulonephritis. Pneumonia, endocarditis, and urinary tract infection are not commonly associated with development of postinfectious acute glomerulonephritis.

A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because a. hepatocyte failure decreases albumin synthesis. b. albumin is excreted in the urine. c. albumin leaks into the interstitial spaces. d. malnutrition is part of nephrotic syndrome.

ANS: B Hypoalbuminemia in nephrotic syndrome is caused by massive albumin excretion in the urine. Hepatocyte failure, malnutrition, and albumin leakage into the interstitial spaces are not characteristic of nephrotic syndrome.

When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of protein," the nurse's response is based on the knowledge that a. his glomeruli have been damaged by his own immune system. b. the glomerular membrane has increased permeability. c. his liver is extremely active in synthesizing protein. d. his renal tubules are full of cellular debris.

ANS: B Massive proteinuria occurs in nephrotic syndrome because the glomerular membrane has increased permeability that causes the leakage of protein. Glomeruli being damaged by the immune system and cellular debris in the renal tubules are not pathophysiologies of the nephrotic syndrome. Although the liver is extremely active in synthesizing protein, it does not explain why massive proteinuria occurs in nephrotic syndrome.

The pain that accompanies kidney disorders is called a. nephritic. b. nephralgia. c. nephrotic. d. nephronitis.

ANS: B Nephralgia is the term for pain that accompanies kidney disorders. Nephritic, nephrotic, and nephronitis are not terms for pain that accompanies kidney disorders.

One cause of an extrinsic renal system obstruction is a. clot. b. pelvic tumor. c. neurogenic bladder. d. papillary necrosis

ANS: B Pelvic tumor is one cause of an extrinsic renal system obstruction. Clot is not a cause of an extrinsic renal system obstruction. Neurogenic blander is not the cause of an extrinsic renal system obstruction. Papillary necrosis is not the cause of an extrinsic renal system obstruction.

The main clinical manifestation of a kidney stone obstructing the ureter is a. oliguria. b. renal colic. c. urge incontinence. d. an abdominal mass.

ANS: B Renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis. Oliguria may occur with kidney stone obstruction, but renal colic is the main clinical manifestation of this condition. Urge incontinence normally occurs when a kidney stone is obstructing the lower urinary tract. Kidney stones are small and located in a retroperitoneal position in the ureter, so they generally do not form a palpable mass.

A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?", the nurse responds a. "Normally, red blood cells that enter the urine are taken back into the blood, but in glomerulonephritis, the kidney disease you have, they stay in the urine and make it coffee-colored." b. "Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored." c. "The bacteria that caused your sore throat have traveled to your kidneys and are causing a little damage there that allows some red blood cells to leak into your urine and make it orange-colored." d. "When parts of your kidneys stopped working, your blood kept flowing and broke some of your little blood vessels, so red blood cells are flowing into your urine and making it coffee-colored."

ANS: B The immune system damages glomeruli in post-streptococcal glomerulonephritis causing red blood cells to leak into the urine, making it coffee-colored. Red blood cells that enter the urine are not taken back into the blood. Red blood cells cause urine to turn coffee-colored, not orange. Capillary breakage is not the cause of the red blood cells entering the urine.

The major cause of glomerulonephritis is a. infection of the glomerular capsule secondary to a urinary tract infection. b. immune system damage to the glomeruli. c. hydronephrosis resulting from kidney stones. d. Streptococcus infection that migrates from the bloodstream to the glomerulus

ANS: B The major cause of glomerulonephritis is immune system damage to glomeruli. Glomerulonephritis is not an infection, but an inflammatory glomerulopathy. Hydronephrosis does not cause glomerulonephritis

The most common type of renal stone is a. uric acid. b. calcium. c. struvite. d. cysteine

ANS: B The most common type of renal stone is calcium oxalate (75%). Uric acid stones account for 7% to 10%. Struvite stones account for 7% to 10%. Cysteine stones account for 1% to 3%.

The manifestations of acute pyelonephritis (Select all that apply.) a. are mild and insidious. b. can result in dehydration. c. often include symptoms of lower urinary tract infection. d. include fever, chills, and costovertebral angle tenderness. e. may include urosepsis

ANS: B, C, D, E Vomiting and fever associated with acute pyelonephritis can result in dehydration. Since an ascending infection from the bladder often causes pyelonephritis, the patient often will show signs of bladder infection. Fever, chills, and costovertebral angle tenderness often accompany this disorder. Urosepsis (infection in the blood from urinary track origin) can result from acute pyelonephritis. The manifestations of acute pyelonephritis occur suddenly, and the patient is acutely ill.

Findings that should prompt an evaluation for renal cancer include a. bacteria in the urine. b. intermittent urinary colic. c. hematuria. d. red blood cell casts in the urine

ANS: C Hematuria is a frequent sign of renal cancer. Bacteria and protein in the urine are not associated with renal cancer. Intermittent urinary colic is associated with renal calculi. Red blood cell casts in the urine are associated with glomerulonephritis

Nephrotic syndrome does not usually cause a. hyperlipidemia. b. proteinuria. c. hematuria. d. generalized edema.

ANS: C Nephrotic syndrome does not usually cause hematuria. Hyperlipidemia is often associated with nephrotic syndrome. Nephrotic syndrome causes proteinuria. Nephrotic syndrome is associated with generalized edema secondary to protein loss.

The pathophysiologic basis of acute glomerulonephritis is a. renal ischemia. b. bacterial invasion of the glomerulus. c. an anaphylactic reaction. d. an immune complex reaction

ANS: D Acute glomerulonephritis is an immune complex reaction that involves IgG. Acute glomerulonephritis is not caused by renal ischemia, bacterial invasion, or anaphylactic reaction.

The individual at highest risk of pyelonephritis who requires monitoring for signs of its occurrence is the a. woman who is paraplegic. b. woman who is pregnant. c. man who has glomerulonephritis. d. man who has chronic urinary tract infections.

ANS: D Anyone who has chronic urinary tract infections is at high risk of developing pyelonephritis. Although pregnancy and stasis of urine with paraplegia do increase the risk of pyelonephritis, another individual has an even higher risk because of an active urinary tract infection. Glomerulonephritis is not an infection.

Nephrotic syndrome involves loss of large amounts of ________ in the urine. a. blood b. sodium c. glucose d. protein

ANS: D By definition, nephrotic syndrome involves loss of large amounts of protein in the urine. Hematuria and glucose loss in urine are not characteristic of nephrotic syndrome. Sodium and water are reabsorbed in nephrotic syndrome.

A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be a. potassium oxalate. b. struvite. c. cysteine. d. uric acid crystals.

ANS: D Gout may lead to uric acid crystals because of elevated serum uric acid levels. Calcium oxalate, not potassium oxalate, stones are associated with hypercalcemia. Struvite calculi are associated with urinary tract infections. Cysteine calculi are associated with a genetic defect

The most common direct cause of acute pyelonephritis is a. urine obstruction. b. systemic bacteremia. c. urethral catheterization. d. infection by E. coli.

ANS: D Infection by E. coli is the most common cause of acute pyelonephritis. Although urine obstruction or reflux can cause acute pyelonephritis, the most common cause is infection by E. coli. Systemic bacteremia may lead to pyelonephritis, but it is not the most common direct cause. Urethral catheterization may cause infection, which could subsequently result in acute pyelonephritis, but catheterization is not the most common direct cause.

Which condition is caused by a genetic defect? a. Acute pyelonephritis b. Hydroureter c. Incontinence d. Polycystic kidney disease

ANS: D Polycystic kidney disease is caused by a genetic defect. Acute pyelonephritis, hydroureter, and incontinence are not caused by genetic defects.

The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is a. hematuria. b. bacteriuria. c. glycosuria. d. proteinuria

ANS: D Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis. Hematuria and bacteriuria are not the major factors underlying the edema associated with nephrotic syndrome and glomerulonephritis. Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis.

Glomerular disorders include a. pyelonephritis. b. obstructive uropathy. c. interstitial cystitis. d. nephrotic syndrome

ANS: D The pathophysiology of nephrotic syndrome occurs at the glomerular membrane. Pyelonephritis generally does not affect the glomerulus. Obstructive uropathy affects the upper and lower urinary tract but does not directly involve the glomerulus. Interstitial cystitis is a bladder disorder