question

Which of the following types of glomerulonephritis is most likely to develop into acute kidney injury?

answer

Rapidly progressive glomerulonephritis progresses to acute renal failure

question

Risk factors for renal cell carcinoma

answer

Obesity Asbestos exposure Cigarette smoking Obesity

question

Problems associated with a lower urinary tract obstruction include

answer

Intermittent urinary stream Urinary retention Increased voiding frequency

question

Risk factors for development of pyelonephritis

answer

Urinary retention and reflux Cystitis

question

Which of the following conditions causes prerenal acute kidney injury?

answer

Severe hypotension (from H.F, hypovolemia or shock) Blood flow to the kidneys is compromised

question

Which of the following disorders is characterized by a neurologic lesion that affects bladder control ?

answer

Neurogenic bladder

question

Why does a person who has nephrotic syndrome have hyperlipidemia?

answer

Hepatocytes synthesize excessive lipids

question

The defining characteristic of severe acute kidney injury is

answer

Oliguria or anuria

question

What is the consequence of an upper urinary tract obstruction in a single ureter?

answer

Hydronephrosis Dilation of the urinary tract occurs proximal to the obstruction. In this case, the proximal ureter and renal pelvis would enlarge

question

The major cause of glomerulonephritis is:

answer

Immune system damage to glomeruli

question

Which of the following is a common component of renal calculi?

answer

Calcium

question

Which of the following conditions is a glomerular disorder?

answer

Nephrotic syndrome Occurs at the glomerular membrane

question

Which of the following conditions is known to cause chronic kidney disease?

answer

Hypertension

question

A major modifiable risk factor for nephrolithiasis is :

answer

Dehydration

question

Which of the following microorganisms causes the vast majority of UTI's?

answer

Escherichia coli

question

Which of the following conditions is characterized by oliguria and hematuria?

answer

Acute glomerulonephritis

question

Which of the following conditions associated with end stage chronic renal disease is the most immediately life threatening?

answer

Hyperkalemia Rationale: from decreased renal excretion of potassium can cause dysrhythmias and cardiac arrest

question

Which of the following symptoms occurs with both cystitis and pyelonephritis?

answer

Dysuria or painful urination

question

What causes anemia in people who have end stage chronic renal disease?

answer

Decreased secretion of erythropoietin

question

Individuals with end stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures because:

answer

They are deficient in active vitamin D Rationale: Vitamin D required for calcium absorption in the digestive tract is activated in the kidneys

question

Why does a person who has nephrotic syndrome have hypoalbuminemia?

answer

Albumin is excreted in the urine

question

Which of the following accurately describes renal insufficiency?

answer

75-90% of the nephrons are not functional

question

The main clinical manifestation of a kidney stone obstructing the ureter is:

answer

Renal colic Rationale: renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis

question

Which of the following is associated with vesicoureteral reflux?

answer

Recurrent cystitis

question

Obstruction of the lower urinary tract in men is often caused by:

answer

Prostate enlargement Rationale: from benign prostatic hyperplasia, occasionally prostate cancer, obstructs the male urethra as it passes through the prostate gland

question

Which of the following factors has a major influence on formation of renal calculi?

answer

Urine pH

question

What is the difference between stress incontinence and urge incontinence?

answer

Stress incontinence is caused by a sphincter problem Urge incontinence is caused by a problem with the detrusor muscle

question

Which of the following is a primary lab finding in end stage chronic renal disease?

answer

Increased serum creatinine Rationale: end stage chronic renal disease causes increased serum creatinine and blood urea nitrogen (BUN) because the dysfunctional kidneys aren't able to excrete these metabolic waste products

question

Which of the following conditions is caused by a genetic defect?

answer

Polycystic kidney disease

question

A major risk factor for developing bladder cancer:

answer

Smoking

question

What happens in renal tubules during the diuretic phase of acute tubular necrosis?

answer

Renal tubular epithelium is regenerating

question

Which of the following infections frequently is associated with development of acute post-streptococcal glomerulonephritis?

answer

Throat infection Streptococcus A infection of the throat (strep throat) frequently is associated with development of acute post- streptococcal glomerulonephritis

question

Nephrotic syndrome involves loss of large amount of what substance in the urine?

answer

Protein By definition, nephrotic syndrome involves loss of large amounts of protein in the urine

question

Acute tubular necrosis can occur from all of the following problems

answer

Antibiotics that are nephrotoxic Ischemia due to hypovolemia Contrast dyes used for radiologic studies

question

Which of the following conditions causes post renal acute kindey injury?

answer

Bilateral kindey stones

question

Two important endocrine functions of kidneys

answer

Production of erythropoietin Activation of Vit D

question

Nephrons

answer

Functional unit Each kindey contains one million Performs all filtration Reabsorption Secretory functions

question

Where are the kidneys located?

answer

Retroperitoneal space in the posterior abdomen

question

Hilum

answer

lymphatic vessels Blood vessels and nerves enter and exit through the hilum

question

Two principal parts of the bladder

answer

Body: stores urine, made up of smooth muscle known as detrussor muscle: contracts as a unit in response to initiation of action potentials Neck

question

How much urine does the bladder collect before stretch receptors signal a need for bladder emptying?

answer

300-500 mL

question

Urethra

answer

Urine is drained from the bladder by the urethra when internal and external sphincters are relaxed

question

Renal parenchyma

answer

Pelvis: composed of urinary collecting structure called calyces Medulla: middle portion, contains renal pyramids Cortex: Outer portion, contains glomeruli and nephron tubules

question

Renal Blood Supply

answer

25% of C.O is circulated to kidneys Blood supplied by renal artery The interlobular arteries branch multiple times to form afferent arterioles for each of the millions of kindey glomeruli

question

Components of a nephron

answer

Own afferent arteriole Capillary tuft Efferent arteriole

question

Efferent arterioles

answer

Form peritubular capillaries (vasa recta) vasa recta wraps around nephron structures

question

Loop structure of vasa recta

answer

Enables them to pick up interstitial fluid without removing excessive solute

question

Three major functions of nephron

answer

Filters water- soluble substances from blood Reabsorbs filtered nutrients, water, electrolytes Secretes wastes or excess substances into the filtrate

question

Cilium

answer

In the nephron Mechanoreceptors and chemoreceptors that sense flow rate and composition of the tubular filtrate

question

Glomerulus

answer

Site of fluid filtration from the blood to the nephron tubule

question

Components of the glomerulus

answer

Formed by the glomerular capillary tuft Podocytes of the Bowman Capsule Basement membrane

question

If glomerulus is injured?

answer

Blood and proteins may be present in the urine

question

Sign basement membrane is dtysfunctioning?

answer

Proteinuria

question

Glomerular filtration rate (GFR)

answer

Averages about 125 mL/min

question

Mesangial cell functions

answer

Provision of structural support for glomerular capillaries Secretion of matrix proteins Phagocytosis Regulate GFR

question

Proximal Convoluted Tubule

answer

Made up of cuboidal epithelium Convoluted to provide greater surface area for reabsorption Contains Mircovilla Reabsorbs about 2/3 of filtered water and electrolytes, glucose, amino acids, proteins and vitamins Water is reabsorbed passively

question

Loop of Henle

answer

Thin descending limb Receives filtrate from proximal convoluted tubules & delivers to amending limb Permeable to water Thick ascending limb Contains powerful Na+- K+ 2Cl- cotransporters that pump ions into the interstitium Impermeable to water

question

Juxtamedullary nephrons

answer

Vital for creating concentrated urine

question

Distal convoluted tubule

answer

Filtrate is hypo-osmotic due to removal of electrolytes in the ascending loop of Henle

question

Aldosterone and Angiotensin II

answer

stimulate tubule cells to reabsorb sodium and water

question

Atrial natriuretic peptide and urodilatin

answer

Inhibit reabsorption

question

Collecting Duct

answer

Form the medullary pyramids Empty into minor calices through the papilla to the renal pelvis

question

Principal P cells

answer

Respond to ADH

question

Intercalated cells

answer

Participate in acid base balance by regulating secretion of acid

question

Filtration rate determined by

answer

permeable surface area

question

Factors affecting filtration pressure

answer

Blood volume Direct relationship with GFR

question

Important chemical mediators of arteriolar resistance

answer

Adenosine Angiotensin II Nitric oxide Prostaglandins

question

Effects of Glucose and Amino Acids

answer

Greater amount of glucose &A.A. Greater amount of sodium reabsorbed by proximal tubule Increased GFR

question

Role of Mesangial Cells

answer

Located around the glomerular capillaries Regulate the surface area available for glomerular filtration

question

Reabsorption and Secretion

answer

Dependent on Na+ reabsorption Made possible by Na+-K+ pump in the basolateral membrane

question

Two routes of reabsorption and secretion

answer

Transcellular transport Paraceullar route

question

Reabsorption of Glucose

answer

All filtered glucose is reabsorbed in proximal tubule These transporters can be overwhelmed by excessive tubular loads of glucose

question

Regulation of Acid Base Balance

answer

Kidney excrete excess H+ Regulate the concentration of bicarbonate HCO3- is filtered freely through the glomerulus and must be efficiently reabsorbed to maintain acid base balance

question

Urine buffers

answer

HPO4-2 and NH3

question

Renal compensation process

answer

Compensate for abnormal lung function

question

Acidosis

answer

When PaCO2 is high Kidneys excrete more H+

question

Alkalosis

answer

PaCO2 is low Kidneys compensate by excreting some of the filtered HCO3-

question

Secretion of Potassium

answer

In the distal tubule, Na+ - K+ pumps are regulated by aldosterone Increased potassium excretion

question

Regulation of blood volume and osmolality

answer

Kidneys regulate blood volume and osmolality by altering GFR and reabsorption from urinary filtrate

question

Antidiuretic Hormone

answer

Vasopressin Increased reabsorption and reduced blood osmolality

question

Problems with ADH

answer

Insufficiency of ADH secondary to pituitary damage Results in diabetes insipidus Large volume of dilute urine excreted Leads to severe fluid imbalances

question

Aldosterone & Angiotensin II

answer

Increase sodium & water reabsorption

question

Renin

answer

Stimulates the release of aldosterone and angiotensin II Decreased blood flow to kidneys Reduced serum sodium levels Activation of sympathetic nerves

question

Diuretic Agents

answer

Drugs that alter the osmolality of urinary filtrate Oppose the reabsorption of water Increase in urine volume

question

ACE inhibitors

answer

Inhibit formation of Angiotensin II and aldosterone

question

Loop diuretics

answer

Blood Na+ - K+- 2Cl- pumps in the ascending loop of Henle

question

Thiazide- like diuretics

answer

Block Na+ reabsorption

question

Potassium wasting diuretics

answer

Cause potassium to be excreted in the urine

question

Aldosterone- blocking agents

answer

are potassium sparing Increase in urine volume

question

Geriatric Considerations

answer

Loss of nephrons Diminished renal blood flow Decrease in the GFR Decreased ability to conserve salt and water More susceptible to fluid and electrolyte imbalances

question

WBC casts

answer

associated with renal infections (pyelonephritis)

question

RBC casts

answer

Indicate inflammation of the glomerulus (glomerulonephritis)

question

Epithelial cell casts indicate

answer

Sloughing of tubular cells (acute tubular necrosis)

question

Serum Creatinine and BUN

answer

are usual indicators of renal function Used to monitor the progression of renal disease

question

Creatinine

answer

end product of muscle metabolism excreted by the kidney Normal level: 0.7- 1.5mg/dl

question

BUN

answer

Urea is an end product of protein metabolism Normal level 10-20 mg/dl

question

IVP (intravenous urography/ pyelography)

answer

Iodine- containing dye injected into the vein Rapid series of X-rays Dye is nephrotoxic meaning poisonous to kidney Hydration helps

question

Renogram

answer

Useful for assessing function

question

Renal Scan

answer

better at detecting structural anomalies

question

Which lab result should the nurse check to best assess renal function?

answer

Creatinine

Chapter 26: Renal function – Flashcards

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