Renal

Question 1

part of nephron

Answer 1

renal corpuscle (Bowman’s capsule and glomerulus)
proximal tubule
loop of Henle (descending and ascending portions)
distal tubule
feed into collecting ducts

Question 2

metabolites filtered in glomerulus

Answer 2

creatinine
uric acid
urea

Question 3

increased serum NaCl detected by JGA will lead to:

Answer 3

increased GFR and vasoconstriction to retain water

Question 4

normal GFR

Answer 4

120-140 mL/min, 180 L/day

Question 5

ADH effects on collecting ducts and urine

Answer 5

increases permeability of collecting ducts, which allows water to escape back into interstitium rather than being excreted (retains water)

Question 6

aldosterone function

Answer 6

increases Na+ and K+ exchange in distal tubule of nephron: causes Na+ retention (and therefore, water retention), and K+ excretion

Question 7

presence of protein in urine (above 150 mg/day) indicates:

Answer 7

increased glomerular permeability; always pathological!

Question 8

normal urine specific gravity

Answer 8

1.020

Question 9

normal urine pH

Answer 9

4.5-8.0

Question 10

pH is always lowest at what time of day?

Answer 10

through the night, leading to lowest urine pH at first voidance in the morning

Question 11

normal plasma creatinine

Answer 11

0.7-1.5 mg/100 mL

Question 12

normal BUN

Answer 12

10-20 mg/dL

Question 13

renal dysfunction/disease causes ___ in creatinine and BUN

Answer 13

increase

Question 14

azotemia def

Answer 14

renal insufficiency –> nitrogenous substrates increased in the blood

Question 15

morphologic examination of renal function

Answer 15

urine microscopy; urine bacteriologic exam; radiologic kidney exams

Question 16

presence of cellular casts in urine indicates:

Answer 16

pyelonephritis

Question 17

presence of red blood cells indicates:

Answer 17

glomerulonephritis

Question 18

presence of fatty casts and/or protein in urine indicates:

Answer 18

nephrotic syndrome

Question 19

lead nephropathy pathophysiology

Answer 19

causes interstitial nephritis –> inflammation impairs nephron function –> slow and progressive renal failure

Question 20

stage I renal failure characteristics

Answer 20

decreased renal reserve, asymptomatic

Question 21

stage II renal failure characteristics

Answer 21

renal insufficiency, azotemia; occurs after 75% of nephrons are destroyed/nonfunctional

Question 22

stage III renal failure characteristics

Answer 22

end stage failure; occurs after 90% of nephrons are destroyed/nonfunctional; aka uremic syndrome

Question 23

most common cause of stage III/end stage renal failure

Answer 23

diabetic nephropathy

Question 24

(creatinine/BUN) is better indicator of renal function; why?

Answer 24

creatinine; because BUN is affected by dietary intake and so may not accurately represent extent of renal insufficiency

Question 25

acute oliguric renal failure urine output

Answer 25

less than 400 mL/day

Question 26

early symptoms of kidney disease are ___ and ___, caused by ___

Answer 26

polyuria; nocturia; inability of kidneys to concentrate urine, aka letting out a whole lot of water

Question 27

uremia symptoms present when GFR falls to ___% of normal

Answer 27

5-10%

Question 28

80% of UTIs are caused by

Answer 28

E. coli

Question 29

predisposing factors for UTIs

Answer 29

urinary calculi; neurogenic bladder; bladder instrumentation (i.e. foley cath); prostatic hypertrophy

Question 30

treatment of acute pyelonephritis

Answer 30

antibiotics -- very effective!

Question 31

glomerulonephritis is usually (bilateral/unilateral)

Answer 31

bilateral

Question 32

patho of acute glomerulonephritis

Answer 32

usually follows b-hemolytic strep infection; antigen-antibody complexes form in glom basement membrane; phagocytes and lysosomes attack basement membrane directly

Question 33

rapidly progressive glomerulonephritis prognosis

Answer 33

<2 years

Question 34

patho of chronic glomerulonephritis

Answer 34

similar to acute, but due to a long-standing disease (i.e. diabetes); progresses gradually over time

Question 35

hypertensive nephrosclerosis etio

Answer 35

arteriosclerosis of afferent arterioles (entering glomerulus) due to long-standing hypertension

Question 36

nephritis resulting from SLE has similar clinical manifestations of ___

Answer 36

acute glomerulonephritis

Question 37

gout etio

Answer 37

increased uric acid in plasma; deposits and crystallizes in joints and kidneys

Question 38

uric acid calculi predisposing factors

Answer 38

gout | chemotherapy

Question 39

>90% of kidney stones contain ___

Answer 39

calcium

Question 40

nephrotoxic substances

Answer 40

glycols spot remover (inhalation) and beer mercury bichloride IV contrast media (in pts with preexisting renal insufficiency)

Question 41

``` renal insufficiency (stage 2) effects: GFR? urine frequency? acid/base? sodium? potassium? toxins/nitrogenous substrates? CV function? respiratory changes? hematocrit? ```

Answer 41

``` GFR - slightly decreased urine frequency - polyuria/nocturia acid/base - mild acidosis sodium - decrease potassium - decrease toxins/nitrogenous substrates - increase CV function - none respiratory changes - mild tachypnea; compensatory response to mild acidosis hematocrit - minimal change ```

Question 42

``` renal failure (stage 3) effects: GFR? urine frequency? acid/base? sodium? potassium? toxins/nitrogenous substrates? CV function? respiratory changes? hematocrit? ```

Answer 42

``` GFR - dramatically decreased (5-10% of normal) urine frequency - oliguria/anuria acid/base - moderate to severe acidosis sodium - increase potassium - increase toxins/nitrogenous substrates - increase CV function - HTN and arrhythmias respiratory changes - Kussmaul respirations hematocrit - decrease d/t diminished EPO ```

Question 43

example of prerenal patho

Answer 43

CV disease: HTN, heart failure, atherosclerosis

Question 44

example of renal patho

Answer 44

any disease that impacts the nephron and interstitial space itself: nephrotoxicity, glomerulonephritis

Question 45

example of postrenal patho

Answer 45

any disease of urinary conduction tubes: calculi, infection, BPH

Question 46

when a pt presents with anuria, start by doing assessments for ___ problems first

Answer 46

postrenal - obstructions, infections, etc

Question 47

post obstructive diuresis def

Answer 47

after relief of obstruction, kidneys kick into diuresis and may cause hypovolemia

Question 48

treat noninfective cystitis with:

Answer 48

muscle relaxants, anticholinergics, antiparasympathetics

Question 49

noninfective pyelonephritis can be caused by:

Answer 49

radiation, chronic inflammation, chronic illness, infection elsewhere

Question 50

glomerulonephritis patho

Answer 50

1. increased glomerular permeability --> proteinuria, hematuria 2. glomerular injury by immune complexes --> decreased GFR, oliguria

Question 51

long-term manifestations of glomerulonephritis

Answer 51

HTN, edema, pleural effusion, ascites, electrolyte imbalances, CV sequelae

Question 52

treatment goals of glomerulonephritis

Answer 52

stop inflammation, treat underlying inflammatory disease, restore fluid/electrolyte balance

Question 53

two causes of acute tubular necrosis

Answer 53

ischemic, nephrotoxic

Question 54

acute tubular necrosis def

Answer 54

dying tubular cells of nephrons, inability to concentrate urine

Question 55

kidney disease 2 major problems

Answer 55

1. unable to concentrate urine, for whatever reason -- polyuria and nocturia, plus all the fluid/electrolyte and CV problems that go with it 2. decreased GFR -- result of RAAS kicking in to compensate for #1, or direct injury to glomeruli

Question 56

short-term manifestations of glomerulonephritis

Answer 56

hematuria, proteinuria, decreased GFR, oliguria

Question 57

most important treatment goal of managing acute tubular necrosis is:

Answer 57

maintaining fluid/electrolyte balance

Question 58

(men/women) are more susceptible to renal cell carcinoma

Answer 58

men

Question 59

renal cancer has (known/unknown) etiology

Answer 59

unknown

Question 60

most common renal vascular anomaly

Answer 60

multiple renal arteries

Question 61

a person on a low protein diet is unable to concentrate urine as well as a person on a high protein diet because:

Answer 61

decreased production of urea

Question 62

factors that contribute to the development of congestive heart failure in chronic renal failure include:

Answer 62

anemia, sodium retention, HTN

Question 63

major bladder cancer risk factor:

Answer 63

smoking

Question 64

causes of hemolytic uremic syndrome

Answer 64

E. coli, shigella, drugs, tumors

Question 65

renal cyst vs renal neoplasm

Answer 65

fluid densities are different

Question 66

horseshoe kidneys are congenital anomalies associated with what disorder?

Answer 66

trisomies

Question 67

true or false: cause of polycystic kidney disease is unknown

Answer 67

false

Question 68

kidneys become (smaller/larger) in end-stage renal disease

Answer 68

smaller

Question 69

Wilms tumor is the result of:

Answer 69

genetic defect on chromosome 11

Question 70

common side effects of dialysis

Answer 70

hyperkalemia, hypotension, muscle cramps