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Question 1

1. The healthy kidney performs several distinct functions. Which of the following is a function of the kidney? a. Excretion of urea, uric acid, and water b. Maintenance of body temperature c. Regulation of lymphocyte production d. Production of insulin and glucagon

Answer 1

1. A: Kidney function includes the excretion of metabolic wastes, including uric acid and water. Body temperature is regulated by the hypothalamus, and is not directly associated with kidney function. Lymphocyte production may be a result of infection. The kidney does not produce insulin and glucagon; the pancreas synthesizes these hormones.

Question 2

2. One of the hormones produced by the kidney is erythropoietin. What is the action of this hormone? a. It promotes the absorption of calcium. b. It enhances water reabsorption. c. It stimulates erythrocyte production. d. It balances human growth hormone (hGH) levels.

Answer 2

2. C: Erythropoietin is a hormone produced by the kidney as a response to low O2 levels; this hormone stimulates erythrocyte production. Calcitriol, synthesized by the kidney, accelerates calcium production. The kidney does act as a receptor for antidiuretic hormone (ADH), which enhances water reabsorption; ADH and hGH are both hormones produced by the pituitary.

Question 3

3. Which of the following tests are commonly used to diagnose renal failure? a. Partial thromboplastin time (PTT), ABO, Rh factor b. Chest x-ray, mammogram c. MRI of lumbar spine, bladder ultrasound d. Blood urea nitrogen (BUN), blood chemistry, creatinine level, kidney ultrasound, urinalysis

Answer 3

3. D: BUN, creatinine levels, and kidney ultrasound are used to determine the size of the kidney and if there is a blockage, and blood chemistries and urinalysis are used to assess kidney status. Chest x-rays and mammograms are used to determine lung disease and breast health. MRIs of the lumbar spine are useful in evaluating the bones, discs and structures of the lower back. Bladder ultrasounds are commonly used as tests to determine urinary retention or obstruction, along with the PTT, ABO, and Rh factor, which are all tests done for blood typing, and would not be commonly used to determine kidney disease.

Question 4

4. Which of the following statements most accurately describes acute renal failure (ARF)? a. It takes several months to develop and is often irreversible. b. It progresses quickly, lasts fewer than 3 months, and results in a loss of nephron function. c. It is frequently linked to diabetes mellitus or lupus erythematosus. d. It commonly lasts for at least 4 to 6 months, and then resolves completely.

Answer 4

4. B: ARF progresses quickly, lasts less than 3 months, and during the acute renal failure, there is a loss of nephron function. ARF is usually reversible. Chronic renal failure may be the result of diabetes or lupus, while acute renal failure is more likely the consequence of trauma, infection, blockage, glomerulonephritis, or toxins.

Question 5

5. Which of the following is a cause of intrarenal ARF? a. Dehydration b. Glomerulonephritis c. Systemic infection d. Trauma

Answer 5

5. B: Glomerulonephritis is an intrinsic or intrarenal type of acute renal failure. Dehydration, systemic infection, and trauma are all possible causes of prerenal acute renal failure.

Question 6

6. Which of the following are characteristics of chronic kidney disease (CKD)? a. Duration of more than 3 months, glomerular filtration rate (GFR) of less than 60 mL/min, abnormalities in blood chemistry, urinalysis and renal ultrasound b. Rapid onset, symptoms lasting up to 2 months, result of blunt trauma c. Confusion, paranoia, abnormal affect, facial tics d. Sudden pain in upper right quadrant, nausea, vomiting, general prostration

Answer 6

6. A: In chronic renal failure (CRF), the disease lasts more than 3 months, with the GFR remaining at less than 60 mL/min, blood chemistry abnormalities including elevated creatinine and BUN levels, and renal ultrasound results that exhibit a smaller than normal kidney. Although diabetes is often associated with CRF, a high glucose level is not a hallmark of this disease. Rapid onset, with symptoms following blunt trauma and with resolution within 2 months, would usually be attributed to ARF. Confusion, paranoia, abnormal affect, and facial tics are frequently linked to psychiatric disorders and side effects of their medications. Sudden upper right quadrant pain, nausea, vomiting, and general prostration may be indicative of gallbladder disease.

Question 7

7. Some conditions that contribute to the development of CKD may include the following disease processes. Which of the following is least likely to be a direct cause of CKD? a. Chronic obstructive pulmonary disease (COPD) b. Diabetes mellitus (type 1 and 2) c. Systemic lupus d. Hypertension

Answer 7

7. A: Although many elderly patients may also suffer from chronic obstructive pulmonary disease it is not considered a direct cause of CKD. Diabetes mellitus (both type 1 and type 2), systemic lupus, and hypertension are all diseases that contribute to the development of CKD.

Question 8

8. Strict glycemic control is extremely important in diabetic patients to reduce their likelihood of developing microvascular and macrovascular disease. Diabetic patients with well-controlled blood sugar levels experience a slower progression to kidney involvement. Which of the following statements is inaccurate? a. Brittle (unstable) diabetic patients should be tested frequently to assess the current blood glucose level. b. High blood glucose levels may require a bolus of 50% dextrose to prevent insulin shock. c. The optimal level of glycemic control is less than 7% HbA1c. d. An elevated glucose level may require the administration of insulin to prevent diabetic coma.

Answer 8

8. B: High glucose levels should be treated with insulin to lower the blood glucose and prevent diabetic coma, not with added dextrose. Dextrose should be administered in cases where the glucose level in the blood is less than 50 mg/dL. Brittle (unstable) diabetic patients should be tested frequently to assess the blood glucose level with the optimal level of glycemic control at less than 7% HbA1c.

Question 9

9. The healthy kidney, in addition to synthesizing hormones, also acts as a receptor for certain hormones. Which of the following hormones does the kidney receive? a. Estrogen, progesterone, and testosterone b. Erythropoietin c. Calcitriol, renin d. Antidiuretic hormone (ADH), aldosterone, and parathyroid hormones

Answer 9

9. D: The kidney acts as a receptor for ADH (anti-diuretic hormone), aldosterone, and parathyroid hormones. ADH, which is produced by the pituitary, acts to enhance water reabsorption. Aldosterone, synthesized by the adrenal cortex, causes the kidneys to retain water and sodium, thereby increasing the blood pressure. Parathyroid hormone, produced by the parathyroid glands, increases the calcium:phosphate ratio and enhances the calcium level in the blood. Estrogen, progesterone, and testosterone are not synthesized by nor received by the kidney. Erythropoietin, calcitriol, and renin are all hormones synthesized by the kidney.

Question 10

10. What is the name of the cup-like structure with a thin, double membrane that surrounds the glomerulus of each nephron? a. Renal capsule b. Bowman capsule c. Afferent arteriole d. Loop of Henle

Answer 10

10. B: The Bowman capsule is a cup-like structure with a thin double membrane that surrounds the glomerulus of each nephron. The renal capsule is the membranous covering of the kidney. An afferent arteriole is part of the renal circulatory system that supplies the blood to the glomerulus. The loop of Henle is the portion of the nephron that connects the proximal convoluted tubule to the distal convoluted tubule and features a hairpin curve that dips into the renal medulla.