CH 22 : Renal disorders Flashcards
Question 1 of 8
George, age 72, recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-sided heart failure. Stroke volume, blood pressure, and cardiac output are all reduced.
George’s renal function may be impaired. Serum blood urea nitrogen (BUN) and creatinine (Cr) levels are increasing and glomerular filtration rate (GFR) is significantly reduced. Oliguria is present, as is edema of the face and extremities.
George seems to be becoming more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia.
Based on the information provided, which type of renal dysfunction is most likely in George’s case: prerenal, intrarenal, or postrenal?
Prerenal
Intrarenal
Postrenal
None. Based on available data, George’s renal function appears normal.
Prerenal
The most likely renal failure type is prerenal. Prerenal failure occurs when the kidneys are not adequately perfused. In George’s case, his heart failure is likely resulting in reduced blood flow to the kidneys. The increasing levels of BUN and Cr, along with decreasing GFR, shows George’s kidneys are not functioning normally.
Question 2 of 8
In George’s condition, why is GFR lower than normal?
Decreased perfusion of the kidney
Elevated pressure due to hydronephrosis
Blockage of the glomerular membrane by antibodies
Cyst formation within the kidneys
Decreased perfusion of the kidney
George’s heart failure likely makes maintaining adequate perfusion of body tissues difficult. As perfusion of the kidneys declines, so does the GFR.
Question 3 of 8
Why are BUN and Cr levels higher than normal in George?
Disruption of the buffering system
Muscle breakdown is increasing serum levels of these factors
Decreased GFR
Antibody attack of the glomeruli have increased secretion of these substances
Decreased GFR
George’s BUN and Cr are increasing because normally these substances are filtered by the kidney and partially removed from the blood. When GFR decreases, these factors increase in the blood.
Question 4 of 8
Why is oliguria occurring in George?
Nephron cell necrosis
Decreased renal perfusion and GFR
Increased BUN and Cr are blocking renal filtration
Cyst formation due to genetic disease is blocking renal blood flow
Decreased renal perfusion and GFR
George is experiencing oliguria for the same reason BUN and Cr levels are elevating: the kidneys are not adequately perfused. Urine is only formed when the blood is filtered. If insufficient blood is available for filtration, urine formation decreases.
Question 5 of 8
Which of the following may explain George’s anemia? Select all that apply.
Decreased erythropoietin
Not enough protein intake
Anemia commonly accompanies heart failure
Lack of intrinsic factor
Glomerular damage
Decreased erythropoietin
Glomerular damage
The kidneys produce erythropoietin to maintain red blood cells levels. If the kidneys are damaged, erythropoietin levels may fall. Intrinsic factor is found in the stomach and is not altered by kidney failure. Finally, if the glomeruli are damaged, red blood cells may be filtered into the urine, leading to hematuria.
Question 6 of 8
What type of edema is George likely to experience with renal failure? Pulmonary edema Periorbital edema Dependent edema Localized edema in feet
Periorbital edema
Edema manifests in a number of ways in the body, but a particular form of edema, periorbital edema, may signify renal failure. The swelling around the eyes often develops with increased fluid accumulation.
Question 7 of 8
Why does George experience disorientation as a result of renal failure? Elevated toxin levels in the blood Anemia Hyperkalemia Elevated urine output by the kidney
Elevated toxin levels in the blood
Encephalopathy may develop with acute or chronic renal failure when toxins buildup in the blood. These toxins begin to compromise brain function.
Question 8 of 8
What treatment option should be considered first for George’s condition? Peritoneal dialysis Antibiotics Hemodialysis Adequate fluid maintenance
Adequate fluid maintenance
In prerenal acute kidney injury, maintaining adequate perfusion to the kidney is key. Thus, in George’s case, adequate fluid maintenance will be required to ensure the kidneys receive enough blood flow to maintain GFR and filter wastes.
Question 1 of 5
What is the most common cause of acute glomerulonephritis?
Streptococcal infection
Epstein-Barr virus
Staphylococcal infection
Cytomegalovirus
Streptococcal infection
Question 2 of 5
Which of the following conditions result from autoantibodies attacking the glomeruli?
Polycystic kidney disease
Pyelonephritis
Nephrolithiasis
Goodpasture’s syndrome
Goodpasture’s syndrome
Question 3 of 5
Damage to the glomeruli may result in which of the following? Select all that apply.
Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
Question 4 of 5
Stone formation within the kidneys in known as _____________________.
pyelonephritis
polycystic kidney disease
nephrolithiasis
nephrotic syndrome
nephrolithiasis
Question 5 of 5
What is the cause of polycystic kidney disease?
Genetic disorder
Autoantibody attack of the glomeruli
Precipitation of crystals in filtrate
Elevated blood sugar
Genetic disorder
