Chapter 21: Kidney Disease

Question 1

The microscopic functional units of the kidney are called

a. nephrons.
b. glomeruli.
c. tubules.
d. loops of Henle.

Answer 1

a. nephrons.

The nephron is the function unit of the kidney. It performs functions such as filtration, reabsorption, secretion, and excretion.

Question 2

The structure responsible for filtering the blood is the

a. loop of Henle.
b. proximal tubule.
c. distal tubule.
d. glomerulus.

Answer 2

d. glomerulus.

The glomerulus filters the blood. Only the larger blood proteins and cells remain behind in the circulating blood as it leaves the glomerulus.

Question 3

Disease conditions that can interfere with normal nephron function include

a. inflammation and infection.
b. chronic caffeine intake.
c. chronic alcohol abuse.
d. anemia.

Answer 3

a. inflammation and infection.

Inflammation and infection can interfere with normal nephron function. The small blood vessels and membranes in the nephrons can become inflamed for a short period. In other cases, entire nephrons or sections of nephrons may be involved. Symptoms of bacterial urinary tract infections may range from mild discomfort to more involved chronic disease.

Question 4

Glomerulonephritis or nephritic syndrome is one of the causes of

a. stage 5 CKD or ESRD.
b. stage 1 CKD.
c. kidney stones.
d. heart failure.

Answer 4

a. stage 5 CKD or ESRD.

The inflammatory process that affects the glomerulus is referred to as glomerulonephritis and is one of the three most common causes of stage 5 CKD.

Question 5

Complications of chronic kidney disease do not include

a. anemia.
b. diabetes mellitus.
c. hypertension.
d. bone pain.

Answer 5

b. diabetes mellitus.

Complications of chronic kidney disease do not include diabetes mellitus. Osteodystrophy, neuropathy, and anemia are all seen with chronic kidney disease. Osteodystrophy results from the decreased activation of vitamin D, neuropathy results from central and peripheral neurologic disturbances and is more prevalent in those with diabetes, and anemia results when the damaged kidney cannot accomplish its normal participation in the production of red blood cells.

Question 6

The presence of protein in the urine is called

a. hematuria.
b. oliguria.
c. proteinuria.
d. anuria.

Answer 6

c. proteinuria.

Proteinuria results from an abnormal excess of serum proteins in the urine.

Question 7

Classic symptoms of acute glomerulonephritis include

a. azotemia.
b. proteinuria.
c. ascites.
d. anemia.

Answer 7

b. proteinuria.

Classic symptoms of acute glomerulonephritis include hematuria and proteinuria, although edema and hypertension also may occur. These patients usually have little appetite, which contributes to feeding problems. If the disease progresses to more renal involvement, signs of oliguria or anuria may develop.

Question 8

Azotemia refers to elevated blood levels of

a. glucose.
b. cholesterol.
c. amines.
d. creatinine and urea.

Answer 8

d. creatinine and urea.

Elevated blood urea nitrogen, serum creatinine, and serum uric acid levels are reflected in the characteristic laboratory finding of azotemia.

Question 9

Nephrotic syndrome, or nephrosis, is a disease that

a. is caused by chronic hypertension.
b. allows large amounts of protein to escape into the tubule.
c. causes the buildup of toxic wastes in the blood.
d. results in the formation of kidney stones.

Answer 9

b. allows large amounts of protein to escape into the tubule.

Nephrotic syndrome, or nephrosis, results from nephron tissue damage to both the glomerulus and tubule. The primary damage is to the major filtering membrane of the glomerulus, which allows large amounts of protein to pass into the tubule.

Question 10

The massive edema of nephrotic syndrome is caused by

a. blockage in the nephron tubules.
b. excessive fluid intake.
c. large protein losses in the urine.
d. a diet too high in sodium.

Answer 10

c. large protein losses in the urine.

Nephrotic syndrome, or nephrosis, results from nephron tissue damage to both the glomerulus and tubule. The primary damage is to the major filtering membrane of the glomerulus, which allows large amounts of protein to pass into the tubule. The large protein loss leads to massive edema and ascites as well as proteinuria.

Question 11

Medical nutrition therapy for nephrotic syndrome includes

a. high protein intake.
b. moderate protein intake.
c. high potassium intake.
d. fluid restriction.

Answer 11

b. moderate protein intake.

Medical nutrition therapy for nephritic syndrome includes protein at 0.8 g/kg/day to meet nutritional and growth needs and without excess. The diet usually is moderate in protein (0.8 g/kg ideal body weight), with the majority of the protein from high biological value sources. Total protein amounts may be modified based on blood urea nitrogen and glomerular filtration rate results. If blood urea nitrogen is elevated and urine output is decreased, dietary protein may be restricted. In addition to protein, sufficient energy is supplied along with adequate vitamins and minerals.

Question 12

The hormone that causes the kidneys to reabsorb sodium and decrease urine production is

a. renin.
b. vitamin D.
c. erythropoietin.
d. antidiuretic hormone.

Answer 12

d. antidiuretic hormone.

In the collecting tubule, a normal, concentrated urine is produced by the influence of the pituitary hormone antidiuretic hormone (ADH), and the osmotic pressure from the more dense surrounding fluid in the central area of the kidney. ADH has the ability to conserve water by causing its reabsorption.

Question 13

The sudden shutdown of kidney function as the result of traumatic injury is called

a. nephrosis.
b. glomerulonephritis.
c. acute kidney failure.
d. chronic kidney failure.

Answer 13

c. acute kidney failure.

Acute kidney failure results when renal function in healthy kidneys shuts down suddenly after some metabolic insult or traumatic injury, causing a life-threatening situation. This is a medical emergency.

Question 14

A major clinical symptom of acute kidney failure is

a. hematuria.
b. proteinuria.
c. oliguria.
d. massive edema.

Answer 14

c. oliguria.

which is caused when the cellular debris from the tissue damage blocks the renal tubules.

Question 15

A progressive increase in serum urea nitrogen and creatinine levels occurs in

a. acute renal failure.
b. glomerulonephritis.
c. chronic kidney failure.
d. nephrotic syndrome.

Answer 15

c. chronic kidney failure.

Increasing loss of nephron function results in elevated amounts of nitrogenous metabolites, such as urea and creatinine.

Question 16

Ms. Jones comes to the emergency department with a severe drug reaction to penicillin. She may be at risk for

a. diabetes or heart disease.
b. high sodium intake.
c. protein-energy malnutrition.
d. acute kidney failure.

Answer 16

d. acute kidney failure.

Acute kidney failure can result from drug reactions in allergic or sensitive persons, such as a penicillin or cyclosporine reaction.

Question 17

Mr. Brady has chronic kidney disease. He has his blood work drawn. An unsurprising finding is

a. low white blood cell count.
b. elevated liver enzymes.
c. low hemoglobin.
d. low folate level.

Answer 17

c. low hemoglobin.

A low hemoglobin and hematocrit can be seen in patients with chronic kidney disease because of an abnormal production of erythropoietin that is responsible for red blood cell production.

Question 18

The bone disease called osteodystrophy is associated with

a. glomerulonephritis.
b. acute renal failure.
c. chronic renal failure.
d. nephrotic syndrome.

Answer 18

c. chronic renal failure.

The disturbed metabolism of calcium and phosphate from lack of vitamin D, a process that occurs in the kidneys, leads to bone pain from osteodystrophy.

Question 19

The classic symptoms of chronic kidney failure result from

a. a diet high in sodium.
b. a diet chronically low in fluid intake.
c. severe trauma to the body.
d. progressive loss of nephrons.

Answer 19

d. progressive loss of nephrons.

Chronic kidney failure, or chronic renal insufficiency, is caused by the progressive breakdown of renal tissues, which impairs all renal function. Few functioning nephrons remain, then gradually deteriorate.

Question 20

The bone disease osteodystrophy develops because of the kidney’s inability to

a. excrete calcium.
b. activate vitamin D.
c. absorb vitamin D.
d. excrete urea and creatinine.

Answer 20

b. activate vitamin D.

The disturbed metabolism of calcium and phosphate from lack of vitamin D activation, a process that occurs in the kidneys, leads to bone pain from osteodystrophy.

Question 21

Symptoms of chronic kidney failure include

a. nitrogen retention.
b. euphoria.
c. jaundice.
d. inability to sleep.

Answer 21

a. nitrogen retention.

Symptoms of chronic kidney disease include the inability to reabsorb water and properly concentrate urine, electrolyte imbalances, nitrogen retention, anemia, hypertension, and azotemia.

Question 22

Carbohydrates and fats are important in the diets of patients with kidney disease because they

a. prevent fatigue.
b. spare protein for tissue synthesis.
c. are low in sodium.
d. are metabolized before they reach the kidney.

Answer 22

b. spare protein for tissue synthesis.

Carbohydrate and fat must supply sufficient nonprotein kilocalories to spare protein for tissue synthesis as well as supply energy.

Question 23

The “cleaning solution” used in hemodialysis is called the

a. filtrate.
b. plasma.
c. urine.
d. dialysate.

Answer 23

d. dialysate.

The dialysate is a solution thought of as a cleaning fluid. Two compartments in the dialysis machine are separated by a filter. One compartment holds blood from the patient that contains all the excess fluids and waste materials; the other holds the dialysate solution.

Question 24

The method of dialysis used with a portable system is

a. hemodialysis.
b. renal dialysis.
c. peritoneal dialysis.
d. continuous dialysis.

Answer 24

c. peritoneal dialysis.

is an alternative form of treatment for dialysis. In this process, the patient introduces the dialysate solution directly into the peritoneal cavity four or five times a day, where it can be exchanged for fluids that contain the metabolic waste products.

Question 25

The patient treated by peritoneal dialysis can increase _____ intake.

a. protein
b. phosphorus
c. caloric
d. fat

Answer 25

a. protein

The patient treated by peritoneal dialysis can increase protein intake to 1.2 to 1.5 g/kg body weight as a result of a more liberal diet

Question 26

For patients with uric acid stones, health practitioners may recommend a diet low in

a. calcium.
b. protein.
c. purines.
d. fat.

Answer 26

c. purines.

Excess excretion of uric acid may be caused by some impairment with the metabolism of purine, a nitrogen end product of dietary protein from which uric acid is formed.

Question 27

The diet recommended for cystine stones is low in

a. calcium.
b. methionine.
c. meats.
d. fat.

Answer 27

b. methionine.

Cystine stones are caused by a genetic metabolic defect in the renal absorption of the amino acids cystine, ornithine, lysine, and arginine, causing an accumulation in the urine. Cystine stones are derived from the essential amino acid methionine, so a low methionine diet is followed.

Question 28

One of the first recommendations for any type of kidney stone is to

a. increase the fiber in the diet.
b. reduce calcium intake.
c. increase fluid intake.
d. decrease protein intake.

Answer 28

c. increase fluid intake.

A large fluid intake is a primary therapy that helps produce more dilute urine and prevent accumulation of materials that form stones.

Question 29

The most common type of kidney stone is composed of

a. calcium.
b. uric acid.
c. cystine.
d. magnesium.

Answer 29

a. calcium.

The most common type of kidney stone (70% to 80%) is composed of calcium oxalate. Approximately half of all calcium stone cases likely result from genetic predisposition.

Question 30

The type of diet recommended for a person with a calcium stone depends on

a. body weight.
b. the composition of the stone.
c. fiber intake.
d. fluid intake.

Answer 30

b. the composition of the stone.

Medical nutrition therapy for calcium stones depends on the composition of the stone. If a stone is composed of calcium phosphate, additional sources of phosphorus should be controlled. If a stone is calcium oxalate, foods high in oxalate should be avoided.

Question 31

Patients with chronic renal disease may need to restrict their intake of foods high in phosphorus, such as

a. milk, nuts, and legumes.
b. meat, chicken, and fish.
c. bread, cereal, rice, and pasta.
d. fruit and potatoes.

Answer 31

a. milk, nuts, and legumes.

Phosphorus-containing foods include milk, nuts, and legumes. A concentration of materials is produced by metabolism of food. Without appropriate filtering, these materials accumulate in the blood, causing metabolic acidosis.

Question 32

For patients treated with dialysis, protein intake should consist mainly of

a. dairy products.
b. vegetarian items.
c. meat, fish, poultry, and eggs.
d. amino acid supplements.

Answer 32

c. meat, fish, poultry, and eggs.

For those on dialysis, at least 50% of protein intake should come from high-biologic value protein to ensure an adequate intake of essential amino acids.