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NURS 5315 > M10 Renal > Flashcards

M10 Renal Flashcards

1
Q

A patient with liver failure is most likely to have low levels of:

A)ammonia

B)creatnine

C)BUN

D)chlorine

A

Answer: C) BUN

BUN is made in the liver, therefore a patient with liver failure will not efficiently make BUN.

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2
Q

You notice in a patient’s chart that they’ve been diagnosed with BPH. Of the following, the patient most likely has what type of renal failure?

A)pre-renal

B)renal

C)post-renal

D)acute tubular necrosis

A

Answer: C) post renal failure

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3
Q

You are trying to determine what type of renal failure your patient has. You order urine studies and find a sodium of 15 meq/L and a high specific gravity of 1.025. The patient most likely has:

A)pre-renal failure

B)intra-renal failure

C)post-renal failure

A

Answer: A) pre-renal failure

The kidneys sense a low GFR and believe that volumes are low in the body, so they attempt to conserve Na+. By reabsorbing Na+ from the filtrate back into the blood, H20 will follow and it will inflate the blood volume. Additionally this movement of water and Na+ back into the blood will create a concentrated urine.

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4
Q

Which of the following medications is NOT typically a cause of intrinsic renal failure?

A)NSAIDS

B)beta blockers

C)ACE inhibitors

D)aminoglycosides

A

Answer: B) beta blockers

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5
Q

What type of relationship do phosphorus and calcium have?

A

Answer: inverse

Note: increased serum Ca+ will cause phosphate levels to drop

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6
Q

What will the parathyroid do if Ca+ levels are low?

A

Answer: PTH will be released

Note: once PTH released the kidney will activate vitamin D, and will produce more vitamin D which is needed to increased the absorption/retention of Ca+

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7
Q

What perentage decrease in GFR is required in order for calcium and phosphorus homeostasis to be altered?

A)10%

B)15%

C)20%

D)25%

A

Answer: D) 25%

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8
Q

Which is not a cause of hypocalcemia r/t kidney issues?

A)decreased renal synthesis of calcitriol

B)increased renal phosphate elimination

C)decreased levels of calcitonin

D)decreased intestinal Ca+ absorption

E)none of the above

A

Answer: B and C

Choice B)increased renal phosphate elimination is incorrect because that would help to increase Ca+ (they have an inverse relationship)

Choice C)decreased levels of calcitonin is incorrect because calcitonin has the opposite effect of PTH and will decrease calcium

The other answer choices are true of hypocalcemia.

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9
Q

What is true about hypocalcemia?

A)decreased serum phosphate will cause hypocalcemia

B)hypocalcemia will decrease PTH activation

C)enhanced renal secretion of phosphate will decrease calcium

D)hypocalcemia can lead to osteodystrophy

A

Answer: D) hypocalcemia can lead to osteodystrophy

Note: Increased phosphate (due to reduced renal elimination) will decrease calcium. Hypocalcemia will cause the parathyroid to be activated and release PTH to mobilize Ca+ from the bone and to create activated vitamin D in the kidney.

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10
Q

Which is not true about secondary hyperparathyroidism?

A)Decreased serum Ca+ will stimulate the parathyroid

B)PTH will be released

C)Ca+ will be mobilized from sarcoplasmic reticulum

D)Activated vitamin D will be created by kidney

A

Answer: C) Ca+ will be mobilized from sarcoplasmic reticulum

In secondary hyperparathyroidism, the low calcium will cause the parathyroid gland to release PTH to mobilize calcium. Calcium can be mobilized from bone, and the PTH stimulation will work to create activated vitamin D in the kidney to help with kidney absorption in the GI.

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11
Q

What issues compound secondary hyperparathyroidism in kidney failure?

A)decreased GFR

B)worsening of hyperphosphatemia

C)worsening of hypocalcemia

D)bone dissolution

A

Answer: All of the above.

If kidney failure is occurring, the GFR is decreased and thus phosphorous is accumulating. An elevated phosphorous level will cause a decrease in calcium. Calcium is low due to decreased renal synthesis of D3 and elevated retention of phosphorus. Even when calcium is mobilized from the bone, the phosphorus can continue to be elevated leading to tertiary hyperparathyroidism.

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12
Q

What hormone will be released if hypercalcemia is present?

A)calcitonin

B)calcitriol

A

Answer: A) calcitonin

Calcitonin has the opposite effect of PTH and will decrease Ca+ when it is elevated.

Calcitriol is activated vitamin D3.

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13
Q

Which is not a function of the kidney?

A)eliminate waste

B)secrete erythropoietin

C)regulate glucose

D)convert amino acids into glucose

E)activate vitamin D

A

Answer: none of the above.

All the choices listed are functions of the kidney.

Functions include eliminating waste, water balance, acid-base balance, BP, secreting erythropoietin, activating vitamin D, glucose regulation (including taking amino acids and converting into glucose, reabsorbing glucose from glomerular filtrate, and uptake of glucose from circulation).

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14
Q

Which of the following is not a function of the kidney?

A)Uptake of glucose from circulation

B)secrete erythropoietin

C)Activate vitamin D3

D)convert fats into glucose

E)one or more of the above

A

Answer D) converting fats into glucose

The kidney will convert amino acids into glucose.

Functions include eliminating waste, water balance, acid-base balance, BP, secreting erythropoietin, activating vitamin D, glucose regulation (including taking amino acids and converting into glucose, reabsorbing glucose from glomerular filtrate, and uptake of glucose from circulation).

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15
Q

What pore/transporter/mechanism is used to absorb filtered glucose in the kidney tubules?

A

Sodium-glucose cotransporter 2 (SGLT2)

The SGLT2 is used in the proximal tubule to absorb filtered glucose, but when serum levels exceed 180 then transporters are saturated and the excess glucose goes into urine to be eliminated from the body.

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16
Q

What is the mechanism of action for SGLT2 drugs?

A)It increases the amount of glucose reabsorbed into blood

B)It works on the ascending LOH

C)It is contraindicated in diabetics

D)None of the above

A

Answer D) none of the above

Drug class SGLT2 will target the sodium-glucose transporter found in the proximal tubule which absorbs filtered glucose. The drug will target the protein and allow glucose to spill into urine which will decrease the serum glucose. This drug is helpful in those with diabetes.

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17
Q
A

A) renal capsule (encloses kidney)

B)renal cortex (houses proximal and distal tubules)

C)renal pyramid (houses secreteing/collecting tubules and LOH). It’s a very “salty” area which creates a gradient.

D)renal artery

E)renal pelvis (renal calyces merge to create renal pelvis)

F)renal vein

G)ureter

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18
Q

What does the renal fascia do?

A)encloses kidney

B)attaches kidney to abdominal wall

C)structures the cortex of the kidney to filter urine

D)acts as a convergence for renal vasculature and ureter on the medial side of the kidney

A

Answer: B) attaches kidney to abdominal wall

The renal fascia is a fatty layer which helps attach the kidney to the abdominal wall.

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19
Q

Which structure of the kidney encases the glomerulus and collects urine?

A)arterioles

B)Bowman’s capsule

C)vasa recta

D)proximal tubule

A

Answer: B) Bowman’s capsule

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20
Q

What epithelial structure wraps the glomerular capillaries and provide a site for blood to be filtered through?

A)juxtaglomerular cells

B)macula dense cells

C)mesangial cells

D)podocytes

A

Answer: D) podocytes

Podocytes are part of Bowman’s capsule and are epithelial cells which wrap around the capillaries of the glomeruli. They are long foot projections which secure the capsule to the vasculature, and provide slits between the projects where blood is filtered through.

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21
Q

Which substance is not reabsorbed in the proximal tubule area?

A)Na+

B)Cl+

C)amino acids

D)K+

E)H+

A

Answer: E) H+

Substances reabsorbed in the proximal tubule are: glucose, A.A., Na, Cl, K, Phosphate, H20

Note: if glucose exceeds 180 it will exceed the threshold and will be excreted into urine.

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22
Q

In the kidneys what is the threshold for serum glucose, where any excess will be eliminated in urine?

A

180 mg/dL

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23
Q

PTH stimulation will ________ (increase/decrease) phosphate, and will _______ (increase/decrease) calcium.

A

PTH stimulation will decrease** phosphate via elimination in urine, and will **increase calcium via enhance reabsorption and other processes.

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24
Q

Which of the kidney tubules is permable only to water?

A)distal convoluted tubule

B)ascending LOH

C)descending LOH

D)collecting duct

A

Answer: C) descending LOH

Water will leave the tubule in the LOH creating concentrated urine.

Note: Na+ and Cl- can passively flow here but it is not significant.

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25
Q

Where can water not be absorbed within the kidney tubule system?

A)distal convoluted tubule

B)ascending LOH

C)descending LOH

D)collecting duct

A

Answer: A)distal convoluted tubule and B) ascending LOH

In the distal convoluted tubule, there is active reabsorption of Na+ but no water reabsorption.

In the ascending LOH, there is active reabsorption (movement of ions out of tubule) of Na, K, Cl, Mg, Ca. No water is reabsorbed here, thus the urine is dilute.

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26
Q

What ion movement occurs at the collecting tubule area?

A)Mg

B)Na+/K+H+

C)Na+/K+

D)K+/Cl-

A

Answer: B) Na+/K+H+

Na+ is reabsorbed in exchange for K+ and H+. This area is regulated by aldosterone (which will increase Na+ and H20 reabsorption and enhance K+ secretion).

ADH can act here as well (H20 will be reabsorbed=concentrated urine).

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27
Q

If the diameter of the afferent arteriole increases, then the GFR will ______. If the diameter of the afferent arteriole decreases, then the GFR will _______.

A

If the diameter of the afferent arteriole increases, then the GFR will increase. If the diameter of the afferent arteriole decreases, then the GFR will decrease.

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28
Q

If the diameter of the efferent arteriole increases, then the GFR will ______. If the diameter of the efferent arteriole decreases, then the GFR will _______.

A

If the diameter of the efferent arteriole increases, then the GFR will decrease. If the diameter of the efferent arteriole decreases, then the GFR will increase.

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29
Q

What area of the cortex does the distal tubule pass between the afferent and efferent arterioles?

A

Juxtaglomerular apparatus (JGA)

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30
Q

Which cells in the JGA release renin?

A)macula densa

B)juxtaglomerular

C)mesangial

D)none of the above

A

Answer: B)juxtaglomerular cells

These cells release renin to help increase GFR when needed. The renin will increase Na+ reabsorption and also release angiotensin II which causes vasoconstriction of the efferent arteriole (causes increased GFR).

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31
Q

Which cells in the JGA sense Na levels?

A)macula densa

B)juxtaglomerular

C)mesangial

D)Na/K+H+ transporter

A

Answer: A) macula densa

Macula densa cells sense changes in Na and help regulate GFR. If blood pressure is low, they will help adenosine to be released which causes vasoconstriction of afferent arteriole (which will decrease GFR).

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32
Q

If blood pressure is low, the _______ cells will help _______ to be released which will _________ the _________ arteriole and cause the GFR to _________.

A)mesangial, renin, vasoconstrict, efferent, increase

B)macula densa, adenosine, vasoconstrict, afferent, decrease

C)juxtaglomerular, renin, vasodilate, efferent, decrease

D)none of the above

A

Answer: B

If blood pressure is low, the macula densa cells will help adenosine** to be released which will **vasoconstrict the afferent arteriole and cause the GFR to decrease.

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33
Q

Match the following cells and functions:

A) macula densa: renin; juxtaglomerular: natriuretic factor/angiotensin II; mesangial: adenosine

B)macula densa:adenosine; juxtaglomerular: renin; mesangial: natriuretic factor/angiotensin II

C) macula densa:renin; juxtaglomerular: adenosine; mesangial: natriuretic factor/angiotensin II

D)none of the above

A

Answer B

Macula densa in response to low BP will help to have adenosine released leading to vasoconstriction of afferent arteriole.

Juxtaglomerular: in response to low BP will release renin which increases Na+ reabsorption and releases angiotensin II so vasoconstriction of efferent arteriole.

Mesangial: has receptors for natriuretic factor and angiotensin II. The natriuretic stimulation will cause vasodilation in afferent arteriole.

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34
Q

What is not true of mesangial cells of the JGA?

A)they act as macrophages

B)can contract to regulate blood flow

C)have receptors for natriuretic factor and aldosterone

D)Natriuretic stimulation will cause vasodilation of the afferent arterioles

A

Answer C) have receptors for natriuretic factor and aldosterone

Mesangial cells have receptors for natriuretic factor and angiotensin II

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35
Q

Which blood flow sequence is correct:

A)renal arteries–>afferent arteriole–>glomerulus

B)renal arteries–efferent arteriole–>glomerulus

C)glomerulus–>afferent arterioles–>capillaries

D)efferent arterioles–>capillaries–>renal artery

A

Answer: A) renal arteries–>afferent arteriole–>glomerulus

Full sequence is: abdominal aorta–>renal arteries–>afferent arteriole–>glomerulus–>efferent arteriole–>capillaries which surround tubules–>renal vein–>inferior vena cava

36
Q

What percentage of blood that enters the glomerulus actually goes into Bowman’s capsule?

A

Answer: 20%

The remaining 80% passes onto the efferent arteriole

37
Q

How can NSAIDS be harmful to kidneys?

A)they block prostaglandins

B)they sequester K+ which worsens hyperkalemia in AKI

C)they can cause intrarenal hemorrhage and loss of nephrons

D)in high doses they overload the kidneys waste excretion capabilities

A

Answer: A) they block prostaglandins

Prostaglandins are renal protective and work to dilate the afferent arterioles which increases the blood flow to the glomerulus thus increasing GFR. NSAIDS inhibit prostaglandins.

38
Q

What drug family can cause AKI for those with pre-existing renal stenosis?

A)NSAIDS

B)ACE inhibitors

C)SGLT2

D)Aluminum antacids

A

Answer: B) ACE inhibitors

ACE inhibitors block angiotensin II by decreasing pressure in glomeruli (exacerbates perfusion issues existing already from renal stenosis).

Remember: antiotensin II constricts efferent arterioles which increases GFR

39
Q

Angiotensin II does what:

A) vasoconstriction

B)stimulates aldosterone

C)causes hyponatremia

D)decreases BP

A

Answer: A & B

Angiotensin II will cause vasoconstriction of efferent arteriole and will stimulate aldosterone (so Na+ and H20 will be reabsorbed which can increase BP and blood volume, and ultimately GFR.)

40
Q

Fluid in the tubules becomes ______ (more/less) dilute as we approach the distal tubule.

A

Answer: more

41
Q

Fluid in the descending LOH is ______ (more/less) concentrated, whereas the fluid in the ascending LOH is ______ (more/less) concentrated.

A

Fluid in the descending LOH is more concentrated, whereas the fluid in the ascending LOH is less concentrated.

42
Q

Urea, a major part of urine has approximately 50% excreted in urine, and 50% recycled by the kidney. What function does urea serve?

A)creates an osmotic gradient

B)allows dilution of urine

C)allows concentration of urine

D)one or more of the above

A

Answer: D) one or more of the above

Urea contributes to the osmotic gradient in the “salty” medulla and is NECESSARY for concentration/dilution of urine.

43
Q

Patients with what deficiency will have difficulty concentrating their urine?

A)ulcerative colitis

B)IBS

C)protein deficiency

D)diabetes type 2

A

Answer: C) protein deficiency

Urea is the end product of protein metabolism, so patients with a protein deficiency cannot adequately concentrate their urine.

44
Q

Catecholamines are released by the sympathetici nerves and cause renal arteriolar ________ (vasoconstriction/vasodilation).

A

Answer: vasoconstriction

Catecholamines will decrease baseline renal fx and GFR.

They increase Na+ and H20 tubular reabsorption which creates DILUTE urine.

45
Q

What effect do the following substances have on urine dilution/concentration? ADH will ______ urine, natriuretic peptides will ______ urine, and diuretics will _______ urine.

A)dilute, dilute, concentrate

B)concentrate, dilute, concentrate

C)dilute, concentrate, concentrate

D)concentrate, dilute, dilute

A

Answer: D) concentrate, dilute, dilute

ADH increases water merability in distal tubule/collecting duct which will concentrate urine. Natriuretic peptides promote diuresis and inhibit Na+/H20 reabsorption as well as inhibiting renin/aldosterine which will dilute urine. Diuretics interfere with Na+ reabsorption so it will dilute urine.

46
Q

Embryonic kidneys start to develop at _____ weeks but the glomeruli develop all the way until ______ months of gestation.

A

Answer: Embryonic kidneys start to develop at 3 weeks but the glomeruli develop all the way until 9 months of gestation.

47
Q

Where would the kidneys be located at each time interval in a developing fetus? Sacral area at _______; 3rd lumbar at ______; and 1st lumbar at ________.

A

Answer: Sacral area at 6 weeks; 3rd lumbar at 3rd month; and 1st lumbar at 9 months.

The kidneys ascend, whereas the bladder will descend into pelvis with growth during childhood.

48
Q

What month would a fetus begin producing urine, which contributes to amniotic fluid?

A

Month 3 of gestation.

49
Q

Which is not true about renal physiology in the infant?

A)ureters are shorter than those of an adult

B)tubule system immature

C)renal blood flow and GFR increase due to decreased vascular resistance

D)Renal vascular resistance is low due to increased renin

A

Answer: D) renal vascular resistance is low due to increased renin.

The other statements are true regarding renal physiology in the infant. Additionally, renal vascular resistance is high due to increased renin. Urine is more dilute and less responsive to ADH. Less urea is excreted because there is a high anabolic state and use of protein to grow.

50
Q

Which is not an age associated change of the renal system?

A)GFR decreases due to atherosclerosis

B)Nephron number decreases

C)Tubular system atrophies

D)Kidney size atrophies

A

Answer: D) kidney size atrophies

The kidney actually undergoes hypertrophy with aging. The other statements are true regarding age related changes. Subtances are not reabsorbed as well (glu/bicarb/Na) and K+ is not eliminated as efficiently (hyperkalemia). Drugs are not cleared as efficiently and vitamin D is not activated as well. The nephron number and size decreases with age.

51
Q

In terms of renal injury, a hypercellularity of glomeruli would be considered a _______ injury, whereas the thickening of the glomeruli basement membrane would be considered a ______ injury.

A)membranous, proliferative

B)hypercelluar shift, membranous

C)hypercellular shift, sclerotic

D) proliferative, membranous

A

Answer: D) proliferative, membranous

52
Q

Primary glomerular disease is caused by ______ whereas secondary glomerular disease is caused by _________.

A

Answer: Primary glomerular disease is caused by an issue within the kidney itself whereas secondary glomerular disease is caused by something outside of the kidney like lupus, or diabetes.

53
Q

Hypercellularity pattern of injury is caused by:

A)an accumulation of homogenous and eosinophilic cells

B)increased number of cells in glomerulus

C)accumulation of extracellular collagenous matrix

D)increased perfusion which cause microthrombi in the renal vasculature and initiate the inflammatory process

A

Answer: B) an increased number of cells in the glomerulus

It is usually caused by an immune or inflammatory response.

One example is basement membrane thickening which causes thickening of capillary walls in glomerulus.

54
Q

What type of injury of the kidney does this describe: an accumulation of homogenous and eoisinophilic cells in the lumen of glomerular capillaries which can obliterate glomerular capillary lumens and is caused by capillary wall injury.

A)sclerosis

B)hyalinosis

C)hypercellularity

A

Answer: B) hyalinosis

An example is focal segmental glomerulosclerosis

55
Q

Sclerotic patterns of injury in the kidney involve the ________ (luminal/extracellular) area/cells, whereas hyalinosis involves the ________ (luminal/extracellular) area/cells.

A

Answer: Sclerotic patterns of injury in the kidney involve the extracellular area/cells, whereas hyalinosis involves the luminal area/cells.

Sclerosis patterns of injury are due to an accumulation of extracellular collagen. They can obliterate capillary lumens if damage is widespread.

56
Q

Which is not a type of kidney stone (composition)?

A)calcium

B)struvite

C)urea

D)cysteine

A

Answer: C) urea

Kidney stone types are: calcium, struvite, uric acid, and cysteine

57
Q

The ______ type of kidney stones are the most common, wherewas the _______ type of kidney stones are least common in adults, but most common in children.

Choices: calcium, struvite, uric acid, cysteine

A

Answer: The calcium type of kidney stones are the most common, wherewas the cysteine type of kidney stones are least common in adults, but most common in children.

58
Q

What type of kidney stone can be caused by chronic UTI with urease producing bacteria?

A)calcium

B)struvite

C)uric acid

D)cysteine

A

Answer: B) struvite

Struvite stones are made of Mg/ammonium/phosphate salts and can be caused by chronic UTIs with urease producing bacteria. The bacteria breakdown urea into salt which act as precipitants to become kidney stones.

59
Q

What type of stone is associated with the breakdown of purines and protein rich diets?

A)calcium

B)uric acid

C)struvite

D)cysteine

A

Answer: B) uric acid

Uric acid stones are also seen in those with gout.

60
Q

Which of the following is true of kidney stones?

A)ions bond to form crystals which turn into stones

B)stones can cause hydronephrosis

C)small stones can pass spontaneously 50% of the time

D)one or more of the above

A

Answer: D) one or more of the above

All of the choices are true.

Note: if hydronephrosis continues, and/or obstruction is unresolved, renal failure can result

61
Q

Which is not a risk factor for kidney stone development?

A)Age less than 50

B)Female

C)Caucasian

D)hypertension

A

Answer: B) female

Risks for kidney stone development include: age less than 50, poor fluid intake, Caucasian, diet, HTN, metabolic syndrome, atherosclerosis, DM

S&S of kidney stone include: flank pain that radiates to groin, anuria, azotemia, hematuria

62
Q

What mechanism explains why when GFR is decreased, the BUN will increase MORE than the increase seen in creatinine?

A)creatinine has a larger molecular size so it cannot be reabsorbed as easily

B)BUN is filtered and reabsorbed

C)BUN carries a negative charge and it is pulled with positively charged ions more easily across the gradient

D)none of the above

A

Answer: B) BUN is filtered and reabsorbed

When GFR is decreased, the BUN is filtered and reabsorbed, whereas creatinine is filtered and secreted. This explains why in pre-renal AKI the BUN:Creatinine ratio is 20:1 (because more BUN is being reabsorbed relative to the amount of creatinine).

Note: creatinine only increases when GFR decreases or if tubal secretion into urine is inhibited

63
Q

Which is true of AKI?

A)it is an acute reduction in renal function with oliguria

B)it is usually reversible

C)it can be caused by kidney stones

D)it can be caused by hypovolemia

A

Answer: all of the above are true

64
Q

In stage 1 of AKI, creatinine is ______ times higher than base, in stage 2 of AKI, creatinine is ______ times higher than base, and in stage 3 of AKI, creatinine is _____ times higher than base.

A

Answer: In stage 1 of AKI, creatinine is 1.5-1.9 times higher than base, in stage 2 of AKI, creatinine is 2.0-2.9 times higher than base, and in stage 3 of AKI, creatinine is 3.0+ times higher than base.

Note stage 3 is also classified if patient is under age 18 and there is an initiation of renal replacement therapy.

65
Q

Which is a s&s of AKI?

A)edema

B)dyspnea

C)electrolyte imbalance

D)metabolic acidosis

A

Answer: all of the above

Other S&S include: oliguria, anuria, fatigue, mental status change (related to uremia), hyperkalemia, hyponatremia

66
Q

What type of AKI would you classify if the patient has a BUN:Creatinine ratio of >20:1?

A)pre-renal

B)intra-renal

C)post-renal

A

Answer: A) pre-renal

The BUN:Creatinine ratio of 20:1 is seen in pre-renal AKI because the BUN is reabsorbed and filtered, whereas creatinine is secreted and filtered.

In pre-renal failure the kidneys “know” they aren’t getting enough fluid and they go on a reabsorbing spree and conserve things like Na, H20, and BUN to restore intravascular volume.

In intra-renal failure there is no hypovolemia so the kidney does not respond by reabsorbing. Additionally, if they kidney is failing due to an internal issue, it cannot change what it absorbs anyway because it is not working propertly so it will not cause a disproportional rise in BUN.

67
Q

What type of AKI would you classify if the patient has a BUN/Creatinine ratio of <20:1?

A)pre-renal

B)intra-renal

C)post-renal

A

Answer: B) intra-renal

In pre-renal failure the kidneys “know” they aren’t getting enough fluid and they go on a reabsorbing spree and conserve things like Na, H20, and BUN to restore intravascular volume.

In intra-renal failure there is no hypovolemia so the kidney does not respond by reabsorbing. Additionally, if they kidney is failing due to an internal issue, it cannot change what it absorbs anyway because it is not working propertly so it will not cause a disproportional rise in BUN.

68
Q

Which is not a cause of pre-renal AKI?

A)vasoconstriction

B)shock

C)renal artery stenosis

D)NSAIDS

A

Answer: None of the above

All the choices are true of pre-renal AKI possible causes. Anything that prevents the kidney from receiving enough blood supply can cause pre-renal AKI. Others include: meds, hypotension, hypovolemia, hemorrhage, heart failure/decreased CO

69
Q

Which is a cause of intra-renal AKI?

A)alomerulonephritis

B)acute tubular necrosis

C)aminoglycosides

D)NSAIDS

E)two or more of the above

A

Answer: E) two or more of the above (choices A,B,C are true)

Intra-renal AKI is impaired kidney function at a cellular level. Can be caused by inflammatory conditions, aminoglycosides, & acute tubular necrosis)

70
Q

What changes will be seen in a patient with intra-renal AKI?

A)increased urine concentrations of Na+

B)decreased urine concentrations of Na+

C)increased urine osmolarity

D)none of the above

A

Answer: A) increased urine concentrations of Na+

Think: the kidney is impaired at a cellular level and is ineffective at reabsorbing Na+ or H20

71
Q

What is a possible cause of post-renal AKI?

A)NSAIDS

B)prostatic hyperplasia

C)renal artery stenosis

D)none of the above

A

Answer: B) prostatic hyperplasia

Post-renal AKI causes include anything that obstructs the urinary tract and increases retrograde pressure which can cause ATN. Causes include BPH, and urinary stone.

72
Q

What pathological scenario does the following information describe. Tubular epithelial cells slough off and obstruct the tubule, which causes increased pressure within the obstructed tubule. The increased pressure pushes fluid into the interstitial area, and decreases GFR.

A)acute tubular necrosis

B)pre-renal AKI

C)HUS

D)nephrolithiasis

A

Answer: A) acute tubular necrosis

ATN is severe necrosis of tubular epithelial cells due to prolonged ischemia from pre-renal AKI. The dead cells slough off and obstruct the tubule. Increased pressure within will push fluid into interstitial area and decrease GFR. The decreased GFR will cause afferent arteriole vasoconstriction which exacerbates the issue.

73
Q

Which of the following is not true of acute tubular necrosis?

A)GFR will increase

B)fluid will be pulled from interstitial space

C)BUN will rise

D)Creatinine will rise

A

Answer: A) GFR will increase

ATN is severe necrosis of tubular epithelial cells due to prolonged ischemia from pre-renal AKI. The dead cells slough off and obstruct the tubule. Increased pressure within will push fluid into interstitial area and decrease GFR. The decreased GFR will cause afferent arteriole vasoconstriction which exacerbates the issue. BUN and creatinine will rise (the creatinine will drop later in later stages and the patient will undergo diuresis).

74
Q

In ATN the patient will initially have decreased GFR and increased creatinine placing them at an ________ (increased/decreased) risk for __________(dehydration/fluid overload) and electrolyte imbalances. The pathological changes progress and the creatinine will drop causing the patient to undergo ________ (diuresis/fluid retetion) and places them at risk for _________ (dehydration/fluid overload).

A

In ATN the patient will initially have decreased GFR and increased creatinine placing them at an increased risk for fluid overload** and electrolyte imbalances. The pathological changes progress and the creatinine will drop causing the patient to undergo **diuresis and places them at risk for dehydration.

75
Q

Which is not a cause of acute tubular necrosis (ATN)?

A)sepsis

B)post-surgical issues

C)obstetrics

D)diabetes

A

Answer: D) diabetes

Causes of ATN include: sepsis, post-surgical issues, obstetrics, meds

76
Q

Which is true of chronic kidney disease?

A)it is irreversible loss of nephron function from a chronic injury

B)it will decrease GFR

C)early stages are characterized by fluid overload and hypernatremia

D)late stages will have fluid overload and hypernatremia

E)one or more of the above

A

Answer E) one or more of the above

CKD is the irreversible loss of nephron function resulting from a chronic injury. The loss of nephrons increases GFR which will increase the pressure in remaining functional nephrons, eventually these nephrons will be damaged by the hyperfiltration occurring, and more fibrosis/scarring will occur.

77
Q

What is the #1 cause of CKD?

A)HTN

B)DM

C)glomerulonephritis

D)polycystic kidney disease

A

Answer: B) DM

78
Q

A FeNa of <1% would be seen in:

A)acute kidney injury

B)acute tubular necrosis

C)chronic kidney disease

A

Answer: A) acute kidney injury

The FeNa is the fractional excretion of Na. It would be <1% because in pre-renal AKI the kidneys think there is a volume deficit and preserve Na+ to pull reabsorb water too.

79
Q

A FeNa of >2% would be seen in:

A)acute kidney injury

B)acute tubular necrosis

C)chronic kidney disease

A

Answer: B) acute tubular necrosis

In ATN there is an issue within the kidney itself (intra-renal AKI) and the tubules are damaged so they are not reabsorbing effectively. Thus, the kidneys are wasting sodium, so the fractional excretion of Na (FeNa) will be more (>2%).

80
Q

What changes are seen in potassium in CKD?

_________ (hyperkalemia/hypokalemia) in late stages with oliguria. And ________ (hyperkalemia/hypokalemia) in early stages.

A

Answer: Hyperkalemia in late stages with oliguria. And hypokalemia in early stages because K+ elimination is maintained.

81
Q

In late stage CKD, sodium levels are increased or decreased?

A

Answer: increased because Na+ is not excreted and patient becomes oliguric

82
Q

In CKD, will phosphorus be elevated or decreased?

A

Answer: increased due to decreased elimination and decreased GFR

83
Q

In CKD, will calcium be increased or decreased?

A

Answer: decreased

Calcium is decreased due to the inverse relationship with phosphorus (which is elevated in CKD). Decreased production of active vitamin D will also decrease Ca+ absorption in GI.

84
Q

In CKD, will magnesium be elevated or decreased if calcium levels are normal?

A

Answer: magnesium will be low because a normal Ca+ will increase PTH?

85
Q

In CKD, will serum bicarbonate be elevated or decreased?

A

Answer: decreased

The kidney cannot reabsorb bicarb or excrete H+ so metabolic acidosis will occur.

86
Q
A

NURS 5315 (4 decks)

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