Pathophysiology: Chapter 39: Alterations of Renal and Urinary Tract Function

Question 1

How does progressive nephrons injury affect angiotensin II activity?

a. Angiotensin II activity is decreased.
b. It is elevated.
c. Angiotensin II activity is totally suppressed.
d. It is not affected.

Answer 1

ANS: B
Angiotensin II activity is elevated with progressive nephron injury. This selection is the
only accurate identification of the effect of progressive nephron injury on angiotensin II
activity.

Question 2

Which mineral accounts for the most common type of renal stone?

a. Magnesium-ammonium-phosphate
b. Uric acid
c. Calcium oxalate
d. Magnesium phosphate

Answer 2

ANS: C
Calcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all
stones requiring treatment.

Question 3

Regarding the formation of renal calculi, what function does pyrophosphate, potassium
citrate, and magnesium perform?
a. They inhibit crystal growth.
b. Pyrophosphate, potassium citrate, and magnesium stimulate the supersaturation of
salt.
c. They facilitate the precipitation of salts from a liquid to a solid state.
d. Pyrophosphate, potassium citrate, and magnesium enhance crystallization of salt
crystals to form stones.

Answer 3

ANS: A
Stone or crystal growth inhibiting substances, including potassium citrate, pyrophosphate,
and magnesium, are capable of crystal growth inhibition. They are not capable of the
functions stated by the other options.

Question 4

Hypercalciuria is primarily attributable to which alteration?

a. Defective renal calcium reabsorption
b. Intestinal hyperabsorption of dietary calcium
c. Bone demineralization caused by prolonged immobilization
d. Hyperparathyroidism

Answer 4

ANS: B
Hypercalciuria is usually attributable to intestinal hyperabsorption of dietary calcium and
less commonly to a defect in renal calcium reabsorption. Hyperparathyroidism and bone
demineralization associated with prolonged immobilization are also known to cause
hypercalciuria but too a much lesser degree.

Question 5

Detrusor hyperreflexia develops from neurologic disorders that originate where?

a. Spinal cord between C2 and S1
b. Spinal cord between S2 and S4
c. Above the pontine micturition center
d. Below the cauda equina

Answer 5

ANS: C
Neurologic disorders that develop above the pontine micturition center result in detrusor
hyperreflexia, also known as an uninhibited or reflex bladder. This selection is the only
option responsible for detrusor hyperreflexia.

Question 6

Considering the innervation of the circular muscles of the bladder neck, which
classification of drug is used to treat bladder neck obstruction?
a. Beta-Adrenergic blocking medications
b. Alpha-Adrenergic blocking medications
c. Parasympathomimetic medications
d. Anticholinesterase medications

Answer 6

ANS: B
Because the bladder neck consists of circular smooth muscle with adrenergic innervation,
detrusor sphincter dyssynergia may be managed by Alpha-adrenergic blocking (antimuscarinic)
medications. This selection is the only option capable of this specific function.

Question 7

Renal cell carcinoma, classified as clear cell tumors, arises from epithelial cells in which
structure?
a. Proximal tubule c. Nephron
b. Distal tubule d. Glomerulus

Answer 7

ANS: A
Renal cell carcinoma, classified as clear cell tumors according to cell type and extent of
metastasis, arises from the proximal tubular epithelium. These tumors are not associated
with the other options.

Question 8

Bladder cancer is associated with the gene mutation of which gene?
a. c-erbB2
b. Human epidermal growth factor receptor 2 (HER2)
c. TP53
d. myc
.

Answer 8

ANS: C
Oncogenes of the ras gene family and tumor-suppressor genes including TP53 mutations
and the inactivation of the retinoblastoma gene (pRb) are implicated in bladder cancer.
This process is not associated with the other options

Question 9

What is the most common cause of uncomplicated urinary tract infections?

a. Staphylococcus c. Proteus
b. Klebsiella d. Escherichia coli

Answer 9

ANS: D

The most common infecting microorganisms are uropathic strains of E. coli (80% to 85%).

Question 10

Which differentiating sign is required to make the diagnosis of pyelonephritis from that of
cystitis?
a. Difficulty starting the stream of urine
b. Spasmodic pain that radiates to the groin
c. Increased glomerular filtration rate
d. Urinalysis confirmation of white blood cell casts

Answer 10

ANS: D
Clinical assessment, alone, is difficult to differentiate the symptoms of cystitis from those
of pyelonephritis. Urine culture, urinalysis, and clinical signs and symptoms establish the
specific diagnosis. White blood cell casts indicate pyelonephritis, but they are not always
present in the urine. This selection is the only option that is considered a required sign of
pyelonephritis.

Question 11

Considering host defense mechanisms, which element in the urine is bacteriostatic?

a. High pH (alkaline urine) c. High glucose
b. High urea d. High calcium

Answer 11

ANS: B
Dilute urine washes out bacteria, and urine with higher urea concentrations (high
osmolarity) is more bacteriostatic.

Question 12

Which clinical manifestations of a urinary tract infection may be demonstrated in an
85-year-old individual?
a. Confusion and poorly localized abdominal discomfort
b. Dysuria, frequency, and suprapubic pain
c. Hematuria and flank pain
d. Pyuria, urgency, and frequency

Answer 12

ANS: A
Older adults with cystitis may demonstrate confusion or vague abdominal discomfort or
otherwise be asymptomatic.

Question 13

Pyelonephritis is usually caused by which type of organism?

a. Bacteria c. Viruses
b. Fungi d. Parasites

Answer 13

ANS: A
Pyelonephritis is usually caused by the bacteria Escherichia coli, Proteus, or
Pseudomonas.

Question 14

Which abnormal laboratory value is found in glomerular disorders?

a. Elevated creatinine concentration
b. Low blood urea nitrogen (BUN)
c. Elevated immunoglobulin A (IgA)
d. Low serum complement

Answer 14

ANS: A
Elevated creatinine concentration is an abnormal laboratory value found in glomerular
disorders. Reduced glomerular filtration rate during glomerular disease is evidenced by
elevated plasma urea, creatinine concentration, or reduced renal creatinine clearance.
Glomerular disorders are not associated with the other options.

Question 15

Which glomerular lesion is characterized by thickening of the glomerular capillary wall
with immune deposition of immunoglobulin G (IgG) and C3?
a. Proliferative c. Mesangial
b. Membranous d. Crescentic

Answer 15

ANS: B

The thickening of the glomerular capillary wall characterizes only membranous lesions.

Question 16

Goodpasture syndrome is an example of which of the following?

a. Antiglomerular basement membrane disease
b. Acute glomerulonephritis
c. Chronic glomerulonephritis
d. Immunoglobulin A (IgA) nephropathy

Answer 16

ANS: A
Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with
immunoglobulin G (IgG) antibody formation against pulmonary capillary and glomerular
basement membranes. Goodpasture syndrome is not an example of any of the other
options.

Question 17

A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria
exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence
of which disorder?
a. Cystitis c. Glomerulonephritis
b. Chronic pyelonephritis d. Nephrotic syndrome

Answer 17

ANS: C
The data suggest the patient has the disorder known as glomerulonephritis. Two major
changes distinctive of more severe glomerulonephritis are (1) hematuria with red blood
cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin as the major protein.
These symptoms do not support the diagnosis of the other options.

Question 18

Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney
disorder?
a. Nephrotic syndrome     
b. Acute glomerulonephritis
c. Chronic glomerulonephritis 
d. Pyelonephritis

Answer 18

ANS: A
Symptoms of nephrotic syndrome include edema, hyperlipidemia, lipiduria, vitamin D
deficiency, and hypothyroidism. These symptoms do not support the other options.

Question 19

Which antibiotics are considered “major culprits” in causing nephrotoxic acute tubular
necrosis (ATN)?
a. Penicillin and ampicillin 
b. Vancomycin and bacitracin
c. Gentamicin and tobramycin 
d. Cefazolin and cefepime

Answer 19

ANS: C
Although numerous antibiotics can produce nephrotoxic ATN, the aminoglycosides
(gentamicin, tobramycin) are the major culprits.

Question 20

Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by
intrinsic (intrarenal) failure?
a. Urine sodium >30 mEq/L
b. Urine osmolality >500 mOsm
c. Fractional excretion of sodium (FENa) <1%
d. Urine sediment has no cells, some hyaline casts

Answer 20

ANS: A

Urine sodium >30 mEq/L is the only option indicative of ATN.

Question 21

How are glucose and insulin used to treat hyperkalemia associated with acute renal
failure?
a. Glucose has an osmotic effect, which attracts water and sodium, resulting in more
dilute blood and a lower potassium concentration.
b. When insulin transports glucose into the cell, it also carries potassium with it.
c. Potassium attaches to receptors on the cell membrane of glucose and is carried into
the cell.
d. Increasing insulin causes ketoacidosis, which causes potassium to move into the
cell in exchange for hydrogen.

Answer 21

ANS: B
This selection is the only option that accurately describes glucose metabolism, causing
potassium to move to the intracellular fluid; insulin infusions therefore can be effective in
shifting potassium from the extracellular to intracellular space, along with the transport of
glucose.

Question 22

Creatinine is primarily excreted by glomerular filtration after being constantly released
from what type of tissue?
a. Nervous system c. Muscle
b. Kidneys d. Liver

Answer 22

ANS: C
Creatinine is constantly released from only muscle tissue to be excreted by glomerular
filtration.

Question 23

Which statement is false concerning the skeletal alterations caused by chronic renal failure
when the glomerular filtration rate (GFR) declines to 25% of normal?
a. Parathyroid hormone is no longer effective in maintaining serum phosphate levels.
b. The parathyroid gland is no longer able to secrete sufficient parathyroid hormone.
c. The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium,
is impaired.
d. The synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and
phosphate resorption from bone by parathyroid hormone, is impaired.

Answer 23

ANS: B
Bone and skeletal changes develop with alterations in calcium and phosphate metabolism
(see Table 38-16). These changes begin when the GFR decreases to 25% or less. The
combined effect of hyperparathyroidism and vitamin D deficiency can result in renal
osteodystrophies (e.g., osteomalacia, osteitis fibrosa with increased risk for fractures).
Other consequences of secondary hyperparathyroidism include soft-tissue and vascular
calcification, cardiovascular disease, and, less commonly, calcific uremic arteriolopathy.
The other options are true.

Question 24

Anemia of chronic renal failure can be successfully treated with which element?

a. Intrinsic factor c. Vitamin D
b. Vitamin B12 d. Erythropoietin

Answer 24

ANS: D
Anemia of chronic renal failure can be successfully treated with erythropoietin. Reduced
erythropoietin secretion and reduced red cell production are evident in anemia resulting
from chronic renal failure. The other options are not relevant to this condition.

Question 25

When the right kidney is obstructed, how will the glomeruli and tubules in the left kidney
compensate?
a. Increase in number 
b. Increase in size
c. Develop collateral circulation 
d. Increase speed of production

Answer 25

ANS: B
These processes cause the contralateral (unobstructed) kidney to increase the size of
individual glomeruli and tubules. The changes described by the other options are not
correct.

Question 26

What medical term is used to identify a functional urinary tract obstruction caused by an
interruption of the nerve supply to the bladder?
a. Neurogenic bladder
b. Obstructed bladder
c. Necrotic bladder
d. Retrograde bladder

Answer 26

ANS: A
Neurogenic bladder is a general term for bladder dysfunction caused by neurologic
disorders. The types of dysfunction are related to the sites in the nervous system that
control sensory and motor bladder function (see Figure 38-3). None of the other options
correctly identify the described condition.