Renal and Urinary Tract Flashcards
Which of the following is a cause of prerenal disease in acute kidney injury?
A Nephrotoxic agents
B Dehydration
C Renal calculi
D Benign prostatic hypertrophy
inadequate kidney perfusion r/t DEHYDRATION
A new patient, a 54-year-old male with a history of cigarette smoking, obesity, and uncontrolled hypertension, presents with new-onset hematuria, dull and aching flank pain, and a palpable flank mass. The diagnosis confirms an advanced stage of renal tumor. Which of the following statements about renal tumors is incorrect?
A. Earlier stages are often silent, with painless hematuria being the most common symptom.
B. 25% to 30% of individuals with renal cell carcinoma (RCC) present with metastasis.
C. Hemolytic uremic syndrome (HUS) is commonly seen in patients with RCC.
D. Clear cell RCC is the most common renal neoplasm and accounts for about 2% of cancer-related deaths.
Hemolytic uremic syndrome (HUS) is an acute disorder characterized by hemolytic anemia, thrombocytopenia (a decrease in blood platelets), and acute renal failure. HUS is a thrombotic microangiopathy and is the most common cause of community-acquired acute kidney injury in children. It most frequently occurs in infants and children under the age of 4, though it can also affect adolescents and adults. HUS is not commonly associated with renal cell carcinoma (RCC
Which of the following statements about incontinence in children is incorrect?
A. Primary incontinence occurs when a child who has been dry for at least 6 months becomes incontinent again, while secondary incontinence occurs when a child has not developed bladder control beyond the age at which bladder control is typically achieved.
B. Incontinence in children can be related to urinary tract infections (UTIs), neurologic disturbances, congenital defects of the bladder, urethra, or bladder neck, as well as allergies.
C. Altered sleep arousal or obstructive sleep apnea may be associated with enuresis.
D. Stressful psychological situations, such as the arrival of a new sibling, may cause incontinence or enuresis to develop.
E. Constipation is frequently present in children with urinary incontinence.
Primary incontinence occurs when a child who has been dry for at least 6 months becomes incontinent again, while secondary incontinence occurs when a child has not developed bladder control beyond the age at which bladder control is typically achieved.
Which of the following ordinarily reduces the risk of stone formation?
A Presence of potassium citrate, magnesium, pyrophosphate, and Tamm Horsefall protein (uromodulin)
B lower than normal concentration of solute in solvent (i.e salts in urine)
C. Having already had 2 stones within the past 5 years
D. Male gender at birth over 50 years
Presence of potassium citrate, magnesium, pyrophosphate, and Tamm Horsefall protein (uromodulin)
A decrease in which of the following clinical measures would most likely be associated with a decreasing Glomerular Filtration Rate (GFR)?
A. renal blood flow
B serum creatinine
C Blood urea nitrogen
D Creatinine Clearance
renal blood flow
reduce renal blood flow reduces
A positive culture for which microbe may co-occur with Acute Glomerulonephritis in children (5-12yrs)?
A. streptococcus pyrogens
B. E. Coli
C. Psuedomonas aeruginosa
D P fimbriae
streptococcus pyrogenes
Acute poststreptococcal glomerulonephritis is caused by strains of streptococcus
You are educating your patient on ways to reduce their risk of nephrolithiasis recurrence. Each of the following would be good advice, except:
A Maintain a dietary calcium intake of 1000-1200mg/day
B Drink cranberry juice to promote more acidic urine
C Minimize high oxalate-containing foods like spinach, beets and nuts
D Maintain good fluid intake to generate >2.5L UOP daily
Drink cranberry juice to promote more acidic urine
NSAID-induced kidney injury would be considered which type of AKI?
A Pre-renal
B Intrarenal
C Post-renal
Pre-renal causes of AKI are related to decreased kidney perfusion, often from hypovolemia, reduced cardiac output, and systemic vasodilation.
NOT Intrarenal AKI is typically caused by acute tubular necrosis (from surgery, shock, hemorrhage, sepsis, burns, and nephrotoxicity from contrast dye, NSAID’s, aminoglycosides, ACE inhibitors, ARBs, antibiotics).
Postrenal causes of AKI are generally from bladder outlet and ureteral obstructions
Which of the following statements best describes the role of the countercurrent exchange mechanism in the renal system and how its disruption could affect kidney function?
A The countercurrent exchange system allows for the reabsorption of glucose in the proximal tubule; disruption leads to increased glucose in the urine (glycosuria).
B The countercurrent exchange system facilitates the conservation of water and sodium; disruption leads to decreased concentration of urine and increased sodium excretion.
C The countercurrent exchange system is responsible for the secretion of potassium in the collecting duct; disruption causes hyperkalemia due to decreased potassium excretion.
D The countercurrent exchange system primarily helps in the filtration of plasma; disruption leads to increased protein loss in urine (proteinuria).
The countercurrent exchange system facilitates the conservation of water and sodium; disruption leads to decreased concentration of urine and increased sodium excretion.
The countercurrent exchange system in the renal nephron, particularly in the loop of Henle, plays a crucial role in concentrating urine and conserving water and sodium. Disruption of this mechanism can result in an inability to concentrate urine, ultimately leading to increased urine output and electrolyte imbalances.
A 45-year-old male presents to the clinic with complaints of difficulty urinating. He reports a weak urinary stream, a sensation of incomplete bladder emptying, and occasionally experiences a painful urination. His medical history includes a traumatic injury to the pelvis from a car accident five years ago, for which he underwent surgery. Upon examination, the physician notes a distended bladder and performs a cystoscopy, revealing a narrowing in the posterior urethra. What is the most likely cause of this patient’s urethral stricture?
A Congenital abnormality
B Infection
C Previous trauma and surgical intervention
D Benign prostatic hyperplasia
Previous trauma and surgical intervention. Urethral strictures are often caused by trauma, particularly in the case of pelvic injuries or surgical procedures in the region. In this patient, the history of pelvic trauma and subsequent surgery are likely contributors to the development of the stricture.
A 10-year-old girl is brought to the pediatric clinic by her mother, who reports that her daughter had a recent upper respiratory infection about two weeks ago. Since then, she has developed swelling in her face, especially in the morning, and her urine appears dark and foamy. The mother also mentions that the child has been feeling fatigued and has had a mild headache. Upon examination, the child is found to have hypertension and periorbital edema. Urinalysis reveals hematuria and proteinuria, and blood tests show elevated serum creatinine and low complement levels. What is the most likely underlying cause of this child’s condition?
A Bacterial endocarditis
B Previous streptococcal infection
C Systemic lupus erythematosus
D Diabetic nephropathy
Previous streptococcal infection : The combination of periorbital edema, hypertension, hematuria, and proteinuria is characteristic of PSGN, a renal complication that can occur after a streptococcal infection. These symptoms align well with typical presentations seen in children following such infections.
George is a nurse practitioner student who is presenting a project to the class on the topic of nephrolithiasis. Which of the following statements about potential risk factors are incorrect
A Males are at higher risk for developing kidney stones
B A decreased fluid intake helps prevent kidney stones from forming
C There is a high risk of recurrence after developing a kidney stone
D Geographic region influence the risk of developing a kidney stone
A decreased fluid intake helps prevent kidney stones from forming
Which of the following types of cystitis is being described: on cystoscopy, the bladder appearance is hyperemic and inflamed, with mucosal pus formation.
A Hemorrhagic cystitis
B Suppurative cystitis
C Ulcerative cystitis
D Gangrenous cystitis
Suppurative cystitis
NOT
ulcerative cystitis shows sloughing of mucosa
gangrenous cystitis shows necrosis of the bladder wall
Which of the following clinical manifestations is not associated with nephroblastoma?
A Hematuria
B Abdominal mass confined to one side
C Hypotension
D Fever
Hypertension may present with nephroblastoma because of the excessive secretion of renin by the tumor
What is the most common bacteria causing bacterial cystitis?
A E. coli
B S. saprophyticus
C Klebsiella
D Pseudomonas
E. Coli —The most common infectious agent of UTI is E. coli, this is a commonly occurring bacteria of the GI flora.
All are clinical manifestations of nephrotic syndrome except?
A. Proteinuria
B Decreased vitamin D
C Hyperalbuminemia
D Lipiduria
hyperalbuminemia– because Hypoalbuminemia is a clinical manifestation of nephrotic syndrome
A 2 year old male patient presents to the clinic with one week of diarrhea with blood in the stool. One week after the diarrhea subsided the patient had symptoms of pallor, bruising, weakness, lethargy and abdominal pain. Labs show metabolic acidosis, azotemia, hyperkalemia, anemia and thrombocytopenia. What is a likely diagnosis for this patient?
A Wilms tumor
B Hemolytic uremic syndrome
C Nephrotic syndrome
D Polycystic kidney disease
Hemolytic uremic syndrome
this syndrome associated with diarrhea is associated with a viral or bacterial agent that is absorbed by the GI tract then brought to the kidneys by WBCs. When the WBCs enter the kidneys there is damage done to the glomerular membranes causing hematuria and the clotting cascade. This causes hemolytic anemia and thrombocytopenia. The patient will have symptoms of AKI, hemolytic anemia and thrombocytopenia.
A 50 year old male patient with a history of recurrent kidney stones is being discharged. As the advanced practice nurse you realize this patient needs more education regarding dietary modification when he says:
A. “I have been eating more veggies and beans and less animal meat”
B. “I stopped adding salt to my food because it also helps with my blood pressure”
C. “I switched to drinking iced tea instead of soda”
D. “I drink 2-3 liters of water a day”
“I switched to drinking iced tea instead of soda”
Which statement regarding Over and under active bladders is correct:
A. Overactive bladder symptoms include urinary urgency, frequency, and nocturia
B. Underactive bladder can be associated with spinal cord injury, stroke, multiple sclerosis and Parkinson’s disease
C. Neuromodulation and drug therapy can be used in treatment of both bladder disorders
D. All of the above
All of the above
A 65 year old male presents complaining of difficulty urinating and urgency and “leaking urine”. States he has noticed some blood in his urine and frequency over the last couple of days but denies any pain with urination and also denies any abdominal or flank pain. Bladder scan reveals 728mL of urine in bladder and patient is unable to void. A urinary catheter is placed and gross blood in urine is returned with multiple clots. Pt denies being on any blood thinners. You are concerned this patient has:
A. Benign Prostate Hypertrophy
B. Cystitis
C. Bladder Cancer
D. Neurogenic bladder
Bladder Cancer
A patient arrives at your primary clinic for a wellness check. The patient states that he has been having lower flank pain for the past two days, and hasn’t been able to produce urine for the last 8 hours despite high levels of hydration. The patient also states that he has a history of recurrent urinary tract infections. Which of these would be your priority intervention?
A Recommend more oral intake of fluids
B Start on broad-spectrum PO antibiotics
C Dietary review for foods high in purine
D Transfer of care to the nearest emergency facility
Transfer care to the nearest emergency facility– This patient is presenting with signs of an obstructional kidney stone with UTI, which is a medical emergency and requires surgical intervention to remove the stone to prevent the patient from going septic
Grace is following up with your clinic after a recent hospitalization due to a urinary tract infection. While monitoring her lab values, you notice her serum creatinine levels are 2.0, BUN of 28, and urine osmolality of 1.020. What statement from Grace would prompt further education?
A I don’t wanna work my kidneys too hard after the hospital, so I’ve been drinking less fluids
B My doctor told me my heart medications weren’t harmful to my kidneys, so I’m still taking them
C I’m watching closely how much food with potassium I’m eating, per what my nurse told me
D I’m making sure to take my antibiotic twice a day like the pharmacist told me
I don’t wanna work my kidneys too hard after the hospital, so I’ve been drinking less fluids — Patients that are at risk for acute kidney injury, especially after a urinary infection, require adequate fluid intake to support cardiovascular function and output, which can assist the kidneys in recovering via better perfusion
A 4-year-old girl is diagnosed with grade II Vesicoureteral Reflux (VUR) after recurrent urinary tract infections. Her parents are concerned about how VUR will affect her future health. Which of the following statements about VUR is accurate and should be included?
A VUR is unrelated to the risk of kidney damage and long-term renal function.
B Children with VUR should avoid all physical activity to prevent further kidney damage.
C Antibiotic prophylaxis is often used to prevent recurrent UTIs in children with VUR.
D VUR is often treated with surgery immediately upon diagnosis to prevent kidney damage.
Prompt treatment of UTIs are essential to prevent renal scarring and pyelonephritis in children that have VUR
An 18-year-old female presents to the emergency department with complaints of flank pain, urinary frequency, urgency, and dysuria. You conduct a urinalysis on this patient and discover bacteriuria positive nitrates and leukocyte esterase. Which diagnosis would you expect for this patient?
A. Renal Colic
B. Cystitis
C. Bladder tumor
D. Kidney tumor
Cystitis (correct) – clinical manifestations include polyuria, urinary frequency, urgency, dysuria, flank pain, cloudy urine, urinalysis of positive nitrates and leukocyte esterase
