Deck 35: Kidney Disease

Question 1

Upon microscopic examination,an individual's urine shows many bacteria,white blood cells,and cellular casts composed of polymorphonuclear leukocytes.It is likely that this individual has:

A) pyelonephritis.
B) rapidly progressing glomerulonephritis.
C) urinary tract infection.
D) end-stage renal disease.

Answer 1

pyelonephritis.

Question 2

A 45-year-old man visits his physician with complaints of insatiable thirst,sudden onset of fatigue,polydipsia,and polyuria.Laboratory results indicate a normal fasting blood sugar.Serum sodium was slightly elevated.Urine was clear and had low specific gravity (hypotonic).The most likely cause of these symptoms and laboratory results would be:

A) diabetes mellitus.
B) acute tubular necrosis.
C) polycystic kidney disease.
D) diabetes insipidus.

Answer 2

diabetes insipidus.

Question 3

If an individual has a normal GFR and a hyperchloremic normal anion gap metabolic acidosis with a freshly voided early morning urine specimen which has a pH of 6.5,what is the likely diagnosis?

A) The pH It is increased above the reference interval due to the conversion of urea to ammonia.
B) This pH is within the healthy reference interval for this specimen.
C) The pH has decreased below the reference interval due to the urea content.
D) There is likely the onset of distal renal tubular acidosis (RTA).

Answer 3

There is likely the onset of distal renal tubular acidosis (RTA).

Question 4

You have been asked what laboratory tests should be requested to assess the electrolyte balance regulatory function of an individual's kidneys.Which of the following is your reply?

A) Serum creatinine,serum urea,serum uric acid,and creatinine clearance
B) Serum sodium and potassium,and arterial blood pH
C) Serum renin and erythropoietin
D) Serum and urine protein

Question 5

A 46-year-old patient visits her physician with a complaint of chest pain,blood in her urine,and oliguria.She states that these symptoms have gotten worse over the past 2 to 3 months.Urine and blood samples are collected.Urine GFR is calculated to be 40 mL/min/1.73 m² and hemoglobin is 8 g/dL.Urine protein was elevated,with the presence of red blood cell casts.Upon review of her health history,it was noted that she was a cigarette smoker with hypertension.The most likely diagnosis in this case would be:

A) nephrotic syndrome.
B) chronic kidney disease (CKD).
C) end-stage renal disease.
D) chronic pyelonephritis.

Question 6

In homeostatic regulation of plasma acid-base concentrations,sodium is both actively and passively exchanged in the tubules for which one of the following ions?

A) Bicarbonate
B) Carbon dioxide
C) Hydrogen
D) Potassium

Question 7

Damage to the glomerulus would be suspected when the urine sediment contains:

A) proteinaceous casts.
B) red blood cell casts.
C) visible proteins.
D) crystals.

Question 8

The functional unit of the kidney is the:

A) lobule.
B) bladder.
C) glomerulus.
D) nephron.

Question 9

If a physician requests a creatinine clearance on an individual,what is the physician attempting to determine?

A) Glomerular filtration rate (GFR)
B) Random urine output volume
C) Serum creatinine level
D) Urine creatinine level

Question 10

The most common glomerular disease worldwide is:

A) acute proliferative glomerulonephritis.
B) acute pyelonephritis.
C) IgA nephropathy.
D) chronic kidney disease.

Question 11

A patient with elevated serum nitrogen compounds,markedly reduced GFR,increased serum sodium and potassium,and metabolic acidosis is diagnosed with acute kidney injury (AKI).Which one of the following is a likely cause?

A) . $\beta$ -Hemolytic streptococcal infection
B) Decreased cardiac output
C) Urinary tract infection
D) Pyelonephritis

Question 12

A 36-year-old individual visits her physician with a complaint of nausea,loss of appetite,weakness,and an inability to concentrate.Laboratory results indicate increased serum urea and creatinine,increased potassium,reduced glomerular filtration rate (GFR),low blood pH,anemia (low red blood cell count),and hypocalcemia.What is the likely diagnosis?

A) IgA nephropathy
B) Chronic kidney disease
C) Uremia
D) Nephrotic syndrome

Question 13

The major artery that expands into the capillary bed that forms the glomerulus is the:

A) renal artery.
B) nephronic artery.
C) vasa recta.
D) arcuate artery.

Question 14

Secretion of renin and aldosterone is induced by low blood pressure and volume.What other hormone would be released in the event of low blood pressure and volume?

A) 1,25(OH₂)Vitamin D₃
B) Growth hormone
C) Erythropoietin
D) Antidiuretic hormone

Question 15

Which one of the following statements regarding creatinine is correct?

A) Serum creatinine levels are elevated early in all renal disease.
B) Normal plasma creatinine does not always indicate normal kidney function.
C) Creatinine levels fluctuate in a diurnal manner.
D) Creatinine is completely reabsorbed by the renal tubules.

Question 16

Why is bone disease a consequence of chronic kidney disease (CKD)?

A) The juxtaglomerular apparatus no longer synthesizes renin in CKD,which keeps calcium phosphate complexes from mineralizing.
B) The basement membrane in Bowman capsule is damaged and calcium is lost in the glomerular filtrate.
C) When glomerular filtration declines,vitamin D activation decreases resulting in reduced calcium,which further leads to resorption of calcium from bone.
D) The synthesis of erythropoietin by peritubular fibroblasts because of reduced red blood cell survival.

Question 17

The portion of a nephron considered the most metabolically active and that is involved in the reabsorption of 60% to 80% of the glomerular filtrate and that secretes 90% of hydrogen ion excreted by the kidney is the:

A) glomerulus.
B) proximal tubule.
C) loop of Henle.
D) distal tubule.

Question 18

Which of the following laboratory results would point to a diagnosis of acute nephritic syndrome in an individual who exhibits hypertension and edema?

A) Increased serum protein,increased GFR,hematuria
B) Increased white blood cells (WBCs)in the urine,bacteriuria,decreased GFR,proteinuria
C) Hematuria,sodium retention,decreased GFR,proteinuria
D) Normal serum urea and creatinine,increased GFR,massive proteinuria

Question 19

Secretion of renin and aldosterone is induced by low blood pressure and volume.Renin is synthesized in the _____ and aldosterone is made in the _____.

A) kidney; adrenal gland
B) kidney; brain
C) adrenal gland; brain
D) adrenal gland; kidney

Question 20

Which one of the following components of the renal system is most important for regulation of plasma electrolytes and acid-base balance?

A) Bladder
B) Loop of Henle
C) Proximal convoluted tubule
D) Distal convoluted tubule

Question 21

The volume of plasma from which a substance is completely removed by the kidneys per unit of time is the definition of:

A) renal threshold.
B) prerenal acute kidney injury.
C) glomerular filtration rate.
D) clearance.

Question 22

Which one of the following is the correct formula for determining glomerular filtration rate?

A) GFR = ([urine concentration of the substance] * volume)/[plasma concentration of the substance]
B) GFR = ([plasma concentration of the substance] * volume)/[urine concentration of the substance]
C) GFR = ([urine concentration of the substance] * volume) * [plasma concentration of the substance]
D) GFR = ([urine concentration of the substance] * volume)+ [plasma concentration of the substance]

Question 23

In an individual with chronic kidney disease,what might be the predominant cause of the low hemoglobin value and anemia?

A) Decreased erythropoietin synthesis
B) Decreased iron absorption
C) Bone loss from decreased 1,25(OH₂)vitamin D₃ synthesis
D) Folate deficiency

Question 24

An individual presents to his physician with generalized weakness and fatigue.Blood is collected and an elevated WBC count with lymphocytosis is noted.Serum protein is moderately decreased,but the urine reagent dipstick does not indicate proteinuria.Upon confirmatory testing with a precipitation test,the urine protein is 4+.Based on other symptoms,the physician suspects multiple myeloma.What might be the cause of the discrepancy in urine protein values?

A) Increased WBCs will interfere with urine protein dipstick values.
B) The urine reagent dipsticks are outdated and must be discarded.
C) The precipitation test was performed without controls.
D) Reagent dipsticks respond mostly to urine albumin and not to other proteins.

Question 25

In multiple myeloma,what protein is likely causing an elevated value in the urine protein confirmatory test?

A) Tamm-Horsfall protein
B) Bence Jones protein
C) Haptoglobin
D) Mucoprotein