Deck 18: Diseases of the Renal System

Question 1

How long does the typical hemodialysis treatments take on average?

A) ​30 minutes
B) ​2 hours
C) ​4 hours
D) ​8 hours
E) ​12 hours

Answer 1

C

Question 2

What hormone influences the reabsorption of sodium within the kidneys?

A) ​aldosterone
B) ​vasopressin
C) ​cortisol
D) ​testosterone
E) epinephrine

Answer 2

A

Question 3

What is the GFR in patients with Stage 5 kidney disease?

A) ​less than 90 mL /min/1.73 m2
B) ​about 70 mL /min/1.73 m2
C) ​less than 45 mL /min/1.73 m2
D) ​about 25 mL /min/1.73 m2
E) ​less than 15 mL /min/1.73 m2

Answer 3

E

Question 4

What structure in the kidney collects the glomerular filtrate?

A) ​loop of Henle
B) ​efferent tubule
C) ​afferent tubule
D) ​Bowman's capsule
E) ​distal tubule

Question 5

What is the leading cause of kidney failure?

A) ​diabetes
B) ​hypotension
C) ​kidney trauma
D) ​heart disease
E) ​bacterial infection

Question 6

What vitamin supplements are typically indicated for people with chronic kidney disease (HD and PD patients)?

A) ​A, B6, E
B) ​B-complex, C and D
C) ​A, B9, K
D) ​B-complex, D, E
E) ​A, C, K

Question 7

How many grams per serving of animal protein does the National Renal Diet recommend for people on kidney dialysis?

A) ​16-20
B) ​12-15
C) ​9-11
D) ​6-8
E) ​3-5

Question 8

Corticosteroids, cyclosporine, tacrolimus, mycophenolate mofetil, and sirolimus are all examples of what type of medication?

A) ​NSAIDs
B) ​analgesics
C) ​antibacterials
D) ​immunosuppressive
E) ​antivirals

Question 9

What pituitary hormone works at the level of the collecting duct to either increase or decrease absorption of water in order to maintain plasma volume and thus blood pressure?

A) ​aldosterone
B) ​vasopressin
C) ​cortisol
D) ​testosterone
E) ​epinephrine

Question 10

What mineral supplements might be beneficial for people with chronic kidney disease (HD and PD patients)?

A) ​iron and zinc
B) ​calcium and magnesium
C) ​calcium and boron
D) ​boron and zinc
E) ​iron and magnesium

Question 11

What is the functioning unit of the kidney called?

A) ​tubule
B) ​cortex
C) ​nephron
D) ​medulla
E) ​glomerulus

Question 12

What vegetables are low in potassium?

A) ​beans, artichokes, beets
B) ​squash, broccoli, Brussels sprouts
C) ​cucumbers, celery, onions
D) ​carrots, lentils, parsnips
E) ​potatoes, pumpkin, legumes

Question 13

The onset of renal failure is not usually apparent until what percentage of renal function is lost?

A) ​50-70%
B) ​about 40%
C) ​20-30%
D) ​about 15%
E) ​5-10%

Question 14

What fruits are low in potassium?

A) ​banana, cantaloupe, figs
B) ​oranges, papayas, prunes
C) ​apples, grapes, raspberries
D) ​kiwis, mangos, nectarines
E) ​avocados, pomegranates, raisins

Question 15

What is a measure of both visceral protein status and acute-phase inflammatory response?

A) ​plasma protein
B) ​serum albumin
C) ​blood sugar levels
D) ​percentage of hematocrit
E) ​blood creatinine levels

Question 16

What is the term for blood in the urine?

A) ​anemia
B) ​proteinuria
C) ​oliguria
D) ​azotemia
E) ​hematuria

Question 17

What percentage of American adults have physiological evidence of chronic kidney disease?

A) ​5%
B) ​10%
C) ​15%
D) ​20%
E) ​25%

Question 18

What is often one of the first signs of renal insufficiency?

A) ​kidney pain
B) ​hematuria
C) ​microalbuminuria
D) ​increased urine output
E) ​low blood pressure

Question 19

What is a build-up of nitrogenous waste products (such as urea) in the blood and body fluids called?

A) ​anemia
B) ​proteinuria
C) ​oliguria
D) ​azotemia
E) ​hematuria

Question 20

What is the recommended daily potassium intake for hemodialysis patients?

A) ​10-11 g/day
B) ​8-9 g/day
C) ​6-7 g/day
D) ​4-5 g/day
E) ​2-3 g/day

Question 21

Medical and nutritional management of acute kidney injury typically aim to maintain BUN (blood urea nitrogen) in the range of:

A) ​60-100 mg/dL
B) ​80-100 mg/dL
C) ​100-120 mg/dL
D) ​120-130 mg/dL
E) ​130-150 mg/dL

Question 22

After kidney transplant, the intake of what dietary factor should be strictly limited to reduce the risk of cardiovascular disease and infection?

A) ​lactose
B) ​simple carbohydrates
C) ​gluten
D) ​alcohol
E) ​protein

Question 23

Approximately how many grams of protein does KL require each day?

A) ​66 g
B) ​78 g
C) ​87 g
D) ​93 g
E) ​110 g

Question 24

What is the most likely source of his infection?

A) ​fistula
B) ​UTI
C) ​catheter
D) ​AV graft
E) ​prostate

Question 25

Patients with acute kidney injury are prone to loss of what type of amino acids?

A) ​leucine and isoleucine
B) ​only essential amino acids
C) ​only non-essential amino acids
D) ​all essential and non-essential amino acids
E) ​only branched-chain amino acids

Question 26

What percentage of HD patients develops ischemic heart disease?

A) ​5%
B) ​10%
C) ​20%
D) ​30%
E) ​40%

Question 27

What percentage of kidney transplant patients display dyslipidemia?

A) ​10%
B) ​25%
C) ​40%
D) ​55%
E) ​70%

Question 28

What food enhances the bioavailability of tacrolimus and cyclosporine?

A) ​spinach
B) ​legumes
C) ​grapefruit
D) ​chocolate
E) ​tomatoes

Question 29

Prolonged exposure to elevations of PTH causes the development of what bone disease (characterized by rapid bone turnover with an excess of collagen production)?

A) ​rickets
B) ​osteomalacia
C) ​osteopenia
D) ​osteosarcoma
E) ​osteitis fibrosa cystica

Question 30

KL visits the dietitian. What information will the dietician most likely share with him?

A) ​He has less of a dietary potassium restriction than he would on HD.
B) ​His dietary phosphorus is unrestricted.
C) ​His fluid intake must be output + 1,000 cc.
D) ​He needs to limit protein of high biological value.
E) ​He cannot consume any sweet fruits.

Question 31

Albumin is a primary carrier for what mineral?

A) ​boron
B) ​iron
C) ​zinc
D) ​calcium
E) ​magnesium

Question 32

What vegetable is considered a high-sodium food?

A) ​olives
B) ​zucchini
C) ​broccoli
D) ​cucumbers
E) ​cabbage

Question 33

Approximately how many kilocalories does KL require daily?

A) ​1,840 kcal
B) ​1,930 kcal
C) ​2,050 kcal
D) ​2,200 kcal
E) ​2,700 kcal

Question 34

Which of the following is likely true about KL's situation?

A) ​He goes to a dialysis center 3x per week.
B) ​His caloric intake needs to be adjusted to account for calories in dialysate.
C) ​He will have to wait 6 weeks for the fistula to mature.
D) ​His prostate infection needs antibiotic therapy.
E) ​He is not a candidate for a kidney transplant.

Question 35

For kidney stones that are composed of uric acid, avoidance of what kind of food is recommended?

A) ​foods high in calcium
B) ​foods high in purines
C) ​foods high in vitamin C
D) ​foods low in magnesium
E) ​foods low in oxalates

Question 36

What type of oral iron supplement causes less GI distress?

A) ​heme iron polypeptides
B) ​ferrous gluconate
C) ​ferrous fumarate
D) ​ferrous sulfate
E) ​polysaccharides

Question 37

What is the prevalence of acute kidney injury in all hospitalized patients in the U.S.?

A) ​1%
B) ​3%
C) ​5%
D) ​7%
E) ​10%

Question 38

What is a more common term for nephrolithiasis?

A) ​kidney necrosis
B) ​kidney cancer
C) ​kidney stones
D) ​viral kidney infection
E) ​bacterial kidney infection

Question 39

The interdialytic weight gain goal in HD patients should not exceed what percentage of body weight?

A) ​2%
B) ​5%
C) ​9%
D) ​12%
E) ​15%

Question 40

What meat is considered a high-sodium food?

A) ​chicken
B) ​turkey
C) ​pepperoni
D) ​steak
E) ​filet of salmon

Question 41

The use of active vitamin D sterols decreases calcium absorption in the intestines.

Question 42

In general, the hemodialysis diet is high in protein and controls intakes of potassium, phosphorus, fluids, and sodium.

Question 43

The protein requirements for HD are slightly higher than for PD.

Question 44

Most commonly, kidney function is measured by the _______________.

Question 45

The _______________ tubule of the kidney contains cells with a complex brush border, tight intercellular junctions, and large numbers of mitochondria.

Question 46

Waste products and excess fluids are removed from the body by the actions of diffusion, ultrafiltration, and _______________.

Question 47

Acute kidney injury is a disorder characterized by an abrupt increase in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance.

Question 48

Kidney stones typically consist of calcium salts, cystine, uric acid, or struvite.

Question 49

Triglyceride levels are particularly reduced in PD patients due to the absorption of glucose from the dialysate.

Question 50

Deficiency of the active form of vitamin D is associated with impaired intestinal calcium absorption and secondary _______________.

Question 51

_______________ is a renal replacement procedure that removes excessive and toxic by-products of metabolism from the blood, thus replacing the filtering function of healthy kidneys.

Question 52

The kidney's role in controlling both hydrogen and bicarbonate ions is a critical component of the maintenance of pH homeostasis.

Question 53

The kidneys are two retroperitoneal organs the size of a fist.

Question 54

Secondary hyperparathyroidism in dialysis patients can progress to severe, intractable forms of _______________ disease.

Question 55

African Americans are nearly four times as likely to develop kidney failure as white Americans.

Question 56

Diabetes, hypotension, and heart disease are the leading causes of kidney failure.

Question 57

The dialysate for PD is available with a range of _______________ concentrations that alter its osmolality and assist in fluid removal.

Question 58

_______________ nephropathy is the most common cause of CKD in the United States.

Question 59

CKD patients are unable to synthesize adequate amounts of endogenous _______________, a hormone that is made by renal tubular cells and important for production of red blood cells.

Question 60

The enzyme _______________ is produced by the kidney and is necessary for the initiation of the renin-angiotensin control of fluid balance.

Question 61

Because serum vitamin _______________ levels are elevated in HD and PD patients, supplementation is not necessary.

Question 62

Supplementation of _______________ soluble vitamins is typically indicated for HD and PD patients due to increased losses during dialysis, anorexia, and poor dietary intake.

Question 63

It is common for the nutritional status of patients with acute kidney injury to decline within a short period of time, owing to _______________ losses.

Question 64

Describe the signs and symptoms associated with inadequate kidney function..

Question 65

List the types of renal replacement therapy for CKD stage 5.

Question 66

Explain why kidney stones form.

Question 67

_______________ carbonate is a phosphate-binder.

Question 68

Etiology of acute kidney injury is classified as pre-renal, intrinsic, or _______________.

Question 69

Since most HD patients receive anticoagulation therapy, caution must be taken if supplementing with vitamin _______________ due to its role in promoting clot formation.

Question 70

_______________, the cause of more than 50% of all kidney stones, is defined as urinary calcium excretion greater than 300 mg per 24 hours in men or 250 mg per 24 hours in women.

Question 71

Describe the procedure of hemodialysis.

Question 72

Low serum calcium levels often accompany CKD due to alterations in vitamin _______________ metabolism.

Question 73

It has been demonstrated that foods high in _______________, including dairy products, can actually prevent the formation of kidney stones.

Question 74

Discuss the etiology of acute kidney injury.

Question 75

Outline the primary functions of the kidney.

Question 76

Describe the use of immunosuppressants for kidney transplants.

Question 77

List the common sources of oral iron supplements.

Question 78

Describe the nutrition diagnoses that might coincide with CKD.

Question 79

List the factors that increase protein requirements for people with chronic kidney disease.

Question 80

In addition to restriction of dietary phosphorus, most patients use phosphate _______________ to prevent gastrointestinal absorption of dietary phosphorus.