©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Nurs 5461 Renal 2 Exam Questions With
Verified Answers
Differential Diagnosis of an Elevated Creatinine - Answers✔determine the cause and if it is
acute or chronic
history+exam, Labs /Diagnostics, ▪ UA ▪ CMP ▪ uric acid level ▪ CPK ▪ CBC ▪ Toxicology ▪
FeNa (Fractional excretion of sodium)-dont do in someone with diuretics, or FEurea (Fractional
Excretion of urea).▪ Renal US
o Renal Biopsy - Answers✔▪ Generally indicated: • when the H&P, labs and diagnostics have
ruled out prerenal and post renal causes. • when intrarenal causes due to primary renal disease is
felt to be likely. • suspect glomerulonephritis
Proteinuria - Answers✔Normal urinary protein excretion is <150mg/24 hours o Daily albumin
excretion is a normal person is < 30mg
Tubular Proteinuria - Answers✔• Occurs as a result of a disease which affects the renal
tubules/interstium of the kidney. The normal protein associated with this type of proteinuria is
beta-2 microglobulin. This is normally absorbed by the proximal tubules. The amount is <2g and
the dipstick may be negative.
Overflow proteinuria - Answers✔Associated with an increased production of low molecular
weight proteins such as light chains in multiple myeloma or myoglobin in rhabdomyolysis.
These proteins exceed the reabsorption capacity of the tubules and spill into the urine. These
proteins are toxic to the tubules and can cause AKI.
Glomerular Proteinuria - Answers✔(4 types) discussed as follows
Transient Proteinuria (glomerular) - Answers✔Does not represent glomerular damage. It occurs
in persons with normal renal function, bland urine sediment, and normal blood pressure. The
amount is less than one 1g/24 hours and usually occurs with fever or heavy exercise and
disappears on repeat testing.
Laboratory Evaluation Transient Proteinuria - Answers✔▪ UA with Microscopy on 3 different
occasions ▪ Albumin to creatinine ratio or protein to creatinine ration in a random urine sample ▪
UA from an early morning sample, before the pt engages in physical activity
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Orthostatic Proteinuria (glomerular) - Answers✔Does not represent glomerular damage. This is
diagnosed when the patient does not have proteinuria upon rising in the morning but has it later
in the day. Typically occurs in tall, thin adolescents or adults less than 30y/o and is associated
with severe lordosis. Renal function is normal and the amount is < 1g/day
Lab evaluation orthostatic proteinuria - Answers✔▪ Urine microscopy ▪ Split urine collection for
protein on sample between 7-11am and another between 11pm-7am
Non-Nephrotic Range Proteinuria (glomerular) - Answers✔o This represents glomerular
damage. The amount of protein in the urine is <3.5g/24 hours and is persistent. They require
close follow up and possibly a renal biopsy.
Nephrotic Range Proteinuria (glomerular) - Answers✔o This represents significant glomerular
damage. The amount of protein in the urine is > 3.5g/24 hours. This warrants a kidney biopsy for
diagnosis and management
Microalbuminuria - Answers✔low levels of urinary albumin excretion 30-300mg of albumin
daily. It has been linked to the identification of early stages of Diabetic Nephropathy, used for
early screening of diabetics
The presence of microalbuminuria in a person without evidence of renal disease and are
hypertensive correlates with the presence of left ventricular hypertrophy
Manifestations of Glomerular Damage - Answers✔• Active urine sediment-dysmorphic red
blood cells and red cell casts • Hypoalbuminemia • Lipiduria • Hyperlipidemia • Edema •
Abnormal renal function • Hypertension
Complications of proteinuria - Answers✔• Pulmonary Edema • Fluid overload • Acute Kidney
Injury - 2/2 intravascular depletion • Increased risk of bacterial infection including SBP •
Increased risk of clotting • Increased risk of cardiovascular disease
Evaluation • Proteinuria - Answers✔may be an incidental finding on regular examination. The
majority of patients are symptomatic
Does the clinical picture fit transient or orthostatic proteinuria? o Is this due to non-renal disease
(heart failure, sleep apnea)
Other Glomerular Proteinuria lab - Answers✔▪ Urine microscopy- check for dysmorphic red
blood cells and red cell casts ▪ 24-hour urine to quantify albumin/protein excretion and for a
creatinine clearance. Spot 5 protein/creatinine ratios can be used for subsequent evaluations. The
degree or proteinuria serves as an independent predictor of the risk of progression to kidney
failure and mortality.
ALL RIGHTS RESERVED.
Nurs 5461 Renal 2 Exam Questions With
Verified Answers
Differential Diagnosis of an Elevated Creatinine - Answers✔determine the cause and if it is
acute or chronic
history+exam, Labs /Diagnostics, ▪ UA ▪ CMP ▪ uric acid level ▪ CPK ▪ CBC ▪ Toxicology ▪
FeNa (Fractional excretion of sodium)-dont do in someone with diuretics, or FEurea (Fractional
Excretion of urea).▪ Renal US
o Renal Biopsy - Answers✔▪ Generally indicated: • when the H&P, labs and diagnostics have
ruled out prerenal and post renal causes. • when intrarenal causes due to primary renal disease is
felt to be likely. • suspect glomerulonephritis
Proteinuria - Answers✔Normal urinary protein excretion is <150mg/24 hours o Daily albumin
excretion is a normal person is < 30mg
Tubular Proteinuria - Answers✔• Occurs as a result of a disease which affects the renal
tubules/interstium of the kidney. The normal protein associated with this type of proteinuria is
beta-2 microglobulin. This is normally absorbed by the proximal tubules. The amount is <2g and
the dipstick may be negative.
Overflow proteinuria - Answers✔Associated with an increased production of low molecular
weight proteins such as light chains in multiple myeloma or myoglobin in rhabdomyolysis.
These proteins exceed the reabsorption capacity of the tubules and spill into the urine. These
proteins are toxic to the tubules and can cause AKI.
Glomerular Proteinuria - Answers✔(4 types) discussed as follows
Transient Proteinuria (glomerular) - Answers✔Does not represent glomerular damage. It occurs
in persons with normal renal function, bland urine sediment, and normal blood pressure. The
amount is less than one 1g/24 hours and usually occurs with fever or heavy exercise and
disappears on repeat testing.
Laboratory Evaluation Transient Proteinuria - Answers✔▪ UA with Microscopy on 3 different
occasions ▪ Albumin to creatinine ratio or protein to creatinine ration in a random urine sample ▪
UA from an early morning sample, before the pt engages in physical activity
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Orthostatic Proteinuria (glomerular) - Answers✔Does not represent glomerular damage. This is
diagnosed when the patient does not have proteinuria upon rising in the morning but has it later
in the day. Typically occurs in tall, thin adolescents or adults less than 30y/o and is associated
with severe lordosis. Renal function is normal and the amount is < 1g/day
Lab evaluation orthostatic proteinuria - Answers✔▪ Urine microscopy ▪ Split urine collection for
protein on sample between 7-11am and another between 11pm-7am
Non-Nephrotic Range Proteinuria (glomerular) - Answers✔o This represents glomerular
damage. The amount of protein in the urine is <3.5g/24 hours and is persistent. They require
close follow up and possibly a renal biopsy.
Nephrotic Range Proteinuria (glomerular) - Answers✔o This represents significant glomerular
damage. The amount of protein in the urine is > 3.5g/24 hours. This warrants a kidney biopsy for
diagnosis and management
Microalbuminuria - Answers✔low levels of urinary albumin excretion 30-300mg of albumin
daily. It has been linked to the identification of early stages of Diabetic Nephropathy, used for
early screening of diabetics
The presence of microalbuminuria in a person without evidence of renal disease and are
hypertensive correlates with the presence of left ventricular hypertrophy
Manifestations of Glomerular Damage - Answers✔• Active urine sediment-dysmorphic red
blood cells and red cell casts • Hypoalbuminemia • Lipiduria • Hyperlipidemia • Edema •
Abnormal renal function • Hypertension
Complications of proteinuria - Answers✔• Pulmonary Edema • Fluid overload • Acute Kidney
Injury - 2/2 intravascular depletion • Increased risk of bacterial infection including SBP •
Increased risk of clotting • Increased risk of cardiovascular disease
Evaluation • Proteinuria - Answers✔may be an incidental finding on regular examination. The
majority of patients are symptomatic
Does the clinical picture fit transient or orthostatic proteinuria? o Is this due to non-renal disease
(heart failure, sleep apnea)
Other Glomerular Proteinuria lab - Answers✔▪ Urine microscopy- check for dysmorphic red
blood cells and red cell casts ▪ 24-hour urine to quantify albumin/protein excretion and for a
creatinine clearance. Spot 5 protein/creatinine ratios can be used for subsequent evaluations. The
degree or proteinuria serves as an independent predictor of the risk of progression to kidney
failure and mortality.
