NURS 320 - Exam 3 Questions and
Answers Complete Solutions
Atrial natriuretic peptide (ANP) secreted in response to - ANSWER-↑ atrial pressure
causes ↑ GFR
↑ Na+ excretion
Aldosterone secreted in response to - ANSWER-↓ blood volume (via AT II)
and ↑ plasma [K+]
causes ↑ Na+ reabsorption
↑ K+ secretion
↑ H+ secretion
Parathyroid hormone (PTH) secreted in response to - ANSWER-↓ plasma [Ca2+]
causes ↑ [Ca2+] reabsorption (DCT),
↓ PO43- reabsorption (PCT)
1,25(OH)2 vitamin D production →↑Ca2+ and PO43- reabsorption
Glomerular Filtration = - ANSWER-~ 180L/day (about 1% is excreted)
2 types of pressure from the capillary - ANSWER-Hydrostatic and Colloidal (aka
oncotic)
Capsule pressure seen in GFR - ANSWER-Back pressure and net filtration pressure
GFR is the index of - ANSWER-Renal function (measure this for good filter)
GFR assessed via: - ANSWER-Inulin - fructose polysaccharide - freely filtered, not
reabsorbed or secreted; clinically, inulin clearance (Cin) is the gold standard
measure of GFR
Creatinine - endogenous substance freely filtered, not reabsorbed, not secreted
except at very high plasma concentrations
Most circulating creatinine comes from - ANSWER-Skeletal muscle, and its
production is fairly constant
Under many conditions, the plasma level of creatinine is a relatively good index of -
ANSWER-GFR
The normal range of GFR for males and females - ANSWER-Males: 97 ~ 137 ml/min
Females: 88 ~ 128 ml/min
Renal Clearance - ANSWER-Volume of plasma from which the substance is cleared
completely per unit time.
,Cx =
(Cx = Clearance of X) - ANSWER-Ux × V/Px
Ux = urine concentration of X
V = urine flow rate
Px = plasma concentration of X
If Cx < GFR, then there is - ANSWER-Net tubular reabsorption of X
If Cx > GFR, then there is - ANSWER-Net tubular secretion of X
If Cx = GFR, then there is - ANSWER-No net reabsorption or secretion
Glomerular Filtration Barrier is Composed of: - ANSWER-- Fenestrated capillary
endothelium (size barrier)
- Fused basement membrane with heparan sulfate (negative charge barrier)
- Epithelial layer consisting of podocyte foot processes
The negative charge barrier is lost in - ANSWER-Nephrotic syndrome, resulting in
albuminuria, proteinuria, generalized edema and hyperlipidemia
Congenital Kidney Disorders - ANSWER-- Complete or bilateral renal agenesis
- Unilateral renal agenesis
- Renal ectopia
- Horseshoe kidney
Congenital Kidney Disorders - Complete or bilateral renal agenesis - ANSWER-- Is
absence of both kidneys
- Is rare, not compatible with life
-Results in oligohydramnios (< 0.5L of amniotic fluid) or anhydramnios (absent
amniotic fluid)
- Known as Potter's syndrome
Complete or bilateral renal agenesis is AKA - ANSWER-Potter's syndrome
Congenital Kidney Disorders - Unilateral renal agenesis - ANSWER-- Is much more
common
- Only have 1 kidney and is usually ok
- Is not usually of any major concern, as long as the other kidney is healthy
Congenital Kidney Disorders - Renal ectopia - ANSWER-- Is abnormal location of a
kidney
- Often in pelvis (kidney located in the thorax)
Ectopia - ANSWER-Abnormal location
Congenital Kidney Disorders - Horseshoe kidney - ANSWER-- Fused kidney fails to
ascend
- Because it causes no symptoms or other problems, it could be argued whether this
condition is a 'disease'
,- May cause urinary tract obstruction
Urinary Tract Obstruction May Occur - ANSWER-Anywhere in the urinary system
What is the most often congenital urinary issue in children, while it is most often
acquired in adults? - ANSWER-Urinary tract obstruction
Causes of urinary tract obstruction - ANSWER-- Pelvis (calculi, tumors, etc)
- Ureter (calculi, inflammation, cancer of uterus, bladder cancer, etc)
- Bladder outlet (BPH, prostate cancer, bladder cancer, spinal disease, etc)
- Urethra (tumor, calculi, trauma, etc)
Urinary Tract Obstructions Clinical Manifestations: - ANSWER-- Renal colic
> Is excruciating pain caused by acute distention of the ureter
> Begins in the kidney area or below it and radiates through the flank until it reaches
the bladder
- Hydronephrosis
> Is progressive dilatation of the renal pelvis and calyces
- Urinary tract infection (UTI)
- Hypertension
Hydronephrosis - ANSWER-The distention and dilation of the renal pelvis, usually
caused by obstruction of the free flow of urine from the kidney
Kidney Stones - ANSWER-- Also called Renal Calculi, Urolithiasis, Renal Stones
- A disease which results from formation of stones that form anywhere in the urinary
tract, including kidney, bladder, and/or urethra
Nephrolithiasis refers to the presence of - ANSWER-Calculi in the kidneys
Causes of kidney stones: - ANSWER-- Decreased urine volume (the urine becomes
too saturated with salts)
- Increase urine pH (calcium stones) or decease urine pH (uric acid stones)
- High concentration of stone-forming substances in the blood or urine (such as uric
acid, calcium and cystine, etc)
- Diet: high-protein, high-Na+ (predisposes to Ca2+ excretion)
- Certain disorders (e.g., hyperparathyroidism and short bowel syndrome)
- Urinary tract infection
- People who have a family history of stone formation
Clinical presentations of kidney stones: - ANSWER-- The pain with kidney stones is
usually of sudden onset, very severe and colicky (intermittent), not improved by
changes in position
- Radiating from the back, down the flank, and into the groin
- Hematuria (due to minor damage to inside wall of kidney, ureter and/or urethra)
- Nausea and vomiting are common
Major complications of kidney stones: - ANSWER-- Hydronephrosis
, - Urinary tract infection (due to obstruction of urine flow)
- Renal damage
- Hypertension
How does one diagnose kidney stones? - ANSWER-X-ray, CT scan
4 types of treatment for kidney stones - ANSWER-(1) increase fluid intake
(2) dietary modification
(3) extracorporeal (outside the body) lithotripsy (shock wave therapy)
(4) surgery
4 Major Types of Urolithiasis - ANSWER-1. Calcium stones
2. Ammonium magnesium phosphate stones (struvite)
3. Uric acid stones (10%)
4. Cystine stones (1%)
Radiopaque types of urolithiasis - ANSWER-Calcium stones and Ammonium
magnesium phosphate stones (struvite)
Radiolucent types of urolithiasis - ANSWER-Uric acid stones (10%) and Cystine
stones (1%)
Calcium stones are composed of - ANSWER-Calcium oxalate or calcium phosphate,
or both
Account for 75~80% of urinary stones
Calcium stones are caused by: - ANSWER-- Increased intestinal absorption of
calcium
- Increased primary renal excretion of calcium
- Hypercalcemia (e.g., ↑ PTH or malignancy or ↑ Vitamin D)
Ammonium magnesium phosphate stones (struvite) is associated with - ANSWER--
Bacterial infection - Urease-positive bugs such as Proteus Vulgaris, Streptococcus or
Klebsiella
- Can form large staghorn (struvite) calculi
- Second most common (15%)
- Common among sexually active females
Uric acid stones have a strong association with - ANSWER-Hyperuricemia (ex. gout)
Cystine stones are associated with - ANSWER-Cystinuria (due to insolubility of
cystine in the urine)
Urinary Tract Infections (UTIs) epidemiology - ANSWER-- Most common bacterial
infection, but can also be caused by fungus (Candida) and parasites
- Each year, 8-10 million MD visits
- 10-20% women experience a UTI in lifetime
- Women (20~50 y) are 50x as likely to get a UTI as a man
Answers Complete Solutions
Atrial natriuretic peptide (ANP) secreted in response to - ANSWER-↑ atrial pressure
causes ↑ GFR
↑ Na+ excretion
Aldosterone secreted in response to - ANSWER-↓ blood volume (via AT II)
and ↑ plasma [K+]
causes ↑ Na+ reabsorption
↑ K+ secretion
↑ H+ secretion
Parathyroid hormone (PTH) secreted in response to - ANSWER-↓ plasma [Ca2+]
causes ↑ [Ca2+] reabsorption (DCT),
↓ PO43- reabsorption (PCT)
1,25(OH)2 vitamin D production →↑Ca2+ and PO43- reabsorption
Glomerular Filtration = - ANSWER-~ 180L/day (about 1% is excreted)
2 types of pressure from the capillary - ANSWER-Hydrostatic and Colloidal (aka
oncotic)
Capsule pressure seen in GFR - ANSWER-Back pressure and net filtration pressure
GFR is the index of - ANSWER-Renal function (measure this for good filter)
GFR assessed via: - ANSWER-Inulin - fructose polysaccharide - freely filtered, not
reabsorbed or secreted; clinically, inulin clearance (Cin) is the gold standard
measure of GFR
Creatinine - endogenous substance freely filtered, not reabsorbed, not secreted
except at very high plasma concentrations
Most circulating creatinine comes from - ANSWER-Skeletal muscle, and its
production is fairly constant
Under many conditions, the plasma level of creatinine is a relatively good index of -
ANSWER-GFR
The normal range of GFR for males and females - ANSWER-Males: 97 ~ 137 ml/min
Females: 88 ~ 128 ml/min
Renal Clearance - ANSWER-Volume of plasma from which the substance is cleared
completely per unit time.
,Cx =
(Cx = Clearance of X) - ANSWER-Ux × V/Px
Ux = urine concentration of X
V = urine flow rate
Px = plasma concentration of X
If Cx < GFR, then there is - ANSWER-Net tubular reabsorption of X
If Cx > GFR, then there is - ANSWER-Net tubular secretion of X
If Cx = GFR, then there is - ANSWER-No net reabsorption or secretion
Glomerular Filtration Barrier is Composed of: - ANSWER-- Fenestrated capillary
endothelium (size barrier)
- Fused basement membrane with heparan sulfate (negative charge barrier)
- Epithelial layer consisting of podocyte foot processes
The negative charge barrier is lost in - ANSWER-Nephrotic syndrome, resulting in
albuminuria, proteinuria, generalized edema and hyperlipidemia
Congenital Kidney Disorders - ANSWER-- Complete or bilateral renal agenesis
- Unilateral renal agenesis
- Renal ectopia
- Horseshoe kidney
Congenital Kidney Disorders - Complete or bilateral renal agenesis - ANSWER-- Is
absence of both kidneys
- Is rare, not compatible with life
-Results in oligohydramnios (< 0.5L of amniotic fluid) or anhydramnios (absent
amniotic fluid)
- Known as Potter's syndrome
Complete or bilateral renal agenesis is AKA - ANSWER-Potter's syndrome
Congenital Kidney Disorders - Unilateral renal agenesis - ANSWER-- Is much more
common
- Only have 1 kidney and is usually ok
- Is not usually of any major concern, as long as the other kidney is healthy
Congenital Kidney Disorders - Renal ectopia - ANSWER-- Is abnormal location of a
kidney
- Often in pelvis (kidney located in the thorax)
Ectopia - ANSWER-Abnormal location
Congenital Kidney Disorders - Horseshoe kidney - ANSWER-- Fused kidney fails to
ascend
- Because it causes no symptoms or other problems, it could be argued whether this
condition is a 'disease'
,- May cause urinary tract obstruction
Urinary Tract Obstruction May Occur - ANSWER-Anywhere in the urinary system
What is the most often congenital urinary issue in children, while it is most often
acquired in adults? - ANSWER-Urinary tract obstruction
Causes of urinary tract obstruction - ANSWER-- Pelvis (calculi, tumors, etc)
- Ureter (calculi, inflammation, cancer of uterus, bladder cancer, etc)
- Bladder outlet (BPH, prostate cancer, bladder cancer, spinal disease, etc)
- Urethra (tumor, calculi, trauma, etc)
Urinary Tract Obstructions Clinical Manifestations: - ANSWER-- Renal colic
> Is excruciating pain caused by acute distention of the ureter
> Begins in the kidney area or below it and radiates through the flank until it reaches
the bladder
- Hydronephrosis
> Is progressive dilatation of the renal pelvis and calyces
- Urinary tract infection (UTI)
- Hypertension
Hydronephrosis - ANSWER-The distention and dilation of the renal pelvis, usually
caused by obstruction of the free flow of urine from the kidney
Kidney Stones - ANSWER-- Also called Renal Calculi, Urolithiasis, Renal Stones
- A disease which results from formation of stones that form anywhere in the urinary
tract, including kidney, bladder, and/or urethra
Nephrolithiasis refers to the presence of - ANSWER-Calculi in the kidneys
Causes of kidney stones: - ANSWER-- Decreased urine volume (the urine becomes
too saturated with salts)
- Increase urine pH (calcium stones) or decease urine pH (uric acid stones)
- High concentration of stone-forming substances in the blood or urine (such as uric
acid, calcium and cystine, etc)
- Diet: high-protein, high-Na+ (predisposes to Ca2+ excretion)
- Certain disorders (e.g., hyperparathyroidism and short bowel syndrome)
- Urinary tract infection
- People who have a family history of stone formation
Clinical presentations of kidney stones: - ANSWER-- The pain with kidney stones is
usually of sudden onset, very severe and colicky (intermittent), not improved by
changes in position
- Radiating from the back, down the flank, and into the groin
- Hematuria (due to minor damage to inside wall of kidney, ureter and/or urethra)
- Nausea and vomiting are common
Major complications of kidney stones: - ANSWER-- Hydronephrosis
, - Urinary tract infection (due to obstruction of urine flow)
- Renal damage
- Hypertension
How does one diagnose kidney stones? - ANSWER-X-ray, CT scan
4 types of treatment for kidney stones - ANSWER-(1) increase fluid intake
(2) dietary modification
(3) extracorporeal (outside the body) lithotripsy (shock wave therapy)
(4) surgery
4 Major Types of Urolithiasis - ANSWER-1. Calcium stones
2. Ammonium magnesium phosphate stones (struvite)
3. Uric acid stones (10%)
4. Cystine stones (1%)
Radiopaque types of urolithiasis - ANSWER-Calcium stones and Ammonium
magnesium phosphate stones (struvite)
Radiolucent types of urolithiasis - ANSWER-Uric acid stones (10%) and Cystine
stones (1%)
Calcium stones are composed of - ANSWER-Calcium oxalate or calcium phosphate,
or both
Account for 75~80% of urinary stones
Calcium stones are caused by: - ANSWER-- Increased intestinal absorption of
calcium
- Increased primary renal excretion of calcium
- Hypercalcemia (e.g., ↑ PTH or malignancy or ↑ Vitamin D)
Ammonium magnesium phosphate stones (struvite) is associated with - ANSWER--
Bacterial infection - Urease-positive bugs such as Proteus Vulgaris, Streptococcus or
Klebsiella
- Can form large staghorn (struvite) calculi
- Second most common (15%)
- Common among sexually active females
Uric acid stones have a strong association with - ANSWER-Hyperuricemia (ex. gout)
Cystine stones are associated with - ANSWER-Cystinuria (due to insolubility of
cystine in the urine)
Urinary Tract Infections (UTIs) epidemiology - ANSWER-- Most common bacterial
infection, but can also be caused by fungus (Candida) and parasites
- Each year, 8-10 million MD visits
- 10-20% women experience a UTI in lifetime
- Women (20~50 y) are 50x as likely to get a UTI as a man
