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Pathophysiology 6th Edition Banasik Tes Bank J




Chapter 26: Renal Function
Banasik: Pathophysiology, 6th Edition


MULTIPLE CHOICE

1. The primary selectivity barrier for glomerular filtration is the J J J J J J J




a. glomerular basement membrane. J J




b. endothelial tight junctions. J J




c. epithelial fenestra. J




d. mesangial cells. J




ANS: A J




The basement membrane is an important selectivity barrier of the glomerulus, preventing plasma
J J J J J J J J J J J J J




proteins, RBCs, WBCs, and platelets from passing through the glomerulus.
J J J J J J J J J




Endothelial tight junctions, epithelial fenestra, and mesangial cells are not the primary selectivity
J J J J J J J J J J J J J




barriers for glomerular filtration.
J J J




2. The glucose transporter in the proximal tubule
J J J J J J




a. has no transport maximum.
J J J




b. does not depend on sodium reabsorption.
J J J J J




c. is ATP-dependent.
J




d. may be saturated at high filtered glucose loads.
J J J J J J J




ANS: D J




The glucose transporter in the proximal tubule may be saturated at high filtered glucose loads;
J J J J J J J J J J J J J J




glycosuria then results. A transport maximum does exist beyond which glycosuria occurs. A
J J J J J J J J J J J J J




sodium-dependent proteinc oN- tU raR poIrN
nsS teG sB
r iTne.
edCeO
d.MThe transporter is not ATP-dependent. J J J J J J J J




3. The primary function of the vasa recta is to
J J J J J J J J




a. secrete renin. J




b. reabsorb NaCl. J




c. reabsorb interstitial fluid. J J




d. secrete urea. J




ANS: C J




The vasa recta are capillaries that surround the loops of Henle and collecting ducts and absorb interstitial
J J J J J J J J J J J J J J J J J




fluid. The vasa recta do not secrete rennin or urea, nor do they reabsorb NaCl.
J J J J J J J J J J J J J J




4. Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed by J J J J J J J J J J J J J J J




the
a. loop of Henle. J J




b. collecting tubule. J




c. distal tubule. J




d. proximal tubule. J




ANS: D J




Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed by the J J J J J J J J J J J J J J J J




proximal tubule. Two thirds of the water and electrolytes filtered by the kidney are not reabsorbed
J J J J J J J J J J J J J J J J




by the loop of Henle, collecting tubule, or distal tubule.
J J J J J J J J J




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, Pathophysiology 6th Edition Banasik Tes Bank J




5. Which finding on urinalysis should prompt further evaluation?
J J J J J J J




a. pH 4.5 J




b. Red blood cells 2 per high-power field J J J J J J




c. Specific gravity of 1.015 J J J




d. White blood cells 20 per high-power field J J J J J J




ANS: D J




This many WBCs in the urine indicate urinary tract infection; 5 or more is not expected. 4.5 is a
J J J J J J J J J J J J J J J J J J J




normal pH. Fewer than 5 RBCs is insignificant. 1.015 is a normal specific gravity.
J J J J J J J J J J J J J




6. Renin is released from J J J




a. the posterior pituitary gland. J J J




b. the liver. J




c. juxtaglomerular cells. J




d. macula densa cells. J J




ANS: C J




Renin is released from the juxtaglomerular cells. Renin is not released from the posterior pituitary
J J J J J J J J J J J J J J J




gland, liver, or macula densa cells.
J J J J J




7. It is true that glucose reabsorption in the tubules
J J J J J J J J




a. occurs passively. J




b. occurs in the proximal convoluted tubule. J J J J J




c. is unlimited. J




d. simply does not occur. J J J




ANS: B J




Glucose reabsorption occursNi n t hRe pI
U S NGisTrequired.
r o xi m a lBc.o nCv o lMu t e d tubule. Glucose reabsorption is notpassive; a
O Glucose reabsorption in the
J J J J J J J J J J J J J




sodium-dependent protein co-transporter J J J J J J J J




tubules is limited by the number of co-transporters; a threshold exists beyond which glycosuria
J J J J J J J J J J J J J J




will result. Glucose reabsorption occurs in the proximal convoluted tubule with the assistance of a
J J J J J J J J J J J J J J J




sodium-dependent protein co-transporter. J J




8. Serious renal impairment generally does not occur until
J J J J J J J J of the total nephrons have been
J J J J J J




damaged.
a. 20%
b. 40%
c. 60%
d. 80%
ANS: D J




Serious renal impairment generally does not occur until 75% to 90% of the total nephrons have
J J J J J J J J J J J J J J J J




been damaged. The other answer options are incorrect.
J J J J J J J




9. An important sign of glomerular basement membrane dysfunction is
J J J J J J J J




a. proteinuria.
b. hematuria.
c. glycosuria.
d. urinary casts. J




ANS: A J




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, Pathophysiology 6th Edition Banasik Tes Bank J




Proteinuria is an important sign of basement membrane dysfunction. Hematuria can be found in
J J J J J J J J J J J J J J




glomerular disorders but it is not specific to this; it can be caused by many disorders.
J J J J J J J J J J J J J J J




Glycosuria is found primarily in diabetes mellitus. Urinary casts do not necessarily mean
J J J J J J J J J J J J J




basement membrane dysfunction. J J




10. The main driving force for glomerular filtration is
J J J J J J J




a. oncotic pressure in the Bowman’s capsule. J J J J J




b. hydrostatic pressure in glomerular capillaries. J J J J




c. permeability of the glomerular membrane. J J J J




d. solute content of the blood in the glomerular capillaries.
J J J J J J J J




ANS: B J




Hydrostatic pressure within the glomerular capillaries is the main driving force for filtration. A
J J J J J J J J J J J J J J




significant drop in blood pressure such as in shock severely reduces glomerular filtration.
J J J J J J J J J J J J J




Oncotic pressure in the Bowman’s capsule, permeability of the glomerular membrane, and solute
J J J J J J J J J J J J J




content of the blood in the glomerular capillaries are not the main driving forces for filtration.
J J J J J J J J J J J J J J J




11. Factors that increase the glomerular filtration rate include
J J J J J J J




a. fluid volume excess. J J




b. increased hydrostatic pressure in the Bowman’s capsule. J J J J J J




c. high oncotic pressure in glomerular capillary blood.
J J J J J J




d. obstruction in the renal tubules. J J J J




ANS: A J




Fluid volume excess increases blood volume which increases glomerular filtration. Increased
J J J J J J J J J J J




hydrostatic pressure in the Bowman’s capsule, high oncotic pressure in the glomerular
J J J J J J J J J J J




capillary, and obstruction ofN naR
r eU tuI
lS buNleGs T
opBp.
JosCeO
fiM
ltration. J J J J




12. The underlying mechanism which directly results in glycosuria is
J J J J J J J J




a. filtration of glucose from the glomerulus. J J J J J




b. exceeding the threshold for glucose reabsorption. J J J J J




c. secretion of glucose into the distal tubule. J J J J J J




d. the mechanism is unknown.
J J J




ANS: B J




Glucose is normally freely filtered but then reabsorbed from the tubules into the peritubular
J J J J J J J J J J J J J J




capillaries. If the threshold for reabsorption is exceeded as in uncontrolled diabetes mellitus,
J J J J J J J J J J J J J




glycosuria results. Glucose is freely filtered from the glomerulus; this is not the direct cause of
J J J J J J J J J J J J J J J J




glycosuria. Glucose is not secreted into the distal tubule. The underlying mechanism that directly
J J J J J J J J J J J J J J




results in glycosuria is exceeding the threshold for glucose reabsorption.
J J J J J J J J J




13. Excess potassium is excreted from the body by the renal system primarily via
J J J J J J J J J J J J




a. glomerular filtration based on blood level of potassium. J J J J J J J




b. reabsorption based on blood level of potassium. J J J J J J




c. secretion based on aldosterone level. J J J J




d. an unknown mechanism.
J J




ANS: C J




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, Pathophysiology 6th Edition Banasik Tes Bank J




Potassium is secreted from the distal tubule and collecting ducts into the tubule lumen under the
J J J J J J J J J J J J J J J J




influence of aldosterone. Excess potassium is not excreted from the body by the renal system via
J J J J J J J J J J J J J J J J




glomerular filtration or the renal system based on the blood level of potassium, nor is it excreted
J J J J J J J J J J J J J J J J J




from the body by the renal system based on the aldosterone level.
J J J J J J J J J J J




14. The glomerular filtration rate is most accurately reflected in the
J J J J J J J J J




a. blood urea nitrogen level. J J J




b. urinary output. J




c. serum osmolality. J




d. serum creatinine level. J J




ANS: D J




Serum creatinine is a fairly reliable indicator of glomerular filtration as it is stable. The blood urea
J J J J J J J J J J J J J J J J J




nitrogen level, urinary output, and serum osmolality are affected by factors that make them less
J J J J J J J J J J J J J J J




reliable as indicators of glomerular filtration.
J J J J J




15. Serum creatinine may be increased by
J J J J J




a. carbohydrate intake. J




b. fat intake. J




c. muscle breakdown. J




d. fluid intake. J




ANS: C J




Creatinine is an end product of muscle metabolism; muscle breakdown will increase the serum
J J J J J J J J J J J J J J




creatinine level. Serum creatinine is not affected by carbohydrate, fat, or fluid intake. Fluid
J J J J J J J J J J J J J J




volume deficit can increase the serum creatinine if it leads to acute renal failure.
J J J J J J J J J J J J J




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MULTIPLE RESPONSE J




1. Hormones that increase sodium reabsorption from the tubular fluid include (Select all that
J J J J J J J J J J J J J




apply.)
a. aldosterone.
b. atrial natriuretic peptide. J J




c. antidiuretic hormone. J




d. urodilatin.
e. angiotensin II. J




ANS: A, E J J




Aldosterone and angiotensin II result in sodium reabsorption. Atrial natriuretic peptide and urodilatin
J J J J J J J J J J J J J




decrease sodium reabsorption. Antidiuretic hormone does not affect sodium reabsorption.
J J J J J J J J J




2. The blood urea nitrogen (BUN) level is affected by (Select all that apply.)
J J J J J J J J J J J J




a. protein intake. J




b. fat intake. J




c. fluid intake. J




d. catabolism.
e. renal function. J




ANS: A, C, D, E
J J J J





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