NURS 5461 Final Quiz The University of Texas at Arlington | Questions with
100% Verified Answers | Latest Update
Question: Renal issues that occur with normal aging
Answer:
Decreased GFR, decreased diluting capacity, decreased concentration ability, decreased sodium
conservation (volume depletion) decreased sodium excreation (salt sensitivity/HTN), decreased
ammonium & bicarb production (metabolic acidosis)
Question: Most accurate indicator of renal function in older adults
Answer:
GFR - declines 8mls per decade starting at age 40
Question: Small amounts of protein in urine
Answer:
Chronic nephrosclerosis from HTN
Question: renal artery stenosis
Answer:
partial or complete blocking of one or both renal arteries - THIS ACTIVATES THE RENIN
ANGIOTENSION ALDOSTERONE SYSTEM AND CAUSES SYSTEMIC HYPERTENSION TO
ATTEMPT TO PERFUSE THE KIDNEY - if pt has a 30% increase in creatinine after starting an ACE
or ARB - think renal artery stenosis - risk factors include smoking, HTN, hyperlipidemia, DM,
aneurysms - renal stenting isn't indicated except in extreme cases when you can't control BP or there is
progressive kidney failure.
Question: Most common cause of AKI
Answer:
Acute tubular necrosis (ATN) followed by prerenal azotemia
Question: Acute Tubular Necrosis (ATN)
Answer:
Damage to the renal tubules due to presence of toxins in the urine or to ischemia. Results in oliguria.
Question: Prerenal azotemia
Answer:
Due to decreased blood flow to kidneys; common cause of acute renal failure - increase bun and
decreased renal flow - treat with volume resuscitation
,Question: acute tubular necrosis diagnostic criteria
Answer:
DIAGNOSIS: URINE SEDIMENT WILL INCLUDE TUBULAR EPITHELIAL CELLS &
GRANULAR MUDDY BROWN CASTS - in oliguria FENa >2% - TREATMENT IS SUPPORTIVE
CARE AND OFTEN TIMES REVERSIBLE
Question: Acute interstitial nephritis
Answer:
Drug-induced hypersensitivity involving the interstitium and tubules; results in acute renal failure
(intrarenal azotemia) - most commone antibiotics to cause this are PENICILLINS, CEPHLOSPORINS,
AND FLUOROQUINOLONES (floxacins)
Question: multiple myeloma "myeloma kidney"
Answer:
malignant neoplasm of bone marrow. Proteins light & heavy chains will deposit in parenchyma - pt will
present with lower back pain - seen AA women - will see sever proteinurea, low anion gap,
hypercalcemia, anemia, and bone pain - treat w chemotherapy (melphalan and prednisone)
Question: 3 types of glomerular disease
Answer:
Acute nephritic syndrome Post infection glomerulonephritis (step/staph) IgA nephropathy
Question: Nephrotic syndrome
Answer:
URINATING >3.5G OF PROTEIN PER DAY! WITH HYPOALBUMINEMIA, HLD, AND EDEMA -
Can be from primary glomerular disease, infection, malignancy, exposure to allergen/medication, DM,
or HTN.
◦ RENAL BIOPSY IS ESSENTIAL FOR EARLY DIAGNOSIS
◦ THERAPY - CONTROLL BP, USE RASS BLOCKERS, SODIUM RESTICTION, STATINS,
ANTICOAGULATION WHEN ALBUMIN IS <2.8
Question: What do RAAS inhibitors do?
Answer:
Decrease proteinuria
Question: Chronic Kidney Disease (CKD)
Answer:
progressive, irreversible loss of kidney function - RENAL GLOMERULAR AND
TUBULOINTERSTITIAL FIBROSIS INCREASES WITH AGE LEADING TO CKD - presents with a
, decompensation of the pts preexisting medical problems. - HTN AND DM ARE HIGH RISK
FACTORS FOR CKD
Question: RAAS (renin-angiotensin-aldosterone system)
Answer:
Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split &
produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal
gland to release aldosterone & causes an increase in peripheral vasoconstriction
Question: Medications to avoid in CKD
Answer:
-NSAIDs- block the synthesis of the renal prostaglandins that promote vasodilation, and this can worsen
renal hypoperfusion
-DEMEROL: Metabolized to normeperidine in the liver, which kidneys excrete
-AMINOGLYCOSIDES, PENICILLIN, AND TETRACYCLINES: Nephrotoxic Medication use can be
complicated by decreased renal clearance - MEDS TO AVOID / USE W CATION NSAID,
CONTRAST, GADOLINIUM, AMINOGLYCOSIDES, AND AMPHOTERICIN B
Question: What stage to screen for Anemia
Answer:
CKD stage 3B - ferritin goal should be >100
Question: Erythropoiesis stimulating agents
Answer:
Can be used to prevent blood transfusion but iron should be replaced prior to starting ESA - do not
initate if hemoglobin is greater than 10 without signs or symptoms.
Question: renal osteodystrophy
Answer:
a general term that refers to bone disease related to CKD and caused by over- or underproduction of
parathyroid hormone or by exposure to aluminum - SCREEN FOR CALCIUM, PHOSPHORUS, AND
PTH ABNORMALITIES BEINING IN STAGE 3 - MAINTAIN PHOSPHORUS BETWEEN 2.7 AND
4.6 IN PTS STAGE 3-4 - RESTRICT DIETARY PHOS IF PTH IS INCREASED AND USE
PHOSPHOURS BINDERS
◦ HIGH PTH IS ASSOCIATED W HIGH FRACTURE RISK - CAN SUPPRESS WITH VITAMIN D
BUT THIS CAN INCREASE CALCIUM SO THOSE MUST BE MONITORED.
◦ If that does happen, CINCALCET CAN BE USED TO LOWER CA, PHOS, AND PTH (if we supress
PTH too much it can lead to bone turn over disease aka adynamic bone disease)
Question: Must screen for what in CKD
Answer:
100% Verified Answers | Latest Update
Question: Renal issues that occur with normal aging
Answer:
Decreased GFR, decreased diluting capacity, decreased concentration ability, decreased sodium
conservation (volume depletion) decreased sodium excreation (salt sensitivity/HTN), decreased
ammonium & bicarb production (metabolic acidosis)
Question: Most accurate indicator of renal function in older adults
Answer:
GFR - declines 8mls per decade starting at age 40
Question: Small amounts of protein in urine
Answer:
Chronic nephrosclerosis from HTN
Question: renal artery stenosis
Answer:
partial or complete blocking of one or both renal arteries - THIS ACTIVATES THE RENIN
ANGIOTENSION ALDOSTERONE SYSTEM AND CAUSES SYSTEMIC HYPERTENSION TO
ATTEMPT TO PERFUSE THE KIDNEY - if pt has a 30% increase in creatinine after starting an ACE
or ARB - think renal artery stenosis - risk factors include smoking, HTN, hyperlipidemia, DM,
aneurysms - renal stenting isn't indicated except in extreme cases when you can't control BP or there is
progressive kidney failure.
Question: Most common cause of AKI
Answer:
Acute tubular necrosis (ATN) followed by prerenal azotemia
Question: Acute Tubular Necrosis (ATN)
Answer:
Damage to the renal tubules due to presence of toxins in the urine or to ischemia. Results in oliguria.
Question: Prerenal azotemia
Answer:
Due to decreased blood flow to kidneys; common cause of acute renal failure - increase bun and
decreased renal flow - treat with volume resuscitation
,Question: acute tubular necrosis diagnostic criteria
Answer:
DIAGNOSIS: URINE SEDIMENT WILL INCLUDE TUBULAR EPITHELIAL CELLS &
GRANULAR MUDDY BROWN CASTS - in oliguria FENa >2% - TREATMENT IS SUPPORTIVE
CARE AND OFTEN TIMES REVERSIBLE
Question: Acute interstitial nephritis
Answer:
Drug-induced hypersensitivity involving the interstitium and tubules; results in acute renal failure
(intrarenal azotemia) - most commone antibiotics to cause this are PENICILLINS, CEPHLOSPORINS,
AND FLUOROQUINOLONES (floxacins)
Question: multiple myeloma "myeloma kidney"
Answer:
malignant neoplasm of bone marrow. Proteins light & heavy chains will deposit in parenchyma - pt will
present with lower back pain - seen AA women - will see sever proteinurea, low anion gap,
hypercalcemia, anemia, and bone pain - treat w chemotherapy (melphalan and prednisone)
Question: 3 types of glomerular disease
Answer:
Acute nephritic syndrome Post infection glomerulonephritis (step/staph) IgA nephropathy
Question: Nephrotic syndrome
Answer:
URINATING >3.5G OF PROTEIN PER DAY! WITH HYPOALBUMINEMIA, HLD, AND EDEMA -
Can be from primary glomerular disease, infection, malignancy, exposure to allergen/medication, DM,
or HTN.
◦ RENAL BIOPSY IS ESSENTIAL FOR EARLY DIAGNOSIS
◦ THERAPY - CONTROLL BP, USE RASS BLOCKERS, SODIUM RESTICTION, STATINS,
ANTICOAGULATION WHEN ALBUMIN IS <2.8
Question: What do RAAS inhibitors do?
Answer:
Decrease proteinuria
Question: Chronic Kidney Disease (CKD)
Answer:
progressive, irreversible loss of kidney function - RENAL GLOMERULAR AND
TUBULOINTERSTITIAL FIBROSIS INCREASES WITH AGE LEADING TO CKD - presents with a
, decompensation of the pts preexisting medical problems. - HTN AND DM ARE HIGH RISK
FACTORS FOR CKD
Question: RAAS (renin-angiotensin-aldosterone system)
Answer:
Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split &
produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal
gland to release aldosterone & causes an increase in peripheral vasoconstriction
Question: Medications to avoid in CKD
Answer:
-NSAIDs- block the synthesis of the renal prostaglandins that promote vasodilation, and this can worsen
renal hypoperfusion
-DEMEROL: Metabolized to normeperidine in the liver, which kidneys excrete
-AMINOGLYCOSIDES, PENICILLIN, AND TETRACYCLINES: Nephrotoxic Medication use can be
complicated by decreased renal clearance - MEDS TO AVOID / USE W CATION NSAID,
CONTRAST, GADOLINIUM, AMINOGLYCOSIDES, AND AMPHOTERICIN B
Question: What stage to screen for Anemia
Answer:
CKD stage 3B - ferritin goal should be >100
Question: Erythropoiesis stimulating agents
Answer:
Can be used to prevent blood transfusion but iron should be replaced prior to starting ESA - do not
initate if hemoglobin is greater than 10 without signs or symptoms.
Question: renal osteodystrophy
Answer:
a general term that refers to bone disease related to CKD and caused by over- or underproduction of
parathyroid hormone or by exposure to aluminum - SCREEN FOR CALCIUM, PHOSPHORUS, AND
PTH ABNORMALITIES BEINING IN STAGE 3 - MAINTAIN PHOSPHORUS BETWEEN 2.7 AND
4.6 IN PTS STAGE 3-4 - RESTRICT DIETARY PHOS IF PTH IS INCREASED AND USE
PHOSPHOURS BINDERS
◦ HIGH PTH IS ASSOCIATED W HIGH FRACTURE RISK - CAN SUPPRESS WITH VITAMIN D
BUT THIS CAN INCREASE CALCIUM SO THOSE MUST BE MONITORED.
◦ If that does happen, CINCALCET CAN BE USED TO LOWER CA, PHOS, AND PTH (if we supress
PTH too much it can lead to bone turn over disease aka adynamic bone disease)
Question: Must screen for what in CKD
Answer:
