An older adult client is diagnosed with a severe urinary tract infection. The nurse assesses the client for which most serious complication?

Choice A reason: Glomerulonephritis is an inflammation of the glomeruli, the filtering units of the kidneys. It can cause damage to the renal tissue and lead to intrinsic acute kidney injury, not prerenal acute kidney injury.

Choice B reason: Fluid volume deficit is a condition in which the body loses more fluid than it takes in. It can cause hypovolemia, which reduces the blood flow to the kidneys and impairs their function. This is the most common cause of prerenal acute kidney injury, which is a result of decreased perfusion to the kidneys.

Choice C reason: Neurogenic bladder is a dysfunction of the bladder caused by a nerve problem. It can affect the ability to store or empty urine. It can cause urinary retention, which increases the pressure in the urinary tract and damages the kidneys. This is a type of postrenal acute kidney injury, which is a result of obstruction to the urine outflow.

Choice D reason: Renal calculus is a solid mass formed from crystals in the urine. It can block the ureter, the tube that carries urine from the kidney to the bladder. It can cause hydronephrosis, which is a swelling of the kidney due to accumulation of urine. This is another type of postrenal acute kidney injury.

Choice A reason: Uric acid is the most common type of renal calculi in clients with gout because it is a condition where the blood has a high level of uric acid, which is a waste product that results from the breakdown of purines, which are substances found in some foods and drinks, such as meat, seafood, and beer. Uric acid can form crystals in the joints, causing inflammation and pain, which is known as gout. Uric acid can also form crystals in the urine, causing kidney stones, which are hard deposits of minerals and salts that can block the urinary tract and cause symptoms such as severe pain, blood in the urine, nausea, and fever.

Choice B reason: Struvite is not the most common type of renal calculi in clients with gout because it is a condition where the urine has a high level of ammonia, which is a chemical that results from the breakdown of urea, which is a waste product that is produced by the liver and excreted by the kidneys. Ammonia can form crystals in the urine, along with magnesium, phosphate, and carbonate, creating struvite stones, which are large and staghorn-shaped stones that can fill the entire kidney or the ureter. Struvite stones are usually associated with urinary tract infections, which are caused by bacteria that produce enzymes that increase the urine pH and the ammonia level.

Choice C reason: Cystine is not the most common type of renal calculi in clients with gout because it is a condition where the urine has a high level of cystine, which is an amino acid that is a building block of proteins. Cystine can form crystals in the urine, causing kidney stones, which are rare and hereditary. Cystine stones are caused by a genetic disorder that affects the transport of cystine and other amino acids in the kidneys, resulting in excessive excretion of cystine in the urine.

Choice D reason: Calcium oxalate is not the most common type of renal calculi in clients with gout because it is a condition where the urine has a high level of calcium and oxalate, which are substances that are normally present in the diet and the body. Calcium and oxalate can form crystals in the urine, causing kidney stones, which are the most common type of kidney stones in the general population, but not in clients with gout. Calcium oxalate stones can be caused by various factors, such as dehydration, high intake of animal protein, low intake of fluids, and certain medications.