The urinalysis results for a client diagnosed with chronic kidney disease (CKD) indicate the presence of protein in the urine. The impairment of which structure within the kidney results in proteinuria?

Choice A reason: Macrophages, lymph, and cytokines are part of the innate immune response, acting after pathogens breach initial barriers. First-line defenses are physical and chemical barriers like mucosa and secretions, not immune cells or fluids. This choice represents secondary defenses, making it incorrect for the primary barrier role.

Choice B reason: Lung epithelium, gastric mucosa, and tears are first-line defenses, preventing pathogen entry. Lung cilia trap microbes, gastric acid kills bacteria, and tears’ lysozymes neutralize pathogens. These physical and chemical barriers form the body’s initial protection, aligning with immunology principles for primary defense against infection.

Choice C reason: Interferon, T cells, and neutrophils are part of adaptive and innate immunity, activated after pathogen penetration. First-line defenses involve barriers like mucosa, not immune mediators or cells. This choice describes secondary immune responses, making it incorrect for the initial protective structures in humans.

Choice D reason: Thymus, bone marrow, and pancreas are involved in immune cell production and metabolism, not direct pathogen defense. First-line defenses are external barriers like lung epithelium or tears. These internal organs support immunity but are not primary barriers, making this incorrect for first-line defense structures.

Choice A reason: Hypertensive crisis is not a feature of Addison’s disease, which causes hypotension due to cortisol and aldosterone deficiency. Cortisol kits address adrenal insufficiency during stress, not hypertension. This choice is incorrect, as it misaligns with Addison’s pathophysiology and cortisol’s role.

Choice B reason: Cortisol is not used for systemic allergic reactions, which require antihistamines or epinephrine. Addison’s patients need cortisol for adrenal insufficiency during stress, as their bodies cannot produce it. This choice is incorrect, as cortisol kits address hypoadrenalism, not anaphylaxis.

Choice C reason: Addison’s disease involves adrenal insufficiency, impairing cortisol production. Stress increases cortisol demand, which the patient cannot meet, risking adrenal crisis. Carrying a cortisol kit allows rapid administration during stress, preventing life-threatening hypotension or shock, aligning with endocrinology evidence for Addison’s management.

Choice D reason: Hyperglycemia is unrelated to Addison’s disease, which does not typically affect glucose metabolism. Cortisol kits address adrenal insufficiency, not blood glucose. This choice is incorrect, as cortisol replacement is for stress-induced hypoadrenalism, not glycemic control, per Addison’s pathophysiological basis.