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Diagnostic Evaluation and GFR Calculation

- The diagnosis of CRF is based on the presence of kidney damage or decreased GFR for three or more months. 

- The GFR can be estimated by using serum creatinine level and other factors such as age, sex, race, and body size.

  • The most commonly used formula is the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation:
  • GFR = 141 x min (Scr/κ, 1)^α x max(Scr/κ , 1)^-1.209 x 0.993^Age x 1.018 [if female] x 1.159 [if black]

where Scr is serum creatinine in mg/dL,

κ is 0.7 for females and 0.9 for males,

α is -0.329 for females and -0.411 for males,

min indicates the minimum of Scr/κ or 1,

and max indicates the maximum of Scr/κ or 1.

 

- The stages of CKD are defined by the GFR as follows:

Stage 1: GFR ≥90 mL/min/1.73 m2 with evidence of kidney damage

Stage 2: GFR 60-89 mL/min/1.73 m2 with evidence of kidney damage

Stage 3a: GFR 45-59 mL/min/1.73 m2

Stage 3b: GFR 30-44 mL/min/1.73 m2

Stage 4: GFR 15-29 mL/min/1.73 m2

Stage 5: GFR <15 mL/min/1.73 m2 or on dialysis

- Other diagnostic tests that may be performed include:

  • Blood tests: to measure electrolytes, blood urea nitrogen (BUN), calcium, phosphorus, parathyroid hormone (PTH), albumin, hemoglobin, hematocrit, platelets, coagulation factors
  • Urine tests: to measure urine volume, specific gravity, osmolality, pH, sodium, potassium
  • Urine culture: to rule out infection
  • Urine protein electrophoresis: to identify the type of proteinuria
  • Renal ultrasound: to assess the size and shape of the kidneys and detect any obstruction or cysts
  • CT scan or MRI: to provide more detailed images of the kidneys and detect any masses or lesions. They can reveal structural changes, such as cysts, tumors, or kidney stones, that may be contributing to kidney damage.
  • Kidney biopsy: to obtain a tissue sample for histological examination and diagnosis of the underlying cause

Questions on Diagnostic Evaluation and GFR Calculation

Correct Answer is D

Explanation

Correct. Conditions such as hypertension and diabetes are well-established risk factors for chronic renal failure. These conditions can cause damage to the blood vessels and filtering units of the kidneys over time, leading to kidney dysfunction.

Correct Answer is C

Explanation

Incorrect. The GFR test does not specifically measure the excretion of potassium and sodium in the urine; instead, it focuses on overall kidney function and filtration rate.

Correct Answer is D

Explanation

Correct. The prognosis for chronic renal failure can vary widely depending on factors such as the cause of kidney disease, the stage of kidney damage, and the client's response to treatment. Early intervention, such as controlling blood pressure and blood sugar levels, can help slow the progression of kidney damage and improve long-term outcomes.

Correct Answer is A

Explanation

Incorrect. Rapid weight loss over a few days is not indicative of fluid retention; rather, it may suggest dehydration or inadequate caloric intake.

Correct Answer is B

Explanation

Incorrect. Providing the client with an analgesic is not the priority when the client reports cloudy dialysate effluent; the focus is on identifying the cause of the cloudiness.

Correct Answer is B

Explanation

Incorrect. While reducing protein intake can result in fewer waste products being generated, the primary reason for limiting protein intake in chronic renal failure is to reduce the strain on the kidneys, not solely to decrease waste production.

Correct Answer is D

Explanation

Correct. Anemia is a common complication of chronic renal failure because the kidneys play a crucial role in producing erythropoietin, a hormone that stimulates red blood cell production. When the kidneys are damaged, erythropoietin production decreases, leading to anemia.

Correct Answer is D

Explanation

Correct. A low-protein diet is prescribed to reduce the production of nitrogenous waste products, such as urea and creatinine, which the damaged kidneys are unable to efficiently excrete. This helps prevent the buildup of waste products in the body.

Correct Answer is C

Explanation

Incorrect. Hypophosphatemia (low phosphate levels) is not a typical electrolyte imbalance in chronic renal failure.

Correct Answer is A

Explanation

Incorrect. Hypermagnesemia and decreased cortisol production are not the primary factors contributing to metabolic bone disease in chronic renal failure.

Correct Answer is A

Explanation

Incorrect. Pharmacological therapy may be part of the treatment plan for chronic renal failure, but it does not focus on removing waste products and excess fluid from the blood like dialysis does.

Correct Answer is C

Explanation

Incorrect. Chronic renal failure is not a result of temporary stress on the kidneys; it is a chronic condition with irreversible kidney damage.

Correct Answer is B

Explanation

Incorrect. Urine storage occurs in the bladder, not the glomerulus

Correct Answer is D

Explanation

Correct. Conditions such as hypertension and diabetes are two of the leading causes of chronic renal failure. Uncontrolled high blood pressure and elevated blood sugar levels can damage the blood vessels and filtering units of the kidneys, leading to chronic kidney disease over time.

Correct Answer is C

Explanation

Incorrect. Family history of kidney disease is a non-modifiable risk factor. While individuals cannot change their family history, they can modify other lifestyle factors, such as smoking, to reduce their overall risk of kidney disease.

Correct Answer is D

Explanation

Correct. Hypertension, or high blood pressure, is a significant risk factor for chronic renal failure. Long-term uncontrolled hypertension can damage the blood vessels in the kidneys, leading to chronic kidney disease.

Correct Answer is B

Explanation

Incorrect. Chronic renal failure can be caused by various factors, but diabetes is a significant and common cause of kidney disease, especially in individuals with uncontrolled diabetes.

Correct Answer is C

Explanation

Incorrect. Antipyretics such as acetaminophen are generally safe when used appropriately and are not considered a risk factor for chronic renal failure.

Correct Answer is C

Explanation

Incorrect. High blood pressure is a well-established risk factor for chronic renal failure. Uncontrolled hypertension can damage the blood vessels in the kidneys, leading to kidney dysfunction over time.

Correct Answer is A

Explanation

Incorrect. Hyperkalemia is a complication of chronic renal failure but may not be an early clinical manifestation. It is more likely to occur as kidney function declines and potassium excretion becomes impaired.

Correct Answer is B

Explanation

Incorrect. Persistent pruritus in a client with chronic renal failure is not necessarily indicative of an allergic reaction to medications. It is more likely related to the buildup of waste products in the blood.

Correct Answer is D

Explanation

Correct. Monitoring the client's weight and fluid intake is the priority action when the client is experiencing anorexia and nausea. These symptoms may indicate fluid and electrolyte imbalances that need to be addressed promptly.

Correct Answer is A

Explanation

Incorrect. Polyuria is not typically associated with fluid overload. Instead, it may be present in early stages of chronic renal failure due to the inability of the kidneys to concentrate urine properly.

Correct Answer is C

Explanation

Incorrect. Assessing the client's daily protein intake is not the priority when the client presents with swelling in the ankles and legs. Fluid retention is a more immediate concern that requires assessment and intervention.

Correct Answer is B

Explanation

Incorrect. Educating the client about potassium-rich foods is important for managing potassium levels, but it is not the priority in this situation. Muscle cramps are more likely related to fluid and electrolyte imbalances rather than potassium intake.

Correct Answer is D

Explanation

Correct. Fatigue and decreased appetite are early clinical manifestations of kidney dysfunction in chronic renal failure. The kidneys play a vital role in filtering waste products and toxins from the blood, and when kidney function is compromised, it can lead to a buildup of waste products in the body, causing fatigue and decreased appetite.

Correct Answer is B

Explanation

Incorrect. Kidney dysfunction in chronic renal failure does not typically lead to low levels of calcium in the bones. Instead, it can lead to abnormalities in phosphorus levels, which affect bone health.

Incorrect. Hypokalemia, or low potassium levels, can cause muscle weakness or cramps but is not typically associated with peripheral neuropathy.

Correct. Hyperphosphatemia, or high phosphorus levels, is common in chronic renal failure due to impaired kidney function. Elevated phosphorus levels can lead to the binding of calcium, resulting in decreased ionized calcium in the blood. This can cause neuromuscular irritability, difficulty concent

Correct. Periorbital edema (swelling around the eyes) and edema in the ankles and feet are classic signs of fluid overload in chronic renal failure. The impaired kidney function in chronic renal failure leads to the retention of fluid and sodium in the body, resulting in edema.

Incorrect. Taking over-the-counter calcium supplements without proper evaluation of calcium levels can be dangerous and may contribute to other imbalances in chronic renal failure.

Incorrect. Chronic renal failure is not typically associated with elevated platelet counts; in fact, it can lead to platelet dysfunction and an increased risk of bleeding.

Incorrect. The GFR test does not specifically assess the excretion of potassium and sodium in the urine; instead, it focuses on overall kidney function and filtration rate.

Incorrect. While a GFR value of 50 mL/min/1.73m² indicates kidney dysfunction, it does not represent severe kidney damage. Severe kidney dysfunction would have a much lower GFR value.

Correct. The GFR can be estimated using formulas that include the serum creatinine level, such as the Modification of Diet in Renal Disease (MDRD) formula or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Correct. There are no special preparations needed for a GFR test. The test can be done at any time, regardless of food intake or hydration status.

Incorrect. A GFR value of 10 mL/min/1.73m² is far below the normal range and indicates significant kidney dysfunction, not normal kidney function.

Incorrect. A GFR value of 60 mL/min/1.73m² is not indicative of severely damaged kidneys. Severe kidney dysfunction would have a much lower GFR value.

Incorrect. Reassuring the client about the brief and tolerable nature of discomfort would be misleading, as the GFR test does not cause discomfort.

Incorrect. Foods high in phosphorus should be restricted in chronic renal failure because the kidneys may have difficulty excreting excess phosphorus, leading to hyperphosphatemia, which can contribute to bone and mineral disorders.

Incorrect. Phosphate binders do not affect potassium excretion. They are specific to phosphate control in the body and do not impact potassium levels.

Incorrect. Medication adherence is essential, but it does not eliminate the need for dietary restrictions in chronic renal failure. Dietary modifications are also a vital part of managing the condition effectively.

<p>Incorrect. ESA therapy is not associated with an increased risk of bleeding or restrictions on engaging in strenuous activities. It is used to manage anemia and improve overall blood cell counts.</p>

Incorrect. Promoting a high-potassium diet is not appropriate for individuals on hemodialysis, as it can lead to hyperkalemia. Clients on hemodialysis typically need to restrict potassium intake.

Incorrect. Discontinuing peritoneal dialysis should be considered if there is clear evidence of infection or other serious complications, but it is not the initial intervention for cloudy drainage without further assessment.

Correct. Calcitriol is the active form of vitamin D and plays a crucial role in regulating calcium and phosphate levels in the body. It helps maintain bone health by promoting the absorption of calcium from the digestive tract and preventing bone demineralization.

Incorrect. Potassium-sparing diuretics may not be the first choice for managing fluid overload and hypertension in chronic renal failure, especially if the client has elevated potassium levels. ACE inhibitors are a more suitable option in this scenario.

Incorrect. Pain medication is not typically needed before starting a peritoneal dialysis exchange, as the procedure itself is not painful. Proper technique and sterile care are the main focus of peritoneal dialysis education.

Incorrect. Fluid restrictions are typically necessary in chronic renal failure to prevent fluid overload and related complications.

Incorrect. Caffeine-containing beverages can contribute to fluid overload and hypertension in chronic renal failure and are not a suitable intervention for addressing fatigue.

Incorrect. Phosphate binders do not typically lower potassium levels, and monitoring potassium intake is not specifically related to their use.

Incorrect. Poultry is a good protein source, but the type of protein is not the main concern for clients at risk for hyperkalemia; it is the overall potassium content of the diet that needs to be reduced.

Incorrect.Physical activity is generally encouraged in clients with chronic renal failure, as it contributes to overall well-being. Hemodialysis may increase energy levels and improve the client's ability to engage in physical activity.

Correct. Constipation is a common side effect of calcium-based phosphate binders. Increasing fluid intake can help alleviate constipation and promote bowel regularity.
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