Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 40: Alterations of Renal and Urinary Tract Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. The functional kidney is associated with which embryonic organ?a. Metanephrosb. Mesonephrosc. Pronephrosd. EndonephrosANS: AThe functional kidney is associated with the metanephros. The kidney develops from three sets of structures: the pronephros (nonfunctional by the end of the embryonic period), mesonephros (nonfunctional), and metanephros (the functional kidney). Endonephros is not relevant to this process.PTS: 1 DIF: Cognitive Level: Remembering 2. When does urine formation and excretion begin?a. At birthb. By 3 months’ gestationc. By 6 months’ gestationd. By 8 months’ gestationANS: BUrine formation and excretion begin by the third month of gestation.PTS: 1 DIF: Cognitive Level: Remembering 3. Compared with an adult, an infant has a greater content of extracellular fluid, as well as a greater rate of fluid exchange. What effect does this have on the fluid balance of a child compared with that of an adult?a. Edema development is less of a problem.b. Overhydration is not difficult to manage.c. Daily fluid requirements are greater.d. The control of dehydration is more difficult.ANS: DAn infant not only has a greater content of extracellular fluid but also has a greater rate of fluid exchange. The adult takes in and excretes approximately 2000 ml of water daily, representing 5% of the total body fluid and 14% of the extracellular fluid. In contrast, the infant’s daily exchange of 600 to 700 ml of water represents 290% of the total body fluid or nearly 50% of the extracellular volume, making control of dehydration and overhydration more difficult.PTS: 1 DIF: Cognitive Level: Remembering 4. What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis?a. Hypospadiasb. Epispadiasc. Hyperspadiasd. ChordeeANS: AHypospadias is a congenital condition in which the urethral meatus is located on the ventral side or undersurface of the penis. In epispadias, the dorsal urethra is not fused and has failed to form into a tube. Epispadias can be seen in both boys and girls. In chordee a shortage of skin on the ventral surface causes the penis to bend or to “bow” ventrally. Hyperspadias is not a condition.PTS: 1 DIF: Cognitive Level: Remembering 5. What initiates inflammation in acute poststreptococcal glomerulonephritis?a. Lysosomal enzymesb. Endotoxins from Streptococcusc. Immune complexesd. Immunoglobulin E (IgE)–mediated responseANS: CThe immune complexes initiate inflammation and glomerular injury in acute poststreptococcal glomerulonephritis. Antigen–antibody complexes are deposited in the glomerulus, or the antigen may be trapped within the glomerulus and immune complexes formed in situ. Lysosomal enzymes contain digestive enzymes. Endotoxins and IgE are not involved in acute poststreptococcal glomerulonephritis.PTS: 1 DIF: Cognitive Level: Remembering 6. Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria?a. Staphylococcus aureusb. Streptococcusc. Pseudomonas aeruginosad. HaemophilusANS: BAGN may be accompanied by a positive throat or skin culture for Streptococcus. AGN is not associated with any of the other organisms.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. A child with acute poststreptococcal glomerulonephritis is voiding smoky, brown-colored urine and asks the healthcare professional to explain what causes it. What explanation by the professional is best?a. Presence of red blood cellsb. Presence of urobilinogenc. Slough from the collecting tubulesd. Protein in the urineANS: AThe urine is usually smoky brown or cola-colored because of the presence of red blood cells. It is not due to urobilinogen, slough, or protein in the urine.PTS: 1 DIF: Cognitive Level: Understanding 8. In immunoglobulin G (IgG) nephropathies such as glomerulonephritis, IgG is deposited in which location?a. Juxtamedullary nephronsb. Glomerulus basement membranesc. Mesangium of the glomerular capillariesd. Parietal epitheliumANS: BIn IgG-mediated nephropathies, lumpy deposits of IgG and C3 complement are found on the glomerulus basement membranes. They are not deposited in any of the other sites.PTS: 1 DIF: Cognitive Level: Remembering 9. What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic-uremic syndrome (HUS)?a. Immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen, and remnants are excreted through the kidneys.b. Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells.c. Endotoxins from E. coli block the erythropoietin produced by the kidneys, which reduces the number of erythrocytes produced by the bone marrow.d. Failure of the nephron to filter urea increases the blood urea nitrogen, which binds to erythrocytes that are subsequently destroyed by the spleen.ANS: BIn HUS, verotoxin from E. coli is absorbed from the intestines, the glomerular arterioles become swollen, and these narrowed vessels damage erythrocytes as they pass through. HUS is responsible for causing a cascade of effects, including lysis of glomerular capillary endothelial cells. HUS is not caused by erythrocyte destruction, reduced erythrocytes, or an increased BUN.PTS: 1 DIF: Cognitive Level: Remembering 10. What is the first indication of nephrotic syndrome in children?a. Periorbital edemab. Scrotal or labial edemac. Frothy urined. AscitesANS: AOnset of nephritic syndrome is insidious, with periorbital edema as the first sign of the disorder. Scrotal or labial edema and ascites can be seen when edema becomes pronounced. Frothy urine is another sign, but usually not the first sign seen.PTS: 1 DIF: Cognitive Level: Remembering 11. Bacteria gain access to the female urinary tract by which means?a. Systemic blood that is filtered through the kidneyb. Bacteria traveling from the lymph adjacent to the bladder and kidneysc. Bacteria ascending the urethra into the bladderd. Colonization of the bladder when urine is staticANS: CUrinary tract infections (UTIs) in girls occur as a result of perineal bacteria, especially Escherichia coli, ascending the urethra. None of the other
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