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Etiology and risk factors

- The most common causes of CRF are diabetes mellitus and hypertension, which account for about two-thirds of the cases.

  • Diabetes Mellitus: Diabetes is the leading cause of chronic kidney disease worldwide. Prolonged high blood sugar levels in diabetes can damage the small blood vessels and filters in the kidneys, leading to impaired kidney function over time.
  • Hypertension (High Blood Pressure): Uncontrolled high blood pressure puts strain on the blood vessels in the kidneys, leading to their gradual deterioration and eventual failure.

- Other causes include:

  • Glomerulonephritis: This term refers to inflammation of the glomeruli, which are the tiny filters in the kidneys responsible for filtering waste and fluids from the blood. Chronic inflammation can lead to scarring and impaired kidney function.
  • Pyelonephritis: This is a type of kidney infection that, if left untreated or recurrent, can cause damage to the kidney tissues and impair their function.
  • Nephrosclerosis: This condition involves the hardening and narrowing of the blood vessels in the kidneys, often caused by high blood pressure or aging. The reduced blood flow can damage the kidney tissues and lead to CRF.
  • Renal Calculi (Kidney Stones): When kidney stones block the flow of urine and cause repeated obstructions, they can damage the kidneys and lead to chronic kidney disease.
  • Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can affect various organs, including the kidneys. Immune system abnormalities may cause inflammation and damage to kidney tissues.
  • Aminoglycosides: These are a class of antibiotics that, when used inappropriately or at high doses, can be toxic to the kidneys and lead to CRF.
  • Hyperparathyroidism: Overactive parathyroid glands can disrupt calcium and phosphorus balance in the body, leading to kidney damage over time.

- Risk Factors for Developing CRF:

  • Older Age: As people age, the risk of developing chronic kidney disease increases. The kidneys naturally undergo some decline in function with age.
  • Family History: A family history of kidney disease may increase an individual's risk of developing CRF, indicating a possible genetic predisposition.
  • Smoking: Smoking has been linked to the progression of kidney disease, as it can worsen blood vessel damage and decrease blood flow to the kidneys.
  • Obesity: Obesity is associated with an increased risk of diabetes and hypertension, both of which are major causes of CRF.
  • Dyslipidemia: Abnormal levels of lipids (cholesterol and triglycerides) in the blood can contribute to kidney damage and the progression of CRF.
  • Cardiovascular Disease: Conditions like heart disease and atherosclerosis can affect kidney health due to decreased blood flow and increased strain on the kidneys.
  • Exposure to Nephrotoxins: Certain medications, environmental toxins, and substances like heavy metals can be harmful to the kidneys and contribute to CRF development.

Questions on Etiology and risk factors

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.QUESTIONS

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.QUESTIONS

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.

Correct Answer is A

Explanation

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

Correct Answer is D

Explanation

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 concentrating, and muscle cramps.

Correct Answer is D

Explanation

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.

Correct Answer is C

Explanation

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.QUESTIONS

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.QUESTIONS

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.

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.

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 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.QUESTIONS

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.Questions
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