NURS 5461 RENAL 2 EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED
Differential Diagnosis of an Elevated Creatinine
determine the cause and if it is acute or chronic
history+exam, Labs /Diagnostics, ▪ UA ▪ CMP ▪ uric acid level ▪ CPK ▪ CBC ▪ Toxicology
▪ FeNa (Fractional excretion of sodium)-dont do in someone with diuretics, or FEurea
(Fractional Excretion of urea).▪ Renal US
o Renal Biopsy
▪ Generally indicated: • when the H&P, labs and diagnostics have ruled out prerenal and
post renal causes. • when intrarenal causes due to primary renal disease is felt to be
likely. • suspect glomerulonephritis
Proteinuria
Normal urinary protein excretion is <150mg/24 hours o Daily albumin excretion is a
normal person is < 30mg
Tubular Proteinuria
• Occurs as a result of a disease which affects the renal tubules/interstium of the kidney.
The normal protein associated with this type of proteinuria is beta-2 microglobulin. This
is normally absorbed by the proximal tubules. The amount is <2g and the dipstick may
be negative.
Overflow proteinuria
, Associated with an increased production of low molecular weight proteins such as light
chains in multiple myeloma or myoglobin in rhabdomyolysis. These proteins exceed the
reabsorption capacity of the tubules and spill into the urine. These proteins are toxic to
the tubules and can cause AKI.
Glomerular Proteinuria
(4 types) discussed as follows
Transient Proteinuria (glomerular)
Does not represent glomerular damage. It occurs in persons with normal renal function,
bland urine sediment, and normal blood pressure. The amount is less than one 1g/24
hours and usually occurs with fever or heavy exercise and disappears on repeat testing.
Laboratory Evaluation Transient Proteinuria
▪ UA with Microscopy on 3 different occasions ▪ Albumin to creatinine ratio or protein to
creatinine ration in a random urine sample ▪ UA from an early morning sample, before
the pt engages in physical activity
Orthostatic Proteinuria (glomerular)
Does not represent glomerular damage. This is diagnosed when the patient does not
have proteinuria upon rising in the morning but has it later in the day. Typically occurs in
tall, thin adolescents or adults less than 30y/o and is associated with severe lordosis.
Renal function is normal and the amount is < 1g/day
Lab evaluation orthostatic proteinuria
▪ Urine microscopy ▪ Split urine collection for protein on sample between 7-11am and
another between 11pm-7am
Non-Nephrotic Range Proteinuria (glomerular)
COMPLETE SOLUTIONS VERIFIED
Differential Diagnosis of an Elevated Creatinine
determine the cause and if it is acute or chronic
history+exam, Labs /Diagnostics, ▪ UA ▪ CMP ▪ uric acid level ▪ CPK ▪ CBC ▪ Toxicology
▪ FeNa (Fractional excretion of sodium)-dont do in someone with diuretics, or FEurea
(Fractional Excretion of urea).▪ Renal US
o Renal Biopsy
▪ Generally indicated: • when the H&P, labs and diagnostics have ruled out prerenal and
post renal causes. • when intrarenal causes due to primary renal disease is felt to be
likely. • suspect glomerulonephritis
Proteinuria
Normal urinary protein excretion is <150mg/24 hours o Daily albumin excretion is a
normal person is < 30mg
Tubular Proteinuria
• Occurs as a result of a disease which affects the renal tubules/interstium of the kidney.
The normal protein associated with this type of proteinuria is beta-2 microglobulin. This
is normally absorbed by the proximal tubules. The amount is <2g and the dipstick may
be negative.
Overflow proteinuria
, Associated with an increased production of low molecular weight proteins such as light
chains in multiple myeloma or myoglobin in rhabdomyolysis. These proteins exceed the
reabsorption capacity of the tubules and spill into the urine. These proteins are toxic to
the tubules and can cause AKI.
Glomerular Proteinuria
(4 types) discussed as follows
Transient Proteinuria (glomerular)
Does not represent glomerular damage. It occurs in persons with normal renal function,
bland urine sediment, and normal blood pressure. The amount is less than one 1g/24
hours and usually occurs with fever or heavy exercise and disappears on repeat testing.
Laboratory Evaluation Transient Proteinuria
▪ UA with Microscopy on 3 different occasions ▪ Albumin to creatinine ratio or protein to
creatinine ration in a random urine sample ▪ UA from an early morning sample, before
the pt engages in physical activity
Orthostatic Proteinuria (glomerular)
Does not represent glomerular damage. This is diagnosed when the patient does not
have proteinuria upon rising in the morning but has it later in the day. Typically occurs in
tall, thin adolescents or adults less than 30y/o and is associated with severe lordosis.
Renal function is normal and the amount is < 1g/day
Lab evaluation orthostatic proteinuria
▪ Urine microscopy ▪ Split urine collection for protein on sample between 7-11am and
another between 11pm-7am
Non-Nephrotic Range Proteinuria (glomerular)
