Choice A is correct. Acute pyelonephritis is a consequence of untreated cystitis. This produces symptoms similar to cystitis in addition to manifestations of flank pain, fever, and dehydration. Massive amounts of proteinuria are a classic manifestation associated with nephrotic syndrome.

Choice C is correct. A 24-hour urine collection is not necessary to diagnose bacterial cystitis. A simple single specimen, urine analysis (UA), would be evaluated to determine if the client has cystitis.

Choice E is correct. Diabetic nephropathy can be prevented by tight glycemic control reflected in the hemoglobin A1C. The higher the A1C equates to more complications such as diabetic nephropathy. This statement is incorrect and warrants follow-up.

Choice B is incorrect. The cause of AKI may be multifactorial, including exposure to nephrotoxic medications (NSAIDs, aminoglycosides).

Choice D is incorrect. PKD is a genetic disorder causing cysts to develop on the affected kidney and may rupture, producing pain and hematuria. This would be an expected finding with PKD.

✓ Pyelonephritis

Pyelonephritis can be divided into either acute or chronic. In acute pyelonephritis, a pathogen ascends the urinary tract causing the client to experience manifestations similar to cystitis as well as fever, tachycardia, and flank pain. Treatment is aggressive antibiotics, hydration, and sometimes hospitalization, depending on its severity.

✓ Acute Kidney Injury

Acute kidney injury (AKI) is a condition caused by hypotension, nephrotoxic medications, or trauma. Treatment is the underlying cause and prevents complications such as chronic kidney disease progression. Nursing care involves administering prescribed intravenous fluid challenges, daily weights, and dietary measures to reduce sodium and potassium.

✓ Bacterial Cystitis

Bacterial cystitis is also known as a bladder infection. E. coli is the offending pathogen in this condition. Treatment is antibiotics, hydration, and avoiding bladder irritants (caffeine, alcohol).

✓ Polycystic Kidney Disease

Polycystic Kidney Disease is a genetic disorder manifested by fluid-filled cysts that grow on the kidneys. Findings in PKD include abdominal or flank pain, hypertension, and hematuria during cyst rupture. The only effective cure for PKD is a kidney transplant. The disease may be treated with ACE inhibitors and dietary modifications (increased sodium intake and the beginning and then decreased as the disease progresses).

✓ Diabetic Nephropathy

Diabetic nephropathy is a vascular complication associated with diabetes mellitus. Its cause is triggered by poor diabetes management which is evidenced by an increased hemoglobin A1C (goal is to be less than 7% for those with diabetes). Treatment is thorough education on diabetes management through lifestyle modifications. ACE inhibitors are quite effective in treating this disorder.