Renal Failure occurs when the kidneys aren’t functioning as they should. You may think that, as a Respiratory Therapist, learning about the kidneys isn’t all that important. This couldn’t be further from the truth.

Did you know that renal failure has significant effects on the cardiopulmonary system?

That is exactly what this study guide is all about. It provides an overview and contains practice questions that are designed to help you learn more about this topic. So if you’re ready, let’s get started.

What is Renal Failure?

Renal Failure occurs when kidneys stop working or aren’t functioning as they should. There are several causes of kidney failure. Here are some examples:

  • Lack of blood flow to the kidneys
  • High blood pressure
  • Diabetes
  • Glomerulonephritis
  • Polycystic kidney disease
  • Kidney stones

Again, there are many potential causes of renal failure. These are just some examples for you to reference.

Renal Failure Practice Questions:

1. What is renal failure?
The inability to maintain fluid, electrolytes, and acid-base balance, excrete waste products, maintain metabolic functions

2. What is acute renal failure?
It is a decrease in creatinine clearance over several days which often has symptoms and many causes.

3. What is chronic renal failure?
It is chronic kidney disease. It is slow, steady deterioration of renal functions that is usually due to diabetes or hypertension. You will only see symptoms in severe stages.

4. What is the composition of the blood largely determined by?
It is determined by what the kidneys retain and excrete.

5. How do you treat chronic renal failure?
You should treat the symptoms with dialysis and antihypertensives.

6. What is dialysis?
It is a procedure for filtering the blood in place of kidney function. It also maintains fluid status, pH and remove nitrogenous waste.

7. What is hemodialysis?
Blood goes through a dialyzer which is a semipermeable membrane filter.

8. What is the function of the kidneys?
It filters dissolved particles from the blood. It also selectively reabsorbs substances needed to maintain normal composition of body fluids. It is where urine is formed.

9. What are the cardiopulmonary problems when the kidneys fail?
Hypertension, CHF, pulmonary edema, anemia, and pH changes.

10. What are nephrons?
They are the functional units of the kidneys. Each kidney has 1 million nephrons. It consists of glomerulus, proximal convoluted tubule, loop of Henle, and distal convoluted tubule. It is where urine is formed.

11. What are the 3 things involved in urine formation?
Glomerular filtration, tubular reabsorption, and tubular secretion.

12. What is glomerular filtration?
Water and dissolved substances (electrolytes) forced out of glomerular capillaries into Bowman’s capsule. The rate of filtration (GFR) is directly proportional to hydrostatic pressure of the blood. About 125 mL of fluid/min is filtered (but only 1 mL/min is excreted).

13. What is the glomerular filtration rate?
The rate at which water and dissolved substances (electrolytes) are forced out of the glomerular capillaries into the Bowman’s capsule. This rate is directly proportional to hydrostatic pressure of the blood. The normal rate is 125 mL/min. GFR is the best overall index of kidney function. Normal GFR varies according to age, sex, and body size, and declines with age. The National Kidney Foundation recommends using the CKD-EPI Creatinine Equation (2009) to estimate GFR.

14. Why are there 2 sets of arterioles in the blood flow of the kidneys?
There are 2 sets of arterioles in the kidney blood flow (the afferent arterioles and efferent arterioles) because arterioles help regulate blood pressure in the glomerulus so that it is just right for glomerular filtration. Arterioles are resistance vessels. They can vasodilate or vasoconstrict to adjust blood pressure. The rate of filtration is directly proportional to the hydrostatic pressure of the blood.

15. What are the 2 ways the kidneys can concentrate or dilute urine?
Countercurrent mechanism and selective permeability.

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16. What ions that the kidneys help to regulate?
Sodium, potassium, calcium, magnesium, and phosphate.

17. What is the kidney?
They filter dissolved particles from the blood and resorb the substances needed. It is the 2 bean-shaped organs in posterior wall of abdominal cavity. They are 12 cm long x 6 cm wide (5 in long x 2 1/2 in wide).

18. What is the hilum?
Medially, in the central concave portion of each part of the kidney. It has a longitudinal fissure. The renal artery, renal vein, and nerves enter and leave kidneys through the hilum.

19. What are the ureters?
Transport urine from the kidney to the bladder, also exist the kidneys through the hilum.

20. What is the cortex?
The outer one-third of the kidney is a dark brownish red layer.

21. What is the medulla?
Middle two-third of the kidney and be a light-colored layer.

22. How is blood supplied to the kidneys?
From right and left renal arteries are main blood supply to kidneys. It enters through hilum of kidney.

23. What are the collecting ducts?
A functional part of the nephron because of their role in urine concentration, ion salvaging, and acid-base balance.

24. What is glomerular filtration?
Water and dissolved substances (i.e. electrolytes) are forced out of the glomerular capillaries by blood pressure (hydrostatic pressure). Rate of filtration is directly proportional to the hydrostatic pressure of blood.

25. What is tubular reabsorption?
Glomerular filtrate passes through proximal through convoluted tubule, loop of Henle, and distal convoluted tubule. Water, sodium, glucose and other substances enter blood.

26. What is tubular secretion?
Various substances are transported from plasma to renal tubule. Substances transported include hydrogen ion H+ and K+.

27. What is sodium?
It is controlled by the regulating of water in the body.

28. What happens when there is low potassium?
causes muscle weakness, diarrhea, metabolic alkalosis, cardiac arrhythmias

29. What happens when there is high potassium?
It causes muscle weakness, metabolic acidosis, and life-threatening arrhythmias. High potassium corrected by excreting more.

30. What is the regulation of acid-base?
Extracellular fluids to acidic and kidneys excrete hydrogen ions. Also, fluid too alkaline which kidney excrete bicarbonate.

31. What is the correlation between mechanical ventilation and renal failure?
Increased pressure during mechanical ventilation decrease venous return to heart, pressure and blood volume in atria decreased, trigger more ADH to be released, and amount of urine produced decreases.

32. What is the Bowman’s capsule?
It collects filtrate from glomerulus.

33. What is the glomerulus?
It squeezes fluid (water, glucose, salts, and urea) out of blood into Bowman’s Capsule.

34. What is the proximal convoluted tubule?
Osmoregulation where most of the glomerular filtrate is reabsorbed.

35. What is the Loop of Henle?
It concentrates the filtrate and allows diffusion of salts and water back into blood.

36. What is the distal convoluted tubule?
It filters out sodium, potassium, and calcium.

37. What is the collecting duct?
It collects urine to be excreted.

38. What is the renal artery?
Blood vessel that carries blood to the kidney.

39. What is the renal vein?
Blood vessel that carries blood away from the kidney and toward the heart.

40. What is the renal pelvis?
Collection site for urine before it exits kidney.

41. What is the afferent arteriole?
It carries blood toward glomerulus.

42. What is the efferent arteriole?
It carries blood out of glomerulus.

43. What is the renal cortex?
It is the outer layer of kidney.

44. What is the renal medulla?
The whole inner portion of kidney.

45. What is osmolarity?
Concentration of potential osmotically active atoms.

46. What is permeable to the descending limb of the loop of Henle?
Water as osmolarity pulls water out.

47. What is permeable to the ascending limb of the loop of Henle?
Na+ as electrochemical gradient pulls sodium out.

48. Where is ADH released?
Posterior pituitary.

49. How does ADH work?
Changes the permeability of the later distal tubule, collecting duct and the medullary collecting duct. Aquaporin permeability in CD and LDT. And urea transport in medullary CD.

50. What happens when ADH is low?
The collecting duct is impermeable to water, so water must be excreted, and high-volume dilute urine is produced.

51. What happens when ADH is high?
The distal tubule and collecting duct are made permeable to water and urea.

52. What is the function of aldosterone?
It causes the kidney to conserve sodium and water.

53. What does it mean if there is an increase in sodium and water?
Increase in blood volume.

54. What do you call the increase in sodium and water along with hormones and everything else?
Renin-angiotensin-aldosterone system (RAAS).

55. In what is the RAAS important in the management of?
Heart failure

56. What is the effect of the increased sympathetic activity and presence of angiotensin II?
It causes pituitary gland to release anti-diuretic hormone.

57. What is the function of ADH?
It causes kidney to conserve water, increasing blood volume and vasoconstriction.

58. What governs blood flow to tissue?
Intrinsic factors.

59. What governs arterial blood pressure?
Extrinsic mechanisms.

60. Give some examples of intrinsic controls?
Metabolic control and paracrine control.

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61. What is active hyperemia?
The increase in organ blood flow that is associated with increased metabolic activity of a tissue or organ.

62. What also increases if the metabolic rate in a tissue?
O2 consumption, production of waste product, and potassium outflow.

63. What does oxygen do to blood vessels in systemic circulation?

64. What happens to the diameter of blood vessels when there is decreased oxygen?
Increases = vasodilation.

65. What is the effect of vasodilation of blood vessels within systemic circulation due to decreased oxygen?
Increases blood supply to the area.

66. What is the effect of vasodilation of the arterioles?
Opening of more capillaries.

67. What breathing pattern is present during renal failure?
Kussmaul breathing.

68. What breath sounds are present during renal failure?
Crackles are likely, especially if the patient also has CHF.

69. What is the expected fluid output for someone with renal failure?
Less than 500 mL per day.

70. Which blood test is helpful in diagnosing renal failure?
Creatinine levels.

Final Thoughts

So there you have it. That wraps up our study guide on renal failure and how it affects the cardiopulmonary system. If you go through these practice questions again and again, you can easily develop a good understanding of this topic.

We also have a guide on Congestive Heart Failure (CHF) that I think will benefit you. Thank you so much for reading and as always, breathe easy my friend. 

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The following are the sources that were used while doing research for this article:

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
  • Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019. [Link]
  • Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
  • “Chronic Kidney Disease and Its Complications.” National Center for Biotechnology Information, June 2008,
  • “Cardiovascular Risk Factors and Incident Acute Renal Failure in Older Adults: The Cardiovascular Health Study.” National Center for Biotechnology Information, Mar. 2008,
  • “Cardiovascular Disease in Patients with Chronic Kidney Disease: A Neglected Subgroup.” National Center for Biotechnology Information, 2016,

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