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Disorders of the kidney.
Urine analysis.
Nephrotic and nephritic
syndrome.
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Azotemia and Urinary
Abnormalities
Disturbances in urine volume→oliguria,
anuria, polyuria
Abnormalities of urine sediment→ red blood
cells (RBC), white blood cells, casts, and
crystals
Abnormal excretion of serum proteins→
proteinuria
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Azotemia and Urinary
Abnormalities 2
Reduction in glomerular filtration rate
(GFR)→ azotemia
Presence of hypertension and/or expanded
total body fluid volume→ edema
Electrolyte abnormalities
Nonconcentrated or concentrated urine→
isosthenuria = isoosmotic with plasma
Fever/pain in some syndromes
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Assessment of glomerular
filtration rate
Serum creatinine level↑→ GFR↓
GFR< 15 mL/min→symptomatic uremia←
acute or chronic renal injury
BUN↑→ azotemia← retention of nitrogenous
waste products
Prerenal, renal, postrenal→ azotemia
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Prerenal Failure
Circulating blood volume↓→ GI bleeding,
burns, diarrhea, diuretics
Effective arterial volume↓→ sepsis,
cardiogenic shock
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Postrenal Azotemia
Urinary tract obstruction→renal pelvic dilatation
Benign prostatic hyperplasia
Cancer of prostate
Cancer of bladder
Calculi
Carcinoma of uterusm colon, rectum
Lymphoma
Accidental surgical ligation
Retroperitoneal fibrosis
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Intrinsic Renal Disease
Acute tubular necrosis (ATN)
Drug-induced interstitial nephritis (NSAIDs)
Severe infections→ sepsis
Systemic diseses→ SLE
Infiltrative disorders→ lymphoma, leukemia
Diseases of glomeruli→ glomerulonepritis
(GN), vasculitis
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Oliguria and Anuria
Oliguria← 24-h urine output of <500 mL
Anuria← complete absence of urine formation
(<50 mL)
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Proteinuria
Dipstick examination
Sulfosalicylic acid or trichloracetic acid precipitation
Glomerular proteinuria
Normal: <150 mg/d of total protein in the urine
Total daily excretion of protein >3.5 g→ nephrotic
syndrome
Multiple myeloma: excreted light chains in the
urine→ Bence-Jones protein
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Hematuria, Pyuria, and Casts
Isolated hematuria→ bleeding from the urinary
tract← stones, neoplasms
Hematuria→ 2-5 RBCs per high-power field
microscope
Dipstick
Gross hematuria with blood clots← postrenal source
Hematuria+pyuria+bacteriuria→ infection→
appropriate culture→ antibiotics
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Hematuria, Pyuria, and Casts 2
Isolated microscopic hematuria→ glomerular
disease→ IgA nephropathy, thin basement
membrane disease← renal biopsy
Hematuria with dysmorphic RBCs + RBC
casts + protein excretion >500 mg/d→
glomerulonephritis
Pyuria + bacteria +WBC casts→
pyelonephritis
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Polyuria
>3 L/d
24-h urine collection
Urine osmolality
Diabetes mellitus
Diabetes insipidus
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Glomerular Diseases
2 kidneys→ 1.8 million glomerular capillary
tufts
Glomerular capillaries filter 120-180 L/d of
plasma water
Inflammation of the glomerular
capillaries→glomerulonephritis
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Glomerular Syndromes
1. Acute Nephritic Syndromes
Poststreptococcal GN
Subacute bacterial endocarditis
Lupus nephritis
IgA nephropathy
ANCA small-vessel vasculitis
Membranoproliferative GN
Mesangioproliferative GN
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Glomerular Syndromes
2. Pulmonary-Renal Syndromes
Goodpasture´s syndrome
ANCA small-vessel vasculitis
Henoch-Schönlein purpura
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Glomerular Syndromes
3. Nephrotic Syndromes
Minimal change disease
Focal segmental glomerulosclerosis
Membranous GN
Diabetic nephropathy
Amyloidosis
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Glomerular Syndromes
4.Basement Membrane Syndromes
Anti-GBM disease
Thin basement membrane disease
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Glomerular Syndromes
5. Glomerular Vascular Syndr.-s
Atheroscleroticnephropathy
Hypertensive nephropathy
Antiphospholipid syndrome
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Glomerular Syndromes
6.Infectious Disease-Associated S.
HIV
Hepatitis Band C
Syphilis
Malaria
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Nephrotic syndrome
Heavy nonselective proteinuria, minimal hematuria,
hypoalbuminemia, hypercholesterolemia, edema,
hypertension
Renal failure
Renal vein thrombosis, pulmonary embolism, deep
vein thrombosis incidence↑→ anticoagulation
Treatment: Steroids+ Cyclophosphamide or
Cyclosporine or Mycophenolate or anti-CD20 Ab
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Lupus nephritis
Complication of SLE
Proteinuria, hematuria, hypertension, renal
failure, RBC casts
Renal biopsy
Treatment: high-dose Steroids +
Cyclophosphamide or Mycophenolate mofetil
for 2-6 months