Kidney Disease PDF

KIDNEY DISEASE Dr.Murtadha Kadhim The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute. what a kidney can do remove waste products from the bo...

KIDNEY DISEASE Dr.Murtadha Kadhim The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute. what a kidney can do remove waste products from the body. remove drugs from the body. balance the body's fluids. release hormones that regulate blood pressure. produce an active form of vitamin D that promotes strong, healthy bones. control the production of red blood cells. What are the first signs of kidney problems? Decreased urine output, although occasionally urine output remains normal. Fluid retention, causing swelling in your legs, ankles or feet. Shortness of breath. Fatigue. Confusion. Nausea. Weakness. Irregular heartbeat. What are the two most common causes of kidney disease? In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 3 out of 4 new cases. Macroscopic examination Colour - Normal- pale yellow in colour due to pigments urochrome,urobilin and uroerythrin. Cloudiness may be caused by excessive cellular material or protein, crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. If the sample contains many red blood cells, it would be cloudy as well as red. WHY TEST RENAL FUNCTION? To asses the functional capacity of kidney Early detection of possible renal impairment. Severity and progression of the impairment. Monitor response to treatment Monitor the safe and effective use of drugs which are excreted in the urine URINE ANALYSIS Urine examination is an extremely valuable and most easily performed test for the evaluation of renal functions. It includes physical or macroscopic examination, chemical examination and microscopic examination of the sediment. Volume - Normal- 1-2.5 L/day - Oliguria- Urine Output < 400ml/ day Seen in - Acute glomerulonephritis - Renal Failure - Polyuria- Urine Output > 2.5 L/ day Seen in - Increased water ingestion - Diabetes mellitus and insipidus. - Anuria- Urine output < 100ml/ day Seen in renal shut down BLOOD EXAMINATION Done to measure substance in blood that are normally excreted by kidney. Their level in blood increases in kidney dysfunction. As markers of renal function creatinine, urea, uric acid and electrolvtes are done for routine analysis. Serum creatinine Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body depending on muscle mass Creatinine is filtered but not reabsorbed in kidney. - Normal range is 0.8-1.3 mg/dl in men and 0.6-1 mg/dI in women. - Not increased above normal until GFR<50 ml/min Increased serum creatinine: - Impaired renal function - Very high protein diet - Anabolic steroid users - Vary large muscle mass: body builders, giants, acromegaly patients - Rhabdomyolysis/crush injury Blood urea - Urea is major nitrogenous end product of protein and amino acid catabolism, produced by liver and distributed throughout intracellular and extracellular fluid. - Urea is filtered freely by the glomeruli. - Many renal diseases with various glomerular, tubular, interstitial or vascular damage can cause an increase in plasma urea concentration. The reference interval for serum urea of healthy adults is 10-40 mg/dI. GLOMERULAR FUNCTION TESTS The GFR is the best measure of glomerular function. - Normal GFR is approximately 125 mL/min - When GFR decreases to 30% of normal> moderate renal insufficiency. Patients remain asymptomatic with only biochemical evidence of a decline in GFR As the GFR decreases further > severe renal insufficiency characterized by profound clinical manifestations of uremia and biochemical abnormalities, such as acidemia; volume overload; and neurologic, cardiac, and respiratory manifestations _ When GFR is 5% to 10% of normal =ESRD Thank you