Renal Diseases II PDF

Renal Diseases II Fatima Yousuf Mohamed MSc Clinical Chemistry Objectives To discuss the causes, clinical features and lab results obtained in each of the following kidney diseases: Renal Tubular Acidosis Nephrogenic Diabetes insipidus Fanconi's Syndrome Renal Calcu...

Renal Diseases II Fatima Yousuf Mohamed MSc Clinical Chemistry Objectives To discuss the causes, clinical features and lab results obtained in each of the following kidney diseases: Renal Tubular Acidosis Nephrogenic Diabetes insipidus Fanconi's Syndrome Renal Calculi Acute Renal Failure Chronic Renal Failure Tubular Diseases Tubular defects results in decreased excretion/reabsorption of certain substances or reduced urinary concentrating capability. Such as: Renal Tubular Acidosis (RTA) Nephrogenic Diabetes Insipidus (NDI) Fanconi's Syndrome Renal Tubular Acidosis (RTA) Clinically, is the most important type. Inherited and acquired disorders. Affecting either proximal or distal convoluted tubules. They are the result of either failure to retain bicarbonate, or inability of the tubules to secrete hydrogen ions. Renal Tubular Acidosis (RTA) Cont… Classified depending on the nature of the tubular defect in to: Distal RTA (type l), characterized by impaired hydrogen ion excretion and the urine cannot be acidified. Proximal RTA (type ll), in which there is decreased bicarbonate reabsorption, resulting in acidosis. Type lv ( hyperkalaemic ) RTA, which is secondary to aldosterone resistance or deficiency. Nephrogenic diabetes insipidus (NDI) Is a disorder characterized by excessive thirst and excretion of large amounts (increase in urine out put) of severely diluted urine, due to insensitivity of the kidney tubules to Antidiuretic hormone (ADH). Fanconi's syndrome Is an inherited or acquired disorders of renal tubular function resulting in: Generalized aminoaciduria Glycosuria Phosphaturia Acidosis Renal calculi (kidney stones) Formed by the combination of various crystallized substances. Caused by decreased fluid intake, dehydration, and saturation of the urine with large amounts of essentially insoluble substances. Can cause obstruction, hematuria, urinary tract infections, and characteristic abdominal pain. Types of renal calculi Calcium Oxalate: caused by hyperparathyroidism, calciuria,vitamin D toxicity, and osteoporosis. Calcium phosphate: caused by excess alkali consumption, and infection with urease producing organisms. Uric acid: caused by gout, and hyperuricemia. Magnesium ammonium phosphate: caused by infectious processes. Cystine: caused by inherited cystinuria. Renal failure Classified according to rate of kidney damage to: Acute renal failure Chronic renal failure Acute Renal Failure Is a sudden, sharp decline in renal function as a result of an acute toxic or hypoxic harm to the kidneys. Diagnosed when excretory kidney function declined over hours to days. Reversible (recovery), or may progress to chronic renal failure. Acute Renal Failure Cont… Is subdivided into three types: Pre-renal failure (defect before the kidney). Primary or intra renal failure (defect in the kidney). Post-renal failure (defect after the kidney). Pre-renal failure Results from reduced blood flow to the kidney due to: Hypovolemia as in: haemorrhage, dehydration, shock. Decreased cardiac out put as in: congestive cardiac failure. Primary (intra) renal failure The defect involves the kidney caused by: Acute glomerulonephritis Acute tubular necrosis Heavy metal/solvent poisoning. Analgesic and aminoglycoside toxicities. Post-renal failure The defect lies in the urinary tract after it exits the kidney caused by: Calculi Prostatic enlargement Tumors of the bladder and prostate Clinical features and lab finding Oliguria and anuria Decreased ability to excrete electrolytes and water result in significant increase in extracellular fluid volume, leading to peripheral edema, hypertension, and congestive heart failure. Elevated BUN and serum creatinine. Pre-Renal vs. intra renal Failure Intra-Renal Pre-Renal > 40 mmol/l < 20 mmol/l Urinary sodium concentration < 1.1 > 1.4 Urine/plasma osmolality ratio < 10 > 14 Urine/plasma urea ratio  Chronic Renal Failure Chronic kidney disease (CKD) Is a clinical syndrome that occurs when there is a gradual decline in renal function over time. Irreversible Caused by: Un controlled diabetes mellitus and hypertension Chronic glomerulonephtitis, and inflammatory diseases e.g pylelonephritis Radiation nephritis Renal obstruction Polycystic kidney disease Clinical features and lab finding Polyuria Hypertension Nausea and vomiting Muscle and bone weakness Abnormal levels of Na, K, Ca and PO4 Anaemia Metabolic acidosis Stages of Chronic Kidney Disease GFR (ml/min/1.73) Description Stage ≥ 90 (with risk At increased risk factors) > 90 Kidney damage with 1 normal GFR 60–89 Kidney damage with 2 mildly ↓ GFR 30–59 Moderate ↓ GFR 3 15–29 Severe ↓ GFR 4 < 15 Kidney failure 5 Seminar Renal replacement therapy Thank you