Glomerular disease

Tubular and interstitial

disease
Azotemia

Pre-renal azotemia

Most are immunologically mediated

Most are caused by toxic or infections
- elevation of:
BUN
Creatinine
- decrease in GFR
- consequence of many renal disorders, and some extrarenal
- happens when theres hypoperfusion of the kidneys
caused by:
Hemorrhage
Shock
Volume depletion
CHF
- this hypoperfusion of the kidneys could impair renal
function in the absence of parenchymal damage

Post renal azotemia

Uremia

- seen when urine flow is obstructed

- term used when azotemia is associated with
costellation of S/Sx and biochemical abnormalities
- failure of renal excretory function, metabolic and
endocrine alteration

Peripheral neuropathy

- uremia in peripheral nerve

Uremic fibrinous
pericarditis
Nephrotic Syndrome
(NoS)

- uremia in the heart

Nephritic syndrome (NiS)

- due to glomerular disease

- dominated by acute onset of gross hematuria
- mild-moderate proteinuria and HPN
- classic presentation of acute post strep
glomerulonephritis
- NiS with rapid decline of GFR (hours to days)

Rapidly progressing
Glomerulonephritis
Acute renal failure

Due to glomrular disease

heavy proteinuria
hypoalbuminemia
severe edema
hyperlipidemia
lipiduria

- oliguria and anuria

- reduced or no urine flow

- recent onset of azotemia

- can result from injury of glomerulus, interstitial injury,
vascular and tubular injury
- rapid and reversible detoriation of kidney

Chronic renal failure

prolonged S/Sx of uremia

end result of chronic renal parenchymal disease
end result of variety of renal disease
major cause of death from renal disease

Renal tubular disease

- polyurea, nocturia and electrolyte disorders (m.

acidosis)
- can be caused by medullary cystic disease

UTI

- bacteriuria and pyuria (leukocytes in the urine)

- can be symptomatic or assymtomatic
- may result to nephritis or cystitis

Nephrolithiasis

- Renal stone
- manifested by:
Renal Colic - renal spasm of pain ()
Hematuria
Stone reccurence

Stages of chronic renal

failure

Stage

1 : Diminished renal reverse

GFR is 50% normal
BUN and creatinine are normal
Susceptible to developing anemia
Asymptomatic

Stage

2 : renal insufficiency
GFR is 20-50% normal
Azotemia appears, with anemia and HPN
Polyuria and nocturia are present

Stage 3: Chronic Renal Failure

Less than 20% normal GFR
Kidney cant regulate volume and solute
composition
Develops edema, hyperkalemia
With GIT, cardio, neuro complications
Stage 4: ESRD

CHRONIC
GLOMERULONEPHRITIS

Primary
glomerulonephritis
Secondary
glomerulonephritis

Nodular
Glomerulosclerosis

CHAPTER 20: The Kidney

GFR is less than 5% normal

Terminal stage

CHRONIC GLOMERULONEPHRITIS
- most common cause of chronic kidney disease in
humans
- only the kidney is involved
- glomerulonephritis that is caused by:
SLE
HPN
DM
Fabrys disease
Seen in DM