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Pat h omechani s m s of the most important renal sympt oms a nd signs. M. Tatár Ústav patologickej fyziológie JLF UK. The most frequent symptoms and signs of renal diseases. h emat u ria, lumbar pain , !protein u ria! p oly u ria and polydipsia , olig u ria a nd an u ria, d ysu ria

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pat h omechani s m s of the most important renal sympt oms a nd signs

Pathomechanismsof the most important renal symptoms and signs

M. Tatár

Ústav patologickej fyziológie JLF UK

the most frequent symptoms and signs of renal diseases
The most frequent symptoms and signs of renal diseases
  • hematuria, lumbar pain, !proteinuria!
  • polyuria and polydipsia, oliguria and anuria, dysuria
  • edema, renal encephalopathy
slide3

Glomerular disorders

proteinuria

hematuria

protein u ria
Proteinuria
  • Prerenal

higher plasmatic concentrations of low molecular proteins: tissue degradable products, proteins of acute phase (fever), myoglobin in rabdomyolysis, light immunoglubulin chains in myeloma

  • Glomerular

 protein leak through GBM; selective, nonselective

  • Tubular

 excretion of low-molecular proteins (1-microglobulin, 2-microglobulin) with  resorption in proximal tubule

  • pyuria and hematuria could mimic proteinuria
protein u ria1
Proteinuria
  • Healthy adult subject : 150 mg/24h

plasma proteins

proteinsfromurinary tract

  • Intensity

1g/24 h – small proteinuria

3.5 g/24 h - proteinuriaaccompanyingnephrotic syndrome (10-30 g/24 h)

hematuria
Hematuria
  • Renal

glomerularorigin

nonglomerular hematuria of renal origin (tumor bleeding, cysts)

  • Subrenal

Mucosal hyperemia due toinflammation

Bleeding from urinary tract: urolitiasis, tumors, trauma

slide9

Tubular disorders

oliguria

polyuria

glycosuria

cystinuria

edema

olig u ria 500 ml d ay
Oliguria ( 500 ml/day)
  • Renal hypoperfusionin low blood pressure

 hydrostatic pressure in glomerulus -  GFR

Prerenal ARF

  • Desquamation of necrotic tubular epithelial cells

 Na resorption – activation of TG mechanism

tubular block

leak of tubular fluid into the interstitium

Intrarenal ARF (ischemic or toxic)

  • Block in urinary tractwith hydronephrosis

Postrenal ARF

  • Uremia: vomiting, apathy, somnolence, foetor azotaemicus, acidotic breathing; laterbleeding, pericarditis, coma
  • Complications: hyperkalemia, lung and brain edema
poly u ria with polydipsi a
Polyuria with polydipsia
  • High liquid intake

Hypervolemia: natriuresis; low ADH production

  • Osmotic diuresis

proximal tubule disorders: low resorption of Na a glucose

hyperglycemia: tubular maximum

chronic renal insufficiency: residual nephrons (increased GFR in nephron, insufficient Na resorption, decreased medullar osmolality)

  • Diabetes insipidus

Hypoosmolalurine ( 100 mOsm/1kg); risk of dehydration)

  • Late diuretic phase of ARF

epithelial regeneration; risk of dehydration and hypokalemie

ne ph rotic syndr ome
Nephrotic syndrome
  • High proteinuria ( 3.5 g/1.73 m2/day)
  • Hypoproteinemia

increased protein katabolism

increasedtransfer into the extravascular space

lostin stool

insufficientproteosynthesisin liver

  • Hyperlipidemia

increased synthesis in liver

  • Edema
e dema
Edema
  • Subjects with hypovolemia and activation of RAA

- (30%)

- small glomerular abnormalities

-clasic theory

  • Subjects with hypervolemiawithout RAA activation, lowrenin and aldosteron

- more serious morphologicaldisorder

- diabetic nephropathy, membranous glomerulonephritis

- increased total Na reabsorption – resorption in distal tubule(hyposensitivity to atrial natriuretic peptide)

- primary edema

izosten u ria
Izostenuria
  • Urine osmolality equal to plasma

- disorder of countercarrent mechanism

  • Accompanied with negativeconcentration trial and polyuria= chronic renal insufficiency
ur e mia in cri
Uremia in CRI

Fatique – anemia

Anorexy, nausea, vomitus – metabolic breakup

Foetor azotaemicus – bacterial breakdown of urea to ammonia

Diarrheawith bleeding - uremic gastroenteritis

Dyspnoe – heart failure, metabolic acidosis, anemia

Headache, visual troubles – arterial hypertension

Polydipsia

Apathy,insomnia, delirium, coma – renalencephalopathy

Pain and deformity inbones – renal osteodystrophy

uremic toxicit y
Uremic toxicity

urea

creatinin

methylguanidine

uric acide

indol, fenol

acetoin, buthylenglycol …

slide18

Urinary tract disorders

renal colic

disuria

incontinence

slide19
Pain
  • Retroperitonealin lumbarregion

hydronephrosis, cystic kidneys

infarction

pyelonephritis

  • Renalcolicwith hematuria

ureter block with stone (increased peristalsis and dilatation)

symptoms of acuteabdomen with peritonealirritation

  • Pain durin micturition (dysuria)

cystitis, uretritis

a cute ne ph ritic syndr ome
Acute nephritic syndrome

face edema

macroscopic hematuria

oliguria

hypertension

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