Pat h omechani s m s of the most important renal sympt oms a nd signs
Download
1 / 20

Pat h omechani s m s of the most important renal sympt oms a nd signs - PowerPoint PPT Presentation


  • 139 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Pat h omechani s m s of the most important renal sympt oms a nd signs' - sinjin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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


Pathomechanisms of the most important renal symptoms and signs

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


Pathomechanisms of the most important renal symptoms and signs

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 …


Pathomechanisms of the most important renal symptoms and signs

Urinary tract disorders

renal colic

disuria

incontinence


Pathomechanisms of the most important renal symptoms and signs
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