Renal I

Above presentations + systemic symptoms (abrupt onset, fever, chills, malaise, weight loss, flank or back pain)

Endogenous substance freely filtered, not reabsorbed, not secreted except at very high plasma concentrations.

Comes from skeletal muscle, and its production is fairly constant.

Invasive
(affects tubules and interstitium)

Pyelonephritis
Acute or chronic

Normal range 8~20 mg/ dL

Influenced by diet, dehydration, and GI tract bleeding.

Level rises, If the GFR decreases due to renal disease or decreased blood flow to kidney.

BUN/ Creatinine ratio is about 10/1
General screen for abnormal renal function

The flow rate of filtered fluid through the kidney.
Blood to lumen

The index of renal function

Regulated by PTH and Vitamin D3

Is distension & dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney. (caused by HTN)

Clinical manifestations:

Renal colic
Is excruciating pain caused by acute distention of the ureter
begins in the kidney area or below it and radiates through the flank until it reaches the bladder.

Hydronephrosis
Is progressive dilatation of the renal pelvis and calyces
Urinary tract infection (UTI)
Hypertension

Non-Pharmacologic Therapy
Aggressive hydration (washout phenomenon)
Cranberry juice or concentrate tablets
↓ recurrent, symptomatic UTI
Prevent bacteria from sticking to the walls
Acidification of urine
Vitamin C
Acidification of urine
Methenamine
Decompose at an acidic pH producing formaldehyde, which is toxic to most bacteria
Not enough data to support its use

Pharmacologic Therapy
Trimethoprim/sulfamethoxazole (TMP/SMX)
Seriously ill patients → IV therapy

To reabsorb bicarbonate from urine, and to excrete hydrogen ions into urine.

General characteristics
Is markedly increased in incidence in women because the short length of the female urethra.
Most frequently involves the normal flora of the colon, E. Coli (ascending routes)
Can be caused by hematogenous bacterial dissemination to the kidney.

Fructose polysaccharide – freely filtered, not reabsorbed or secreted; clinically, inulin clearance is the gold standard measure of GFR.

Second most common (15%)
Associated with bacterial infection (Urease-positive bugs such as Proteus Vulgaris, Streptococcus or Klebsiella)
Can form large staghorn (struvite) calculi

Antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and an increase in urine concentration.

An abnormal backward movement of urine from the bladder into ureters or kidneys.

Lumen to external environment.

Clinical presentation:
The pain with kidney stones is usually of sudden onset, very severe and colicky (intermittent), not improved by changes in position
Radiating from the back, down the flank, and into the groin
Hematuria (due to minor damage to inside wall of kidney, ureter and/or urethra)
Nausea and vomiting are common

Major complications:
Hydronephrosis
Urinary tract infection (due to obstruction of urine flow)
Renal damage
Hypertension

Diagnosis: X-ray, CT scan

Treatment: (1) increase fluid intake; (2) dietary modification; (3)extracorporeal (outside the body) lithotripsy (shock wave therapy); (4) surgery

The process by which solutes and water are removed from the tubular fluid and transported into the blood.

Lumen to blood

Predisposing factors
Obstruction of urinary flow
Surgery on the kidney or urinary tract
Catheters inserted through the urethra into the bladder
Gynecologic abnormalities

↑ frequency and urgency of urination
Suprapubic pain (e.g., cystitis)
Dysuria: painful urination or burning with urination (e.g., urethritis)
Nocturia: urination at night
Pyuria/Hematuria: Pus or blood in urine
Cloudy urine
Foul or strong urine odor

Host defense mechanisms include:
Micturition (urination) → flushing (washout phenomenon)
Protective mucus (coats bladder epithelial cells)
Local immune responses and IgA
Normal bacterial flora
Low urine pH (pH: 5~6)

May occur anywhere in the urinary system.
Is most often congenital in children, while it is most often acquired in adults.

Causes:
Pelvis (calculi, tumors, etc)
Ureter (calculi, inflammation, cancer of uterus, bladder cancer, etc)
Bladder outlet (BPH, prostate cancer, bladder cancer, spinal disease, etc)
Urethra (tumor, calculi, trauma, etc)

Non-invasive
(Superficial or mucosal)

Urethritis
Urethra
Cystitis
Bladder

Lost in nephrotic syndrome, resulting in albuminuria, proteinuria, generalized edema and hyperlipidemia.

Regulated by Aldosterone

The volume of plasma that is completely cleared each minute of any substance that finds its way into the urine.

Used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute.

Account for 70~80% of urinary stones (Most Common)
Are composed of calcium oxalate or calcium phosphate, or both
Caused by
Increased intestinal absorption of calcium
Increased primary renal excretion of calcium
Hypercalcemia (e.g., ↑ PTH or malignancy or ↑ Vitamin D)

(10%)
Strong association with hyperuricemia (e.g., gout)

Regulated by RAA system

The transfer of materials from peritubular capillaries to renal tubular lumen.

Blood to lumen.