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Difference between revisions of "Medical kidney diseases"
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Medical kidney diseases (view source)
Revision as of 03:10, 9 November 2010
, 03:10, 9 November 2010re-arrange, more clinical
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Kidney tumours are dealt with in the ''[[kidney tumours]]'' article. | Kidney tumours are dealt with in the ''[[kidney tumours]]'' article. | ||
==Normal== | ==Clinical== | ||
=== | ===Glomerular filtration rate=== | ||
* | *Abbreviated ''GFR''. | ||
* | *Ultimate measure of renal function. | ||
*Declines with age. | |||
*Normal range (dependent on age): 116-75 mL/min/1.73m<sup>2</sup>.<ref>URL: [http://www.kidney.org/professionals/KLS/gfr.cfm http://www.kidney.org/professionals/KLS/gfr.cfm]. Accessed on: 8 November 2010.</ref> | |||
===Creatinine=== | |||
*The standard screening test for renal function. | |||
*Dinosaurs use the units mg/dL; normal with these units is:<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm http://www.nlm.nih.gov/medlineplus/ency/article/003475.htm]. Accessed on: 8 November 2010.</ref> 0.8 to 1.4 mg/dL. | |||
*300 mmol/L is the general cut-point for referral to a nephrologist.<ref name=pmid>{{cite journal |author=Mendelssohn DC, Barrett BJ, Brownscombe LM, ''et al.'' |title=Elevated levels of serum creatinine: recommendations for management and referral |journal=CMAJ |volume=161 |issue=4 |pages=413–7 |year=1999 |month=August |pmid=10478168 |pmc=1230545 |doi= |url=http://www.cmaj.ca/cgi/content/full/161/4/413}}</ref> | |||
===Urine protein to creatinine ratio=== | |||
*Indicator of proteinuria. | |||
*Predictor of glomerular filtration rate.<ref name=pmid9501711>{{cite journal |author=Ruggenenti P, Gaspari F, Perna A, Remuzzi G |title=Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes |journal=BMJ |volume=316 |issue=7130 |pages=504–9 |year=1998 |month=February |pmid=9501711 |pmc=2665663 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665663/pdf/9501711.pdf}}</ref> | |||
Cut points:<ref>URL: [http://www.fpnotebook.com/urology/lab/urnprtntcrtnrt.htm http://www.fpnotebook.com/urology/lab/urnprtntcrtnrt.htm]. Accessed on: 8 November 2010.</ref> | |||
*Normal (2 years and older): <0.2 g protein / g Creatinine | |||
*Nephrotic range: >3.5 g protein / g Creatinine. | |||
===Urine dip=== | |||
Findings:<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/003586.htm http://www.nlm.nih.gov/medlineplus/ency/article/003586.htm]. Accessed on: 20 September 2010.</ref> | |||
*RBC casts = acute bleed, e.g. nephritic syndrome. | |||
*WBC casts = interstitial nephritis, e.g. pylonephritis, parenchymal infection. | |||
*Hemegranular casts = acute tubular necrosis, transplant rejection. | |||
====Urine crystals==== | |||
{{main|Crystals in body fluids}} | |||
==Clinical presentations== | ===Clinical presentations=== | ||
===Nephrotic syndrome=== | ====Nephrotic syndrome==== | ||
Features: | Features: | ||
*Anasarca (whole body - edema). | *Anasarca (whole body - edema). | ||
| Line 17: | Line 40: | ||
*Hypoalbuminemia. | *Hypoalbuminemia. | ||
===Nephritic syndrome=== | ====Nephritic syndrome==== | ||
Features - mnemonic ''PHAROH'':<ref>URL: [http://books.google.com/books?id=5bmg8xiLxkMC&pg=PA249&lpg=PA249&dq=Nephritic+syndrome+PHAROH#v=onepage&q=Nephritic%20syndrome%20PHAROH&f=false http://books.google.com/books?id=5bmg8xiLxkMC&pg=PA249&lpg=PA249&dq=Nephritic+syndrome+PHAROH#v=onepage&q=Nephritic%20syndrome%20PHAROH&f=false]. Accessed on: 9 December 2009.</ref> | Features - mnemonic ''PHAROH'':<ref>URL: [http://books.google.com/books?id=5bmg8xiLxkMC&pg=PA249&lpg=PA249&dq=Nephritic+syndrome+PHAROH#v=onepage&q=Nephritic%20syndrome%20PHAROH&f=false http://books.google.com/books?id=5bmg8xiLxkMC&pg=PA249&lpg=PA249&dq=Nephritic+syndrome+PHAROH#v=onepage&q=Nephritic%20syndrome%20PHAROH&f=false]. Accessed on: 9 December 2009.</ref> | ||
*Proteinuria. | *Proteinuria. | ||
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*Hematuria. | *Hematuria. | ||
===Mixed=== | ====Mixed==== | ||
*Features of nephritic syndrome and nephrotic syndrome. | *Features of nephritic syndrome and nephrotic syndrome. | ||
=== | ==Normal== | ||
===Epithelium<ref name=Ref_PBoD956>{{Ref PBoD|956}}</ref>=== | |||
* | *The glomeruli visceral epithelium is part of the capillary wall (part of the glomerular tuft). | ||
* | *The parietal epithelium is part of Bowman's capsule. | ||
Remember: '''v'''isceral has '''v'''essels. | |||
==Basic approach to renal biopsy== | ==Basic approach to renal biopsy== | ||