Difference between revisions of "Medical kidney diseases"

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re-arrange, more clinical
(re-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==
===Epithelium<ref name=Ref_PBoD956>{{Ref PBoD|956}}</ref>===
===Glomerular filtration rate===
*The glomeruli visceral epithelium is part of the capillary wall (part of the glomerular tuft).  
*Abbreviated ''GFR''.
*The parietal epithelium is part of Bowman's capsule.
*Ultimate measure of renal function.
Remember: '''v'''isceral has '''v'''essels.
*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).
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*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.


===Urine dip===
==Normal==
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>
===Epithelium<ref name=Ref_PBoD956>{{Ref PBoD|956}}</ref>===
*RBC casts = acute bleed, e.g. nephritic syndrome.
*The glomeruli visceral epithelium is part of the capillary wall (part of the glomerular tuft).  
*WBC casts = interstitial nephritis, e.g. pylonephritis, parenchymal infection.
*The parietal epithelium is part of Bowman's capsule.
*Hemegranular casts = acute tubular necrosis, transplant rejection.
Remember: '''v'''isceral has '''v'''essels.
 
====Urine crystals====
{{main|Crystals in body fluids}}


==Basic approach to renal biopsy==
==Basic approach to renal biopsy==
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