Normal kidney functions occur through numerous cellular processes to maintain body homeostasis. Disturbances in any of those functions can lead to a constellation of abnormalities that may be detrimental to survival. The clinical manifestations of those disorders depend on the pathophysiology of the renal injury and often are identified initially as a complex of symptoms, abnormal physical findings, and laboratory changes that together make possible the identification of specific syndromes. These renal syndromes (Table 44-1) may arise as a consequence of a systemic illness or can occur as a primary renal disease. Nephrologic syndromes usually consist of several elements that reflect the underlying pathologic processes. The duration and severity of the disease affect those findings and typically include one or more of the following: (1) reduction in glomerular filtration rate (GFR) (azotemia), (2) abnormalities of urine sediment [red blood cells (RBC), white blood cells, casts, and crystals], (3) abnormal excretion of serum proteins (proteinuria), (4) disturbances in urine volume (oliguria, anuria, polyuria), (5) presence of hypertension and/or expanded total body fluid volume (edema), (6) electrolyte abnormalities, (7) in some syndromes, fever/pain. The combination of these findings should permit identification of one of the major nephrologic syndromes (Table 44-1) and will allow differential diagnoses to be narrowed and the appropriate diagnostic evaluation and therapeutic course to be determined. All these syndromes and their associated diseases are discussed in more detail in subsequent chapters. This chapter focuses on several aspects of renal abnormalities that are critically important for distinguishing among those processes: (1) reduction in GFR leading to azotemia, (2) alterations of the urinary sediment and/or protein excretion, and (3) abnormalities of urinary volume.
Table 44-1 Initial Clinical and Laboratory Data Base for Defining Major Syndromes in Nephrology |Favorite Table|Download (.pdf)
Table 44-1 Initial Clinical and Laboratory Data Base for Defining Major Syndromes in Nephrology
|Syndromes||Important Clues to Diagnosis||Findings That Are Common||Location of Discussion of Disease-Causing Syndrome|
|Acute or rapidly progressive renal failure|
Documented recent decline in GFR
|Chaps. 279, 283, 285, 289|
Hematuria, RBC casts
|Chronic renal failure|
Azotemia for >3 months
Prolonged symptoms or signs of uremia
Symptoms or signs of renal osteodystrophy
Kidneys reduced in size bilaterally
Broad casts in urinary sediment
|Chaps. 278, 280|
Proteinuria >3.5 g per 1.73 m2 per 24 h
|Asymptomatic urinary abnormalities|
Proteinuria (below nephrotic range)
Sterile pyuria, casts
|Urinary tract infection/pyelonephritis|
Bacteriuria >105 colonies per milliliter
Other infectious agent documented in urine
Pyuria, leukocyte casts
Bladder tenderness, flank tenderness
|Renal tubule defects|
Renal transport defects
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