MLAB 2401: Clinical Chemistry Keri Brophy-Martinez Pathophysiology of Renal Function

Glomerular Diseases Associated with damage to the glomeruli of the nephron Lead to tubular dysfunction Can be acute or chronic

Acute Glomerulonephritis (AGN) Characterized by rapid onset of symptoms that indicate damage to the glomeruli. Population affected includes children and young adults

Acute Glomerulonephritis (AGN) Causes of: AGN often follows a group A streptococcal infection Circulating immune complexes trigger an inflammatory response in the glomerular basement membrane Toxin/Drug-related exposures Acute kidney infections Systemic diseases

Acute Glomerulonephritis (AGN) Symptoms Hematuria Proteinuria Oliguria Fever Malaise Rapid Onset Edema Hypertension Sodium & water retention Laboratory Findings Decreased GFR Increased BUN & creatinine Hyaline, granular, RBC casts Increased protein in urine Blood in urine

Chronic Glomerulonephritis (CGN) Associated with the end stage of persistent glomerular damage Irreversible loss of renal tissue Can result in renal failure Symptoms of CGN include: edema, fatigue, hypertension, metabolic acidosis, proteinuria, decreased urine volume

Nephrotic Syndrome Causes of: Hallmark Complications of glomerulonephritis Circulatory disorders affecting kidneys Hallmark Increased permeability of glomerular basement membrane Allows for proteins & lipids to enter GFR

Nephrotic Syndrome Symptoms: Massive proteinuria (>3 g/day) Albuminuria (>1.5 g/day) Pitting edema Hyperlipidemia Hypoalbuminemia Lipiduria: oval fat bodies

Urinary Tract Infection Causes of: Pyelonephritis (kidneys) Acute: no permanent damage Chronic: permanent damage, possible renal failure Cystitis (bladder) Lab Findings Positive nitrite on dipstick Hematuria Pyuria WBC casts

Obstructions Causes of: Leads to chronic renal failure Renal calculi Calcium oxalate most common Tumors Urethral strictures Leads to chronic renal failure

Renal Failure Acute Sudden decline in renal function GFR < 10 mL/minute Caused by nephrotoxic agents, necrosis, hemorrhaging Hemolytic transfusions reactions Burns Cardiac failure Antifreeze ingestions

Renal Failure: Chronic (CKD) Gradual decline in function Associated with hypertension and diabetes Risk factors Autoimmune diseases Urinary tract and systemic infections Some medications Complications from CKD Anemia Hyperparathyroidism Vitamin D deficiency/insufficiency Mineral and bone disorders

Dialysis Method used to rid the body of waste products

References Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & Wilkins. Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson. Vassalotti, MD, J. A., & Kaufman, MD, H. W. (2013, July). New Guidelines to Evaluate and manage Chronic Kidney Disease. MLO, 24-26.