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

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

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

4. 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

5. 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

6. 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

7. 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

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

9. 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

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

11. 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

12. 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

13. Dialysis
Method used to rid the body of waste products

14. 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,