Kidney nontumor
General
Renal disease - general

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 12 September 2017, last major update April 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Renal disease nontumor

Table of Contents
Definition / general
Cite this page: Sangle, N. Renal disease - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyrenaldisease.html. Accessed October 20th, 2017.
Definition / general
  • 20% of women get urinary tract infections
  • 1% of Americans develop renal stones
  • Divided for analytical purposes into diseases of glomeruli, tubules, interstitium and vessels
  • Glomerular diseases tend to be immunologically mediated; tubular and interstitial disorders are often due to toxins / infections
  • Glomerular and tubular disease affect each other because glomerular disease impairs the tubular blood supply and increases tubular toxins and tubular disease causes increased intraglomerular pressure
  • Acute nephritic syndrome:
    • Grossly visible hematuria, hypertension, azotemia, oliguria, mild edema, red blood cell casts and variable proteinuria (Wikipedia: Nephritic syndrome)
    • Associated with postinfectious glomerulonephritis, early lupus, diffuse crescentic and membranoproliferative glomerulonephritis
  • Acute renal failure:
    • Abrupt anuria or oliguria with rapidly progressive azotemia identified by increase in BUN (blood urea nitrogen) or ammonia
  • Azotemia:
    • Increased serum BUN and creatinine due to reduced GFR (glomerular filtration rate)
    • Causes are prerenal (hemorrhage, shock, congestive heart failure, volume depletion), renal and postrenal (obstruction)
  • Chronic renal failure:
    • Azotemia progressing to uremia over a period of years
    • Stages of chronic renal failure:
      • Diminished renal reserve (GFR 50% normal) with normal BUN/creatinine
      • Renal insufficiency: azotemia, anemia, hypertension, polyuria and nocturia
      • Renal failure: GFR < 20% normal, kidneys cannot regulate volume of solutes and patient develops edema, metabolic acidosis and hypocalcemia
      • End stage renal disease: GFR < 5% normal, represents the end stage of various renal diseases
  • Nephrotic syndrome:
    • Proteinuria > 3.5 g/day, hypoalbuminemia (serum level < 3 g/dl), hyperlipidemia, lipiduria and severe edema (anasarca)
    • Due to derangement in glomerular capillary walls, which leads to increased permeability to plasma proteins, causing massive (nonselective) proteinuria, microhematuria in 50%, hypoalbuminemia and generalized edema (pitting, periorbital and dependent edema), hypertension in up to 25% and thrombotic tendency
    • Hyperlipidemia is due to increased lipoprotein synthesis and decreased catabolism
    • Lipiduria is due to leakage of lipoproteins with albumin
    • Patients are prone to staphylococcus and pneumococcal infections due to loss of immunoglobulins and factor B of complement
    • Thrombosis and thromboemboli are due to loss of anticoagulants such as antithrombin III and antiplasmin
    • Associated with minimal change disease (more common in children), focal and segmental glomerulosclerosis, membranous glomerulonephritis (more common in adults), systemic disease (SLE, diabetes, amyloidosis) and congenital nephrotic syndrome
  • Uremia:
    • Azotemia plus clinical signs / symptoms (gastroenteritis, peripheral neuropathy, fibrinous pericarditis, secondary hyperparathyroidism); associated with chronic renal failure
    • Tubular defects cause polyuria, nocturia and electrolyte disorders; due to diseases directly or indirectly affecting tubular function