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Pathomechanisms of Renal Symptoms and Signs

This article discusses the most common symptoms and signs of renal diseases, including hematuria, lumbar pain, proteinuria, polyuria, polydipsia, oliguria, anuria, dysuria, edema, and renal encephalopathy. It also explains the pathomechanisms of glomerular disorders, tubular disorders, and urinary tract disorders.

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Pathomechanisms of Renal Symptoms and Signs

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  1. Pathomechanismsof the most important renal symptoms and signs M. Tatár Ústav patologickej fyziológie JLF UK

  2. The most frequent symptoms and signs of renal diseases • hematuria, lumbar pain, !proteinuria! • polyuria and polydipsia, oliguria and anuria, dysuria • edema, renal encephalopathy

  3. Glomerular disorders proteinuria hematuria

  4. Proteinuria • Prerenal higher plasmatic concentrations of low molecular proteins: tissue degradable products, proteins of acute phase (fever), myoglobin in rabdomyolysis, light immunoglubulin chains in myeloma • Glomerular  protein leak through GBM; selective, nonselective • Tubular  excretion of low-molecular proteins (1-microglobulin, 2-microglobulin) with  resorption in proximal tubule • pyuria and hematuria could mimic proteinuria

  5. Proteinuria • Healthy adult subject : 150 mg/24h plasma proteins proteinsfromurinary tract • Intensity 1g/24 h – small proteinuria 3.5 g/24 h - proteinuriaaccompanyingnephrotic syndrome (10-30 g/24 h)

  6. Hematuria • Renal glomerularorigin nonglomerular hematuria of renal origin (tumor bleeding, cysts) • Subrenal Mucosal hyperemia due toinflammation Bleeding from urinary tract: urolitiasis, tumors, trauma

  7. Tubular disorders oliguria polyuria glycosuria cystinuria edema

  8. Oliguria ( 500 ml/day) • Renal hypoperfusionin low blood pressure  hydrostatic pressure in glomerulus -  GFR Prerenal ARF • Desquamation of necrotic tubular epithelial cells  Na resorption – activation of TG mechanism tubular block leak of tubular fluid into the interstitium Intrarenal ARF (ischemic or toxic) • Block in urinary tractwith hydronephrosis Postrenal ARF • Uremia: vomiting, apathy, somnolence, foetor azotaemicus, acidotic breathing; laterbleeding, pericarditis, coma • Complications: hyperkalemia, lung and brain edema

  9. Polyuria with polydipsia • High liquid intake Hypervolemia: natriuresis; low ADH production • Osmotic diuresis proximal tubule disorders: low resorption of Na a glucose hyperglycemia: tubular maximum chronic renal insufficiency: residual nephrons (increased GFR in nephron, insufficient Na resorption, decreased medullar osmolality) • Diabetes insipidus Hypoosmolalurine ( 100 mOsm/1kg); risk of dehydration) • Late diuretic phase of ARF epithelial regeneration; risk of dehydration and hypokalemie

  10. Nephrotic syndrome • High proteinuria ( 3.5 g/1.73 m2/day) • Hypoproteinemia increased protein katabolism increasedtransfer into the extravascular space lostin stool insufficientproteosynthesisin liver • Hyperlipidemia increased synthesis in liver • Edema

  11. Edema • Subjects with hypovolemia and activation of RAA - (30%) - small glomerular abnormalities -clasic theory • Subjects with hypervolemiawithout RAA activation, lowrenin and aldosteron - more serious morphologicaldisorder - diabetic nephropathy, membranous glomerulonephritis - increased total Na reabsorption – resorption in distal tubule(hyposensitivity to atrial natriuretic peptide) - primary edema

  12. Izostenuria • Urine osmolality equal to plasma - disorder of countercarrent mechanism • Accompanied with negativeconcentration trial and polyuria= chronic renal insufficiency

  13. Uremia in CRI Fatique – anemia Anorexy, nausea, vomitus – metabolic breakup Foetor azotaemicus – bacterial breakdown of urea to ammonia Diarrheawith bleeding - uremic gastroenteritis Dyspnoe – heart failure, metabolic acidosis, anemia Headache, visual troubles – arterial hypertension Polydipsia Apathy,insomnia, delirium, coma – renalencephalopathy Pain and deformity inbones – renal osteodystrophy

  14. Uremic toxicity urea creatinin methylguanidine uric acide indol, fenol acetoin, buthylenglycol …

  15. Urinary tract disorders renal colic disuria incontinence

  16. Pain • Retroperitonealin lumbarregion hydronephrosis, cystic kidneys infarction pyelonephritis • Renalcolicwith hematuria ureter block with stone (increased peristalsis and dilatation) symptoms of acuteabdomen with peritonealirritation • Pain durin micturition (dysuria) cystitis, uretritis

  17. Acute nephritic syndrome face edema macroscopic hematuria oliguria hypertension

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