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Pat h omechani s m s of the most important renal sympt oms a nd signs

Pat h omechani s m s of the most important renal sympt oms a nd signs. M. Tatár Ústav patologickej fyziológie JLF UK. The most frequent symptoms and signs of renal diseases. h emat u ria, lumbar pain , !protein u ria! p oly u ria and polydipsia , olig u ria a nd an u ria, d ysu ria

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Pat h omechani s m s of the most important renal sympt oms a nd 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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