Syndroms of kidney

Question 1

what are the Kidney Disease Syndromes

Answer 1

• 1. urinary syndrome
• 2. renal colic
• 3. renal arterial hypertension
• 4. nephrotic syndrome
• 5. nephritic syndrome
• 6. acute renal failure
• 7. chronic renal failure
• 8. urinary tract inflammation syndrome

Question 2

explain the Urinary syndrome , causes , clinical minfsatation

Answer 2

–causes :
1 - acute and chronic glomerulonephritis;
2 - pyelonephritis;
3 - interstitial nephritis;
4 - diabetic nephropathy;
5 - amyloidosis;
6 - kidney tuberculosis

– clinical minfsatation:
* Clinical manifestation: latent course, no complaints.
* Blood pressure within normal limits or slightly increased;
* Urine tests:
* Hematuria (commonly microhematuria)
* Leucocyturia
* Proteinuria (< 3 g/24 h)

Question 3

explain the Renal colic syndrom , DF , Mechanism of pain , Clinical manifestations , Characteristic signs of renal colic , Diagnosis ,Complications

Answer 3

–DF : is manifested by pain due to obstruction of the upper urinary tract (calyces of the kidney, pelvis and ureters). More common in men.
-The main reason is obstruction of the urinary system:
* urolithiasis,
* calculous pyelonephritis.
–Mechanism of pain:
* overflow of the pyelocaliceal system with urine above the site of occlusion,
* increased pressure in the renal pelvis,
* impaired blood circulation in the kidney
* muscle spasm
* local inflammation and swelling at the site of obstruction
—Clinical manifestations:
1-A sudden attack of pain in the lumbar region, provoked by physical exertion
2-Nature of pain: acute
* Spreading: to the entire corresponding half of the abdomen, radiating to the inguinal region.
* The patient is constantly changing position.
* Duration: from several hours to a day
* Accompanied by: nausea, vomiting, frequent painful urination, stool retention, muscle tension of the anterior abdominal wall, increased blood pressure.
–Characteristic signs of renal colic :
* expectoration concrement (usually after a pain attack)
* hematuria (often macrohematuria) due to trauma to
the stone and a sharp increase in pressure inside the
pelvis.
–Diagnosis :
* X-ray of the abdomen
* Intravenous urography IVU
* Ultrasound
* urinalysis
–Complications:
* acute and chronic pyelonephritis,
* hydronephrosis,
* acute renal failure (with ureteral occlusion - obstructive anuria),
* chronic renal failure (associated with the terminal stage of chronic pyelonephritis)

Question 4

explain the Renal hypertension syndrome , DF , detected in,Patogenesis ,Patogenesis,Complications of malignant arterial hypertension

Answer 4

–DF : Hypertensive syndrome is a pathological condition,
which is based on an increase in blood pressure due
to pathology of the kidneys or renal vessels
–Hypertensive syndrome may be detected in:
* 1) parenchymal (acute and chronic glomerulonephritis
chronic pyelonephritis, diabetic nephropathy, nephrocarcinoma, polycystic kidney disease;
* 2) Vasorenal hypertension renal artery stenosis
atherosclerosis of the vessels of the kidneys, aortoarteritis
–Patogenesis:
* vasorenal or renoparenchymal genesis of hypertension
- retention of Na and water due to activation of reninangiotensin-aldosteron system (RAAS) and depression
of prostaglandin-callecrein system function
–Manifestations :
* depends on degree of BP elevation and damage of cardiovascular system. Changes in urine appears before increase of BP.
* headache, blurred vision, pain in the heart, shortness of breath
* ↑BP (especially high and persistent diastolic pressure),
* left ventricular hypertrophy
* pronounced retinopathy
* systolic murmur during auscultation of the abdomen at the site of projection of the renal arteries,
* signs of narrowing of the renal vessel during aortography
–Complications of malignant arterial hypertension:
* loss of vision (blindness),
* hypertensive encephalopathy,
* heart failure

Question 5

explain Nephrotic syndrome : DF , Etiology,Clinical manifestations ,Complications, diagnosis

Answer 5

–DF : is a complex of symptoms, including:
* Massive proteinuria (>3.5 g/24 h)
* Hypoalbuminemia (< 35 g/l)
* Disproteinemia (hyper-α2- globulinemia)
* Dislipidemia (cholesterol increase)
* Edema (due to ↓of serum oncotic pressure and retention of Na )
-NB! : Arterial hypertension and hematuria are
not characteristic signs of nephrotic
syndrome!
–Etiology :
1. Primary glomerulonephritis (acute and chronic)
2. Kidney damage in the following conditions:
* a) infectious and parasitic diseases - chronic viral hepatitis; malaria, schistosomiasis; infectious endocarditis;
* b) systemic diseases - systemic lupus erythematosus, hemorrhagic vasculitis; rheumatoid arthritis;
* c) amyloidosis;
* d) diabetes mellitus;
* e) tumors - paraneoplastic nephrotic syndrome with
bronchogenic cancer, cancer of the parenchyma of the kidney,
stomach, colon, malignant lymphoma;
3. Drug damage to the kidneys: antiepileptic drugs, gold
preparations, mercury, D-penicillamine, antibiotics).
–Clinical manifestations
* The leading clinical sign of nephrotic syndrome is edema,
from moderate to degree anasarca with dropsy cavities
(ascites, hydrothorax, hydropericardium).
* skin - pale, dry, atrophic.
–Complications of nephrotic syndrome:
* 1. infectious (bacterial, viral, fungal), due to the low
content of immunoglobulins lost with urine proteins.
frequent pneumonia, pleurisy.
* 2. vascular - peripheral phlebo- and
arteriothromboses (pulmonary embolism, thrombosis
of the arteries of the kidney with the development of
necrosis of its parenchyma, strokes, myocardial
infarction), in connection with severe
hypercoagulation.
* In patients with NS due to severe dyslipidemia, the
development of atherosclerosis occurs earlier.
Hyperlipidemia is a factor in the progression of
glomerular damage and leads to glomerulosclerosis
–Diagnosis :
* 1. Urinalysis - high relative density (may
* reach 1,030-1,050), contains hyaline, granular,
* epithelial and waxy cylinders, white blood cells.
* 2. Immunological studies
* 3. Kidney biopsy
* 4. Blood test – hyperfibrinogenemia.

Question 6

explain Nephritic (acute nephritic) syndrome , DF ,Causes,Manifestations,Complications

Answer 6

–DF :
* this symptom complex is characterized by inflammation of the glomerular apparatus of the kidneys.
* The occurrence of acute nephritic syndrome is most
characteristic of acute post-streptococcal nephritis (especially
in children and young men), 2-3 weeks after the infection
–Causes:
* 1. Infections
* 1.1. Acute post-streptococcal glomerulonephritis
* 1.2. Other glomerulonephritis associated with
* infection: - bacterial: infectious endocarditis, sepsis; -viral: hepatitis B and C, - parasitic: malaria,btoxoplasmosis
* 2. Primary chronic glomerulonephritis
* 3. Systemic diseases:
* - systemic lupus erythematosus;
* - systemic vasculitis;
—Manifestations:
* 1. Edema (periorbital puffiness, ankle edema from latent edema to anasarca)
* 2. Urinary syndrome (brown or cola-coloured urine, proteinuria <3.5 g / day).
* 3. Arterial hypertension
* 4. Oliguria
–Complications:
1. Renal eclampsia:
* - a significant increase in blood pressure;
* - cramps;
* - visual impairment;
* - coma
2. Acute left ventricular failure:
* cardiac asthma, pulmonary edema
3. Acute renal failure

Question 7

explain Acute renal failure ,DF ,Etiology ,Clinical manifestations ,treatment ,

Answer 7

–df :
* a sudden impairment of renal function with a delay
in the elimination of nitrogen metabolism products
from the body and an upset of water-electrolyte and
acid-alkaline balance.
* result of severe acute renal blood flow damage,
glomerular filtration, and tubular reabsorption,
usually occurring simultaneously
–Eiology :3 groups of acute renal failure
1-Prerenal:
Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
2-Intrarenal:
Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
3-Postrenal:
Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
—Clinical manifestations
1. The period of action of the etiological factor - symptoms of
the disease leading to acute renal failure
2. Oligoanuric period (2-3 weeks):
* - decrease in diuresis, edema, weight gain, nausea, vomiting;
* - pulmonary edema, edema brain, uremic coma;
* - increased creatinine, potassium, urea in the blood serum,
hyperhydration, metabolic acidosis
3. Reduction period (5-10 days):
* - polyuria;
* - dehydration, decreased concentration, potassium, sodium
* 4. Recovery (6-12 months)
–treatment : Hemodialysis * Treatment of acute and chronic renal failure using the artificial kidney apparatus.

Question 8

explain Chronic renal failure , DF,Etiology ,clinincal manfsitation ,Diagnostic criteria of chronic renal failure,Classification of chronic renal failure

Answer 8

–df :The clinical condition resulting from chronic
derangement and insufficiency of renal excretory and
regulatory function (uremia)
–Eitology :
* glomerulonephritis - 57.4%;
* pyelonephritis - 13.9%;
* polycystic kidney disease - 11.1%;
* diabetic nephrosclerosis - 5.1%;
* congenital and hereditary lesions of the kidneys - 3.8%;
* systemic diseases –2.2%;
* arterial hypertension - 2.0%;
* amyloidosis - 0.9%
–clinincal manfsitation :
1-Cardiovascular: High blood pressure, increased heart rate
2-Immune: Increased risk of infection
3-Musculoskeletal :Renal osteodystrophy, decreased calcium, vitamin D impairment, hyperparathyroidism, pathological fractures
4-Neurological: Peripheral neuropathy, restless legs, change in level of consciousness,
5-Gastrointestinal: Anorexia, nausea, vomiting, halitosis, metallic taste in mouth, bleeding in gastrointestinal tract
Renal: Decreased urine output, azotemia, proteinuria, hernaturia, hyperuricemia
6-Respiratory : Increased respiratory rate, Kussmaul respirations, crackles, decreased Po2
–Diagnosis :
* - a decrease in glomerular filtration rate, an increase
in the concentration of creatinine, urea, potassium,
uric acid;
* - a decrease in the specific gravity of urine (isostenuria, hypostenuria);
* - reduction in hemoglobin, erythropoietin
production;
* - metabolic acidosis;
* - violation of phosphorus-calcium metabolism;
* - reduction in the size of the kidneys and parenchyma
–Classification of chronic renal failure:
is based on the grade of severity and characteristic clinical
manifestations.
* Mild: GFR is 30—50 ml/min.
* Moderate: GFR is 10—30 ml/min.
— anemia;
— hypertension;
— osteodystrophy.
* Grave: GFR is 5—10 ml/min.
— nausea;
— anorexia;
— pruritus.
* Terminal (end-stage): GFR is < 5 ml/min.
— pericarditis; — pulmonary edema; — coma.

Question 9

Norms indicators of kidney function

Answer 9

• serum potassium (K) 3,5-5,1 mmol/L).
• serum creatinine concentration in men with normal
  GFR is 1.2 mg/dL (110 μmol/L);
• in women, 1 mg/dL (90 μmol/L).
• Glomerular filtration rate (GFR) 115—125 ml/min)