David S. Albers, Ph.D.PSB 329March 26, 2014

Renal function is essential for maintaining homeostasis and to excrete waste substancesRenal function is impaired:

Infancy unable to concentrate urineElderly renal function declines as a normal aging processIn disease states diabetes, HTN, atherosclerosis can all affect renal functionIncontinence

an array of tests performed on urine and one of the most common methods of medical diagnosisColorAppearance Specific gravity -pHKetone bodiesProteins

Albustix Test Urobilinogen BilirubinIcotestGlucoseBenedict's TestHemoglobin TestRBC number WBC number hCG

Urine is supposed to be sterileExcellent culture medium for bacterial growthWomen more vulnerable than menMost infections are ascending coming from organisms in the perineal area

Nephrosclerosis:

Similar vascular changes as in arteriosclerosis in the kidneyDecreased blood supply to the kidney ischemia atrophyIncreased renin release BP renal ischemiaMay lead to chronic renal failureMay be secondary to hypertension or diabetes

Inflammation of the glomeruliPost-infectious

After having an URI with group A beta hemolytic strepAntibodies form, and create an antigen-antibody complexTrapped in the glomeruli inflammation and complement activationvessels become leakyproteins and RBCs are now able to get into the filtrate

Ca2+ salts

increased in alkaline urineDietLow fluid intakeUric acid

Hyperuricemia (ie gout)increased in acidic urineUrinary stasis=infectionHydronephrosis

Urinary buildupTissue necrosis via compression of blood vessels

Develops rapidlyBUN/creatinine serum levelsMetabolic acidosis Hyperkalemia

Prerenal

Severe and sudden hypotension, burns, heart failure, injury, myoglobin release from damaged skeletal muscleIntrarenal

Nephrotoxins including drugs (ex. NSAIDS), obstructions by calculi and blood clotsPostrenal

Obstruction of urine flow

Gradual and irreversibleCaused by

DiseaseHypertensionDiabetesToxinsAnemia, acidosis, azotemiaDialysis/transplant

Sustains life when kidneys failTemporary measure until patient receives a kidney transplantIn acute renal failure, dialysis is used until kidneys recoverTwo forms of dialysis:

Peritoneal Hemodialysis

Kidney transplantation is a life-extending procedure. Typical patient will live 10-15 years longer with a kidney transplant than if kept on dialysis.March 10, 2010Boston Globe

PrimaryTubular epithelium (most commonly)Asymptomatic at the beginningMetastasizes to the liver, lungs, bone, or CNS before it is diagnosedHigh mortalityMen> womenSmokers have high risk