Definition

 • Kidney disease can present with variable combinations of proteinuria (above the upper limit of normal, usually defined by a urinary protein to creatinine ratio of >50 mg/ mmol), and/ or macro- or micro- haematuria, with or without acute or chronic renal dysfunction.

 Aetiology

 • Primary renal diseases, most commonly glomerulonephritides, tubulointerstitial diseases, either acquired or inherited.

• Systemic diseases can also present with isolated urinary abnormalities (e.g. early stages of diabetic nephropathy present with non- nephrotic proteinuria; some forms of amyloidosis present with only low- level proteinuria and renal dysfunction).

• A biopsy may or may not be needed to determine the cause, depending on clinical and biochemical findings.

 • A biopsy is usually indicated in patients with haematuria with presence of acanthocytes or red blood cell casts with an elevated serum creatinine level or proteinuria; in patients with proteinuria >1 g/ d on multiple visits with no clear comorbidity (e.g. diabetes or hypertension), especially if accompanied by an increase in serum creatinine; and in patients with proteinuria>3 g/ d in the absence of diabetes or a rapid increase in proteinuria even in patients with diabetes.

• A biopsy is usually not necessary in the case of diabetic patients showing a typical clinical course of progressive proteinuria and CKD, or in patients with isolated haematuria with neither dysfunction nor proteinuria, who usually have a benign clinical course (other non- kidney diseases of the genitourinary tract will need to be excluded).

Pathogenesis

• Glomerular disease: dysfunction of the glomerular filtration barrier with leakage of protein and/ or red blood cells into the urine. Dysmorphic red blood cells and heavy proteinuria are suggestive of glomerular disease.

• Tubular epithelial cell injury can lead to low- level proteinuria and low- level haematuria.

Presentation

 • Can be asymptomatic and picked up at a routine medical examination (e.g. urinary dipstick test).

• Can be picked up through the appearance of macroscopic haematuria or frothy urine.

Biochemistry

 • Creatinine can be normal or elevated.

• Proteinuria may be present.

• Macro- or microhaematuria may be present.

Prognosis

 • Depends on the cause; see individual causes.

مواضيع ذات صلة

Reflux nephropathy

Acute tubulointerstitial nephritis

Acute tubular injury

فرط نشاط جارات الدرق البدئي (PHPT) Primary hyperparathyroidism

Chronic kidney disease (CKD)

Cirrhosis

Primary sclerosing cholangitis

Primary biliary cholangitis

Alcoholic liver disease

Chronic viral hepatitis

Unilateral leg swelling

قصور الدرق ( Hypothyroidism )