Questions to prepare for classes and examination
• General causes and mechanisms of kidneys dysfunction. Disorders of filtration, tubular reabsorption and excretion.
• Renal insufficiency: definition, general causes, mechanisms and manifestations.
• Uremic syndrome: definition, typical manifestations and consequences. Uremic coma.
• Syndromes of acute and chronic renal insufficiency: typical features, causes and manifestations.
• Nephrotic and nefritic syndromes: typical features, causes and manifestations.
• Pyelonephritis: characteristic features, causes and pathogenesis.
• Nephrolitiasis: causes, mechanisms of development, consequences.
• Characteristic changes in urinalysis and syndromes of renal insufficiency.
N 120
A 48-year-old patient K. has been suffering from chronic diffuse glomerulonephritis for five years. During the last several weeks he notes the emergence of the following symptoms: dull aching in the region of the heart, palpitations, generalized edema, especially prominent in the lower extremities on walking.
Urine test data: 24-h urine volume 1.100 ml, specific gravity 1.042, protein content 3.3%. The urinary sediment microscopic examination reveals the presence of a large amount of granular and waxy casts. Blood pressure 170/95 mm Hg. Blood biochemistry data: blood urea nitrogen 6.9 mmol/L (normal values: 3.3-6.6 mmol/L), total protein content
48 g/L (N: 70-80 g/L), albumin 15 g/L (N: 40-50 g/L), globulins 28 g/L
(N: 20-30 g/L), hyperlipidemia, hypernatremia. Acid-base status: pH=7.34,
PaCO2=33 mm Hg, SB=17.0 meq/L, BB=36 meq/L, BE=-7 meq/L, titratable acidity 10 mmol/d, NH4+=18 mmol/d.
Questions
• What forms of pathology are observed in this patient? What is the cause-effect and chronological relationship between these forms of pathology? Substantiate your answer.