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Transcript
Internal Medicine
CHAPTER FOUR
DISEASES OF THE KIDNEYS
1. Introduction to Renal Disease
Learning objectives: at the end of this lesson the student will be able to:
1. List common etiologies of renal diseases.
2. Describe the calcification of renal diseases.
3. Identify common clinical manifestation of renal diseases.
4. Understand the diagnostic approach to renal diseases.
• Patients with renal disease may have a variety of different clinical presentations.
• Some have symptoms that are directly referable to the kidney (gross hematuria, flank
pain) or to associated extrarenal symptoms (edema, hypertension, signs of uremia).
• Many patients, however, are asymptomatic and are noted on routine examination to
have an elevated plasma creatinine concentration or an abnormal urinalysis.
• Specific disorders are more likely to be either acute or chronic in duration, thereby
narrowing the differential diagnosis among patients presenting with similar clinical
findings related to the kidney.
Major causes of renal diseases.
Renal function is based upon four sequential steps, which are isolated to specific areas of the
kidney or surrounding structures:
1. First, blood from the renal arteries is delivered to the glomeruli.
2. The glomeruli form an ultrafiltrate, which subsequently flows into the renal tubules.
3. The tubules reabsorb and secrete solute and/or water from the ultrafiltrate.
4. The final tubular fluid, the urine, leaves the kidney, draining sequentially into the renal
pelvis, ureter, and bladder, from which it is excreted through the urethra.
The causes of renal disease are traditionally classified based on the portion of the renal
anatomy most affected by the disorder
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