RT Book, Section
A1 Mount, David B.
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1177884131
T1 Azotemia and Urinary Abnormalities
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1177884131
RD 2024/04/19
AB Normal  kidney  functions  occur  through  numerous  cellular  processes  to  maintain  body  homeostasis.  Disturbances  in  any  of  these  functions  can  lead  to  abnormalities  that  may  be  detrimental  to  survival.  Clinical  manifestations  of  these  disorders  depend  on  the  pathophysiology  of  renal  injury  and  often  are  identified  as  a  complex  of  symptoms,  abnormal  physical  findings,  and  laboratory  changes  that  constitute  specific  syndromes.  These  renal  syndromes  (Table  48-1)  may  arise  from  systemic  illness  or  as  primary  renal  disease.  Nephrologic  syndromes  usually  consist  of  several  elements  that  reflect  the  underlying  pathologic  processes,  typically  including  one  or  more  of  the  following:  (1)  reduction  in  glomerular  filtration  rate  (GFR),  (2)  abnormalities  of  urine  sediment  (red  blood  cells  [RBCs],  white  blood  cells  [WBCs],  casts,  and  crystals),  (3)  abnormal  excretion  of  serum  proteins  (proteinuria),  (4)  disturbances  in  urine  volume  (oliguria,  anuria,  polyuria),  (5)  presence  of  hypertension  and/or  expanded  total  body  fluid  volume  (edema),  (6)  electrolyte  abnormalities,  and  (7)  in  some  syndromes,  fever/pain.  The  specific  combination  of  these  findings  should  permit  identification  of  one  of  the  major  nephrologic  syndromes  (Table  48-1)  and  allow  differential  diagnoses  to  be  narrowed  so  that  the  appropriate  diagnostic  and  therapeutic  course  can  be  determined.  All  these  syndromes  and  their  associated  diseases  are  discussed  in  more  detail  in  subsequent  chapters.  This  chapter  focuses  on  several  aspects  of  renal  abnormalities  that  are  critically  important  for  distinguishing  among  those  processes:  (1)  reduction  in  GFR,  (2)  alterations  of  the  urinary  sediment  and/or  protein  excretion,  and  (3)  abnormalities  of  urinary  volume.