Kidneys

dr. maryam al-ghamdi

BIOC 416
❑Introduction
❑Kidney functions
❑Structure & function of nephrons
❑Renal function
❑ Causes of kidney diseases
❑Creatinine test & Creatinine clearance test
❑Blood Urea Nitrogen (BUN)
❑Cystatin C
❑Urine osmolality
❑Assessment of glomerular integrity
❑Urinalysis
❑Diseases of the kidneys & Management of kidney disorders

unit
Introduction The Nephron is Made of:
G
-
-

▪ The kidneys are bean-shaped organs, each about the size A) Glomerulus
of aG
-

fist. They are located near the middle of the back,

-
B) Glomerular Capsule
just below the rib cage, one on each side of the spine.
-

- C) Renal Tubule(proximal convoluted tubule,

small -

▪ The right kidney is generally slightly smaller and lower

-
loop of Henle, and distal convoluted tubule)
than the left due to the larger size of the liver on the right
-
D) Collecting Duct
-

side of the body. ▪ A tuft of capillaries called the glomerulus is

-

▪ Each kidney contains around one-

million nephrons. contained in each nephron. The glomerulus is
▪ In general, the kidneys can adequately function with only surrounded by Bowman's capsule responsible
&

for filtering the blood.

-

C one third of the normal number of nephrons. don't filter

T
-

▪ The glomerular filtrate have the same large

▪ In humans, formation of nephron is complete at 36-40
wks of gestation., but functional maturation with tubular composition of the plasm except RBC-WBC&
- -

growth & elongation continues during the 1st decade of protein (the filtrate free of proteins)because
-

life. Because new nephrons can’t be formed after birth, the endothelium provides a barrier (wall) to red
so any disease that results in progressive loss of nephrons and white blood cells which is permeable to
can lead to renal insufficiency water and low MW substances and impermeable
▪ The word "renal" refers to the kidneys. function in first 10 Years to macromolecules.
 -
>-
-
O
▪CAfferent arteriole are a group of blood vessels Which supplies blood to the
kidneys.
⑤
▪ Glomerulus is a network of small blood vessels, its surrounding by Bowman's
capsule receives blood supply from an afferent arteriole. The main function of
the glomerulus is to filter plasma to produce glomerular filtrate.
- -

▪[Proximal Convoluted Tubule : Reabsorption of water, ions, and all organic

nutrients such as (glucose & amino acid)
▪ Loop of Henle : Reabsorption further of water by descending limb, because The
-

ascending limp is impermeable to H2O .While Chloride ions accompanied by

Na+ are pumped out of the ascending limp of loop Henle into the interstitial
fluid. S tions acid
, drug todin &R wate, Nas ca
▪ Distell convoluted tubule : Secretion of ions acid and drug
- - -
toxin and variable
reabsorption of water, sodium Ione and calcium Ione under normal control
- -- z
▪ Collecting duct: variable reabsorption of water and reabsorption or secretion of
-
Na, K, H, and HCO3 and finally delivery of urine through Papillary duct

#
What gets filtered in the glomerulus ?

Freely filtered (filtered = passed) Not filtered (not passed)

▪ H2 O ions
▪ Protein
▪ Elements : (Na+, K+, Cl-, Mg2+ , ▪ Blood Large
PO4) ▪ cells Protein, blood , cells

▪ Glucose
▪ Urea
▪ Creatinine

water , ion , Glucose , area

creativine

553 -
 urive : Yellowish fluid stored in bladden

&
Secrete fromM through
Kyigy
Urethra
& Short Answer
& Short answer

Kidney functions Formation of urine and what is a renal function

---

▪ The kidneys are vital organs responsible for performing several essential functions that are critical for ▪ The formation of urine is a complex process that occurs within the kidneys. It involves the
maintaining overall health and homeostasis in the body. filtration of blood to remove waste products, reabsorption of essential substances, and the
▪ Filtration of Blood: filter waste products, excess substances, and toxins from the bloodstream. secretion of waste and excess substances into the urine.
▪ Excretion of Waste Products: such as urea and creatinine from the blood and excrete them in the urine.
Also eliminate various toxins, drugs, and metabolic byproducts from the bloodstream. -
-
1-Filtration: Blood passes through the glomeruli, This filtration process allows water,
-

electrolytes, and small molecules (glucose, amino acids, etc.) to pass through into the
▪ Maintains homeostasis by maintains water and electrolyte balance by hormones and maintains acid base - - -

balance by reabsorbing sodium bicarbonate and controlling their excretion into urine. - renal tubules while retaining larger molecules like proteins and
L
-
blood cells.glomerular
filtrate, amount 120-125 ml/ min equivalent to volume 170 L/24h. However, urine
-

▪ Vitamin D Activation: The kidneys are involved in the conversion of inactive vitamin D into its active
form, calcitriol. Active vitamin D helps regulate calcium and phosphate levels in the body, essential for production 1-2 L\24h depending on fluid intake.
bone health.
▪ Kidney secrete Renin enzyme which play a crucial role in the regulation of blood pressure and the body's 2-Reabsorption :70% of the filtered fluid, travels through the renal tubules, various
-

fluid balance through its involvement in the renin-angiotensin-aldosterone system substances that are essential for the body (such as glucose, electrolytes, and water) are
▪ Kidney secrete active hormones such as :
-
hormone of Kidney function -
reabsorbed back into the bloodstream. This reabsorption helps maintain the body's fluid
Aldosterone: a hormone that helps regulate
regulation.
- - sodium and potassium levels, further impacting blood pressure and electrolyte balance.
3-Secretion: : During this step, certain waste products, excess ions, and other substances
adequate oxygen-carrying capacity in the blood..
-
Erythropoietin: a hormone that stimulates the bone marrow to produce red blood cells. This helps maintain
(such as drugs) are actively transported from theOne
- -

blood into the renal tubules. This helps

- - -

-
Calcitriol: active metabolite of vitamin D. It increases the level of Calcium absorbed by the intestines and eliminate additional waste and maintain appropriate concentrations of substances in the
ups the reabsorption of Phosphate in the kidney in mineralization of bone body. -

4-Urine Formation: The modified filtrate, now referred to as urine, continues to move
< S , excrete , VD , maintaine Renin through the# renal tubules and-
>collecting ducts.
,
enzym
hormon
formation of urive
Filteration . Reabsorption Secretion
&
 ADH , Epo AND GFR
aldosterone
&
S
,
,
Hormone Control the Urine Formation What is -
Glomerular filtration rate (GFR): &

•-
Antidiuretic Hormone (ADH) or Vasopressin: regulates water reabsorption in the renal ▪ GFR is a crucial- indicator of kidney function measure of how effectively the kidneys
[filter waste and excess substances from the[ blood.
-

tubules and collecting ducts. It increases the permeability of these structures to water,
-

- -

allowing more water to be reabsorbed back into the bloodstream ↓ ▪ GFR is measured in (ml/min) Glomerular filtration rate depend on size, age, gender,
↑ ADH
ADH u n i ve
wight, and race . GFR decline with age.
- ~ -
• High ADH level causes the body to produce less urine ( conc urine) & diluted urine is - -

produced in the Absence of ADH ↓ ▪ GFR is also used to find the stage of chronic kidney disease.
▪ GFR- -
cannot be measured directly in routine clinical practice, it can be estimated using
-
• Aldosterone regulates sodium and potassium balance. It acts on the renal tubules to
increase the reabsorption of sodium and water while promoting the excretion of
various formulas and tests such as : Serum Creatinine
▪ The staging of chronic kidney disease:
potassium. This hormone helps maintain electrolyte balance, blood volume, and blood
- - -
▪ Stage 1 Individuals who have kidney damage but a normal GFR
pressure.
▪ Stage 2, the glomerular filtration rate starts to fall.
-
Na
• Atrial Natriuretic Peptide (ANP) is released in response to - high blood pressure and
> ▪ A normal GFR is about 120 mL/min for men and about 100 mL/min for women.
increased blood volume. It promotes the excretion of sodium andC water in the kidneys,
▪ When individuals get below 60 mL/min, problems start to occur. These are the patients
-

leading toEincreased urine output. Secrete

↑ urive
Na , wate
who are at risk Moderate decrease in GFR, for example, for acute renal failure when
•&Erythropoietin (EPO): EPO stimulates the production of red blood cells in the bone
-
exposed to contrast media, particularly if they have diabetes.
marrow. It plays a role in maintaining adequate oxygen-carrying capacity in the blood and
=>
▪ When they get further declines in GFR down to stage 4 or into stage 5, when they need
renal replacement therapy, then we're quite aware of this problem.
-

supporting tissues. =
Production RBC in bone
blood
.
maintain adequate o carrying capacity
in
▪ It's important to note that a GFR value alone doesn't provide a complete picture of kidney
• These hormones work together to regulate various aspects of kidney function, including health
water and electrolyte balance, blood pressure, and acid-base balance.

Depend on size , race

wieght
, gender
age ,

Estimated of( eGFR) &The staging of chronic kidney disease:

Kidney Description GFR
Damage
Stage

1 Normal or minimal 90 +
kidney damage with
normal GFR

2 Mild decrease in GFR 60-89

3 Moderate decrease in 30-59

GFR
4 Severe decrease in GFR 15-29

5 Kidney failure < 15

 &
because there is loss in

-
giCreatinine plasma
volume
of univ
Biochemical Investigation Of Kidney Function
-

&
Tests provide valuable information about how well the kidneys are filtering waste ▪ Creatinine is a waste product produced by muscles
products, maintaining fluid and electrolyte balance, and regulating acid-base
equilibrium. >
▪ The level of creatinine in the blood is a commonly used indicator of kidney function.
▪ Plasma creatinine conc. is the most reliable biochemical test of glomerular function.
>
A. Tests of glomerular filtration rate eGFR
▪ The range for Plasma creatinine in adult is 60-120μmol/L.

⑪
1. Creatinine &

3. Urea S
2. Measurement of creatinine clearance

4. Cystatin C
▪ A change in creatinine conc. may be due to changes in muscle mass (starvation, after
surgery, malnutrition ). or changes in excretion (renal failure).
▪ Plasma creatinine conc. is related to the
>
-
E
↓
muscle bulk which decline with age.
-

▪ A normal plasma creatinine does not necessarily imply normal renal function, although a
B. Tests of tubular function raised creatinine does usually indicate impaired renal functionIn Renal failure
1. Urine osmolality ▪ Men generally have higher creatinine levels than women. (Why?)

s
2. Fluid deprivation test Due to Cater Skeletal mass to men

▪ It's important to note that serum creatinine levels alone may not provide a complete picture of
3. Urinary acidification tests kidney function. Other factors, such as age, muscle mass, and medications, can influence
4. Glycosuria creatinine levels. Therefore, healthcare providers often interpret creatinine levels alongside
eGFR and other clinical indicators to make accurate assessments of kidney health.
C. Urinalysis
*
Creativine !5

E
normal renal
&
-

>
- function
&
reativive-
>
·
2. iSC is sus
impairedounction
-

I 30s
,

High plasma Creatinine Creatinine Clearance Test

&
↑ -

#-
▪ Creatinine clearance is a measure of how effectively the kidneys are filtering and clearing
▪ Acute or chronic E
renal failure
- & creatinine from
--
the bloodstream..
- -

▪ Creatinine clearance in adult normally (100-120ml\ min)

- -

▪ A-high meat intake can cause temporary increase.

GFR
-

▪ Creatinine clearance test is done on both a blood sample and on a sample of urine collected
▪ Exercise over 24 hours (24-hour urine sample).
=
- 2
-
▪ Certain medicines can cause creatinine clearance levels to be lower than normal. Like
▪ Some drugs such as antibiotics and salicylates
-
antibiotics, Certain conditions, such as diabetes and congestive heart failure.
1-Creatinine clearance = U × V ml/min
Low plasma creatinine
P
▪ In subjects with a-
small total muscle mass.
-
U = concentration of creatinine in urine
P = concentration of creatinine in plasma
▪ In children. ~
- V =volume of urine collected in T minutes

▪ In pregnancy ~
d
▪ Patients treated with #
-

corticoids &
2-Creatinine clearance = (140-age ) × Weight × Constant
Serum Creatinine
▪ Starvation
&
This Method not required URINE

Constant = (1 for men & 0.85 for women)

Relationship between creatinine clearance
and plasma creatinine concentration
 C
BUN ( Blood Urea Nitrogen )
See video : https://www.youtube.com/watch?v=mH9g0gRYoKE Protein
• Urea is a waste product that is formed in the liver when proteins are broken
CREATININE CLEARANCE (NURSING) down and produces ammonia. Ammonia is a toxic product of nitrogen Pit

- -55 metabolism which should be removed from our body through urea cycle Gi ↑

converts excess ammonia into urea It is then excreted by the kidneys through
urine.-
>
• Blood Urea Nitrogen (BUN) is a blood test that measures the concentration of
- -

nitrogen used as a-
& -

25S G -
marker of kidney function and hydration status.
3 >
-
~

• Blood Urea Nitrogen = BUN x 2.14 = Urea

-

259 9)

C
-
-

urive
• Blood urea level is sensitive but not specific indicator for renal dysfunction,
-
because it maybe change in: Dietary protein -Protein catabolism
-

BUN= 50% urea

as
• Nitrogen content of Urea = 14 *2= 28
• Urea reflect to whole Molecule M.wt = 60 60 ÷ 28 = 2.14 mmol /L
• Normal range of urea (2.1-7 mmol /L )

12
↓ Low
2▪
urea
de
▪ Severe liver diseases. not formation
I

Pregnancy decrease due futes

to
from
area
cycle
in liver
URIC ACID
-
Purien

Uric acid is a- waste product that is formed when the body breaks
-

?▪▪ -
Very low protein diet
Certain medications ↓ down & purines, which are substances found in certain foods and filtered
&medication
-

cells. Uric acid is normally filtered out of the blood by the- kidneys
-

5▪ Low muscle mass↓liver Pregnancy Low proteine

and excreted
- through urine. However, if the body produces too
-

Diet Low

High Urea
&
musche
mass
much uric acid or if the kidneys don't effectively clear it from the
↑
Pre-renal uri d ,
-

blood, it can =>

lead to elevated -uric acid levels in the blood, a
-
1. high protein diet
i 3condition known as hyperuricemia. Which is major risk factor for
-

2. gastro-intestinal haemorrhage - "protein meal"

-

3. increased protein catabolism↑

-
-
&- trauma, major surgery, extreme starvation with Gmech
gout formation of solid uric acid crystals in joints
muscle breakdown increased renal reabsorption of urea - any cause of reduced Extremely high levels of uric acid can lead to a condition known as
&
is
renal perfusion, for example, congestive cardiac failure, shock, severe diarrhoea. uric acid nephropathy, where uric acid crystals can accumulate in
4. Drug therapy leading to an increased production e.g. tetracyclines, corticosteroid
-
-
the kidneys and cause kidney damage..
↑ Protein in dief
• Net excretion of uric acid of normal human is 500 mg/day,
haemorrhage
normal human plasma uric acid 2-7 mg/dl
gastro-intestual
↑ protein Catabolism

↑ Drug therapy
 > by cells
Protein- in Kidney
-
Cystatin C
the-
-
▪ Cystatin C is a protein that is produced bycells in the kidneys. It is a small molecule that is freely filtered by
-
glomeruli (tiny filters) in the kidneys and is then almost completely reabsorbed and catabolized by the
-

-
renal tubules.
▪ The level of cystatin C in the blood can serve as a marker of kidney function
-9
▪ A test may be used as an alternative to creatinine and creatinine clearance, so it is early detection
.

-
-

▪ Cystatin C is not affected by body- mass or diet, and hence is a more reliable marker of kidney function than
creatinine. ↓
-

X &
▪ A decline in kidney function leads to & decreases-in the GFR and--
to increases in cystatin C and other measures
of kidney function, such as creatinine and urea in the blood. The increases in these levels occur because the
kidneys are not able to properly filter the blood at a normal rate, causing their accumulation in the blood.
▪ Recent studies suggest that increased levels of cystatin C may also indicate an increased risk of heart disease,
heart failure, and mortality & M
Levels of cystatin-c are altered in following conditions:
• Cancer patient
• Thyroid dysfunction
• Glucocorticoid therapy
• Cigarette smoking
• HIV infection
• Increased levels in MI,stroke,heart failure,peripheral arterial syndrome
• Increased in metabolic syndrome & in alzheimers disease

B. Tests of renal tubular function: Osmolality measurements in plasma and urine

Tests of renal tubular function help assess the health and efficiency of the renal
tubules, which are responsible for reabsorbing essential substances and excreting E ▪ Osmolality measurements play a significant role in diagnosing and managing various conditions related to
water and solute balance ability to concentrate affected
the unive
by rinal
waste products. is highly

• Urine pH: Urine pH measures the acidity

E or[
,- 4 5-7
Urine
alkalinity of urine. Abnormal pH
.

affected by renal diseases

-
▪ Osmolality serves as general marker of tubular function. Because the ability to concentrate the urine is highly
- -

levels can indicate renal tubular acidosis, a condition where the kidneys don't
-

X
-

effectively regulate acid-base balance. ▪ In healthy adults, the urinary osmolality can vary from a minimum of about 50 to a maximum of about 1200
mOsm/kg H2O. It is to be noted that the concentrating ability tends toC
fall with age.
• Urine Osmolality: Urine osmolality measures the concentration of solutes in urine,
indicating the kidney's ability to concentrate or dilute urine properly. Higher C
▪ Plasma Osmolality: Plasma osmolality measures the concentration of solutes in the blood. It's an important
mineral content and lower amounts of water lead to a high osmolality.↑ Xmineral
-g
-
-
-

indicator of the body's overall solute balance and hydration status.

-

&
s
• Urine Electrolytes: Measuring- electrolyte concentrations (sodium, potassium, ▪ Urine osmolality: measures the concentration of-C
solutes in urine. It reflects the kidney's ability to concentrate
chloride) in urine can provide information about tubular reabsorption and
-
-

d or dilute urine based on the body's hydration needs. Urine osmolality is influenced by antidiuretic hormone
-

M
-

secretion.
F

Na K 2 -

&
s (ADH) levels. High urine osmolality suggests the kidneys are concentrating urine to conserve water, while lowd
, ,

• Glucose Tolerance Test: Elevated glucose in the urine can indicate impaired -
urine osmolality indicates dilution of urine. ·
=>

X tubular reabsorption
-

-
- --

-
-
,&
& SS1 v jS & -

▪ If the urine osmolality is 600mosm/kg or more, tubular function is usually regarded as intact
• Amino Acid Clearance:. Elevated amino acids can indicate disorders like
&cystinuria.
- -

[
▪ When the urine osmolality does not differ greatly from plasma, the renal tubules are not reabsorbing water

C
-
-

• Water Deprivation Test: Used to diagnose disorders like diabetes insipidus

51%, 141 %
3/
,
 5/1531
Fluid deprivation test - J15] i
C. Urinalysis
- -

·
• Medical procedure used to assess the body's ability to concentrate urine and regulate
water balance. Can be used to determine whether the patient has diabetes insipidus as
-
-

opposed to other causes of polydipsia (a condition of excessive thirst that causes an

▪ Urinalysis is a common diagnostic test that involves the chemical analysis of
urine to provide insights into various aspects of health.
excessive intake of water). =S
▪ It is routine test for every patient, type specimen depend on the test
How is a water deprivation test done? Avoid
drink wat
performed (Qualitative, Microbiology, random, 24-hour collection and timed
The patient is instructed to avoid -
drinking water or-
other fluids for a -
specified period. to
see how your body responds serum
collection after use of medicine)
= T sonality
The test usually begins early in the morning. Baseline measurements of weight, blood ▪ Urinalysis involves two main components:
-
-

pressure, urine volume, and urine osmolality are taken. Blood samples are collected to

-
- -

measure serum osmolality and other relevant parameters.

-

▪ physical examination involves colour, clarity, and&

-
odour.
Throughout the test, monitors the patient's vital signs, urine output, and changes in body -
▪ chemical analysis of urine involves testing for the presence of various
weight.
substances Suh as Glucose, Protein, Ketones, Bilirubin, Leukocytes, Crystals
If you have diabetes insipidus, you'll continue to pee large amounts of dilute urine when
normally you'd only pee a small amount of concentrated urine. and Microscopic Examination using a microscope to look for cellular
The time of deprivation may vary from 4 to 18 hours. The serum osmolality and urine
- ~
elements, casts, bacteria, and other microscopic components in the urine.
osmolality are both measured in the test.

the urive is concentrated in early morning

to overnight retention in bladder
Composition of Human Urine: Ingredients ~ 50 g dry weight/L Urine sample
r
Initial mooring sample is
preferred.
Urine sample must be analysis
within T
1 hour, If the collection
kept in refrigerator
- T]2-8 it
should be not for 8 hours,

I
because on- standing urea in
&
urine decompose to ammonia ,
& &
sample much be suspectable to
-

Bactria and the PH become

-
alkaline.
 Pale yellow - deepamper due to
> chrome
Physical Characteristics
Appearance : urine color range from pale
yellow to deep amber due to pigment call
urochrome and it depend on the concentration
Abnormal urine color red, orange, blue,
green, or brown can be caused by a variety of
issues. For example, it can result from taking
& 2
certain medications, eating certain C
-
foods,
3

-
having certain medical conditions, dehydrated ,
&

or may be caused by 5infection, disease.

Cloudy or milky urine is a sign of a urinary
-

tract-infection, which may also cause a& bad

smell. Milky urine may also be caused by
-
bacteria, crystals, fat, white or red blood cells,
or[mucus in the urine

Specific gravity -
• Specific gravity measures the concentration The normal range for urine specific
of solutes in urine compared to distilled gravity is 1.005 to 1.030. Normal value
-

water. It indicates the ability of the kidneys ↓

- -

ranges may vary slightly among

to concentrate or dilute urine. Lower -
-

specific gravity might suggest ↑ different laboratories. Some labs use -

J overhydration, while higher specific gravity different measurements
~ L &
might indicate dehydration. - M
4 ; 5/1

• This is a semi-quantitative measure of &

concentration of substance in urine . It W
measured by C strip OR refractor meter to -

limit variation in the color interpretation. E -

albumin ,
• A higher specific gravity indicates a more &
gucose

concentrated urine. · -

• Assessment of urinary specific gravity

usually just confirms the impression gained
by visually inspecting the colour of the
urine. Digital Urine Specific Gravity
SG , semi-quantitive & measure the concentration of solutin unive

- ability Kidney to concentrate or dilute

Compared to water ,

quitative q
5, 1
Contitative urime . & So dehydration & Countrated uriv

↓ So over hydration
Odour
Common Crystals :
- -
▪ Normal urine has aromatic odour due to aromatic acid Uric acid. Uric acid crystals can be different types of shapes: barrel, plate-like, or diamond.
Calcium oxalate. Calcium oxalate crystals are shaped like dumbbells or envelopes struvite stones typically

E
▪ Diabatic urine has fruity odour due to[
ketones

-
look like smooth rocks or pebbles within the bladder…..elc.

&
▪ Ammoniacal odour due to decomposition of urea
-

PH: Urine is usually acidic

Volume: The volume of urine produced can vary throughout the day and is influenced by
factors such as fluid intake, physical activity, and overall health. Normal daily urine output for
adults is typically around 1 to 2 liters, but variations are normal.
Foam: The presence of foam or bubbles on the surface of urine can vary based on the force of
urination and the concentration of substances. While it's usually harmless, persistent foamy
urine could be a sign of excess protein. ↑ protein- >foam
-1/1
Urine sediments: Microscopic examination of sediment from freshly passed urine should be
centrifuged at low. Remove all but the bottom 0.5 ml of fluid suspend the pellet looking for
cells, casts, fat droplets. There are two type of crystal : common and pathological
Urinary crystals. (A) Calcium oxalate crystals; (B) uric acid crystals (C) triple phosphate crystals with amorphous
phosphates ; (D) cystine crystals.

54 49 ,

n repuropathy
nerpathg
Smo

/
& /
&
 Blood
infection
hematuria , Malignancy Urinary
Contaminate from Menstruation

cell casts
glomerular disease

r
.

Red
-jj S/ -
>
> crystals

&
inflammation ,
-

Pathologic crystal Y Leucocytes

=

infection

- Blood:-hematuria is consistent

-
with various possibilities ranging
To
from malignancy through urinary
tract infection to contamination
5 5 - 1
Red blood cell cast in urine
from menstruation.
.

j1-
-j)4- Red Cell casts could indicate
↳ glomerular disease
- Crystals
②

irn - Leucocytes in the urine suggests

- acute-
inflammation and the
glomerular presence of a urinary tract

[
infection.

casts of urive
↓
/

I
Urinary casts

&
-

&
Can you identify the type of crystals in these images?
• Are cylindrical structures

-
-

=>
produced
-
by the kidney and
-

present in the urine in certain

-
-

&disease states.
• Cast are cylindrical structure - I
composed mainly
· of mucoprotein
they are different type of cast like
granular, hyaline, fatty acid, and
waxy cast
•
Diseases of the kidneys
Kidney diseases can have various causes, ranging from genetic factors to
lifestyle choices and underlying medical condition
▪Diabetes -I s
- S
▪High blood pressure &
-

--

I
E▪Glomerular diseases -
▪Inherited and congenital kidney diseases
Disease , X 5
▪Poisons and trauma
=

▪Kidney Stones &

-
Stone -

▪Certain Medications and Toxins

- Medication
-

▪Chronic Alcohol or Drug Use

▪Poor Lifestyle Choices: An unhealthy diet, lack of exercise, smoking, and
obesity can increase the risk of kidney disease Renal replacement treatment

Dialysis
remove
=> Waste product
>
/
& Kidney [
not able

>
- ↑excess flinc
When

to
-

Filter
[ to live
chance

Tetroductive
- -
-

I&
Study case
X
=

Dialysis
The process ofC removing • An 8-year-old girl was admitted to hospital with generalized
waste products and oedema. Her urine had become frothy and has proteinuria.
-

Investigations -
excess fluid from the

Seein
body. Dialysis is Serum ↓Urea 2.0 mmol/L (3.3 – 6.7)
necessary when the ↓Creatinine 45 μmol/L ( 60 -120)
kidneys are not able to ↓Total protein 35 g/L (60-80)
Fr
adequately filter the ↓Albumin 15g/L (35 -50)
blood. Dialysis allows Cholesterol 12mmol/L (< 5 mmol/L)
patients with kidney What is your diagnosis?
failure a chance to live
-

productive lives. 2
-
-

difecte in filteration lead Liter

to all
↓ macromouch
gumerwer