Lupus nephritis

systemic lupus erythematosus
Clinically, haematuria and proteinuria are present, frequently with nephrotic syndrome, hypertension, hypocomplementemia, elevated anti-dsDNA titres and elevated serum creatinine. Class V disease (membranous glomerulonephritis) is characterized by diffuse thickening of the glomerular capillary wall (segmentally or globally), with diffuse membrane thickening, and subepithelial deposits seen under the electron microscope. Clinically, stage V presents with signs of nephrotic syndrome. Microscopic haematuria and hypertension may also been seen. Stage V can also lead to thrombotic complications such as renal vein thromboses or pulmonary emboli.

Urine

urinaryhuman urinepiss
The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The system produces urine by a process of filtration, reabsorption, and tubular secretion. The kidneys extract the soluble wastes from the bloodstream, as well as excess water, sugars, and a variety of other compounds. The resulting urine contains high concentrations of urea and other substances, including toxins. Urine flows from the kidneys through the ureter, bladder, and finally the urethra before passing from the body. Research looking at the duration of urination in a range of mammal species found that nine larger species urinated for 21 ± 13 seconds irrespective of body size.

Nephron

renal tubulenephronsrenal tubules
The nephron (from Greek νεφρός – nephros, meaning "kidney") is the microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman's capsule. The renal tubule extends from the capsule. The capsule and tubule are connected and are composed of epithelial cells with a lumen. A healthy adult has 0.8 to 1.5 million nephrons in each kidney. Blood is filtered as it passes through three layers: the endothelial cells of the capillary wall, its basement membrane, and between the foot processes of the podocytes of the lining of the capsule.

Nephritic syndrome

Acute nephritic syndromechronic nephritisChronic nephritic syndrome
Nephritic syndrome is a syndrome comprising signs of nephritis, which is kidney disease involving inflammation. It often occurs in glomerulonephritis, which is characterized by a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins and red blood cells to pass into the urine (yielding proteinuria and hematuria). By contrast, nephrotic syndrome is characterized by only proteins moving into the urine. Nephritic syndrome, like nephrotic syndrome, may involve hypoalbuminemia due to the protein albumin moving from the blood to the urine.

Proteinuria

protein in the urineproteinIsolated proteinuria
Nephrotic syndromes (i.e. intrinsic renal failure). Pre-eclampsia. Eclampsia. Toxic lesions of kidneys. Amyloidosis. Collagen vascular diseases (e.g. systemic lupus erythematosus). Dehydration. Glomerular diseases, such as membranous glomerulonephritis, focal segmental glomerulonephritis, minimal change disease (lipoid nephrosis). Strenuous exercise. Stress. Benign orthostatic (postural) proteinuria. Focal segmental glomerulosclerosis (FSGS). IgA nephropathy (i.e. Berger's disease). IgM nephropathy. Membranoproliferative glomerulonephritis. Membranous nephropathy. Minimal change disease. Sarcoidosis. Alport's syndrome. Diabetes mellitus (diabetic nephropathy). Drugs (e.g.

Clinical urine tests

urinalysisurine testurine sample
Waxy casts – associated with chronic renal disease. Urine culture – a microbiological culture of urine samples, detecting bacteriuria, is indicated when a urinary tract infection is suspected. Ictotest – this test is used to detect the destruction of old red blood cells in the urine. Hemoglobin test – this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urinary system, which cause hemoglobin to appear in the urine. Uroscopy, the ancient form of this analysis. Urinary casts. Proteinuria. Urine test strip. Urine collection device. Pregnancy test, measures hCG levels in urine. Lab Tests Online: Urinalysis.

Interstitial nephritis

tubulointerstitial nephritisacute interstitial nephritisTubulo-interstitial nephritis
Blood in the urine and occasional RBC casts. Sterile pyuria: white blood cells and no bacteria. Nephrotic-range amount of protein in the urine may be seen with NSAID-associated AIN.

Renal function

glomerular filtration ratekidney functioncreatinine clearance
The most relevant assessments in a renal ultrasound are renal sizes, echogenicity and any signs of hydronephrosis. Renal enlargement usually indicates diabetic nephropathy, focal segmental glomerular sclerosis or myeloma. Renal atrophy suggests longstanding chronic renal disease. Risk factors for kidney disease include diabetes, high blood pressure, family history, older age, ethnic group and smoking. For most patients, a GFR over 60 mL/min/1.73m 2 is adequate. But significant decline of the GFR from a previous test result can be an early indicator of kidney disease requiring medical intervention.

Rapidly progressive glomerulonephritis

Rapidly progressing glomerulonephritiscrescentsglomerular crescent
Regardless of the underlying cause, RPGN involves severe injury to the kidneys' glomeruli, with many of the glomeruli containing characteristic glomerular crescents (crescent-shaped scars). Most types of RPGN are characterized by severe and rapid loss of kidney function featuring severe hematuria (blood in the urine), red blood cell casts in the urine, and proteinuria (protein in the urine), sometimes exceeding 3 g protein/24 h, a range associated with nephrotic syndrome. Some patients also experience hypertension (high blood pressure) and edema. Severe disease is characterized by pronounced oliguria or anuria, which portends a poor prognosis.

Glomerulonephritis

C3 glomerulonephritisglomerular nephritisglomerulonephritis, membranoproliferative
These forms usually result in the nephrotic syndrome. Causes include: Minimal change disease is characterised as a cause of nephrotic syndrome without visible changes in the glomerulus on microscopy. Minimal change disease typically presents with edema, an increase in proteins passed from urine and decrease in blood protein levels, and an increase in circulating lipids (i.e., nephrotic syndrome) and is the most common cause of the nephrotic syndrome in children.

Infection

infectious diseaseinfectious diseasesinfections
Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.

Vitamin D

DCalciferol1,25 Dihydroxy vitamin D
If hypercalcemia is not treated, it results in excess deposits of calcium in soft tissues and organs such as the kidneys, liver, and heart, resulting in pain and organ damage. The main symptoms of vitamin D overdose which are those of hypercalcemia including anorexia, nausea, and vomiting. These may be followed by polyuria, polydipsia, weakness, insomnia, nervousness, pruritus and ultimately renal failure. Furthermore, proteinuria, urinary casts, azotemia, and metastatic calcification (especially in the kidneys) may develop.

IgA nephropathy

Berger's diseaseBerger diseaseglomerulonephritis, iga
. * IGA Nephropathy on National Institute of Diabetes and Digestive and Kidney Diseases Severe flank/abdominal pain. High blood pressure. Hematuria (gross, frank, microscopic). Compromised immune system. Edema in hands and feet. Cola- or tea-colored urine. Nephrotic syndrome (3-3.5 grams of protein loss in the urine, associated with a poorer prognosis). Acute kidney failure (either as a complication of the frank hematuria, when it usually recovers, or due to rapidly progressive glomerulonephritis which often leads to chronic kidney failure).

Cholesterol embolism

cholesterol embolicholesterolCholesterol embolus
If the kidneys are involved, tests of kidney function (such as urea and creatinine) are elevated. The complete blood count may show particularly high numbers of a type of white blood cell known as eosinophils (more than 0.5 billion per liter); this occurs in only 60-80% of cases, so normal eosinophil counts do not rule out the diagnosis. Examination of the urine may show red blood cells (occasionally in casts as seen under the microscope) and increased levels of protein; in a third of the cases with kidney involvement, eosinophils can also be detected in the urine.

Renal biopsy

kidney biopsyComplications
While renal biopsy is not indicated in all cases of haematuria, it may be performed in those with glomerular haematuria (blood that is thought to come from damage to the glomerulus) or when combined with features of progressive renal disease (e.g. increasing proteinuria, elevated blood pressure and kidney failure). One example is the nephritic syndrome. Proteinuria (or protein in the urine) occurs in many renal conditions. Renal biopsy is usually reserved for patients with high or increasing levels of proteinuria, or for patients who have proteinuria along with other signs of renal dysfunction. One example is the nephrotic syndrome.

Kidney failure

renal failurekidney problemsrenal impairment
Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome. Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease. Diagnosis of acute failure is often based on a combination of factors such as decrease urine production or increased serum creatinine. Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy. It is also equivalent to stage 5 chronic kidney disease. Treatment of acute failure depends on the underlying cause.

Tamm–Horsfall protein

Tamm-Horsfall proteinUMODuromodulin
It is not derived from blood plasma but is produced by the thick ascending limb of the loop of Henle of the mammalian kidney. While the monomeric molecule has a MW of approximately 85 kDa, it is physiologically present in urine in large aggregates of up to several million Da. When this protein is concentrated at low pH, it forms a gel. Uromodulin represents the most abundant protein in normal human urine (results based on MSMS determinations). It is the matrix of urinary casts derived from the secretion of renal tubular cells.

Creatinine

serum creatininenormal kidney functioncreatinin
Cystatin C – novel marker of kidney function. Jaffe reaction – an example of creatinine assay methodology. Rhabdomyolysis – may be diagnosed using creatinine levels. Nephrotic syndrome. Creatinine at Lab Tests Online. Creatinine: analyte monograph – The Association for Clinical Biochemistry and Laboratory Medicine.

Minimal change disease

lipoid nephrosisMinimal change lesionminimal change nephropathy
Minimal change disease (also known as MCD, minimal change glomerulopathy, and nil disease, among others) is a disease affecting the kidneys which causes a nephrotic syndrome. Nephrotic syndrome leads to the loss of significant amounts of protein in the urine, which causes the widespread oedema (soft tissue swelling) and impaired kidney function commonly experienced by those affected by the disease. It is most common in children and has a peak incidence at 2 to 6 years of age. MCD is responsible for 10-25% of nephrotic syndrome cases in adults. It is also the most common cause of nephrotic syndrome of unclear cause (idiopathic) in children.

Peritoneum

peritonealintraperitonealparietal peritoneum
Some structures, such as the kidneys, are "primarily retroperitoneal", while others such as the majority of the duodenum, are "secondarily retroperitoneal", meaning that structure developed intraperitoneally but lost its mesentery and thus became retroperitoneal. The peritoneum develops ultimately from the mesoderm of the trilaminar embryo. As the mesoderm differentiates, one region known as the lateral plate mesoderm splits to form two layers separated by an intraembryonic coelom. These two layers develop later into the visceral and parietal layers found in all serous cavities, including the peritoneum.

Collecting duct system

collecting ductcortical collecting ductcollecting ducts
In the absence of ADH, water in the renal filtrate is left alone to enter the urine, promoting diuresis. When ADH is present, aquaporins allow for the reabsorption of this water, thereby inhibiting diuresis. "Collecting Duct (Kidney)". – "Urinary System: kidney, medulla, collecting duct and ascending tubule". – "Urinary System: kidney, H&E, collecting duct and ascending tubule".

Pyelonephritis

kidney infectionpyelitisurosepsis
The kidney parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, the glomerulus and vessels are normal. Gross pathology often reveals pathognomonic radiations of bleeding and suppuration through the renal pelvis to the renal cortex. Chronic pyelonephritis implies recurrent kidney infections and can result in scarring of the renal parenchyma and impaired function, especially in the setting of obstruction.

Adrenal gland

adrenal glandsadrenalsuprarenal gland
The adrenal glands are located on both sides of the body in the retroperitoneum, above and slightly medial to the kidneys. In humans, the right adrenal gland is pyramidal in shape, whereas the left is semilunar or crescent shaped and somewhat larger. The adrenal glands measure approximately 3 cm in width, 5.0 cm in length, and up to 1.0 cm in thickness. Their combined weight in an adult human ranges from 7 to 10 grams. The glands are yellowish in colour. The adrenal glands are surrounded by a fatty capsule and lie within the renal fascia, which also surrounds the kidneys. A weak septum (wall) of connective tissue separates the glands from the kidneys.

Electrolyte

electrolyteselectrolyticionic solution
The interpretation of these values is somewhat meaningless without analysis of the clinical history and is often impossible without parallel measurements of renal function. The electrolytes measured most often are sodium and potassium. Chloride levels are rarely measured except for arterial blood gas interpretations, since they are inherently linked to sodium levels. One important test conducted on urine is the specific gravity test to determine the occurrence of an electrolyte imbalance.

Kidney transplantation

kidney transplantrenal transplantationrenal transplant
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Exchanges and chains are a novel approach to expand the living donor pool.