This document discusses common manifestations, diagnostic tests, and various disorders that can affect the kidneys. It covers renal disorders including congenital abnormalities, neoplasms, infections, obstructions, and glomerular disorders. Pain, abnormal urinalysis findings, and diagnostic imaging are mentioned as common indications of kidney disease. Specific conditions like renal agenesis, cystic kidney disease, renal cell carcinoma, nephroblastoma, pyelonephritis, nephrolithiasis, and glomerulonephritis are explained in terms of symptoms, causes, diagnosis, and treatment approaches.

1. CHAPTER 27
INTRARENAL DISORDERS

2. COMMON MANIFESTATIONS OF
KIDNEY DISEASE
Pain
• Renal pain generally felt at costovertebral
angle
• Pain transmitted to the spinal cord between
T10 and L1 by sympathetic afferent neurons;
may be felt throughout dermatomes of T10-L1
• Due to distention and inflammation of the
renal capsule, has a dull, constant character

3. COMMON MANIFESTATIONS OF
KIDNEY DISEASE (CONT.)
Abnormal Urinalysis Findings
• Provides a foundation for the differential
diagnosis of renal dysfunction
• Dipstick and microscopic urinalysis results
provide clues to intrarenal pathologies

4. COMMON MANIFESTATIONS OF
KIDNEY DISEASE (CONT.)

5. COMMON MANIFESTATIONS OF
KIDNEY DISEASE (CONT.)
Other Diagnostic Tests
• KUB identifies gross abnormalities related to size,
position, and shape (may show renal calculi)
• Renogram/renal scan shows renal vasculature
• Ultrasonography differentiates tissue
characteristics
• CT/MRI used to provide detailed information
about the vasculature and tissue

6. CONGENITAL ABNORMALITIES
Renal Agenesis and Hypoplasia
• Relatively rare; associated with other
congenital abnormalities
• Bilateral renal agenesis not compatible with life
• Unilateral renal agenesis results in
compensatory hypertrophy of functional
kidney
• A single normal kidney is sufficient to maintain
normal renal function

7. CONGENITAL ABNORMALITIES
(CONT.)
Cystic Kidney Diseases
• Genetically transmitted renal disorder resulting
in cysts that can expand and disrupt urine
formation and flow; may be localized to one
area or affect both kidneys
• Autosomal recessive forms are evident at birth
• Autosomal dominant types cause symptoms
later in life
• Renal failure necessitates dialysis or
transplantation

8. NEOPLASMS
Benign Renal Neoplasms
• Symptoms depend on the size; may be
asymptomatic until large enough to form
palpable abdominal mass, hematuria, and
flank pain
• Usually diagnosed with renal ultrasound
and/or CT scan
• Nephrectomy remains treatment of choice

9. NEOPLASMS (CONT.)
Renal Cell Carcinoma
• May have familial pattern
• Risk factors include smoking and obesity
• Usually asymptomatic until advanced;
presenting S/S include CVA tenderness,
hematuria, palpable mass
• Nephrectomy is typical treatment;
metastases may be particularly resistant to
radiation, immunotherapy and
chemotherapy

10. NEOPLASMS (CONT.)

11. NEOPLASMS (CONT.)
Nephroblastoma (Wilms Tumor)
• Most common kidney cancer in children
• Identified by palpable abdominal mass; may
also have pain, hypertension, and/or
hematuria
• Nephrectomy, radiation therapy, and
chemotherapy are used for treatment;
excellent cure rate

12. INFECTION
Acute Pyelonephritis
• Infection of renal pelvis and parenchyma
usually due to an ascending urinary tract
infection
• CVA tenderness a classic sign
• Accompanied by fever, chills, N/V, anorexia
• Presence of WBC casts is indicative of upper
UTI
• Should be promptly managed with
antimicrobials to avoid decreased renal
function

13. INFECTION (CONT.)

14. INFECTION (CONT.)
Chronic Pyelonephritis
• Can result in chronic kidney disease
• Usually associated with vesicoureteral reflux
or obstructive process leading to persistent
urine stasis
• Ongoing inflammation causes fibrosis and
scarring and loss of functional nephrons
• Diagnosed by renal imaging
• Treatment includes correction of underlying
processes and extended antimicrobial
therapy

15. OBSTRUCTION
Renal Calculi (Nephrolithiasis)
• Obstructive processes result in urine stasis,
predisposing to infection and structural
damage
• Common causes include stones, tumors,
prostatic hypertrophy, and strictures of the
ureters or urethra
• Renal stones are most common

16. OBSTRUCTION (CONT.)

17. OBSTRUCTION (CONT.)
Renal Calculi (Nephrolithiasis)
• Complete obstruction leads to
hydronephrosis, decreased GFR, and
ischemic damage due to increased
intraluminal pressure
• Prolonged postrenal ARF may result in ATN
and CKD
• Stones tend to form in urinary tract due to
solute supersaturation, low urine volume, and
abnormal urine pH

18. OBSTRUCTION (CONT.)
Renal Calculi (Nephrolithiasis)
• Most stones composed of calcium crystals;
others include uric acid, struvite, cystine, and
stones associated with certain medications
• Stationary stones usually asymptomatic; stone
migration causes intense renal colic pain
abrupt in onset and may radiate; N/V,
diaphoresis is common

19. OBSTRUCTION (CONT.)
Renal Calculi (Nephrolithiasis)
• Most stones pass spontaneously
• Other interventions may be necessary
including lithotripsy or endoscopic
approaches
• Stones tend to recur; prevention enhanced
by high fluid intake to dilute the urine and
dietary changes based on the type of stone

20. GLOMERULAR DISORDERS
• Glomerulopathies alter glomerular capillary
structure and function
• Damage mediated by immune processes
• May result in some combination of hematuria,
proteinuria, abnormal casts, decreased GFR,
edema, and hypertension

21. GLOMERULAR DISORDERS
(CONT.)
Glomerulonephritis
• Immune response to variety of potential
triggers; may have primary or secondary
etiology
• Attraction of immune cells to the area of
inflammation results in lysosomal degradation
of the basement membrane
• GFR may fall due to contraction of mesangial
cells resulting in decreased surface area for
filtration

22. GLOMERULAR DISORDERS
(CONT.)
Glomerulonephritis
• Treatment may include steroids,
plasmapheresis, and supportive measures
such as dietary and fluid management
• Management of systemic and renal
hypertension
• ESRD is a common outcome of chronic
glomerulonephritis; dialysis or kidney
transplantation may be necessary

23. GLOMERULAR DISORDERS
(CONT.)

24. GLOMERULAR DISORDERS
(CONT.)
Nephrotic Syndrome
• Occurs due to increased glomerular
permeability to proteins
• Urinary loss of 3 to 3.5 g of protein per day
• Proteinuria leads to hypoalbuminemia and
generalized edema; decreased blood colloid
osmotic pressure; increase in liver activity can
cause hyperlipidemia and hypercoagulability

25. GLOMERULAR DISORDERS
(CONT.)

26. GLOMERULAR DISORDERS
(CONT.)
Nephrotic Syndrome
• Treatment is conservative; consists of
symptom management
• Management of underlying process when
identified
• Many cases resolve spontaneously but can
progress to ESRD