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25. TYPICAL FORMS OF PATHOLOGY OF THE EXCRETORY FUNCTION OF KIDNEYS

Questions to prepare for classes and examination

 General causes and mechanisms of kidneys dysfunction. Disorders of filtration, tubular reabsorption and excretion.

 Renal insufficiency: definition, general causes, mechanisms and manifestations.

 Uremic syndrome: definition, typical manifestations and consequences. Uremic coma.

 Syndromes of acute and chronic renal insufficiency: typical features, causes and manifestations.

 Nephrotic and nefritic syndromes: typical features, causes and manifestations.

 Pyelonephritis: characteristic features, causes and pathogenesis.

 Nephrolitiasis: causes, mechanisms of development, consequences.

 Characteristic changes in urinalysis and syndromes of renal insufficiency.

N 120

A 48-year-old patient K. has been suffering from chronic diffuse glomerulonephritis for five years. During the last several weeks he notes the emergence of the following symptoms: dull aching in the region of the heart, palpitations, generalized edema, especially prominent in the lower extremities on walking.

Urine test data: 24-h urine volume 1.100 ml, specific gravity 1.042, protein content 3.3%. The urinary sediment microscopic examination reveals the presence of a large amount of granular and waxy casts. Blood pressure 170/95 mm Hg. Blood biochemistry data: blood urea nitrogen 6.9 mmol/L (normal values: 3.3-6.6 mmol/L), total protein content

48 g/L (N: 70-80 g/L), albumin 15 g/L (N: 40-50 g/L), globulins 28 g/L

(N: 20-30 g/L), hyperlipidemia, hypernatremia. Acid-base status: pH=7.34,

PaCO2=33 mm Hg, SB=17.0 meq/L, BB=36 meq/L, BE=-7 meq/L, titratable acidity 10 mmol/d, NH4+=18 mmol/d.

Questions

 What forms of pathology are observed in this patient? What is the cause-effect and chronological relationship between these forms of pathology? Substantiate your answer.

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