Kidney Disorders 501

b. Glomerulonephritis
Characterized by dysmorphic RBCs (damaged RBCs with an irregular membrane)
c. Renal cell carcinoma (RCC) and Wilms tumor Infection MCC LUT
2. Lower urinary tract (LUT; bladder, urethra, prostate) causes of hematuria include: hematuria
a. Infection (most common)
b. Transitional cell carcinoma (TCC) TCC bladder: MC
noninfectious cause of
Most common noninfectious cause of hematuria LUT hematuria
c. Benign prostatic hyperplasia (BPH)
Most common cause of microscopic hematuria in adult males BPH: MCC microscopic
3. Drugs associated with hematuria include: hematuria in adult
a. Anticoagulants (warfarin, heparin) males
b. Cyclophosphamide
(1) Hemorrhagic cystitis Anticoagulants: MC
(2) Risk factor for TCC drugs causing hematuria
B. Proteinuria
1. General
a. Definitionprotein >150mg/24 hours or >30mg/dL (dipstick)
b. Persistent proteinuria usually indicates renal disease.
c. Qualitative tests include dipsticks and sulfosalicylic acid (SSA). Persistent proteinuria:
(1) Dipsticks are specific for albumin. usually indicates
(2) SSA detects albumin and globulins. intrinsic renal disease
d. Quantitative test is a 24-hour urine collection.
2. Types of proteinuria (Table 20-1)
III. Renal Function Tests
A. Serum blood urea nitrogen (BUN) Urea: end-product of
1. Normal serum BUN is 7 to 18mg/dL. AA, pyrimidine,
2. Definitionend-product of amino acid (AA), pyrimidine, and ammonia metabolism ammonia metabolism
a. Produced by the liver urea cycle
b. Filtered in the kidneys Urea produced in urea
cycle in liver
(1) Urea is partly reabsorbed in the proximal tubule.
(2) Amount reabsorbed is renal blood flow dependent. Urea: proximal tubule
(a) If glomerular filtration rate (GFR) is decreased, more is reabsorbed. reabsorption is renal
(b) If GFR is increased, less is reabsorbed. blood flow dependent
c. Extrarenal loss (e.g., skin, bowel) may occur with very high serum concentration.
d. Serum levels depend on the following: Urea: some extrarenal
loss (e.g., skin) with
(1) GFR
high serum
(2) Protein content in the diet concentration
(3) Proximal tubule reabsorption
(4) Functional status of the urea cycle
3. Causes of increased and decreased serum BUN (Table 20-2) CHF: MCC serum BUN

TABLE 20-1 Types of Proteinuria

TYPE DEFINITION CAUSES
Functional Protein <2 g/24 hr Fever, exercise, congestive heart failure
Not associated with renal disease Orthostatic (postural): occurs with standing and is absent in the
recumbent state; urine protein is absent in the first morning
void; no progression to renal disease
Overflow Protein loss is variable Multiple myeloma with BJ proteinuria
LMW proteinuria Hemoglobinuria: e.g., intravascular hemolysis
Amount filtered > tubular Myoglobinuria: crush injuries, McArdle glycogenosis (deficient
reabsorption muscle phosphorylase); increase in serum creatine kinase
Glomerular Nephritic syndrome: protein Damage of GBM: nonselective proteinuria with loss of albumin
>150 mg/24 hr but <3.5 g/24 hr and globulins; examplepoststreptococcal
Nephrotic syndrome: protein glomerulonephritis
>3.5 g/24 hr Loss of negative charge on GBM: selective proteinuria with loss
of albumin and not globulins; exampleminimal change
disease (lipoid nephrosis)
Tubular Protein <2 g/24 hr Heavy metal poisoning: examplelead and mercury poisoning
Defect in proximal tubule Fanconi syndrome: inability to reabsorb glucose, amino acids,
reabsorption of LMW proteins uric acid, phosphate, and bicarbonate.
(e.g., amino acids at normal Hartnup disease: defect in reabsorption of neutral amino acids
filtered loads) (e.g., tryptophan) in the gastrointestinal tract and kidneys
BJ, Bence Jones; GBM, glomerular basement membrane; LMW, low molecular weight.