Harrison's Internal Medicine Chapter 45. Azotemia and Urinary Abnormalities Azotemia and Urinary Abnormalities: Introduction Normal kidney functions occur through numerous cellular processes to maintain body homeostasis. Disturbances in any of these functions can lead to a constellation of abnormalities that may be detrimental to survival. The clinical manifestations of these disorders will depend upon the pathophysiology of the renal injury and will often be initially identified as a complex of symptoms, abnormal physical findings, and laboratory changes that together make possible the identification of specific syndromes. These renal syndromes (Table 45-1) may arise as the consequence of a systemic illness or. | Chapter 045. Azotemia and Urinary Abnormalities Part 1 Harrison s Internal Medicine Chapter 45. Azotemia and Urinary Abnormalities Azotemia and Urinary Abnormalities Introduction Normal kidney functions occur through numerous cellular processes to maintain body homeostasis. Disturbances in any of these functions can lead to a constellation of abnormalities that may be detrimental to survival. The clinical manifestations of these disorders will depend upon the pathophysiology of the renal injury and will often be initially identified as a complex of symptoms abnormal physical findings and laboratory changes that together make possible the identification of specific syndromes. These renal syndromes Table 45-1 may arise as the consequence of a systemic illness or can occur as a primary renal disease. Nephrologic syndromes usually consist of several elements that reflect the underlying pathologic processes. The duration and severity of the disease will affect these findings and typically include one or more of the following 1 disturbances in urine volume oliguria anuria polyuria 2 abnormalities of urine sediment red blood cells RBC white blood cells casts and crystals 3 abnormal excretion of serum proteins proteinuria 4 reduction in glomerular filtration rate GFR azotemia 5 presence of hypertension and or expanded total body fluid volume edema 6 electrolyte abnormalities or 7 in some syndromes fever pain. The combination of these findings should permit identification of one of the major nephrologic syndromes Table 45-1 and will allow differential diagnoses to be narrowed and the appropriate diagnostic evaluation and therapeutic course to be determined. Each of these syndromes and their associated diseases are discussed in more detail in subsequent chapters. This chapter will focus on several aspects of renal abnormalities that are critically important to distinguishing among these processes 1 reduction in GFR leading to azotemia 2 alterations of the urinary sediment .
