ABNORMALITIES OF RENAL FUNCTION

AZOTEMIA: - Azotemia is the retention of nitrogenous waste products excreted by the kidney. Increased levels of blood urea nitrogen (BUN) [>10.7 mmol/L (>30 mg/dL)] and creatinine [>133 μmol/L (>1.5 mg/dL)] are ordinarily indicative of impaired renal function. Renal function can be estimated by determining the clearance of creatinine (CLcr) (normal >100 mL/min); this can be directly measured from a 24-h urine collection using the following equation:

Creatinine clearance (mL/min) = (uCr × uV)/(sCr × 1440)

1. Where uCr is urine creatinine in mg/dL
2. Where sCr is serum creatinine in mg/dL
3. Where uV is 24-h urine volume in mL
4. Where 1440 represents number of minutes in 24 hour.

DESCRIPTION: -

The “adequacy” or “completeness” of the collection is estimated by the urinary volume and creatinine content; creatinine is produced from muscle and excreted at a relatively constant rate. For a 20- to 50-year-old man, creatinine excretion should be 18.5–25.0 mg/kg body weight; for a woman of the same age, it should be 16.5–22.4 mg/kg body weight. For example, an 80-kg man should excrete between ~1500 and 2000 mg of creatinine in an “adequate” collection. Creatinine excretion is also influenced by age and muscle mass. Notably, creatinine is an imperfect measure of glomerular filtration rate (GFR), since it is both filtered by glomeruli and secreted by proximal tubular cells; the relative contribution of tubular secretion increases with advancing renal dysfunction, such that creatinine clearance will provide an overestimate of the “true” GFR in pts with chronic kidney disease. Isotopic markers that are filtered and not secreted (e.g., iothalamate) provide more accurate estimates GFR.

Haematuria:-

MAJOR CAUSES OF HEMATURIA: -

• Lower Urinary Tract
• Bacterial cystitis
• Interstitial cystitis
• Urethritis (infectious or inflammatory)
• Passed or passing kidney stone
• Transitional cell carcinoma of bladder or structures proximal to it
• Squamous cell carcinoma of bladder (e.g., following schistosomiasis)
• Upper Urinary Tract
• Renal cell carcinoma
• Age-related renal cysts
• Other neoplasms (e.g., oncocytoma, hamartoma)
• Acquired renal cystic disease
• Congenital cystic disease, including autosomal dominant form
• Glomerular diseases
• Interstitial renal diseases, including interstitial nephritis
• Nephrolithiasis
• Pyelonephritis
• Renal infarction
• Hypercalciuria
• Hyperuricosuria.

PYURIA: -

This may accompany hematuria in inflammatory glomerular diseases. Isolated pyuria is most commonly observed in association with an infection of the upper or lower urinary tract. Pyuria may also occur with allergic interstitial nephritis (often with a preponderance of eosinophils), transplant rejection, and noninfectious, nonallergic tubulointerstitial diseases, including atheroembolic renal disease. The finding of “sterile” pyuria (i.e., urinary white blood cells without bacteria) in the appropriate clinical setting should raise suspicion of renal tuberculosis.

HOMEOPATHIC MANAGEMENT: -

There are many medicines which are used effectively in managing renal diseases such as:-

• Lycopodium
• Berberis vulgaris
• Cantharides
• Apis mel
• Lachesis.