Renal Pathophysiology

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Urinalysis and Approach to the Patient With Renal Dysfunction

CASE PRESENTATION-1 A 67-year-old man has previously been well and has no past history of kidney disease. A plasma creatinine concentration drawn 3 months ago was relatively normal at 1.1 mg/dL, and the urinalysis was unremarkable. Over the past month, the patient has noted easy fatigability and mild but persistent back pain. During the past week, his appetite began to diminish and he experienced a 3-lb weight loss. Physical examination shows an ill-appearing man, but no specific abnormal ities are found. Laboratory data reveal the following: Blood urea nitrogen (BUN) = 110 mg/dL (9-25) Creatinine = 8.4 mg/dL (0.8-1.4) Hematocrit = 25% (previous value normal at 41%) Urinalysis = trace protein by dipstick, no cells or casts in the sediment Protein/creatinine = 3.6 g/g ( < 0.2)

OBJECTIVES

By the end of this chapter, you should have an understanding of each of the following issues:  The different types of proteinuria and how they are detected  The distinction between glomerular and extraglomerular bleeding  The difference between acute and chronic renal disease

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