Medical Archive

Introduction

?? ? ??

• Polyuria
  • >2,000 mL/day
• Oliguria
  • ?500 mL/day
  • ?0.5mL/kg/hr

????????

BUN	??, ????, ???? ?? ????? ???
Scr	???? ?? ???. GFR ??? ??. Ccr = Ucr x V / Pcr
99mTc-DTPA	GFR? ??? ??? Ccr? ?? ????.

BUN/Cr ratio
BUN? ??? ????? ??? ??, ?? ??? ??. 
Cr? ???? ???? ??. ??: 10:1~12:1
??
catabolic? ??(sepsis, steroid)
Bleeding, LC ? ?? ??? ??? BUN? ???? ??.

???????

FE_Na= 
2.5% ?? : AKI (Na ??? ?)
1% ?? : prerenal azotemia (??? ??)

Azotemia

Assessment of GFR

??? 100-120mL/min. Creatinine clearance? ??.
Ccr = Ucr * V / Pcr = {(140-??) * lean B.W.} / 72*Pcr  [??: *0.85]
ACEI, NSAID, Anti-histamine ? ?? ?? / Dopamine ?? ?? ??

Approach to the patient

Abnormalities of the urine

Proteinuria

????
Dipstick (30,100,300, 1g/dL), SSA

????
24hr ????. Crn ?? ???? ??? ??.
??? ???? spot urine Protine/Creatinine(UPCR), > 300mg

Urine protein electrophoresis
Glomerular origin: FSGS, diabetes
Tubular origin: ????? ?? – ????? ?? (B2 microglobulin)
Overload proteinuria: MM(dipstick? 24hr ? ??? ?), Rhabdo.
*Sterile pyuria: ???? ????? ???? WBC ?? ?.

???	Dipstick	Albumin? ?? ????
+1	30 mg/dL
+2	100 mg/dL	? ???? 24hr ?? check???
+3	300 mg/dL
+4	1000 mg/dL
???	1? spot urine	2? ?? : Uprotein/UCreatinine <0.2 (2? ??? congenital ?? ?? ?? x)

??? ??? : ???? + / 1g? ?? ??. ??? ?? x
???? ??? 4mg/m2/hr. 40? ??? nephrotic.

Hematuria, pyuria, and casts

??? ??

• ??
  • ????: IgA nephropathy, Alport ?
  • ?????: ??? ?????(m/c), ??, ??
• ?? ??
  • (??) ?????? ??? ??.
    • Initial hematuria suggests urethral damage
    • Terminal hematuria indicates bladder or prostatic damage.
    • Total hematuria reflects damage anywhere int he. urinary tract.
    • Clots are not usually seen with renal causes of hematuria
  • Dipstick -> Proteinuria -> RBC cast, dysmorphic RBC? ????(glomerulonephritis)?? ?? ??
  • ?????
    • Pyuria ????? UTI ??? ?? ?? 
    • ???? IVP, renal US? ?? ?? ??.
  • ?? ??? ??? cystoscopy.
  • ??? ???? renal CT. ?? ????? f/u

	???	? ?
??? ??	+	–
??	???	???
??????	?? ??	???? ??
??? ???	+	–
?? ??	–	+
??? ??	Dysmorphic	Isomorphic

Dipstick (+) ?? hemoglobulinuria / myoglobulinuria / ?? ?? ????.
RBC > 5?/HPF ? ? ?? ??
? ? ????? ??? (m/c : ???. ??? ??? ???? ??!)

• RBC casts
  • Sign of glomerular bleeding
  • Glomerulonephritis
• WBC casts
  • Tubulointerstitial inflammation
  • Pyelonephritis, interstitial nephritis, transplant rejection
• Fatty casts “oval fat bodies”
  • Lipid droplets. Associated with “Maltese cross” sign
  • Nephrotic syndrome
• Granular casts “muddy brown”
  • Sloughed tubular epithelial cells with pigmented granules 
  • Acute tubular necrosis d/t nephrotoxin or ischemia
• Waxy casts
  • Large eosinophilic waxy casts in multiple myeloma
    • Light chains precipitate with Tamm-Horsfall protein, denegerated hyaline cast
    • ? tubular obstruction ? renal impairment
  • ESRD/CKD
• Hyaline casts
  • Nonspecific, can be a normal finding, often seen in concentrated urine samples
  • Tamm-Horsfall protein

Abnormalities of urine volume

Polyuria