Renal Tubular Disease

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Contents 1 More Specific Terms 2 Etiology 3 Pathology 4 Laboratory 5 More General Terms 6 Additional Terms 7 References

More Specific Terms

• acute tubular necrosis (ATN)
• medullary sponge kidney disease
• pyelonephritis
• renal tubular acidosis (RTA)
• renal tubulointerstitial disease

Etiology

• hereditary disorders (see hereditary renal tubular defects)
• acquired disorders

• renal tubular acidosis type IV ( RTA-4)
• oncogenic osteomalacia

Pathology

• patterns of renal tubular injury [1]

• tubular proteinuria < 1.5-2 g/day
• proximal tubule dysfunction

• hypokalemia
• hypouricemia
• hypophosphatemia
• acidosis
• glycosuria
• aminoaciduria

• distal tubule dysfunction

• hyperchloremic acidosis*
• hyperkalemia or hypokalemia
• salt wasting

• medullary concentration dysfunction

• nephrogenic diabetes insipidus with decreased urine concentrating ability

• azotemia ( renal insufficiency)

• transport dysfunction of renal tubular injury [2]

• reduced GFR*

• obliteration of vasculature
• obstruction of renal tubules

• Fanconi syndrome

• impaired proximal tubular reabsorption of glucose, amino acids, phosphate & bicarbonate

• hyperchloremic acidosis*

• reduced ammonia production
• inability to acidify collecting duct fluid (distal renal tubular acidosis)
• proximal tubular bicarbonate wasting

• tubular or low-molecular weight proteinuria*

• defect is proximal tubular protein reabsorption

• polyuria, isosthenuria*
• hyperkalemia*

• K+ secretory defects
• aldosterone resistance

• salt wasting

• distal tubular damage
• failure of Na+ reabsorption

• * common

Laboratory

• urinalysis

• urine sediment)

• pyuria
• leukocyte casts
• urine eosinophils
• hematuria

• urine protein (tubular proteinuria)
• aminoaciduria
• glycosuria

• serum chemistries

• BUN, creatinine -> azotemia
• serum K+ -> hyperkalemia
• hypouricemia
• hypophosphatemia
• acidosis

More General Terms

• kidney disease; renal disease

Additional Terms

• hereditary renal tubular defects

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998
2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1314, 1324

renal tubular disease