renal

renal

 [re´nal]

pertaining to the kidney; called also nephric.

renal clearance tests laboratory tests that determine the ability of the kidney to remove certain substances from the blood. The most commonly used is the creatinine clearance test, which is a measure of the glomerular filtration rate.

renal failure inability of the kidney to maintain normal function, so that waste products and metabolites accumulate in the blood. This affects most of the body's systems because of its important role in maintaining fluid balance, regulating the electrochemical composition of body fluids, providing constant protection against acid-base imbalance, and controlling blood pressure. Called also kidney failure.

Acute renal failure occurs suddenly and may be caused by physical trauma, infection, inflammation, or exposure to nephrotoxic chemicals. Nephrotoxic agents include drugs such as penicillins, sulfonamides, aminoglycosides, and tetracyclines; radiographic iodine contrast materials; and heavy metals. These agents inflict damage on the renal tubules, causing tubular necrosis, and may also indirectly harm the tubules by producing severe vasoconstriction of renal blood vessels with ischemia of kidney tissue. Other causes of tubular ischemia include circulatory collapse, severe dehydration, and hypotension in certain compromised surgical patients.



Acute renal failure may be classified as: prerenal, associated with poor systemic perfusion and decreased renal blood flow; intrarenal, associated with renal ischemia or toxins; or postrenal, resulting from the obstruction of urine flow out of the kidneys.

oliguria is the hallmark of tubular necrosis, but it is not always present. Other symptoms besides a marked decrease in urinary output are related to fluid and electrolyte imbalances, anemia, hypertension, and uremia. In addition to supportive measures to restore and maintain a tolerable internal environment during acute renal failure, it may be necessary to remove toxic wastes by hemodialysis or peritoneal dialysis.

Chronic renal failure is a progressive loss of kidney function that may eventually progress to end-stage renal disease. The clinical course is described in four stages. First there is decreased renal reserve, with diminishing renal function but without accumulation of the end products of protein metabolism; the patient has no symptoms. In the second stage, renal insufficiency, the glomerular filtration rate (GFR) is depressed to about 30 ml per minute and plasma chemistry begins to show abnormalities as waste products accumulate. The third stage, frank renal failure, is characterized by steadily rising serum creatinine and blood urea nitrogen levels accompanying a drop in the GFR. The fourth and final stage is uremia; levels of protein end products continue to rise, residual urine function is less than 15 per cent, and all body systems are impaired.



Causes of renal failure are many and can be roughly divided into three groups: (1) those that directly affect the kidney by infection, inflammation, and upper urinary tract obstruction; (2) those in which there is an obstruction of the lower urinary tract; and (3) systemic diseases and toxicities, such as hypercalcemia, hypertension, disseminated lupus erythematosus, atheroma, and diabetes mellitus.

Treatment. The treatment of chronic renal failure is highly complex owing to its impact on systems throughout the body. It involves prevention of imbalances in water and electrolytes whenever possible and correction of these imbalances when they do occur. Therapy may include phosphate binders to prevent absorption of phosphorus from the intestinal tract, antihypertensive agents to control high blood pressure, diuretics to manage hypervolemia, erythropoietin to manage anemia, and cardiac drugs to manage heart failure. Fluids often are restricted to a given amount during each 24-hour period. Dietary restrictions are aimed at minimizing urea toxicity, controlling various metabolic upheavals and providing optimal nutrition. Protein intake is an especially critical factor because the end products of the metabolism of protein and amino acids are excreted for the most part by the kidney.



Symptomatic relief of the many manifestations of end-stage renal disease is a challenge to every member of the health care team. Virtually every system within the body is adversely affected in some way. Pathophysiologic changes involve the gastrointestinal tract, the skin, the cardiovascular system, the lungs, bone, and blood, and the metabolism of glucose and protein.

Hemodialysis or peritoneal dialysis may be employed to rid the body of wastes that the kidney can no longer handle. For some patients transplantation of a human kidney is a viable alternative to continuous dialysis. Others who cannot withstand surgery and long-term immunosuppression are not good candidates for a kidney transplant.

neph·ric

(nef'rik),

Relating to the kidney.

Synonym(s): renal

renal

(rē′nəl)

adj.

Of, relating to, or in the region of the kidneys.

renal

adjective Referring to one or more kidneys.

paraneoplastic syndrome

Oncology A co-morbid condition due to the indirect–remote or 'biologic' effects of malignancy, which may be the first sign of a neoplasm or its recurrence; PSs occur in > 15% of CAs, are caused by hormones, growth factors, biological response modifiers, and other as-yet unidentified factors, and may regress with treatment of the primary tumor. See Ectopic hormone.

Paraneoplastic syndromes

GI tract, eg anorexia, vomiting, protein-losing enteropathy, liver disease

Hematologic, eg leukemoid reaction, reactive eosinophilia, peripheral 'cytoses or 'cytopenias, hemolysis, DIC, thromboembolism, thrombophlebitis migrans

Hormonal effects

Metabolic disease, eg lactic acidosis, hypertrophic pulmonary osteoarthropathy, hyperamylasemia, hyperlipidemia

Neuromuscular, eg peripheral neuropathy, myopathy, CNS, spinal cord degeneration, inflammation

Renal, eg nephrotic syndrome, uric acid nephropathy

Skin, eg bullous mucocutaneous lesions, acquired ichthyosis, acanthosis nigricans, dermatomyositis

Others, eg callus formation, hypertension, and amyloidosis

neph·ric

(nef'rik)

Relating to the kidney.
Synonym(s): renal.

renal

Pertaining to the kidneys.

renal

pertaining to the kidney.

Renal

Relating to the kidney. The renal artery is one of two branches of the large blood vessel in the stomach area that serves the kidneys, ureters (tubes that carry urine from the kidney to the bladder) and adrenal glands.

Mentioned in: Cox-2 Inhibitors, Glomerulonephritis, Hantavirus Infections, Hyperaldosteronism, Kidney Nuclear Medicine Scan, Retrograde Urethrography

neph·ric

(nef'rik)

Relating to the kidney.
Synonym(s): renal.

Patient discussion about renal

Q. what cause pain around kidney uncomfortable pressure swelling right side back

A. thanx....the pain is dull and there's no fever: muscular pain perhaps? If it worsens, persists or fever developes; I will head to the Doctor. thamx again....

Q. experiencing sharp pain in my right kidney region... pain is acute and doesnt radiate... recently PE left lung have been taking warfrin, panadiene forte, two kinds of cholesterol/triglycerine reducing meds and champix quit smoking medication... recently tests showed the hight cholesterol and triglys' levels and also a swollen liver... pain is not in my liver area... past pain in this kidney recurrent but never as bad. always dull.. many years ago had a uti, which caused high protiene levels.. very bad at finishing anti-biotics... recently had tonsilitis.. This hurts and is tender to touch but does not bring on sharp pain when touched, sharp pain comes and goes after taking pain relief

A. Go to see a doctor - although its tempting to make the diagnosis over the net (I have several ideas about what it might be), it sounds like serious, especially if you had a PE lately - it could be a thrombus in the vein of the kidney, or maybe a stone (sounds like that according to the description of the pain). However, as I said, making the diagnosis without even seeing you isn't the wisest thing to do.

Take care,