Clinical syndromes of kidney disease
- Topic
Kidney diseases show themselves through a handful of syndromes. Naming the syndrome tells you which part of the kidney is hurt.
What it is
The kidney has four compartments (glomeruli, tubules, interstitium and vessels), and each tends to fail in its own way. Glomerular disease shows as blood or protein in the urine, tubular disease as lost concentrating power or acid-base disorders, and any of them can end in acute or chronic loss of filtration. Because all compartments depend on each other, a chronic injury anywhere eventually scars the whole organ.
Key facts
- The kidney has a large reserve: much of it can be lost before the creatinine rises.
- Tubular syndromes show as polyuria, nocturia, electrolyte loss and metabolic acidosis.
- End-stage kidney disease is the point where survival needs dialysis or transplantation.
Renal syndromes: what you see and where the damage usually is
| Syndrome | Key findings | Usual site |
|---|---|---|
| Acute kidney injury | Creatinine rises over hours to days; oliguria or anuria; fluid and potassium overload | Tubules (ischemic or toxic), but also glomeruli, vessels or obstruction |
| Nephrotic syndrome | Heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria | Podocytes and the filtration barrier |
| Nephritic syndrome | Hematuria with red cell casts, hypertension, oliguria, mild proteinuria | Inflamed, hypercellular glomeruli |
| Rapidly progressive glomerulonephritis | Nephritic picture with loss of function over days to weeks | Glomeruli with crescents |
| Chronic kidney disease | Slow loss of GFR, anemia, bone disease, hypertension | All compartments, ending in scarred kidneys |
| Tubular defects | Polyuria, nocturia, acidosis, electrolyte wasting | Proximal or distal tubules |
Clinical notes
- Prerenal azotemia shows concentrated urine with low sodium; once tubules are injured, the urine sodium rises.
- Postrenal azotemia corrects when the obstruction is relieved, if relief comes before permanent damage.
- Urinary infection (bacteria and pus cells) and stones (colic and hematuria) are the commonest non-fatal kidney problems.
In the lab
- Creatinine and estimated GFR measure filtration; the urinalysis and sediment (casts, red cells, fat) point to the compartment.
Test yourself
Think of the answer, then tap the question to see it.
What separates nephritic from nephrotic syndrome?
Nephritic is inflammatory: hematuria, red cell casts and hypertension with modest proteinuria. Nephrotic is a leaky filter: heavy proteinuria, low albumin, edema and hyperlipidemia.
What is the difference between azotemia and uremia?
Azotemia is the laboratory finding of raised urea and creatinine; uremia is azotemia with symptoms and systemic damage such as pericarditis and encephalopathy.
Which kind of azotemia is caused by an enlarged prostate?
Postrenal azotemia, from obstruction of urine outflow below the kidneys.
Elsewhere in DurgiPedia
- Physiology of acute and chronic kidney failure
- Glomerular filtration: the barrier and its determinants
- Creatinine and estimated glomerular filtration rate (eGFR)
- Urinalysis
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Acute Kidney Injury (StatPearls (NCBI Bookshelf), 2024); Chronic Kidney Disease (StatPearls (NCBI Bookshelf), 2024).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.