Clinical and Laboratory

Assessment of The Patients

With Renal Disease

DR. Dr. Syakib Bakri, Sp.PD-KGH

 Main function of the kidney
 Maintenance of body composition
 Volume of fluid in the body & osmolality
 Electrolytes content & concentration (Na+, K+, Cl-,
Ca+, Mg2+, & PO4+)
 Acidity
 Excretion of metabolic and product and foreign
substances
 Production and secretion enzymes and
hormones
 Renin
 Erythropoetin
 1,25 dihydroxyvitamin D3
 Ten syndrome in Nephrology

Acute nephritis (AN)

Nephrotic syndrome (NS)
Asymptomatic urinary abnormalities (AU)
Acute renal failure (ARF)
Chronic kidney disease (CKD)
Urinary tract infection (UT)
Urinary tract obstruction (UO)
Renal tubule defects (RD)
Hypertension (H)
Nephrolithiasis (NL)
 Initial clinical data base for nephrology
Finding AN NS AU ARF CKD UI UO TD H NL

Hematuria N ○ ● ○ ○ ○ ●
Oligouria ● ○ ● ○ ●
Anuria ● ● ○ ●
Polyuria ●
Nocturia ○ ○ ○ ○
Urinary retention S
Slow stream ●
UI symptoms ● ●
Edema ○ ● ○ ○
Uremic symptoms ● ●
Renal colic ●
Stone Passage S
Hypertension ● ○ ○ N,S
Tender bladder or flank ● ●
Full bladder after voiding S
Large prostate ●
Large kidney ● ●

○ occurs in the syndrome ● important clue to the syndrome, N : necessary for the diagnosis of the
syndrome S: sufficient for the diagnosis of the syndrome unless clearly cause by another disease
 Initial laboratory data base for nephrology
Finding AN NS AU ARF CKD UI UO TD H NL
URINALYSIS
Proteinuria ○ N ● ○ ○ ● ○
Hematuria N ○ ● ○ ○ ○ ○ ●
RBC cast ● ● ○
WBC cast ● ●
Pyuria ○ ○
Broad cast ●
Other cast ○ ○ ○ ○ ○
Bacteriuria ●
Glucosuria ●
BLOOD COUNT
Anemia ○ ●
BLOOD CHEMISTRY
 Ureum / creatinine N N N

○ occurs in the syndrome ● important clue to the syndrome, N : necessary for the diagnosis of the
syndrome S: sufficient for the diagnosis of the syndrome unless clearly cause by another disease
 Data Needed to establish syndromes

Type of Data AN NS AU ARF CKD UI UO TD H NL

24-h protein excretion ○

Urinary protein ○
electrophoresis
Urine culture ○
Serial blood pressure ○ ○

Serial GFR ○ ○ ○
Serial serum creatinine ○
Serial urine volume ○ ○
○ ○ ○
Intravenous pyelogram
○ ○ ○
Retrograd pyelogram
Bone radiograph* ○

○ data needed to establish syndromes

* skull, fingers, and clavicles for osteitis fibrosa cystica; long bones and scapulae for osteomalacia