0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
Chronic Renal Failure 347■SKIN: pruritis, easy bruising, petechiae, cutaneous infarcts, palpable
purpura, calcinosis.
tests
Laboratory
■Basic blood tests:
➣Early disease: elevated serum creatinine, BUN
➣Advanced disease: early disease+hyperkalemia, hypobicar-
bonatemia, hyperphosphatemia, hypocalcemia, hypercalcemia,
hypermagnesemia, elevated serum PTH, decreased serum 1,25
(OH)2 vitamin D3, elevated alkaline phosphatase, anemia
■Basic urine tests:
➣Early disease: microalbuminuria/proteinuria, microhematuria,
pyuria, casts including: RBC, WBC, granular; crystalluria
➣Advanced disease: same as early and hyaline casts
➣Urinalysis Patterns:
➣Glomerulonephritis: hematuria, dysmorphic RBCs, heavy pro-
teinuria (urine protein/creatinine ratio≥3.0) and RBC casts
➣Tubulointerstitial nephritis: microhematuria, pyuria,+WBC
casts, mild proteinuria (urine protein/creatinine ratio≤2.0) and
waxy casts
➣Renal Ischemia (Vasculitis, atheroembolism, renal artery steno-
sis) or Urinary obstruction: Minimal cellular elements+protein-
uria
➣Urine [Na] and fractional Na excretion (FENa) not helpful
Specific Diagnostic Tests:
■Creatinine clearance (Ccr)
■Spot urine albumin mg/gram creatinine mg ratio (> 30 and < 300=
microalbuminuria; > 300=macroalbuminuria); spot urine total
protein mg/creatinine mg ratio (>0.15 abnormal)
■Anti-nuclear antibodies (SLE), Anti-neutrophil cytoplasmic anti-
body, hepatitis B surface antigen, Anti-hepatitis C antibody; HIV,
complement components 3 and 4, anti-topoisomerase antibody,
cryoglobulins, serum and urine protein electrophoresis, urine
immunofixation (light chain deposition disease)
Imaging:
■Chest X-Ray to evaluate heart and lungs (see management)
■Renal ultrasound
➣Early disease: Normal or enlarged kidneys; cystic-autosomal
dominant polycystic kidney disease (ADPKD); hydronephrosis