Azotemia: Dept Biochemistry
Azotemia: Dept Biochemistry
Azotemia: Dept Biochemistry
DEPT BIOCHEMISTRY
Azotemia is an elevation of blood urea nitrogen (BUN) and serum
creatinine levels.
In ATN :
epithelial damage leads to functional decline in the ability of the
tubules to reabsorb salt, water, and other electrolytes.
Excretion of acid and potassium is also impaired.
In more severe ATN, the tubular lumen is filled with epithelial
casts, causing intraluminal obstruction and resulting in a declining
GFR.
Acute interstitial nephritis :
is characterized by inflammation and edema,
which result in azotemia, hematuria, sterile pyuria, white blood
cell (WBC) casts with variable eosinophiluria, proteinuria, and
hyaline casts.
The net effect is a loss of urinary concentrating ability, with low
osmolality (< 500 mOsm/L), low specific gravity (< 1.015), high
urinary sodium (>40 mEq/L), and, occasionally, hyperkalemia and
renal tubular acidosis.
Glomerulonephritis or vasculitis :
the presence of hematuria, red blood cells (RBCs), WBCs, granular and cellular casts,
and a variable degree of proteinuria.
Nephrotic syndrome usually is not associated with active inflammation and often presents
as proteinuria greater than 3.5 g/24 h.
Glomerular diseases :
reduce GFR by changing basement membrane permeability and stimulating the renin-
aldosterone axis.
nephrotic syndrome : the urinary sediment is inactive, and there is gross proteinuria (>3.5
g/day), hypoalbuminemia, hyperlipidemia, and edema. Azotemia and hypertension are
uncommon initially, but their presence may indicate advanced disease.
In nephritic syndrome :
the urinary sediment is active with WBC or RBC casts, granular
casts, and azotemia.
Proteinuria is less obvious, but increased salt and water retention in
glomerulonephritis can lead to hypertension, edema formation,
decreased output, low urinary excretion of sodium, and increased
specific gravity.
In addition to accumulation of urea creatinine and other waste products,
a substantial reduction in GFR in CKD results in the following: