Question

Q1) with respect to Renal failure (R.T)

a) What are the general biochemical features of (R.F)?

b) What are the characteristics of Fanconi Syndrome?

Answer 1

Answer with discussion and explanation:

1.a) When kidneys are unable to meet the excretory and metabolic functions of the body, it is termed as renal failure.

Acute renal failure is defined as rapid, potentially reversible decline in renal function sufficient enough to result in accumulation of nitrogenous waste products in the body. It is characterized by a) S. creatinine > 4 mg/dL, b) Anuria (nil urine output) > 12 hours c) Urine output < 0.3 mL/kg/hour for last 24 hours.

Chronic renal failure is defined as an irreversible deterioration in renal function over 3 months with glomerular filteration rate (GFR) < 15 mL/ minute.

Biochemical features of renal failure:

* S. Creatinine - Nitrogenous waste product which is excreted in urine. Normal value range from 0.8 mg - 1.4 mg/dL.

* Blood urea - It is also a nitrogenous waste product. Normal value ranges from 10- 40 mg/dL.

* Serum potassium - Potassium level rises in failure and may predispose for cardiac arrhythmias which can be life threatening. Normal value is 3.5 - 5.0 mEq/L.

* Serum phosphorus - Due to underexcretion and increased absorption, phosphorus also accumulates in the body. Normal serum phosphorus level is 2.5 - 4.5 mg/dL.

* Hypocalcemia - Increased phosphorus binds with calcium causing hypocalcemia. Reduced level of active Vitamin D is also responsible for reduced calcium levels in blood. Normal calcium level is 8.5 - 10 mg/dL.

* Metabolic acidosis - It is due to raised hydrogen ion concentration and reduced bicarbonate concentration. It is characterized by pH < 7.35 and bicarbonate < 24 mEq/litre in the blood.

* Anemia - It occurs in chronic renal failure. Anemia is usually of normocytic normochromic type. In case of coexisting iron deficiency anemia can be microcytic hypochromic type.

* Novel biomarkers for acute kidney injury are Cystatin C , kidney injury molecule-1 (KIM-1), neutrophil gelatinase associated lipocalin (NGAL).

b) Fanconi syndrome is caused by proximal renal tubular defects which may be inherited or sporadic.

It is characterized by glycosuria (loss of glucose in urine), phosphaturia (loss of phosphate in urine) , hypercalciuria (loss of calcium in urine), aminoaciduria (loss of aminoacids in urine), bicarbonaturia (loss of bicarbonate in urine), proximal renal tubular acidosis (pH <7.35), hypokalemia d(Low potassium in blood).

Clinical features with which patient can present are:

* Polyuria (excessive urination), dehydration

* Poor growth

* Rickets (in children), osteomalacia (in adults)

* Renal failure.