How Kidney and Metabolic Disease Affect Kidney Function

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  • 0:44 What Shouldn't Be in Urine
  • 1:18 Diabetes Mellitus
  • 2:44 Glomerulonephritis
  • 5:12 Chronic Kidney Disease
  • 5:53 Hypertension
  • 6:51 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson explores chronic kidney disease and the metabolic disorders that affect kidney function. We'll delve into diabetes mellitus, hypertension, and glomerulonephritis and learn what your urine can tell you about your health.

Kidney Disease

When everything is hunky-dory, your kidneys do an excellent job of ensuring what needs to be filtered or absorbed gets done right, right on time. However, there are conditions outside of the kidney's control that can overwhelm the kidney's ability to do its job. These conditions may be a symptom of a metabolic disorder that causes kidney damage. In addition, there are times when the kidneys themselves are sick, and this causes trouble for them and the rest of the body. We'll delve into some of these interesting but terrible diseases in this lesson.

Structures of a kidney nephron
Kidney Nephron Structures

What Shouldn't Be in Urine

As we move on, you must keep in mind that while there are some small deviations from this rule, under normal conditions, there shouldn't be any glucose or any large structures such as proteins and cells in the urine. If there is glucose, proteins like albumin and hemoglobin, or cells such as leukocytes (white blood cells) or erythrocytes (red blood cells) in the urine, that means there is something wrong in the kidneys, or something along the rest of the urinary tract, or both.

Diabetes Mellitus

One example of a metabolic disorder that can affect kidney function is diabetes mellitus. This is a disease whereby the body stops producing or responding to insulin, which is a hormone that drives glucose into the cells and out of the bloodstream. If a person with diabetes doesn't have their body properly controlled through medication, there can be deadly consequences. One of the many clues physicians can use to diagnose diabetes is the presence of glucose in the urine, something we call glucosuria.

If we have glucose in the urine, it means we have exceeded something called the 'renal threshold.' This means that the level of glucose in blood is so high that when the glomerulus filters the glucose into the tubules, the proximal convoluted tubule's reabsorptive capacity of glucose is breached, and it dumps what it cannot hold back into the urine. Think of the proximal tubules as a dam. If there is a massive amount of water behind a dam that wasn't built to control such a high amount of water in the first place, the dam will be breached and will send the excess water into the river below. In our case, that river is the rest of the renal tubule.


Structure of a normal glomerular capillary
Glomerular Capillary

In contrast to diabetes, which can secondarily cause kidney problems, there is an affliction which may be primarily due to issues within the kidneys themselves. This disorder is called primary glomerulonephritis, which is the inflammation of the kidney's glomerulus. If a disorder occurring outside of the kidneys, such as diabetes, is causing the inflammation, the disease is known as secondary glomerulonephritis.

It's easy to remember what glomerulonephritis means because you can easily spot the word glomerulus in the term. The word 'nephro' refers to the kidney, while the ending '-itis' refers to the inflammation of something. Hence, we get inflammation of the kidney's glomerulus, or glomerulonephritis.

In this disease, inflammatory factors begin to tick off your glomerular capillaries by damaging them. The capillaries normally have cells which are joined in a formation just big enough to let small molecules through but not porous enough to let large structures through. However, if the cells get really mad, due to inflammatory mediators hurting them, they begin to break down and move apart from one another, like you would break down and cry or move away from someone you're angry with. As these cells get damaged and move away from one another in anger, the capillary walls become even more porous than before!

This is a problem, as large structures can now freely pass through the glomerulus and into the urine. In cases of glomerulonephritis, we may see red blood cells in the urine, something called hematuria, or proteins like albumin in the urine, something we call proteinuria. Since albumin is the main protein of human blood plasma, it should make sense why it is often found in the urine in cases of glomerulonephritis.

The problem with proteinuria is that it may, by itself, cause further damage to the kidney. So, you get a wicked circle of damage causing more damage in the case of glomerulonephritis. It's like that old saying: 'Negativity breeds more negativity.' It couldn't be more true in this case.

Inflammation of the glomerular capillaries weakens their walls.

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