Renal Disease

Tubular disease can result in retention of metabolic waste products, acid-base and electrolyte disturbances, and compromised urine concentrating ability. These effects will occur when 70% or more of the functional mass of the kidneys is gone. On the other hand, primary glomerular diseases will result in “leakage” of substances, particularly proteins, which do not normally pass through the glomerular capillaries. Protein-losing glomerulopathies are not necessarily accompanied by tubular impairment. However, the remainder of the nephron associated with the damaged or destroyed glomerulus will have partial or complete loss of function. If the disease progresses and glomeruli are increasingly destroyed such that the total functional mass of the kidneys is reduced by about 70% or greater, typical signs of renal failure will be seen. In contrast, primary tubular diseases do not often lead to significant glomerular leakage of proteins, because the glomeruli that are functioning are not leaking protein.