Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (563 page)

   Severe anemia out of proportion to azotemia occurs.

   Altered renal tubular function may result in hypophosphatemia, oliguria, and nephrogenic diabetes insipidus. Urine sediment is typically bland.

   Kidney biopsy can be helpful if a definitive diagnosis is needed.

Suggested Reading

Dimopoulos MA, Terpos E, Chanan-Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group.
J Clin Oncol.
2010;28(33):4976–4984.
http://myeloma.org/pdfs/IMWG-Renal-Impairment.pdf

POLYARTERITIS NODOSA, RENAL DISEASE

   Overview

   See polyarteritis nodosa.

   Renal involvement occurs in 75% of polyarteritis nodosa patients and is associated with renal insufficiency and hypertension. Renal infarction can also be seen in severe cases.

   Laboratory Findings

   Mild azotemia that is slowly progressive.

   Albuminuria and hematuria are common. Fat bodies are frequently present in urine sediment.

RENAL TUBERCULOSIS

See Chapter
7
, Genitourinary System Disorders.

SCLERODERMA, RENAL DISEASE

   Overview

   See scleroderma.

   Renal involvement occurs in more than 50% of scleroderma patients and is associated with increased mortality.

   Scleroderma renal crisis (SRC) is the most severe renal condition associated with scleroderma. SRC is seen in approximately 10–20% of diffuse cutaneous scleroderma patients and in only 1% of patients with limited cutaneous scleroderma. It is characterized by acute onset of hypertension, thrombotic microangiopathy, progressive renal failure, and a 5-year survival rate of 65%.