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Kidney Function: A Clinical Summary
The kidneys are essential regulatory organs whose primary clinical functions are to maintain internal homeostasis and remove waste. Their failure disrupts nearly every bodily system.

Core Clinical Functions:

Waste & Toxin Clearance: Filter blood to excrete metabolic wastes (urea, creatinine), drugs, and toxins. Measured clinically by GFR (Glomerular Filtration Rate) and serum creatinine.

Fluid & Electrolyte Balance: Precisely regulate total body water, sodium, potassium, calcium, and phosphate. Imbalances cause edema, hypertension, arrhythmias (e.g., hyperkalemia), and bone disease.

Acid-Base Homeostasis: Excrete daily acid load and regenerate bicarbonate to maintain normal blood pH. Failure leads to metabolic acidosis.

Blood Pressure Regulation: Control extracellular fluid volume and release renin to activate the RAAS system. Chronic kidney disease is a major cause of secondary hypertension.

Endocrine Functions:

Produce erythropoietin (EPO); deficiency causes anemia of CKD.

Activate Vitamin D; deficiency causes hypocalcemia and renal osteodystrophy.

Clinical Assessment:

Blood Tests: Serum creatinine, BUN, electrolytes, eGFR.

Urinalysis: Protein, blood, glucose, casts (identifies glomerular vs. tubular disease).

Imaging: Ultrasound for structure, obstruction, or cystic disease.

Key Clinical Syndromes of Dysfunction:

Acute Kidney Injury (AKI): Rapid decline in function (↑creatinine). Causes: Pre-renal (low flow), intrinsic (direct damage), post-renal (obstruction).

Chronic Kidney Disease (CKD): Progressive, irreversible loss of function. Staged by eGFR. Major causes: Diabetes and Hypertension.

Nephrotic Syndrome: Heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia.

Nephritic Syndrome: Hematuria, hypertension, mild proteinuria, ↓GFR (glomerular inflammation).

End-Stage Renal Disease (ESRD): Requires renal replacement therapy (dialysis or transplant).

In clinical practice, kidney function is a vital sign of systemic health. Its decline has wide-ranging consequences, making early detection and management of underlying causes (diabetes, hypertension) paramount.