Patient With Urinary Symptoms

The presence of disease in urinary tract may be detected because of

1. Presentation with a symptom or clinical sign that indicates an underlying renal disorder

2. The presence of a systemic disease known to involve the kidney

3. The finding of asymptomatic urinary abnormalities or disordered renal function tests

Symptoms of renal disease include

Disturbance in the act of micturition

Alteration in the amount and appearance of urine

Pain : renal, ureteric, vesical, and urethral

General symptoms of renal disease

Disturbance in the act of micturition

1.Frequency - Passing urine more often than usual without increase in the amount of urine

Results from..

Irritation of the bladder

Reduction in the capacity of the bladder

Pressure from a pelvic tumour

Disturbance in the act of micturition

2. Dysuria - Pain experienced prior to, during, or following micturition usually in the urethra or suprapubic region

Usually results from disease of the..

Bladder

Prostate

Urethra

Disturbance in the act of micturition

3.Retention of urine

Occurs in

Obstructive lesions of the urethra

Disease of the spinal cord

Coma

Disturbance in the act of micturition

4.Nocturia - Passing urine in the night (commonly associated with polyuria)

Other causes

Diabetes mellitus

Prostatism

Cystitis

Bladder tumours

Disturbance in the act of micturition

5. Incontinence of urine

Seen in

Cerebrovascular lesions

Paraplegia

Multiple slerosis

Prolapsed uterus with cystocele

Disturbance in the act of micturition

6. Hesitancy

Delay in initiating the urine flow usually seen in males with prostatism

Alteration in the amount of urine

Polyuria - over 3000 ml per day

Oliguria - less than 300 ml per day

Anuria - neglible urine output

Alteration in the amount of urine

Causes of polyuria

1.Diabetes Mellitus

2.Diabetes Insipidus

3.Psychogenic polydipsia

4.Chronic renal failure

5.Hypokalemia

6.Hypercalcemia

Alteration in the amount of urine

Oliguria

Seen in acute renal failure

Pre renal failure – Shock

Haemorrhage

Dehydration

Cardiac failure

Intrinsic renal failure –

Acute glomerulonephritis

Acute tubular necrosis

Alteration in the amount of urine

Anuria

Must be differentiated from retention of urine

Causes include

Infarction of a kidney or both kidneys

Bilateral cortical necrosis

Complete obstruction of both ureters

Alteration in the appearance of urine

1. Haematuria

Red or smoky brown colour

Alteration in the appearance of urine

Causes of haematuria

Painless – Urinary tract obstrution

Tuberculosis

Urogenital tumors

Glomerulonephritis

Renal cystic disease

Painful – Renal calculi

Urinary tract infection

Reflux nephropathy

Renal papillary necrosis

Renal infarction

Alteration in the appearance of urine

2. Blackish or coca cola in colour due to haemoglobinuria and myoglobinuria

Alteration in the appearance of urine

3.Frothy urine

Commonly due to proteinuria

Alteration in the appearance of urine

Proteinuria

A small amount of protein (usually less than 100 mg) is normally excreted in the urine daily in healthy people

Proteinuria

Significant proteinuria

Physiological

Pathological

Proteinuria

Physiological

(Proteinuria less than 1000 mg / L)

Transient Proteinuria without renal damage seen in

Cold exposure

Vigorous exercise

Febrile illness

Congestive cardiac failure

Proteinuria

Pathological proteinuria

Proteinuria more than 1000 mg / L

Commonly seen in

Glomerular disease

Tubular disease

Amount is very small or no proteinuria in some renal diseases

Polycystic kidney disease

Renal scarring

Obstructive uropathy

Alteration in the appearance of urine

Urine become turbid with

Infection

Precipitated urates

Precipitated phosphates

Alteration in the appearance of urine

Drugs causing discolouration of urine

Tetracycline yellow

Desferrioxamine reddish brown

Phenindione pink

Nitrofurantoin brown

Rifampicin- red

Methylene blue green

Methyl dopa grey

Metronidazole darkening of urine

Pain – as a manifestation of renal disease

Burning sensation or discomfort over suprapubic region – Cystitis

Perineal pain or rectal pain – Prostatitis

Pain felt in the flank, hypochondrium or iliac fossa – Renal pain

Pain – as a manifestation of renal disease

Acute obstruction of ureters due to stone or blood clot – Colicky pain radiates from loin to groin and to the testicle in the male

Chronic obstruction – less severe pain and sometimes no pain

Enlarged kidneys – dull, nagging or flank pain

Acute glomerulonephritis – typically painless

General symptoms and signs of renal disease

1.Fever - Urinary tract infection may be associated with renal abnormality

2.Dyspnoea

Fluid overload in renal impairment

Metabolic acidosis in renal impairment

Pleural effusion in nephrotic syndrome

General symptoms and signs of renal disease

3.Oedema (facial and dependent)

chronic kidney disease

nephrotic syndrome

4.Pruritus – in chronic kidney disease

5.Distal brown discolouration of nails – in chronic kidney disease

General symptoms and signs of renal disease

6.Pallor – in chronic kidney disease

7.Hyperpigmentation - in chronic kidney disease

General symptoms and signs of renal disease

8.Symptoms of ureamia

Anorexia

Lethargy

Nausea

Poor sleep

Poor concentration

Itching

Restless legs

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