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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