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