THE RENAL SYSTEM SIGNS AND SYMPTOMS

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THE RENAL SYSTEM SIGNS AND
SYMPTOMS
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HISTORY TAKING IMPORTANT ROLE

• PRIOR HISTORY
• PAST MEDICAL HISTORY
• ACUTE INFECTIONS
• CHRONIC INFECTIONS
• TOXIC SUBSTANCES
• SECUNDARY TO OTHER DISEASES

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PAST MEDICAL HISTORY

• ACUTE INFECTIONS
• (Especially ? HEMOLITIC STREPTOCOCCUS)
• TONSILITTIS
• SCARLET FEVER
• POSTSTREPTOCOCCAL SYNDROME
• CHRONIC INFECTIONS
• TUBERCULOSIS
• AMILOYDOSIS(secondary)
• Viral infections

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PAST MEDICAL HISTORY

• TOXICS
• DRUGS
• Aminoglycosides, lithium, ciclosporin and
  tacrolimus,
• Heavy metals
• non-steroidal anti-inflammatory drugs
• DIETARY Calcium-rich food.
• MECANICAL
• RENAL EMBOLISM or THROMBOSIS
• SECUNDARY TO OTHER DISEASES
• Hypertension, Diabetes, PARATHYROIDS diseases

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FAMILY HISTORY

• DM
• HTN
• POLYCYSTIC KIDNEY DISEASE

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SIGNS AND SYMPTOMS

1. RENAL PAIN
2. DIURESIS disturbances
3. URINE ABNORMALITIES
4. RENAL EDEMA
5. GENERAL MANIFESTATIONS

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RENAL PAIN

• RENAL COLIC
• CHRONIC LOIN PAIN

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RENAL COLIC

• ONSET SUDDEN
• TRIGGERS VIBRATIONS, PHYSICAL ACTIVITY, RAPID
  WALKING
• LOCATION RENAL ANGLE (usually UNILATERALLY)
• RADIATION LOINS?FLANKS?FOSSAS?GROINS?GENITALIA
• INTENSITY and DURATION SEVERE, SUSTAINED
• AGRAVATED by PALPATION, COUGH, SNEEZING
• AMELIORATED by HEAT
• ASSOCIATED with
• RESTLENESS, PALOR, COLD SWEATING
• NAUSEA, VOMITINGS
• TACHYCARDIA, ANGINAL PAIN,
• ILEUS,
• MICTURITION disturbances

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RENAL COLIC
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RENAL COLIC

• CAUSES
• KIDNEY STONES
• PAPILLARY NECROSIS

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DIURESIS DISTURBANCES

• POLYURIA
• OLIGURIA
• ANURIA
• NOCTURIA

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EXAMINATION OF THE URINE

• HAEMATURIA
• PYURIA
• PROTEINURIA

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EXAMINATION OF THE URINE
Macroscopic Biochemical Microscopic Microbiological
CLARITY Specific Gravity RBCs, WBCs CULTURES SENSITIVES
COLOR pH BACTERIA
ODOUR BLOOD CASTS NITRITES
VOLUME PROTEIN CRYSTALS
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HAEMATURIA

• The presence of red blood cells in the urine
• due to bleeding from the kidneys or urinary tract
  
• CAN BE
• MICROSCOPIC (10001mil. erythrocytes/ml/min)
• MACROSCOPIC ( gt1mil. erythrocytes/ml/min)
• Color of the haematuria
• RED or BROWN
• CAN LEAD to CLOTS and HAEMATIC DEPOSITS

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HAEMATURIA

• CAUSES
• PRERENAL HEMORRHAGIC conditions coagulopathies
• thrombopathies, vasculopathies
• RENAL glomerulonephrites, interstitial
  nephrites, tuberculosis,
• tumors, traumas, renal stones, polycystic
  kidney disease
• hypertensive nephrosclerosis, acute tubular
  necrosis,
• renal ischaemia (renovascular disease)
• schistosomiasis, urinary tract infection
• reflux nephropathy and renal scarring
• POSTRENAL
• URETER stones, tumor, inflammation,
• vascular malformation, traumas
• BLADDER tumor, stones, inflammation, polyp,
  foreign objects
• URETHRO-PROSTATIC tumor, stones, inflammation
• strictures, foreign objects, malformation

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HAEMATURIA

• 3 CUPS TEST
• INITIAL ? URETHRA, PROSTATE
• TERMINAL ? BLADDER
• TOTAL ? KIDNEYS and URETER

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HAEMATURIA

• DIFFERENTIAL
• CONCENTRATED urine increased specific gravity
• CONJUGATED BILIRUBIN
• RED-BROWN normalized when heated ? URATES
• drugs L-Dopa
• RED DRUGS (rifampicin, metronidazol)
• FOOD beetroot, blackberries

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PYURIA

• PRESENCE OF PUS CELL IN THE URINE
• CAN BE
• MICROSCOPIC LEUCOCYTURIA
• MACROSCOPIC
• - changes in urine aspect
• LOSS of LUSTRE, TRANSPARENCY,
• MUCUS FRAGMENTS, PUS DEPOSITS
• - changes in odor of the urine

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PYURIA

• CAUSES
• PRERENAL septicemia,
• hematogenous dissemination of other systemic
  infections
• RENAL tuberculosis, infected kidney stones,
  tumors,
• malformations,
• POSTRENAL
• STONES
• NEOPLASMS
• MALFORMATION
• CYSTITIS
• INVASIVE UROLOGICAL MANEUVERS
• BENIGN HYPERTROPHY/CANCER PROSTATE

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PYURIA

• DIFFERENTIAL
• CLOUDY urines
• URATES, PHOSPHATES
• Clarifies when HEATED/ACID adding
• CHYLURIA
• URETHRITIS
• VAGINITIS

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PROTEINURIA

• PRESENCE OF PROTEINS IN THE URINE
• QUANTITY
• MICROALBUMINURIA 30-300 mg/day
• MEDIUM 300mg 3.5 g/day
• HIGH gt 3.5 g/day

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PROTEINURIA

• CAUSES
• PRERENAL (normal glomerular filter)
• High protein levels in the blood (transfusions)
• Plasma cell dyscrazias
• RENAL
• abnormal glomerular permeability,
• decreased tubular reabsorbtion, tubular secretion
• GLOMERULOPATHIES, TUBULOPATHIES
• POSTRENAL
• Massive epithelial desquamations leucocyturia

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PROTEINURIA

• URINE PROTEIN ELECTROPHORESIS (UPEP)
• GLOMERULAR
• SELECTIVE
• NONSELECTIVE
• TUBULAR
• ABNORMAL PROTEINS

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GLOMERULAR PROTEINURIA

• SELECTIVE
• mostly ALBUMIN
• GLOMERULOPATHIES with potential reversible
  evolution
• NONSELECTIVE
• ALL PLASMA PROTEINS
• SEVERE, IRREVERSIBLE GLOMERULOPATHIES

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TUBULAR PROTEINURIA

• UPEP ?
• TAMM-HORSFALL
• ?2 MICROGLOBULIN
• CAUSES
• TUBULAR INJURY of any cause
• CHRONIC KIDNEY FAILURE
• PYELONEPHRITIS
• HYPERTENSION

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ABNORMAL PROTEINURIA

• EXCESS OF LIGHT CHAINS
• CAUSES
• MULTIPLE MYELOMA
• ESSENTIAL MACROGLOBULINEMIA
• AMYLOIDOSIS
• LYMPHOMAS

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PHYSIOLOGICAL PROTEINURIA

• Only ALBUMIN
• Of transient character
• CAUSES
• FEVER
• CHILLS
• EXERCISE
• EXTENDED ORTHOSTATISM
• INTERMITTENT PROTEINURIA
• CONGESTIVE HEART FAILURE

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GENERAL MANIFESTATIONS

• FEVER
• SKIN and APPENDAGES OF SKIN
• RESPIRATORY changes
• DYSPNEA,
• CARDIOVASCULAR changes
• URAEMIC PERICARDITIS
• RHYTHM and CONDUCTION abnormalities
• MYOCARDIAL CONTRACTION changes
• HYPOTENSION

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GENERAL MANIFESTATIONS

• GASTROINTESTINAL
• NAUSEA, VOMITINGS
• ALTERED BOWELL HABIT
• NEUROLOGICAL
• SOMNOLENCE, RESTLENESS, COMA
• SENSORIAL or MOTOR abnormalities
• PERIPHERAL NEUROPATHY

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RENAL SYSTEM PHYSICAL EXAMINATION

• GENERAL PHYSICAL EXAMINATION
• SKIN and SKIN APPENDAGES
• PALLOR, LEMON-YELLOW COMPLEXION, DRY SKIN
• ITCHING, SCRATCH MARKS
• UREMIC FROST
• UREMIDES
• BROWN LINE PIGMENTATION OF NAILS
• RENAL EDEMA

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LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATION

• I. INSPECTION

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LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATION

• I. INSPECTION
• LOMBAR REGIONS
• ABNORMAL BULGING/RETRACTION SKIN CHANGES
• BULGING INFLAMMATION PERINEPHRITIC ABCESS
• VERTEBRAL MUSCLES CONTRACTURE renal colic
• ABDOMEN
• BULGING OF THE FLANKS THIN patients,
  CHILDREN
• UNI or BILATERAL
• In KIDNEY CYSTS, TUMORS
• HYPOGASTRIC BULGING
• BLADDER DISTENTION
• GENITALIA

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KIDNEYS PALPATION
RIGHT LEFT
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LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATION

• II. KIDNEY PALPATION
• (C) ONE HAND
• place your left thumb in the right hypocondrium/
  right thumb
• in the left hypocondrium
• the other four fingers are placed in the
  costovertebral angle
• try to catch the kidney between thumb and
  fingers and palpate it
• with your thumb
• in CHILDREN, VERY SLENDER PATIENTS

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LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATION

• II. KIDNEY PALPATION
• ENLARGED
• unilaterally PTOSIS, COMPENSATORY HYPERTROPHY,
• NEOPLASM, CYSTS
• bilaterally POLYCYSTIC KIDNEY ISEASE (PKD)
• uni or bilateralLY HYDRONEPHROSIS,
  PYONEPHROSIS