THE RENAL SYSTEM SIGNS AND SYMPTOMS

HISTORY TAKING = IMPORTANT ROLEPRIOR HISTORY PAST MEDICAL HISTORY

ACUTE INFECTIONSCHRONIC INFECTIONSTOXIC SUBSTANCESSECUNDARY TO OTHER DISEASES

PAST MEDICAL HISTORYACUTE INFECTIONS

(Especially HEMOLITIC STREPTOCOCCUS)TONSILITTIS;SCARLET FEVERPOSTSTREPTOCOCCAL SYNDROME;

CHRONIC INFECTIONSTUBERCULOSISAMILOYDOSIS(secondary)Viral infections

PAST MEDICAL HISTORYTOXICS

DRUGS:Aminoglycosides, lithium, ciclosporin and tacrolimus,Heavy metals non-steroidal anti-inflammatory drugsDIETARY: Calcium-rich food.MECANICAL

RENAL EMBOLISM or THROMBOSIS;SECUNDARY TO OTHER DISEASES

Hypertension, Diabetes, PARATHYROIDS diseases

FAMILY HISTORYDMHTNPOLYCYSTIC KIDNEY DISEASE

SIGNS AND SYMPTOMSRENAL PAINDIURESIS disturbancesURINE ABNORMALITIESRENAL EDEMAGENERAL MANIFESTATIONS

RENAL PAINRENAL COLICCHRONIC LOIN PAIN

RENAL COLICONSET: SUDDENTRIGGERS: VIBRATIONS, PHYSICAL ACTIVITY, RAPID WALKINGLOCATION: RENAL ANGLE (usually UNILATERALLY);RADIATION: LOINSFLANKSFOSSASGROINSGENITALIA;INTENSITY and DURATION: SEVERE, SUSTAINEDAGRAVATED by: PALPATION, COUGH, SNEEZINGAMELIORATED by: HEATASSOCIATED with:RESTLENESS, PALOR, COLD SWEATINGNAUSEA, VOMITINGSTACHYCARDIA, ANGINAL PAIN,ILEUS, MICTURITION disturbances

RENAL COLIC

RENAL COLICCAUSES:KIDNEY STONESPAPILLARY NECROSIS

DIURESIS DISTURBANCESPOLYURIAOLIGURIAANURIANOCTURIA

EXAMINATION OF THE URINE

HAEMATURIAPYURIAPROTEINURIA

EXAMINATION OF THE URINE

MacroscopicBiochemicalMicroscopicMicrobiologicalCLARITYSpecific Gravity RBCs, WBCsCULTURESSENSITIVESCOLORpHBACTERIAODOURBLOODCASTSNITRITESVOLUMEPROTEINCRYSTALS

HAEMATURIA

The presence of red blood cells in the urinedue to bleeding from the kidneys or urinary tract CAN BE:MICROSCOPIC (10001mil. erythrocytes/ml/min) MACROSCOPIC ( >1mil. erythrocytes/ml/min)Color of the haematuria: RED or BROWNCAN LEAD to CLOTS and HAEMATIC DEPOSITS

HAEMATURIA

CAUSESPRERENAL: HEMORRHAGIC conditions: coagulopathies thrombopathies, vasculopathiesRENAL: glomerulonephrites, interstitial nephrites, tuberculosis, tumors, traumas, renal stones, polycystic kidney disease hypertensive nephrosclerosis, acute tubular necrosis, renal ischaemia (renovascular disease)schistosomiasis, urinary tract infectionreflux nephropathy and renal scarringPOSTRENAL:URETER: stones, tumor, inflammation,vascular malformation, traumasBLADDER: tumor, stones, inflammation, polyp, foreign objectsURETHRO-PROSTATIC: tumor, stones, inflammationstrictures, foreign objects, malformation

HAEMATURIA

3 CUPS TEST:INITIAL URETHRA, PROSTATETERMINAL BLADDERTOTAL KIDNEYS and URETER

HAEMATURIA

DIFFERENTIALCONCENTRATED urine increased specific gravityCONJUGATED BILIRUBINRED-BROWN normalized when heated URATES drugs: L-DopaRED DRUGS (rifampicin, metronidazol) FOOD: beetroot, blackberries

PYURIA

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

PYURIA

CAUSESPRERENAL: septicemia, hematogenous dissemination of other systemic infectionsRENAL: tuberculosis, infected kidney stones, tumors, malformations, POSTRENAL:STONESNEOPLASMSMALFORMATIONCYSTITISINVASIVE UROLOGICAL MANEUVERSBENIGN HYPERTROPHY/CANCER PROSTATE

PYURIA

DIFFERENTIALCLOUDY urinesURATES, PHOSPHATESClarifies when HEATED/ACID addingCHYLURIAURETHRITISVAGINITIS

PROTEINURIA

PRESENCE OF PROTEINS IN THE URINEQUANTITY MICROALBUMINURIA 30-300 mg/dayMEDIUM300mg 3.5 g/dayHIGH> 3.5 g/day

PROTEINURIA

CAUSESPRERENAL (normal glomerular filter)High protein levels in the blood (transfusions)Plasma cell dyscraziasRENAL abnormal glomerular permeability, decreased tubular reabsorbtion, tubular secretionGLOMERULOPATHIES, TUBULOPATHIESPOSTRENALMassive epithelial desquamations + leucocyturia

PROTEINURIA

URINE PROTEIN ELECTROPHORESIS (UPEP)GLOMERULARSELECTIVENONSELECTIVETUBULARABNORMAL PROTEINS

GLOMERULAR PROTEINURIA

SELECTIVEmostly ALBUMINGLOMERULOPATHIES with potential reversible evolutionNONSELECTIVEALL PLASMA PROTEINSSEVERE, IRREVERSIBLE GLOMERULOPATHIES

TUBULAR PROTEINURIA

UPEP TAMM-HORSFALL 2 MICROGLOBULINCAUSESTUBULAR INJURY of any causeCHRONIC KIDNEY FAILUREPYELONEPHRITISHYPERTENSION

ABNORMAL PROTEINURIA

EXCESS OF LIGHT CHAINS CAUSES:MULTIPLE MYELOMAESSENTIAL MACROGLOBULINEMIAAMYLOIDOSISLYMPHOMAS

PHYSIOLOGICAL PROTEINURIA

Only ALBUMINOf transient characterCAUSES:FEVERCHILLSEXERCISEEXTENDED ORTHOSTATISMINTERMITTENT PROTEINURIACONGESTIVE HEART FAILURE

GENERAL MANIFESTATIONS

FEVERSKIN and APPENDAGES OF SKINRESPIRATORY changesDYSPNEA, CARDIOVASCULAR changesURAEMIC PERICARDITISRHYTHM and CONDUCTION abnormalitiesMYOCARDIAL CONTRACTION changesHYPOTENSION

GENERAL MANIFESTATIONS

GASTROINTESTINALNAUSEA, VOMITINGSALTERED BOWELL HABITNEUROLOGICALSOMNOLENCE, RESTLENESS, COMASENSORIAL or MOTOR abnormalitiesPERIPHERAL NEUROPATHY

RENAL SYSTEM PHYSICAL EXAMINATIONGENERAL PHYSICAL EXAMINATIONSKIN and SKIN APPENDAGES:PALLOR, LEMON-YELLOW COMPLEXION, DRY SKINITCHING, SCRATCH MARKSUREMIC FROSTUREMIDESBROWN LINE PIGMENTATION OF NAILS RENAL EDEMA

LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATIONI. INSPECTION

LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATIONI. INSPECTIONLOMBAR REGIONSABNORMAL BULGING/RETRACTION; SKIN CHANGESBULGING + INFLAMMATION: PERINEPHRITIC ABCESSVERTEBRAL MUSCLES CONTRACTURE: renal colicABDOMENBULGING OF THE FLANKS THIN patients, CHILDREN UNI or BILATERALIn: KIDNEY CYSTS, TUMORSHYPOGASTRIC BULGINGBLADDER DISTENTIONGENITALIA

KIDNEYS PALPATION RIGHTLEFT

LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATIONII. 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

LOMBAR REGION, ABDOMEN and GENITALIA EXAMINATIONII. KIDNEY PALPATIONENLARGED: unilaterally: PTOSIS, COMPENSATORY HYPERTROPHY, NEOPLASM, CYSTSbilaterally: POLYCYSTIC KIDNEY ISEASE (PKD)uni or bilateralLY: HYDRONEPHROSIS, PYONEPHROSIS