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Renal Semeiology

Renal Semeiology. By: Maryam Hami MD, Associate Prof. of Nephrology Mashhad University of Medical sciences(MUMS). Pain: Kidney pain Ureteral pain Bladder pain Dysuria Other symptoms other than pain may accompany voiding: Urgency Frequency Hesitency Incontinence.

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Renal Semeiology

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  1. Renal Semeiology By: MaryamHami MD, Associate Prof. of Nephrology Mashhad University of Medical sciences(MUMS)

  2. Pain: • Kidney pain • Ureteral pain • Bladder pain • Dysuria • Other symptoms other than pain may accompany voiding: • Urgency • Frequency • Hesitency • Incontinence

  3. Kidney pain is produced by sudden distention of the renal capsule and is typically dull, and steady • Ureteral pain is a severe colicky pain that often originates in the CVA and radiates around the trunk

  4. Bladder pain • Bladder disorders may cause suprapubic pain

  5. Dysuria • refers to painfulurination • Difficult urination is also sometimes described as dysuria • It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria

  6. This is typically described to be a burning or stinging sensation. It is most often a result of • urinary tract infection • STD • bladder stones • bladder tumours • prostatedisorders • anticholinergicdrugs

  7. Urgency: Is an unusually intense and immediate desire to void. It can be associated with infection, old age • Frequency: urination at short intervals without increase in daily volume or urinary output, due to reduced bladder capacity. It can be associated with infection, bladder neck problems • Hesitency: difficulty in beginning the flow of urine; associated with BPH in men and narrowing of the urethral opening and may be caused by emotional stress

  8. Incontinence: is any involuntary leakage of urine. Common etiology are: • Polyuria • Prostate disorders (BPH and cancers) • Caffeine and Cola • Brain disorders (MS, spinal cord injuries, Parkinson disease, stroke)

  9. Stress incontinence, is due essentially to insufficient strength of the pelvic floor muscles. • Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need to urinate. • Overflow incontinence: Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed urine.

  10. Abnormalities of Urine Volume • Oliguria: is the low output ofurine, It is clinically classified as an output below 400 ml/day • The decreased output of urine may be a sign ofdehydration, renal failure, hypovolemic shock, multiple organ dysfunction syndrome, orurinary obstruction/urinary retention.

  11. Anuria: absence of urine, clinically classified as below 100ml/day • Anuria can be caused by • total urinary tract obstruction • total renal artery or vein occlusion • Shock • Cortical necrosis • severe ATN • Rapidly progressive glomerulonephritis

  12. Polyuria: • urine>3 L/d • Polyuria results from two potential mechanisms: • nonabsorbable solutes diuresis • water diuresis (DI) • If the urine volume is >3 L/d and urine osmolality is >300 mosmol/L, then a solute diuresis is clearly present and a search for the responsible solute(s) is mandatory

  13. urine preparation and examination We prepare urine sample by centrifugation • Urine supernatant: • Urine Sediment:

  14. Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase Chemical Analysis • Urine Dipstick

  15. Negative Trace (100 mg/dL) + (250 mg/dL) ++ (500 mg/dL) +++ (1000 mg/dL) ++++ (2000+ mg/dL) • Glucosuria

  16. Negative + (weak) ++ (moderate) +++ (strong) • Bilirrubinuria

  17. 0.2 mg/dL 1 mg/dL 2 mg/dL 4 mg/dL 8 mg/dL • Urobilinogenuria

  18. Hematuria • Normal red blood cell excretion in the urine is up to 2 million RBCs per day. • Hematuria is defined as two to five RBCs per high-power field (HPF) and can be detected by dipstick. • Common causes of isolated hematuria include: • Stones • Neoplasms • Tuberculosis • Trauma • Prostatitis

  19. A single urinalysis with hematuria is common and can result from menstruation, viral illness, allergy, exercise, mild trauma • persistent or significant hematuria: • three RBCs/HPF on three urinalyses • single urinalysis with >100 RBCs • gross hematuria identified significant renal or urologic lesions in 9.1%

  20. Hematuria with dysmorphic RBCs, RBC casts, and protein excretion >500 mg/d is virtually diagnostic of glomerulonephritis. • RBC casts form as RBCs that enter the tubule fluid become trapped in a cylindrical mold of gelled Tamm-Horsfall protein

  21. Pyuria • refers to urine which contains pus. Defined as the presence of 4 or more neutrophils per high power field

  22. cylanduria • a cast formed from gelled protein precipitated in the renal tubules and molded to the tubular lumen; pieces of these casts break off and are washed out with the urine. • Types named for their constituent material include epithelial, granular, hyaline, cellular and waxy casts.

  23. WBC CAST Infection tubulointerstitialprocesses such as interstitial nephritis, systemic lupus erythematosus, and transplant rejection.

  24. crystals • Crystalluria indicates that the urine is supersaturated with the compounds that comprise the crystals, e.g. ammonium, magnesium and phosphate for struvite. Crystals can be seen in the urine of clinically healthy animals or in animals with no evidence of urinary disease (such as obstruction and/or urolithiasis). 

  25. Proteinuria • means the presence of an excess of serumproteins in the urine • The dipstick measurement detects mostly albumin and gives false-positive results when • pH > 7.0 • urine is very concentrated • contaminated with blood. • A very dilute urine may obscure significant proteinuria on dipstick examination • proteinuria that is not predominantly albumin will be missed.

  26. Proteins in “Normal” Urine Protein % of Total Daily Maximum Albumin 30% 30 mg Tamm-Horsfall 50% 40 mg Immunoglobulins 12% 14 mg Secretory IgA 3% 6 mg Other 5% 10 mg TOTAL100% 150 mg

  27. Common Causes of Benign Proteinuria Dehydration Emotional stress Fever Heat injury Inflammatory processIntense activity Most acute illnesses Orthostatic (postural) disorder

  28. Cause of Proteinuria as Related to Quantity

  29. Glomerular syndromes • Nephrotic syndrome classically presents with heavy proteinuria (>3.5 g/d), minimal hematuria, hypoalbuminemia, hypercholesterolemia, edema, lipiduria and hypertension • Acute nephritic syndromesclassically present with hypertension, hematuria, red blood cell casts, pyuria, and mild to moderate (1-2 g/d) proteinuria, a fall in GFR .

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