Clinical manifestations of renal diseaseDr. Thilak JayalathSenior Lecturer in MedicineFaculty of MedicinePeradeniya

The presence of renal disease in a patient may be detected because of

Presentation with a symptom or clinical sign that indicates an underlying renal disorder

The presence of a systemic disease known to involve the kidney

The presence of renal disease in a patient may be detected because of

A family history of inherited renal disease

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 micturitionFrequency Passing urine more often than usual without increase in the amount of urine

Disturbance in the act of micturitionFrequency Results from Irritation of the bladder Reduction in the capacity of the bladder Pressure from a pelvic tumour

Disturbance in the act of micturitionDysuria Pain in passing urineUsually results from disease of the Bladder Prostate Urethra

Disturbance in the act of micturitionDysuria Pain experienced prior to , during, or following micturition usually in the urethra or suprapubic region Commonly due to infection of lower urethral tract

Disturbance in the act of micturitionRetention of urineOccurs in Obstructive lesions of the urethra Disease of the spinal cord Coma

Disturbance in the act of micturitionIncontinence of urineSeen in Cerebrovascular lesions Paraplegia Multiple slerosis Prolapsed uterus with cystocele

Disturbance in the act of micturitionNocturia Passing urine in the night ( commonly associated with polyuria) Other causes Prostatism Cystitis Bladder tumours

Disturbance in the act of micturitionStranguarySevere supra pubic pain associated with inability to pass urine Seen in Cystitis Bladder tumour

Disturbance in the act of micturitionHesitancyDelay in initiating the urine flowSeen in males with prostatism

Disturbance in the act of micturitionPneumaturiaPassing of air bubbles in the urineMost often caused by a fistula between the bladder and the colon as a result of Diverticular abscess Malignant tumour

Alteration in the amount of urine

Polyuria - over 3000 ml per dayOliguria - less than 300 ml per dayAnuria - neglible urine output

Alteration in the amount of urinePolyuria causes Diabetes Mellitus Diabetes Insipidus Psychogenic polydipsia Chronic renal failure Hypokalemia Hypercalcemia

Alteration in the amount of urineOliguria Seen in acute renal failurePre renal failure Shock Haemorrhage Dehydration Cardiac failure

Alteration in the amount of urineOliguria Seen in acute renal failureIntrinsic renal failure Acute glomerulonephritis Acute tubular necrosis

Alteration in the amount of urineAnuria Must be differentiated from retention of urineCauses include Infarction of a kidney or both kidneys Bilateral cortical necrosis Complete obstruction of both ureters

Alteration in the appearance of urine 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

Alteration in the appearance of urine Causes of haematuria Painful Renal calculi Urinary tract infection Reflux nephropathy Renal papillary necrosis Renal infarction

Alteration in the appearance of urine Urine become blackish or coca cola in colour Haemoglobinuria Myoglobinuria

Alteration in the appearance of urine Frothy urine Commonly due to proteinuria

Alteration in the appearance of urine ProteinuriaA small amount of protein ( usually less than 100 mg ) is normally excreted in the urine daily in healthy people

Alteration in the appearance of urine Proteinuria50 % of proteins excreted in urine derive from plasma proteinsRemainder of proteins- postglomerular Secretary products of distal tubular cells ( Tamm Horsfall proteins ) From lower urinary tract ( Prostate, Urethral and semen )

Alteration in the appearance of urine ProteinuriaUrine tests for protein best performed on fresh concentrated urine and an early morning sample is the best

Alteration in the appearance of urine ProteinuriaSignificant proteinuria Physiological Pathological

Alteration in the appearance of urine ProteinuriaPhysiological( Proteinuria less than 1000 mg / L )When disappears lying supine is called orthostatic proteinuria

Alteration in the appearance of urine ProteinuriaTransient proteinuria without renal damage seen in Cold exposure Vigorous exercise Febrile illness Congestive cardiac failure

Alteration in the appearance of urine ProteinuriaPathological proteinuria( Proteinuria more than 1000 mg / L )

Alteration in the appearance of urine ProteinuriaPathological proteinuriaCommonly seen in Glomerular disease Tubular disease

Alteration in the appearance of urine ProteinuriaAmount is very small or no proteinuria in some renal diseases Polycystic kidney disease Renal scarring Obstructive uropathy

Alteration in the appearance of urine ProteinuriaAlbumin - 30 mg per day excreted in healthy people Conventional urine tests give positive tests when albumin level exceeds 300mg / day ( 200 mg / L )

Alteration in the appearance of urine ProteinuriaMicroalbuminuria ( Misnormer )Albumin excretion rate more than normal ( 30 mg/day ) , but less than the detectable level with conventional tests ( 300 mg/ day ) 30 - 300 mg /day20 - 200 mg / L

Alteration in the appearance of urine ProteinuriaMicroalbuminuria ( Misnormer )Seen in Diabetic nephropathy Hypertensive renal disease

Alteration in the appearance of urine ProteinuriaMicroalbuminuria ( Misnormer )Detection needs special reagent strips

Alteration in the appearance of urine Urine become turbid with Infection Precipitated urates Precipitated phosphates

Alteration in the appearance of urine Urine colour gets darkened on standing Porphyria Alkaptonuria

Alteration in the appearance of urine Drugs causing discolouration of urineTetracycline YellowSennakoat OrangeDesferrioxamine Reddish BrownPhenindione PinkNitrofurantoin BrownRifampicin- RedMethylene Blue GreenMethyl Dopa GreyMetronidazole Darkening Of urine

Pain as a manifestation of renal disease Burning sensation or dyscomfort over suprapubic region - CystitisPerineal pain or rectal pain ProstatitisPain 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 maleChronic obstruction less severe pain and sometimes no pain

Pain as a manifestation of renal disease Enlarged kidneys dull, nagging or flank painAcute glomerulonephritis typically painless

General symptoms and signs of renal diseaseFever Urinary tract infection may be associated with renal abnormality

General symptoms and signs of renal diseaseDyspnoea - fluid overload in renal impairment metabolic acidosis in renal impairment pleural effusion in nephrotic syndrome

General symptoms and signs of renal diseaseOedema ( facial and dependent ) chronic kidney disease nephrotic syndrome

General symptoms and signs of renal diseasePruritus in chronic kidney disease

Distal brown discolouration of nails - in chronic kidney disease

General symptoms and signs of renal diseasePallor in chronic kidney disease

Hyperpigmentation in chronic kidney disease

Symptoms of renal disease Symptoms of ureamia Anorexia Lethargy Nausea Poor sleep Poor concentration Itching Restless legs

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