Date post: | 12-Apr-2017 |
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COMMON URINARY
SYMPTOMYousaf Khan
Renal Dialysis LecturerIPMS, KMU
POLYURIA: Persistent large increase in urine output. Excessive or abnormally large production or passage
of urine (>3 L per day in adults).
Micturition: in which there is passage of small amount of urine with increased frequency.
Polyuria is due to free water excretion or due to excessive solute excretion.
CAUSESPhysiological Excessive intake of fluid Cold climate Anxiety Pro rich dietPathological Endocrine Renal Systemic Psychiatric Drugs Iatrogenic
EXCESSIVE SOLUTE EXCRETION Due to excretion of increased non absorbable
solutes(such as glucose) – SOLUTE DIURESIS Urine output > 3 L per day Urine osmolality > 300 msmol/L
Causes: Glycosuria is uncontrolled daibetes mellitus Mannitol administration High protein diet causing increase urea production and
excretion. Excessive sodium loss in cystic renal disease Renal tubular demage Bartter syndrome: excessive urinary potassium loss –
hypokalemia and hypotension.
FREE WATER EXCRETION Due to excretion of increased water(from a defect in
ADH production or renal responsiveness) – WATER DIURESIS
Urine output >3 L per day Urine is dilute (<250 mosmol/ L)
Causes – polydipsia Central diabetes insipidus ( central or nephrogenic).
INCREASE FREQUENCY OF MICTURITION Frequent passage of small volume of urine without
an increase in total volume
Causes: Renal : pyelonephritis Ureter : stone Bladder: cystitis and BPH Urethera: urethitis Gynecological: vaginitis and pregnancy Psychological: depression and tension
PROTEINURIA Normal urinary protein excretion should be < 150
mg/day. Abnormal proteinuria was defined as excretion of
protein > 150 mg/day. Heavy proteinuria > 1g/dl – indicate glomerular
origin Mild to moderate – tubular defect
CAUSES Primary renal disease Glomerulonephritis
Secondary Renal disease Systemic disease : diabetes, hypertension and
amyloidosis Drugs: captopril, penicillamine, heroin and NSAID Infection: Hepatitis B, infective endocarditis, malaria,
AIDS Allergy: Vaccine, bee sting
TYPE OF PROTEINURIAFunctional proteinuria: Stresses – no renal disorder, 1g/d. Causes: exercise, fever, severe hypertension, burns,
postoperative and acute alcohol abuse.
Orthostatic proteinuria: when a patient is standing but not when recumbent, benign
condition usually occurring below the age 30.
Isolated proteinuria: Defined as proteinuria without hematuria or reduction in
glomerular filtration rate (GRF) In most cases, patient is asymptomatic Urine sediment is unremarkable Causes: diabetes mellitus and amyloidosis
Overload proteinuria: From production of excessive amounts of filterable protein Such bence – jones protein in multiple myeloma, myoglobinuria in rhabdomyolysis.
Tubular proteinuria: From inability of damage tubule to reabsorb normally filtered
proteins. Causes: acute tubular necrosis, toxic injury, drug induced
interstitial nephrititis,
Microalbuminuria Normal < 30 microgram / per minute. Dipstick can detect – concentration is more than 100 mg/L. Albumin excretion > 20 microgram / min or 30 -300 mg/24. Indicator of diabetic nephropathy.
EVALUATION OF PATIENT WITH PROTEINURIA
24- hour urinary proteins > 3.5 g/24 h – nephrotic range
Measurement of urinary proteinUrine dipsticknegativetrace between 15-30mg/dl1+ 30-100 mg/dl2+ 100-300mg/dl3+ 300-1000mg/dl4+ >1000mg/dl
Albumin – creatinine ratio: Ratio b/w urinary protein concentration and urinary
creatinine concentration. 30 mg of albumin per gram of creatinine is
considered abnormal
Renal Biopsy: Proteinuria is associated with renal insufficiency
particularly if it is acute in onset.
MANAGEMENT Reducing proteinuria may also reduce progression of
renal disease Low protein diet Treatment of underlying cause.
HEMATURIA Causes: Renal causes may be glomerular or non glomerular in originGlomerular causes: IgA nephropathy Nephritic syndorm Post – streptococcal glomerulonephrititis Membranoproliferative glomerulonephrititis
Non – glomerular causes: Renal cyste Renal stone, interstitial nephritis Renal tumors
Extra – renal causes: Ureter: stone and papiloma Bladder: trauma, stone, hemorrhagic cystitis urethra; trauma infection, tumors and stone Blood disorderDrugs: Anticoagulants Analgesic abuse Cyclophosphomide antibiotics
GROSS HEMATURIA Non – glomeular in origin In the absence of infection gross hematuria from a
lower urinary tract is most commonly. Due to from transitional cell carcinoma of bladder. Blood in start of voiding comes from urethra Blood diffusely present through out the urine comes
from the bladder or above. Blood only at the end of micturition suggest
bleeding from prostate or bladder base
MICROSCOPIC HEMATURIA Glomerulonephritis Renal T.B Collagen disease e.g SLE Malignant hypertension Blood disorder Infective endocarditis Benign prostatichyperplasia
INVESTIGATION Urine analysis: protienuria and cast suggest renal in origin Urine culture and sensitivity, urine cytology, IVP,
ultrasound kidney, and ultra sound abdomen.
Condition which may mimic hematuria Hemoglobinuria: urine gives a positive chemical test for
hemoglobine, but no red cells are detectable.
Myoglobinuria: no red cell are seen but chemical tests for hemoglobin are positive. Myoglobin can bee distinguished by spectrometry.
Acute intermittent porphyria: fresh urine appears normal but on standing for some hours a dark red color develops.
URINARY RETENSION The inability to voluntarily void urine
CATEGORIES OF URINARY RETENTION Obstructive Infectious & Inflammatory Pharmacologic Neurologic Other
CAUSES OF URINARY RETENTIONOBSTRUCTIVE Benign prostatic hyperplasia Strictures Bladder calculi Faecal Impactation Phimosis Benign/malignant pelvic masses Organ prolapse Pelvic mass – gynae malignancy Uterine fibroid / ovarian cyst Foreign bodies
INFECTIOUS AND INFLAMMATORYCAUSES Prostatitis Prostatic abscess Cystitis Acute vaginitis Herpes simplex virus
PHARMACOLOGIC CAUSES Drugs with anticholingeric properties eg:
tricylic antidepressants (amitriptyline) Opioids NSAIDs in men Antiparkinsonian agents (levodopa) Antipsychotics (chlopromazine) Muscle relaxants (Baclofen)
NEUROLOGIC CAUSEAUTONOMIC OR PERIPHERAL NERVE Diabetes mellitus,BRAIN Tumour, Parkinson’s disease,SPINAL CORD Haematoma / abscess
OTHER CAUSES Post-op complications
Pregnancy-associated retention
Trauma eg: penile fracture or laceration
Idiopathic detrusor failure
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