Chlamydial urethritisDiagnosis is usually suggested by the
presence of mucopurulent urethral discharge and history of multiple
sexual partners. Dysuria and urinary frequency can occur.
Urinalysis reveals absent bacteriuria. Urine culture shows less
than 100 colonies/ml.DD1!onococcal urethritis less common than
chlamydial urethritis. "he urethral discharge is purulent #rather
than mucopurulent$ and !ram stain usually reveals the causative
organisms.% &atients with acute bacterial cystitis 'present
with dysuria$ urinary frequency$ suprapubic discomfort and urinary
(ndings of bacteriuria and pyuria. )ucopurulent cervical discharge
is not found.Urine culture shows colonies in excess of 1000/ml.*
&atients with acute pyelonephritis appear toxic and present
with fever. nausea. vomiting. +an, pain. dysuria. and
costovertebral tenderness.Urinalysis shows bacteriuria and pyuria.
Urine culture reveals greater than 10$000 colonies/ml.-./lan, pain$
suggests renal capsular distension."he advantages of renal
transplantation over dialysis are'11 . .etter survival and quality
of life. %. 0nemia. bone disease. and hypertension persist in spite
of dialysis1 these are better controlled with transplantation. *.
"ransplant patients have a return of normal endocrine$ sexual$ and
reproductive functions. and enhanced energy levels1 thus. returning
to fulltime employment and more strenuous physical activity is
possible. 2. 3n diabetics. autonomic neuropathy persists or worsens
after dialysis1 whereas. it stabili4es or improves with
transplantation. 5. 6xpected survival rate after transplantation is
758 at one year and 998 at (ve years.Choice of Donor"ransplantation
from a living related donor has the least graft re:ection and best
graft survival$ followed by a living non;related donor$ and cadaver
graft..enign prostatic hyperplasia #.&erentiate prostate cancer
from .&ective in patients with @J6;associated
nephritis.-ephrotic syndrome-ephrotic syndrome is a clinical
complex characteri4ed by' 1. &roteinuria# D *;*.5 g/day;most
important manifestation %. ects are worsening of hypertension #*08
of patients$ headaches # 158 of patients and +u;li,e symptoms # 58
of patients.Cryoglobulinemia31"he common presentation includes
'palpable purpura$ glomerulonephritis$ non;speci(c systemic
symptoms$ arthralgias$ hepatosplenomegaly$ peripheral neuropathy$
and hypocomplementemia. )ost patients also have ect on
myocytes.0lportAs syndrome@uspect 0lportAs syndrome in patients
with recurrent episodes of hematuria$ sensorineural deafness and a
family history of renal failure.6lectron microscopy (ndings include
'alternating areas of thinned and thic,ened capillary loops with
splitting of the glomerular basement membrane #!.).DD1"hin basement
membrane diseasealso a familial disorder$ but it presents in
adulthood as microscopic hematuria without proteinuria. =enal
biopsy reveals amar,edly thinned basement membrane. % .enign
recurrent hematuria asymptomatic =enal biopsy is normal in most
cases. "his condition has an excellent prognosis.acute tubular
necrosis #0"- following hypovolemic shoc,.@erum .U- and Cr ratio is
less than %0' 1 .Cther (ndings that support this diagnosis are' 1 .
Urine osmolality of *00;*50 mCsm/J #but never H *00 %. Urine -a of
D %0 m6q/J *. /6;;;;-a ;;D %843)uddy brown granular cast;0cute
tubular necrosis .Cther Casts'=.C casts ;!lomerulonephritis ?.C
casts ;3nterstitial nephritis and pyelonephritis /atty casts
;-ephrotic syndrome .road and waWX casts ;Chronic renal
failure.
