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Common urinary symptom

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Complete urinary symptom

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Common urinary symptom

  1. 1. Yousaf Khan Renal Dialysis Lecturer IPMS, KMU
  2. 2.  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.
  3. 3. Physiological  Excessive intake of fluid  Cold climate  Anxiety  Pro rich diet Pathological  Endocrine  Renal  Systemic  Psychiatric  Drugs  Iatrogenic
  4. 4.  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.
  5. 5.  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).
  6. 6.  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
  7. 7.  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
  8. 8. 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
  9. 9. Functional 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
  10. 10. 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.
  11. 11. 24- hour urinary proteins  > 3.5 g/24 h – nephrotic range Measurement of urinary protein Urine dipstick negative trace between 15-30mg/dl 1+ 30-100 mg/dl 2+ 100-300mg/dl 3+ 300-1000mg/dl 4+ >1000mg/dl
  12. 12. 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.
  13. 13.  Reducing proteinuria may also reduce progression of renal disease  Low protein diet  Treatment of underlying cause.
  14. 14. Causes:  Renal causes may be glomerular or non glomerular in origin Glomerular causes:  IgA nephropathy  Nephritic syndorm  Post – streptococcal glomerulonephrititis  Membranoproliferative glomerulonephrititis Non – glomerular causes:  Renal cyste  Renal stone, interstitial nephritis  Renal tumors
  15. 15.  Extra – renal causes:  Ureter: stone and papiloma  Bladder: trauma, stone, hemorrhagic cystitis  urethra; trauma infection, tumors and stone  Blood disorder Drugs:  Anticoagulants  Analgesic abuse  Cyclophosphomide  antibiotics
  16. 16.  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
  17. 17.  Glomerulonephritis  Renal T.B  Collagen disease e.g SLE  Malignant hypertension  Blood disorder  Infective endocarditis  Benign prostatichyperplasia
  18. 18.  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.
  19. 19. The inability to voluntarily void urine
  20. 20.  Obstructive  Infectious & Inflammatory  Pharmacologic  Neurologic  Other
  21. 21.  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
  22. 22.  Prostatitis  Prostatic abscess  Cystitis  Acute vaginitis  Herpes simplex virus
  23. 23.  Drugs with anticholingeric properties eg: tricylic antidepressants (amitriptyline)  Opioids  NSAIDs in men  Antiparkinsonian agents (levodopa)  Antipsychotics (chlopromazine)  Muscle relaxants (Baclofen)
  24. 24. AUTONOMIC OR PERIPHERAL NERVE  Diabetes mellitus, BRAIN  Tumour, Parkinson’s disease, SPINAL CORD  Haematoma / abscess
  25. 25.  Post-op complications  Pregnancy-associated retention  Trauma eg: penile fracture or laceration  Idiopathic detrusor failure
  26. 26. Thank you

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