SYMPTOMS AND SIGNS OF RENAL DISEASES_240319_025615.pdf

SYMPTOMS AND SIGNS OF RENAL DISEASES_240319_025615.pdf

1. SYMPTOMS AND SIGNS OF
RENAL DISEASE
BY
Dr J U Okoye (FWACP)
(Consultant Physician/Nephrologist)
UNTH, Enugu

2. Introduction
•Renal disease is often revealed only by incidental finding of
Hypertension, Proteinuria, Azotemia or Anemia.
•High index of suspicion is required in the setting of likely causes as
acute Fluid losses, sepsis, certain drugs, other Nephrotoxins,
vasculitidis, Bladder outlet obstruction, Essential hypertension,
Diabetes mellitus, SCD, chronic infections ( HIV, HBV, HCV), etc.

3. Pain
•Dysuria: burning or tingling sensation within urethral meatus or over
the supra-pubic area during or after micturition. Seen in acute UTI
•Dysuria with urinary frequency and urgency constitutes Cystitis
syndrome
•Flank(or upper quadrant or iliac fossa) pain: can be severe colicky
pain from acute luminal obstruction from stones, tumors etc. Usually
radiates to the groin. Severe pain may occur in enlarged (polycystic)
kidney and in acute pyelonephritis (usually with constitutional
symptoms). Mild to moderate pain in glomerulonephritidis
•Perineal or Rectal pain as acute prostatits

4. Hematuria
•Can originate from any part of the UGS
•Can be from GN, RCC, cancer of the uro-epithelium, renal stones,
papillary necrosis, prostatic enlargement or malingnancy.
•Can be Total or Terminal
•Can be painfulor painless
•Coloursrange from smoky(small quantity), to brownor red(large
quantity) to dark (from large amount of Hbin lysed blood)

5. Frequency / volume of micturition
•Nocturia: is more significant
•Associated with UTI (small volume), BOO, Neurologic bladder (spastic)
early CKD, DM, DI
•Polyuria(>3l/d): as in recovery phase of AKI, psychogenic polydipsia,
hyperglycemia, DI, electrolyte disturbances (hypokalemia,
hypercalcemia)
•Oliguria: (<400ml/d) Seen in ATN, glomerular lesions: GN, diabetic
nephropathy; ESRD
•Anuria:(<50-100ml/d); seen in BOO, bilateral cortical necrosis,
bilateral renal artery or vein thrombosis, RPGN

6. Body swelling / others
•Facial, ankle, leg, thigh, scrotal, abdominal, sacral from fluid
retention following loss of oncotic pressure (proteinuria)
•Frothy (foamy) urine:when persisting as seen in proteinuria,
hyperbilirubinuria, glycosuria (conc. urine). (noted also in rapid
urination, semen in urine).
•Poor streamingof urine in stricture, and prostatism
•Hesitancy(difficulty initiating micturition) and
•Terminaldribbling (difficulty stopping micturition), are both from
prostatism
•Urethral discharge as in UTIs, STIs

7. Others
•Dyspneafrom pulmonary oedema, /other heart failure symptoms
•Epigastric, precordial pain, Angina pectoris in Gastritis, pericarditis
and M I
•Hemoptysisas part pulmonary renal syndromes (pulmoedema,
Good-pasture, Wegener granulomatosis,MPA, Churg-Strauss
syndrome).
•Bleeding tendencies, G I bleeding, melena
•Muscle weakness, bone pain,
•Strokes, paresthesia, foot drop
•Blurred vision from retinopathy

8. Uremia: (symptoms and signs of renal failure)
•Tiredness
•Lack of concentration and inability to cope with mental and physical
daily activities
•Nausea, Vomiting (usu. early morning especially while brushing
teeth), Diarrhea, and generalized pruritus in advanced renal disease
•NB: Vomiting can occur with renal colic and acute pyelonephritis
•Confusion, Seizure, and Coma in severe kidney disease

9. Signs of renal disease
•Skin:
Dry flaky skin (CKD), scratch marks (from pruritus), uremic frost
(dandruff on forehead from urea crystallizing from sweat), AVF, or scars
from dialysis access, purpura
•Pallor, Leuconychia(in hypoproteinemicstate)
•Beau’sLine (from severe previous illness), splinter hemorrhages in
nail beds in vasculitidisand endocarditis
•Oedema(puffy face, pedal, ankle, leg, lower limb, scrotal, sacral)
•Short stature in those who develop renal disease in childhood due to
impaired puberty

10. Other signs
•Renal rickets: Valgus(knock) or Varus(Bow) knee deformity in those who
develop renal dx from childhood
•Raised BP usually severe and secondary
•Asterixis, also hand tremors, myoclonus
•Restless leg syndrome in dialysis patients
•Ballotablekidneys in polycystic, hydronephrotickidneys or those with
tumors of UGS
•Renal angle or punch tenderness (infection, rejection or infarction)
•Pericardialrub, pleural friction rub
•Ascites, abdominal bruit(in Renal artery stenosis)

11. THANK
YOU