Intro to renal system
- 1. RENAL SYSTEM History and symptoms analysis
- 2. DYSURIA • Ask about: • • Systemic upset with fever, and suprapubic discomfort. Pyelonephritis is suggested by a history of significant fever (> 38.0°C), rigors, vomiting and flank pain. There may not always be symptoms of a preceding UTI. • • Symptoms of urine outflow obstruction (slow flow, hesitancy, incomplete emptying, dribbling, nocturia). • • History of sexual contacts.
- 3. LOIN PAIN • Ask about: • • Location of the pain: is it just in the loin (pelvic/upper ureter obstruction) or does it radiate into the testicle or labium (lower ureter obstruction)? • • Presence of fever, rigors and dysuria: these may suggest infection. • • Previous episodes of loin pain.
- 4. VOIDING SYMPTOMS • Ask about: • • Urgency, frequency, nocturia and urge incontinence (storage symptoms). • • Hesitancy, poor stream, straining to void and terminal dribbling (voiding symptoms). These symptoms may be followed by a sense of incomplete emptying.
- 8. HEMATURIA • Ask about: • • Loin pain, as this may indicate ureteric obstruction due to blood, calculi or a tumour. Flank pain and hematuria may be features of renal cell carcinoma. • • Fever, dysuria, suprapubic pain and urinary frequency, which may indicate urinary infection. • • Family history of renal disease; polycystic kidney disease can present with visible haematuria due to cyst rupture.
- 9. PRINCIPAL SOURCES OF HAEMATURIA
- 10. PROTEINURIA • Ask about: • • Weight loss, altered bowel habit, cough, back pain or chronic inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease or bronchiectasis (in particular if undertreated). The latter cause nephrotic syndrome as a result of renal AA amyloid deposition. • • Ankle swelling (pitting oedema). Younger patients may also notice facial swelling and puffy eyelids, especially first thing in the morning. • • Breathlessness (pleural effusions). • • Abdominal swelling (ascites).
- 14. RENAL ANGLE TENDERNESS IN ACUTE PYELONEPHRITIS Costovertebral Angle Tenderness Exam | CVA Percussion Assessment Test - YouTube
- 18. SYSTEMIC EXAMINATION OF RENAL SYSTEM
- 19. THAT’S ALL FOR TODAY!