This document discusses the clinical manifestations of renal disease that can help detect underlying kidney disorders. Symptoms include disturbances in urination like frequency, pain, retention, incontinence, and nocturia. Changes in urine such as amount, appearance, and presence of blood, protein, or casts are also discussed. Pain symptoms can include flank pain, ureteric colic, or suprapubic discomfort. General symptoms include fever, swelling, fatigue, itching, and pallor. Detecting these clinical signs is important for identifying renal abnormalities.

1. Clinical manifestations of
renal disease
Dr. Thilak Jayalath
Senior Lecturer in
Medicine
Faculty of Medicine
Peradeniya

2. The presence of renal disease in
a patient may be detected
because of
• Presentation with a symptom or
clinical sign that indicates an
underlying renal disorder
• The presence of a systemic
disease known to involve the
kidney

3. The presence of renal disease in
a patient may be detected
because of
• A family history of inherited
renal disease
• The finding of asymptomatic
urinary abnormalities or
disordered renal function tests

4. Symptoms of renal disease
include
• Disturbance in the act of
micturition
• Alteration in the amount and
appearance of urine
• Pain : renal, ureteric, vesical,
and urethral
• General symptoms of renal

5. Disturbance in the act of
micturition
Frequency
Passing urine more often than
usual without increase in the
amount of urine

6. Disturbance in the act of
micturition
Frequency
Results from
• Irritation of the bladder
• Reduction in the capacity of the
bladder
• Pressure from a pelvic tumour

7. Disturbance in the act of
micturition
Dysuria
Pain in passing urine
Usually results from disease of
the
• Bladder
• Prostate

8. Disturbance in the act of
micturition
Dysuria
Pain experienced prior to ,
during, or following micturition
usually in the urethra or
suprapubic region
Commonly due to infection of
lower urethral tract

9. Disturbance in the act of
micturition
Retention of urine
Occurs in
• Obstructive lesions of the
urethra
• Disease of the spinal cord
• Coma

10. Disturbance in the act of
micturition
Incontinence of urine
Seen in
• Cerebrovascular lesions
• Paraplegia
• Multiple slerosis
• Prolapsed uterus with cystocele

11. Disturbance in the act of
micturition
Nocturia
Passing urine in the night (
commonly associated with polyuria)
Other causes
• Prostatism
• Cystitis
• Bladder tumours

12. Disturbance in the act of
micturition
Stranguary
Severe supra pubic pain associated
with inability to pass urine
Seen in
• Cystitis
• Bladder tumour

13. Disturbance in the act of
micturition
Hesitancy
Delay in initiating the urine flow
Seen in males with prostatism

14. Disturbance in the act of
micturition
Pneumaturia
Passing of air bubbles in the urine
Most often caused by a fistula
between the bladder and the colon
as a result of
• Diverticular abscess
• Malignant tumour

15. Alteration in the amount of
urine
Polyuria - over 3000 ml per day
Oliguria - less than 300 ml per
day
Anuria - neglible urine
output

16. Alteration in the amount of
urine
Polyuria causes
• Diabetes Mellitus
• Diabetes Insipidus
• Psychogenic polydipsia
• Chronic renal failure
• Hypokalemia
• Hypercalcemia

17. Alteration in the amount of
urine
Oliguria
Seen in acute renal failure
Pre renal failure – Shock
Haemorrhage
Dehydration
Cardiac failure

18. Alteration in the amount of
urine
Oliguria
Seen in acute renal failure
Intrinsic renal failure –
Acute glomerulonephritis
Acute tubular necrosis

19. Alteration in the amount of
urine
Anuria
Must be differentiated from retention of urine
Causes include
• Infarction of a kidney or both kidneys
• Bilateral cortical necrosis
• Complete obstruction of both ureters

20. Alteration in the appearance of
urine
Haematuria – Red or smoky brown
colour

21. Alteration in the appearance of
urine
Causes of haematuria
Painless – Urinary tract obstrution
Tuberculosis
Urogenital tumors
Glomerulonephritis
Renal cystic disease

22. Alteration in the appearance of
urine
Causes of haematuria
Painful – Renal calculi
Urinary tract infection
Reflux nephropathy
Renal papillary necrosis
Renal infarction

23. Alteration in the appearance of
urine
Urine become blackish or coca cola
in colour
• Haemoglobinuria
• Myoglobinuria

24. Alteration in the appearance of
urine
Frothy urine
Commonly due to proteinuria

25. Alteration in the appearance of
urine
Proteinuria
A small amount of protein ( usually
less than 100 mg ) is normally
excreted in the urine daily in healthy
people

26. Alteration in the appearance of
urine
Proteinuria
50 % of proteins excreted in urine
derive from plasma proteins
Remainder of proteins-
postglomerular
• Secretary products of distal tubular cells (
Tamm Horsfall proteins )

27. Alteration in the appearance of
urine
Proteinuria
Urine tests for protein best
performed on fresh concentrated
urine and an early morning sample
is the best

28. Alteration in the appearance of
urine
Proteinuria
Significant proteinuria
• Physiological
• Pathological

29. Alteration in the appearance of
urine
Proteinuria
Physiological
( Proteinuria less than 1000 mg / L
)
When disappears lying supine is
called orthostatic proteinuria

30. Alteration in the appearance of
urine
Proteinuria
Transient proteinuria without renal
damage seen in
• Cold exposure
• Vigorous exercise
• Febrile illness
• Congestive cardiac failure

31. Alteration in the appearance of
urine
Proteinuria
Pathological proteinuria
( Proteinuria more than 1000 mg / L
)

32. Alteration in the appearance of
urine
Proteinuria
Pathological proteinuria
Commonly seen in
• Glomerular disease
• Tubular disease

33. Alteration in the appearance of
urine
Proteinuria
Amount is very small or no proteinuria in
some renal diseases
• Polycystic kidney disease
• Renal scarring
• Obstructive uropathy

34. Alteration in the appearance of
urine
Proteinuria
Albumin - 30 mg per day excreted in
healthy people
Conventional urine tests give positive
tests when albumin level exceeds
300mg / day
( 200 mg / L )

35. Alteration in the appearance of
urine
Proteinuria
Microalbuminuria ( Misnormer )
Albumin excretion rate more than
normal ( 30 mg/day ) , but less than
the detectable level with conventional
tests ( 300 mg/ day )
30 - 300 mg /day
20 - 200 mg / L

36. Alteration in the appearance of
urine
Proteinuria
Microalbuminuria ( Misnormer )
Seen in
• Diabetic nephropathy
• Hypertensive renal disease

37. Alteration in the appearance of
urine
Proteinuria
Microalbuminuria ( Misnormer )
Detection needs special reagent
strips

38. Alteration in the appearance of
urine
Urine become turbid with
• Infection
• Precipitated urates
• Precipitated phosphates

39. Alteration in the appearance of
urine
Urine colour gets darkened on
standing
• Porphyria
• Alkaptonuria

40. Alteration in the appearance of
urine
Drugs causing discolouration of
urineTetracycline Yellow
Sennakoat Orange
Desferrioxamine Reddish Brown
Phenindione Pink
Nitrofurantoin Brown
Rifampicin- Red
Methylene Blue Green
Methyl Dopa Grey
Metronidazole Darkening Of urine

41. Pain – as a manifestation of
renal disease
Burning sensation or dyscomfort
over suprapubic region - Cystitis
Perineal pain or rectal pain –
Prostatitis
Pain felt in the flank,
hypochondrium or iliac fossa –
Renal pain

42. Pain – as a manifestation of
renal disease
Acute obstruction of ureters due
to stone or blood clot – Colicky
pain radiates from loin to groin
and to the testicle in the male
Chronic obstruction – less severe
pain and sometimes no pain

43. Pain – as a manifestation of
renal disease
Enlarged kidneys – dull, nagging
or flank pain
Acute glomerulonephritis –
typically painless

44. General symptoms and signs of
renal disease
Fever – Urinary tract infection
may be associated with renal
abnormality

45. General symptoms and signs of
renal disease
Dyspnoea - fluid overload in renal
impairment
metabolic acidosis in
renal impairment
pleural effusion in
nephrotic syndrome

46. General symptoms and signs of
renal disease
Oedema ( facial and dependent )
chronic kidney disease
nephrotic syndrome

47. General symptoms and signs of
renal disease
Pruritus – in chronic kidney disease
Distal brown discolouration of nails
- in chronic kidney disease

48. General symptoms and signs of
renal disease
Pallor – in chronic kidney disease
Hyperpigmentation
in chronic kidney disease

49. Symptoms of renal disease
Symptoms of ureamia
Anorexia
Lethargy
Nausea
Poor sleep
Poor concentration
Itching
Restless legs

50. End