This document outlines various conditions related to the renal system and urinary tract. It discusses increased or decreased urine production, hematuria, retention, incontinence, and pain. Causes and signs of different conditions are provided. Investigations for evaluating the renal system include urine tests, renal function tests, radiological imaging like ultrasound, CT, MRI, and tests to examine the kidneys, ureters, and bladder.

1. Renal System
1. POLYUREA (INCREASE FREQUENCY OF URINE) >1500ML/DAY
CAUSES . DIABETES MELLITUS
. ACRETE NEPHRITIS / NEPHROTIC SYNDROME
. POST PITUTARY TUMOUR
2. OLIGURIA (DECREASE FREQUENCY OF URINE) < 500 ML/DAY
3. ANURIA (ABSENCE OF FORMATION OF URINE)
CAUSES OF OLIGURIA & ANURIA
. PYREXIA & EXCESSIVE SWEATING
. VOMITING, LOOSE MOTION, DEHYDRATION
. HYPOVOLAEMIA
. PROSTATIC HYPERTROPHY
. CHRONIC RENAL FAILURE
. CHF
. STRICTURE IN URINARY BLADDER (STONE ETC.)

2. 4. Nocturia (Increase frequency of urine at Night)
. Diabetes Mellitus
. HTI
5. Haematuria:
True Haematurea
False Haematurea
Macroscopic Haematures
Microscopic Haematures.
True Haematurea – Colour of urine is red and RBCs are present in urine (200 > 2RBC)
False Haematurea – Colour of urine is red but RBC are not present in urine.
Cause – By eating Beat root
– Rifampicin
– Pyridium

3. True Haematurea
 Painful Haematurea
 Painless
 Pre Micturation Haematurea
 With Micturation Haematurea (Mixed)
 Post Micturation
Causes – Pre Micturation Haematurea
. Urethal Causes (Injury)
. BPH
– With Micturation Haematurea (Mixed)
. Ureteric Causes (Stone)

4. . Renal Causes
. Stone
. Polycustic Kidney
. Glomerulonephritis
. Malignaut tumour in Kidney
. T.B. of Kidney
Post Micturation Haematurea
. Any cause in urinary bladder
. Cystitis
. Vesical Calculus
. CA of Urinary Bladder
Extra Renal Causes
. SABE
. Appendicitis
. Salfringitis
. Diverticulitis

5. 6. Retention of Urine:
It should be differentiated from Anurea/ oliguria. In retention of
urine kidney function is normal while oliguria & Anuria indicate towards
disturbed function of the kidney.
Causes :
. Urethral obstruction
. Urethral Stricture
. Pin hole meatus (Esp. in children)
. Phymosis
. Prostatic hypertrophy
. Spinal causes.

6. 7. Incontinence of urine:
Improper involuntary passage of urine resulting is wetting.
Causes:
. Common in old age (due to damage of brash cells)
. Common in Multipase (due to weakening of muscles)
. In paraplagis (lower body paralysis)
. Pressure on bladder
8. Pain in Renal angle or lein:
(Angle between 12th rib & Erector spinaemus).
Causes
. Inflammatory condition in Kidney (i.e., stone)
. It is colicky in nature
. It is in agony and in restless condition pain goes from loin to
groin, scrotum, glans, labias.

7. Signs
1. Oedems:
. Oedems of Renal origin starts from face. (Peri or bitaol oedems)
. Oedems of Cardiac origin starts from legs.
. Oedems of Heptic origin starts from abdomen.
2. Rashes on skin : seen in Uraemia
Breath smell : seen in Uraemia / Renal failure
3. Nails : Half Half nails seen in Renal failure.
Ben’s line (Transverseriolgeson nail – chronicity of dis.)
4. Ascites.
5. Signs of Hypertension (if Renal cause)

8. Inspection
1. Oedems / Generalised anasarce in Acute Renal failure.
2. Skin: Rough, Dry, Dark brown with scratches & wrinkles in chronic
Renal failure.
3. Nails: White & Opaque nails in chronic Renal failure.
Palpation
Palpation of kidney by Bimannual method. Generally Kidney are
not palpable.
palpable kidney indicates:
. Hydronephrosis (May be unilateral)
. Polycystic Kidney (Always Bilateral)

9. Persussion
. Fluid thrill
. Shifting dullness
. Pleural effusion may be in Nephrotic syndrome.
Anscultration
. Bruit (on Renala)
Indicates stenosis of Renala.
(If this sound is heard over the heart, it is called murmur.)

10. Investigation of Renal system
1. Urine test
Physical examination
. Normal amount (It may vary from 700-2500ml)
. Specific gravity (1.003-1.030)
. Odour
Chemical Examination
. Protein
. Ketone bodies
. Bile salts
. Bile pigments.
Microscopic Examination
. RBS
. Pus Cells
. Cast (Hyalina Cast indicates Glomerulonephrites)
. Crystals
Urine Culture & Sensitivity
2. R&T (Renal function test)
. Blood urea (Normal 20-40 mg / 100ml)
. Serum Creatinine (0.5 mg – 1.2 mg)

11. Radiological Investigation
1. Plane X-ray abdomen for KUB (Kidney, Ureter, Bladder)
2. IVU (Intravenous Urography)
3. IVP Intravenous Pyelography) for kidney function.
4. USG (Ultra Sonography)
5. C.T. Scan
6. Cystography
7. Urethrography
8. MRI (Magnatic Resonant Imaging)