This document discusses various types of urinary system dysfunction including impaired renal function, hematuria, proteinuria, polyuria, and urinary incontinence. For each type, it outlines potential causes, evaluation steps such as medical history, examinations, and investigations, and treatment approaches focused on addressing underlying causes.

1. Urinary system dysfunction

2. Impaired renal function
 Can be pre-renal, renal, post-renal
 Causes-
 Azotemia- increase in blood urea and/or
creatinine, due to reduced GFR
 Oliguria- decreased urine output, usually
<500 ml. per day in adult
 Covered later as ARF & CRF

3. Hematuria
Presence of RBC in urine
Microscopic or macroscopic

4. Causes
 Lower urinary tract
 BPH (age >50), prostatitis
 Stones (age <40), UTI/STD
 Malignancy- TCC
 Trauma
 Upper urinary tract
 Nephritic syndrome- PSGN/RPGN, IgA nephropathy
 Papillary necrosis- DM, analgesics, sickle cell disease
 Interstitial nephritis- antibiotics
 RCC
 Other- change in color without RBC

5. Work-up
 History- timing of blood in urine,
associated symptoms
 Examination- HT, edema, mass,
PR exam. for prostate
 Investigation-
 Urine analysis- RBC, WBC, protein, casts, malig.
cells
 CBC, RFT
 X-ray KUB, IVP, CT scan
 Cystoscopy +/- biopsy

6. Treatment
Of underlying cause

7. Proteinuria
Excretion of >150 mg. protein/d.
Massive - >3.5 gms./day

8. Urinary proteins
 α2 microglobulins
 Tamm-Horsfall mucoprotein
 Albumin- 10-15 mg./day
 β2 microglobulins, lysozyme etc.

9. Causes
 Glomerular diseases
 Nephrotic syndrome
 Glomerulonephritis
 Diabetic nephropathy
 IgA nephropathy
 SLE
 Overflow proteinuria
 Multiple myeloma- Bence Jones protein
 Low reabsorption at proximal tubule
 Fanconi syndrome

10. Evaluation
 Dipstick- qualitative
 24 hour urine- quantitative
 Protein:Creatinine ratio >45 mg./mmol.,
in spot urine sample provides
alternative estimate of 24 hr proteinuria

11. Polyuria
Urine output >3 litres/day

12. Causes
 Inadequate vasopressin secretion
 Pituitary damage
 Inadequate vasopressin response
 Tubular damage- pyelonephritis, analgesic nephropathy,
obstructive uropathy, MM, ADPKD, Amphotericin,
hypercalcemic or hypokalemic nephropathy
 Solute diuresis
 Glucose, mannitol, urea
 Natriuresis
 Diuretic phase of ATN, Bartter’s syndrome
 Primary polydipsia

13. Water deprivation test
 >3% weight loss or after 14 hours
 Normally- urine<0.5 ml/min, osm.>700
 Psychogenic polydipsia- osm.>400
 Diabetes insipidus- urine>0.5 ml/min,
osmolality commonly <200 mosmol/kg.
 Vasopressin- 5 mU/min infusion
 Central DI- urine osm. increases >9%
 Nephrogenic DI- no change

14. Dysuria, Frequency, Urgency
 Lower urinary tract symptoms
 Commonly due to infection
 Cystitis in females, urethritis in males
 Fever & flank pain suggest pyelonephritis
 Prompt treatment & follow-up warranted-
 Pregnancy
 Structural abnormality,
 Immunosuppressed, Diabetic
 Recent LUT instrumentation

15. Urinary incontinence
Voluntary or involuntary
Leakage of urine

16. Types
 Urge- detrusor overactivity
Rule out bladder stone/tumor
 Overflow- detrusor underactivity
Neurogenic bladder, increased PVR
 Stress- urethral incompetence
Leakage of urine in response to any stress
 Functional

17. Evaluation
 History- diary, associated symptoms
 Examination
 Investigation-
 Urinalysis
 Ultrasound
 Urodynamics
 Cystoscopy

18. Treatment
 Urge-
 Bladder training
 Pelvic floor muscle exercises
 Drugs- Tolterodine, Darifenacin/Solifenacin
 Overflow
 CIC, indwelling catheter
 Stress
 Timed voiding
 Pelvic floor muscle exercises
 Duloxetine
 Surgery
 Other- BPH
 Alpha-blockers- Tamsulosin
 5-alpha reductase inhibitors- Finasteride
 Surgery- TURP