Complete urinary symptom

1. Yousaf Khan
Renal Dialysis Lecturer
IPMS, KMU

2.  Persistent large increase in urine output.
 Excessive or abnormally large production or passage of
urine (>3 L per day in adults).
 Micturition: in which there is passage of small amount of
urine with increased frequency.
 Polyuria is due to free water excretion or due to excessive
solute excretion.

3. Physiological
 Excessive intake of fluid
 Cold climate
 Anxiety
 Pro rich diet
Pathological
 Endocrine
 Renal
 Systemic
 Psychiatric
 Drugs
 Iatrogenic

4.  Due to excretion of increased non absorbable solutes(such
as glucose) – SOLUTE DIURESIS
 Urine output > 3 L per day
 Urine osmolality > 300 msmol/L
Causes:
 Glycosuria is uncontrolled daibetes mellitus
 Mannitol administration
 High protein diet causing increase urea production and
excretion.
 Excessive sodium loss in cystic renal disease
 Renal tubular demage
 Bartter syndrome: excessive urinary potassium loss –
hypokalemia and hypotension.

5.  Due to excretion of increased water(from a defect in ADH
production or renal responsiveness) – WATER DIURESIS
 Urine output >3 L per day
 Urine is dilute (<250 mosmol/ L)
 Causes – polydipsia
 Central diabetes insipidus ( central or nephrogenic).

6.  Frequent passage of small volume of urine without an
increase in total volume
 Causes:
 Renal : pyelonephritis
 Ureter : stone
 Bladder: cystitis and BPH
 Urethera: urethitis
 Gynecological: vaginitis and pregnancy
 Psychological: depression and tension

7.  Normal urinary protein excretion should be < 150 mg/day.
 Abnormal proteinuria was defined as excretion of protein >
150 mg/day.
 Heavy proteinuria > 1g/dl – indicate glomerular origin
 Mild to moderate – tubular defect

8. Primary renal disease
 Glomerulonephritis
Secondary Renal disease
 Systemic disease : diabetes, hypertension and amyloidosis
 Drugs: captopril, penicillamine, heroin and NSAID
 Infection: Hepatitis B, infective endocarditis, malaria, AIDS
 Allergy: Vaccine, bee sting

9. Functional proteinuria:
 Stresses – no renal disorder, 1g/d.
 Causes: exercise, fever, severe hypertension, burns,
postoperative and acute alcohol abuse.
Orthostatic proteinuria:
 when a patient is standing but not when recumbent, benign
condition usually occurring below the age 30.
Isolated proteinuria:
 Defined as proteinuria without hematuria or reduction in
glomerular filtration rate (GRF)
 In most cases, patient is asymptomatic
 Urine sediment is unremarkable
 Causes: diabetes mellitus and amyloidosis

10. Overload proteinuria:
 From production of excessive amounts of filterable protein
 Such bence – jones protein in multiple myeloma,
myoglobinuria in rhabdomyolysis.
Tubular proteinuria:
 From inability of damage tubule to reabsorb normally filtered
proteins.
 Causes: acute tubular necrosis, toxic injury, drug induced
interstitial nephrititis,
Microalbuminuria
 Normal < 30 microgram / per minute.
 Dipstick can detect – concentration is more than 100 mg/L.
 Albumin excretion > 20 microgram / min or 30 -300 mg/24.
 Indicator of diabetic nephropathy.

11. 24- hour urinary proteins
 > 3.5 g/24 h – nephrotic range
Measurement of urinary protein
Urine dipstick
negative
trace between 15-30mg/dl
1+ 30-100 mg/dl
2+ 100-300mg/dl
3+ 300-1000mg/dl
4+ >1000mg/dl

12. Albumin – creatinine ratio:
 Ratio b/w urinary protein concentration and urinary
creatinine concentration.
 30 mg of albumin per gram of creatinine is considered
abnormal
Renal Biopsy:
 Proteinuria is associated with renal insufficiency
particularly if it is acute in onset.

13.  Reducing proteinuria may also reduce progression of renal
disease
 Low protein diet
 Treatment of underlying cause.

14. Causes:
 Renal causes
may be glomerular or non glomerular in origin
Glomerular causes:
 IgA nephropathy
 Nephritic syndorm
 Post – streptococcal glomerulonephrititis
 Membranoproliferative glomerulonephrititis
Non – glomerular causes:
 Renal cyste
 Renal stone, interstitial nephritis
 Renal tumors

15.  Extra – renal causes:
 Ureter: stone and papiloma
 Bladder: trauma, stone, hemorrhagic cystitis
 urethra; trauma infection, tumors and stone
 Blood disorder
Drugs:
 Anticoagulants
 Analgesic abuse
 Cyclophosphomide
 antibiotics

16.  Non – glomeular in origin
 In the absence of infection gross hematuria from a lower
urinary tract is most commonly.
 Due to from transitional cell carcinoma of bladder.
 Blood in start of voiding comes from urethra
 Blood diffusely present through out the urine comes from
the bladder or above.
 Blood only at the end of micturition suggest bleeding from
prostate or bladder base

17.  Glomerulonephritis
 Renal T.B
 Collagen disease e.g SLE
 Malignant hypertension
 Blood disorder
 Infective endocarditis
 Benign prostatichyperplasia

18.  Urine analysis: protienuria and cast suggest renal in origin
 Urine culture and sensitivity, urine cytology, IVP,
ultrasound kidney, and ultra sound abdomen.
 Condition which may mimic hematuria
 Hemoglobinuria: urine gives a positive chemical test for
hemoglobine, but no red cells are detectable.
 Myoglobinuria: no red cell are seen but chemical tests for
hemoglobin are positive. Myoglobin can bee distinguished
by spectrometry.
 Acute intermittent porphyria: fresh urine appears normal
but on standing for some hours a dark red color develops.

19. The inability to voluntarily void urine

20.  Obstructive
 Infectious & Inflammatory
 Pharmacologic
 Neurologic
 Other

21.  Benign prostatic hyperplasia
 Strictures
 Bladder calculi
 Faecal Impactation
 Phimosis
 Benign/malignant pelvic masses
 Organ prolapse
 Pelvic mass – gynae malignancy
 Uterine fibroid / ovarian cyst
 Foreign bodies

22.  Prostatitis
 Prostatic abscess
 Cystitis
 Acute vaginitis
 Herpes simplex virus

23.  Drugs with anticholingeric properties eg:
tricylic antidepressants (amitriptyline)
 Opioids
 NSAIDs in men
 Antiparkinsonian agents (levodopa)
 Antipsychotics (chlopromazine)
 Muscle relaxants (Baclofen)

24. AUTONOMIC OR PERIPHERAL NERVE
 Diabetes mellitus,
BRAIN
 Tumour, Parkinson’s disease,
SPINAL CORD
 Haematoma / abscess

25.  Post-op complications
 Pregnancy-associated retention
 Trauma eg: penile fracture or laceration
 Idiopathic detrusor failure

26. Thank you