Clinical

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

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

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

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

Disturbance in the act of

micturition
Frequency
Passing urine more often
than usual without increase
in the amount of urine

Disturbance in the act of

micturition
Frequency
Results from
Irritation of the bladder
Reduction in the capacity
of the bladder
Pressure from a pelvic

Disturbance in the act of

micturition
Dysuria
Pain in passing urine
Usually results from disease
of the
Bladder
Prostate

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

Disturbance in the act of

micturition
Retention of urine
Occurs in
Obstructive lesions of the
urethra
Disease of the spinal cord
Coma

Disturbance in the act of

micturition
Incontinence of urine
Seen in
Cerebrovascular lesions
Paraplegia
Multiple slerosis
Prolapsed uterus with

Disturbance in the act of

micturition
Nocturia
Passing urine in the night
( commonly associated with
polyuria)
Other causes
Prostatism
Cystitis

Disturbance in the act of

micturition
Stranguary
Severe supra pubic pain
associated with inability to pass
urine
Seen in
Cystitis
Bladder tumour

Disturbance in the act of

micturition
Hesitancy
Delay in initiating the urine flow
Seen in males with prostatism

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

Alteration in the amount

of urine
Polyuria
day

- over 3000 ml per

Oliguria
per day

- less than 300 ml

Anuria
output

- neglible urine

Alteration in the amount

of urine
Polyuria causes
Diabetes Mellitus
Diabetes Insipidus
Psychogenic polydipsia
Chronic renal failure
Hypokalemia
Hypercalcemia

Alteration in the amount

of urine
Oliguria
Seen in acute renal failure
Pre renal failure Shock
Haemorrhage
Dehydration
Cardiac failure

Alteration in the amount

of urine
Oliguria
Seen in acute renal failure
Intrinsic renal failure
Acute glomerulonephritis
Acute tubular necrosis

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

Alteration in the appearance

of urine
Haematuria Red or smoky
brown
colour

Alteration in the appearance

of urine
Causes of haematuria
Painless Urinary tract
obstrution
Tuberculosis
Urogenital tumors
Glomerulonephritis

Alteration in the appearance

of urine
Causes of haematuria
Painful Renal calculi
Urinary tract infection
Reflux nephropathy
Renal papillary
necrosis

Alteration in the appearance

of urine
Urine become blackish or coca
cola in colour
Haemoglobinuria
Myoglobinuria

Alteration in the appearance

of urine
Frothy urine
Commonly due to proteinuria

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

Alteration in the appearance

of urine
Proteinuria
50 % of proteins excreted in
urine derive from plasma
proteins
Remainder of proteinspostglomerular
Secretary products of distal tubular
cells ( Tamm Horsfall proteins )

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

Alteration in the appearance

of urine
Proteinuria
Significant proteinuria
Physiological
Pathological

Alteration in the appearance

of urine
Proteinuria
Physiological
( Proteinuria less than 1000
mg / L )
When disappears lying supine
is called orthostatic proteinuria

Alteration in the appearance

of urine
Proteinuria
Transient proteinuria without
renal damage seen in
Cold exposure
Vigorous exercise
Febrile illness
Congestive cardiac failure

Alteration in the appearance

of urine
Proteinuria
Pathological proteinuria
( Proteinuria more than 1000
mg / L )

Alteration in the appearance

of urine
Proteinuria
Pathological proteinuria
Commonly seen in
Glomerular disease
Tubular disease

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

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 )

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

Alteration in the appearance

of urine
Proteinuria
Microalbuminuria ( Misnormer )

Seen in
Diabetic nephropathy
Hypertensive renal disease

Alteration in the appearance

of urine
Proteinuria
Microalbuminuria ( Misnormer )

Detection needs special

reagent strips

Alteration in the appearance

of urine
Urine become turbid with
Infection
Precipitated urates
Precipitated phosphates

Alteration in the appearance

of urine
Urine colour gets
darkened on standing
Porphyria
Alkaptonuria

Alteration in the appearance

of urine
Drugs causing discolouration of
urine
Tetracycline
Yellow
Sennakoat

Orange

Desferrioxamine

Reddish Brown

Phenindione

Pink

Nitrofurantoin

Brown

Rifampicin-

Red

Methylene Blue
Methyl Dopa
Metronidazole
urine

Green
Grey
Darkening Of

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

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

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

General symptoms and

signs of renal disease
Fever Urinary tract infection
renal

may be associated with

abnormality

General symptoms and

signs of renal disease
Dyspnoea - fluid overload in
renal
impairment
metabolic acidosis in
renal
impairment
pleural effusion in
nephrotic

General symptoms and

signs of renal disease
Oedema ( facial and dependent
)
chronic kidney
disease
nephrotic syndrome

General symptoms and

signs of renal disease
Pruritus in chronic kidney
disease
Distal brown discolouration of
nails - in chronic kidney
disease

General symptoms and

signs of renal disease
Pallor in chronic kidney
disease
Hyperpigmentation
in chronic kidney disease

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

End