Hx ofGenitoUrinary

System

UrinarySymptoms

Hematuria

at beginning orend of micturition

urethral inflam.

trauma

prostatic dis.

on standing porphyria

other causes drugs (rifampicin)

severe muscle trauma

change inurinevolume orstream

polyuria, nocturia, anuria

hisetancy

size of stream

dribbling

urine retention

strangury (recurrent slow, painful urination)

pis­en­doux: desire to urinate after having done

double voiding (incomplete bladder emptying)

Urinaryincontinence

Causes

UTI

delerium

diuretics

immobility

atrophic urethritis or vaginitis

types

stressincontinence

after sudden inintra­abdominal pressure

overactivityof detruser urge to urinate then leakage

underactivityof detruser frequency, nocturia

urethralobstruction

dribbling afterincomplete urination

urinary obstruction

common in elderly men (prostatism)

micturitionhesitancy (difficult starting)

size of stream

terminal dribbling

strangury, pis­en­doux

Causes

calculus

blood clot

prostatic mass

retroperitoneal fibrosis

uterine prolapse

dysuria

renal colic

fever, loin pain

urethral discharge

Genital Symptoms

Mensesimpotenceloss of libidoinfertilitypregnancyurethral or vaginal dischargegenital rash

ChronicRenalFailure(CRF)

symptoms are due to uremia

Causes

Glomerulonephritis

DM

systemic vascular dis.

analgesic nephropathy

reflux nephropathy

hypertensive nephrosclerosis

polycystic kidneys

obstruction

amyloid

Pathophysiology

dehydration >>nocturia

fail excrete Na>>hypertension

renal tubule damage >>Na loss>>hypotension

oliguria  >>hyperkalemia(K excretion depend on urine volume)

fail acid excretion >>metabolic acidosis

fail hydroxylate vit. D3 >>vit. D deficiency>>2ry  hyperparathyroidism>> Ca &  P>>bone dis.

fail excrete erythropoietin>>normochromic normocytic anemia

Renal function

normal  GFR  90­120  mL/min.(estimated by creatinine clearance)

serum creatinine

serum urea

Symptoms

anuria  (<50 mL/d),  oliguria  (<400 mL/d)nocturia, or polyuria

anorexia

vomiting

fatigue, hiccup, insomnia

pruritus, itching, edema

complications

bone pain

fractures

hypercalcemia

pericarditis

hypertension

cardiac failure,ischemic heart dis.

neuropathy

peptic ulcer

ask about dialysisask about renal transplantation

features suggestingchronic rather than acute

small kidney size

renal bond dis.

anemia

peripheral neuropathy

Menstrual &Sexual Hx

menarche

regularity of periods

dysmenorrhea, menorrhagia

vaginal discharge

gravidity, parity

contraception

Past Hx

recurrent UTI

renal calculi

pelvic surgery

Family Hx

polycystic  kidney dis.(autosomal dominant)

Alport's  syndrome(deafness with renal impairment)

Done  by:  Mohammad  Al­Marhoon               Dr.Marhoon@Gmail.comReference:  Clinical  Examination  (Talley)WWW.SMSO.NET

General

hyperventilation <<metabolic acidosishiccupdrowsy, coma <<terminal renal failure

myoclonic jerks, tetany, seizures <<low Cahydration

Hands

nails

hypoalbuminemia

leuchonychia(white transverse opaque bands)Muehrcke's nails(paired white transverse lines)

renal failureMee's lines(single transverse white line)

chronic renal failure 1/2 & 1/2 nails

anemia with pallorasterixis in terminal chronic renal failure

AV fistula

Arms

bruising <<chronic renal failure

skin pigmentationscratch marks <<Ca deposition

peripheral neuropathymyopathy

Face

anemia, jaundice

band keratopathy (Ca depositionbeneath corneal epithelium)

uremic fetormucosal ulcers

Abdomen

inspectionscars

nephrectomytransplanted kidney

peritoneal dialysis

ascites

palpation

enlarged kidney bulges forward

perinephric abscess bulge backward

unilateral renal mass

renal cell carcinoma

hydronephrosispolycystic kidneyacute pyelonephritis

renal abscess

bilateral renal mass

polycystic kidneyshydronephrosis

nephrotic synd.infiltrative dis. (amyloid)

percussion shifting dullness

bladder

auscultation ofrenal bruit above umbilicus, 2 cm lateral to midline

in 50% of pt. with renal artery stenosis

Back

strike vertebral column for bony tendernessMurphy's kidney punchstrike renal angle

sacral edema

Legs

edema

purpurapigmentation

scratch marks

peripheral neuropathy & myopathygout arthropathy

Urine

colortransparency

smell

specific gravitynormal 1.002­1.025

low >>chronic renal failure

high >>dehydration

Chemical analysis

pHnormal urine is acid

consistent alkaline early morning urine &cannot be acidified >>distal RTA

protein

glucoseDM

salicylates, ascorbic acidinability to absorb glucose (Fanconi synd.)

ketones

causesDKA

starvation

ketone bodiesacetone

B­hydroxybutyric acid

acetoacetic acid

bloodhematuria

hemoglobinuria

myoglobinuria

nitriteindicate bacterial infection

urine sediments

RBCsnormal <5

WBCsnormal <10

Casts

hyalineconsist of Tamm­Horsfall mucoprotein

Granularconsist of hyaline materialusually with proteinuria

red cell casts1ry glomerular dis.

white cell castsbacterial pyelonephritits

fatty castsnephrotic synd.

Done  by:  Mohammad  Al­Marhoon                Dr.Marhoon@Gmail.comReference:  Clinical  Examination  (Talley)WWW.SMSO.NET