II. Clinical Manifestations of Urogenital Diseases

The kidney alone is a complex organ, with several functions as highlighted earlier. Its chief function is to manufacture urine from blood – filter out what is not needed, and keep what is. Thus abnormal renal function is clinically manifested in the nature (components eg. cells, protein) and volume of urine. 

Here are some important definitions: 

Uraemia – Azotaemia together with clinical signs and symptoms. Often, other organs area also affected, eg. Uraemic gastroenteritis, peripheral neuropathy, uraemic fibrinous pericarditis. 

Azotaemia – Biochemical abnormality characterised by raised blood urea nitrogen (BUN) and creatinine levels

Click on the tabs below to look at the clinical manifestations and some basic investigations 

Renal, ureteric symptoms

  • Flank pain (eg. Pyelonephritis)
  • Colic (eg. Calculi)
  • Flank mass, dragging sensation (eg. Polycystic kidney disease)

Abnormal nature of urine  

  • Abnormal volume: Too high or low (renal failure, obstruction)
  • Nature/Colour
    • Haematuria (causes include glomerular diseases, tubulointerstitial and lower urinary tract infections, stones, bleeding diatheses)
    • Frothy (proteinuria)
    • Brown (myoglobinuria)
    • Purulent (pyuria)

Abnormal micturition (urination)   

  • Dysuria (Infection/Inflammation, obstruction)
  • Frequency (Infection/Inflammationm obstruction)
  • Dribbling, hesitancy (obstruction eg. Benign prostatic hyperplasia)

Systemic signs and symptoms

  • Fever (pyelonephritis, lower urinary tract infection)

Signs and symptoms of chronic renal failure and uraemia

  • Skin sallow appearance, pruritus
  • Fatigue, pallor – anaemia
  • Nausea, vomiting, gastroenteritis
  • Encephalopathy, peripheral neuropathy
  • Dehydration
  • Cardiovascular complications – cardiomyopathy, heart failure, pulmonary oedema, uraemic pericarditis

Urine examination is very important in urogenital diseases

  • Volume (too little, too much)
    • Presence of RBCs (Haematuria)
    • Presence of WBCs
    • Presence and amount of protein in urine (proteinuria)
    • Microbiological investigations (eg. culture)
    • Microscopic pathologic examination (eg.for LUT malignancy)

Blood investigations are also important in assessing renal function:

  • Blood urea nitrogen (BUN)
  • Creatinine
  • Glomerular filtration rate
  • Electrolytes – hyperkalaemia, metabolic acidosis

Imaging

  • Kidney, lower urinary tract

Kidney biopsy

  • Glomerular, Tubulointerstitial and Vascular diseases
  • Tumours