Symptoms and Diagnosis of Kidney and Urinary Tract potx

Symptoms and Diagnosis of Kidney and Urinary Tract Some urinary tract disorders rarely cause symptoms until the problem is very advanced; these include kidney failure, tumors and stone

Symptoms and Diagnosis of Kidney

and Urinary Tract

Some urinary tract disorders rarely cause symptoms until the problem is very advanced; these include kidney failure, tumors and stones that do not block urine flow, and some low-grade infections Sometimes, symptoms occur but are very general and difficult for the doctor to connect to the kidney For example, a general feeling of illness (malaise), loss of appetite, nausea, or generalized itching may be the only symptoms of chronic kidney failure In older people, mental confusion may be the first recognized symptom of infection or kidney failure Symptoms that are more suggestive of a kidney or urinary problem include pain in the side (flank), swelling of the lower extremities, and problems with urination BURNING OR PAIN WITH URINATION

Burning or pain with urination (dysuria) may be felt at the opening to the urethra

or, less often, over the bladder (in the pelvis, the lower part of the abdomen just above the pubic bone) Occasionally, if a woman has vaginal irritation (for example, due to inflammation or infection of the vagina or of the area surrounding

the vaginal opening, called vulvovaginitis), she may feel a burning sensation when urinating

Causes

Dysuria is very common, particularly among adult women, in whom it is often caused by urinary tract infections, such as cystitis and urethritis However, dysuria can occur in men and women of any age and can have many noninfectious causes

Common Causes of Dysuria

Type

Examples

Infectious*

Cervicitis

Cystitis (more common in women)

Epididymo-orchitis

Prostatitis

Urethritis

Vulvovaginitis

Inflammatory

Inflammatory connective tissue disorders (reactive arthritis or Behçet's syndrome) Interstitial cystitis (noninfectious bladder inflammation)

Vulvar vestibulitis (increased vulvar sensitivity to pain)

Physical

Catheterization of the bladder

Obstruction of the bladder neck (for example, due to benign prostatic hyperplasia)

or urethra (due to strictures)

Other

Atrophic vaginitis or urethritis

Tumors

*Common infectious organisms include nonsexually transmitted bacteria (mostlyEscherichia coli) and sexually transmitted organisms (such as those that cause gonorrhea, chlamydial infection, and trichomoniasis)

Evaluation

Doctors can sometimes get clues to the cause based on where symptoms are most severe For example, if symptoms are most severe just above the pubic bone, a bladder infection (cystitis) may be the cause Women with frequent episodes of cystitis may recognize characteristic symptoms that suggest another episode If symptoms are most severe at the opening of the urethra, urethritis may be the cause In men with a penile discharge, urethritis is often the cause If burning affects mainly the vagina and the woman has a discharge, vaginitis may be the cause

Examination may confirm a condition that could be causing dysuria For example, vaginal or penile discharge can be confirmed Inflammation or atrophy of the vagina or vulva may confirm vulvovaginitis An enlarged prostate may confirm benign prostatic hyperplasia Tenderness of the epididymis or testes may suggest epididymo-orchitis, and tenderness of the prostate may suggest prostatitis

Doctors do not always agree on the need for tests Some doctors just treat adult women who have symptoms that suggest cystitis Other doctors usually do testing for all people or for people in whom the diagnosis is not clear The first test is usually a urinalysis Urine culture is often done to identify the organism causing infection and to determine which antibiotics will be effective For women, a sample of vaginal discharge is examined on a slide using a microscope Men and women with a urethral discharge are tested for gonorrhea and chlamydia

Treatment

The cause is treated Often, the cause is an infection, and treatment produces relief

in 1 or 2 days If dysuria is severe, phenazopyridine

can be taken for the first 2 days to relieve discomfort Phenazopyridine

turns the urine a red-orange color

SWELLING

Swelling results from accumulation of fluid in the tissues (edema) The swelling may cause weight gain Swelling is usually most noticeable in the ankles and feet, but it may also involve the abdomen, lower back, hands, and face If swelling is particularly severe, fluid may accumulate in the lungs, causing difficulty breathing

Causes

Swelling may occur if the kidneys are unable to excrete excess water and sodium from the body, as in kidney failure Swelling may also develop from a kidney disorder that causes the loss of large amounts of blood protein (especially albumin) in the urine (nephrotic syndrome) When the albumin level in the blood drops sufficiently, swelling occurs as fluid leaks from the circulation into the tissues

Other disorders may also cause swelling Heart failure, caused by inadequate pumping by the heart, signals the kidneys to retain salt and fluid, which may accumulate in tissues Advanced liver disease also signals the kidneys to retain salt and fluid; swelling is worsened by the reduction in blood protein that occurs This protein decrease causes fluid to leak into the tissues If swelling occurs in only one limb, the cause is probably something related to the limb (such as a blood clot in a vein or an injury) rather than a kidney, heart, or liver problem

Evaluation and Treatment

Doctors usually assess the presence and degree of swelling by pressing on the person's shins If the skin retains the impression of the doctor's finger, extra fluid

is present The person's symptoms and the doctor's physical examination suggest whether the kidneys, liver, or heart is the cause, but doctors also obtain a urinalysis and blood tests of liver and kidney function If heart failure is suspected,

a chest x-ray and sometimes an echocardiogram are obtained To diagnose nephrotic syndrome, doctors may assess urinary loss of protein by calculating the ratio of total protein to creatinine in a urine specimen

The underlying disorder is treated when possible Swelling can often be relieved

by a diuretic if the kidneys are working properly If the kidneys are not working properly and fluid has collected in the lungs, the person may need dialysis

INCREASED URINATION

Most people urinate about 4 to 6 times a day, mostly in the daytime Normally, adults pass between 3 cups (700 milliliters) and 2 quarts (2 liters) of urine a day Infants may pass as little as 1 cup (230 milliliters) per day Urination can be increased if a person produces an excess volume of urine or produces a normal volume of urine but feels the need to go more often (urinary frequency)

Causes

Increased Volume: Excess urine can be caused by drinking too much fluid (polydipsia), by taking diuretic drugs or substances that have a diuretic effect, such

as alcohol or caffeine, or by having a high level of sugar in the blood (as in diabetes mellitus) A rare condition called diabetes insipidus causes excess urine because of problems with a brain hormone called antidiuretic hormone (also called vasopressin) Antidiuretic hormone helps the kidney reabsorb fluid If too little antidiuretic hormone is produced (a condition called central diabetes insipidus) or

if the kidney is unable to properly respond to it (nephrogenic diabetes insipidus), the person urinates excessively

Increased Frequency: A frequent need to urinate without an increase in the total daily output of urine can occur when something irritates or presses on the bladder

A urinary tract infection (UTI) is the most common cause of bladder irritation Rarer causes include a stone or tumor in the bladder A tumor or other mass (or even the uterus if a woman is pregnant) pressing on the outside of the bladder can

also cause a frequent urge to urinate because the mass reduces the capacity of the bladder An inability to fully empty the bladder because of partial obstruction, often from an enlarged prostate (in men), can produce frequency

Evaluation and Treatment

The doctor asks about the use of diuretics Symptoms such as pain or burning may indicate infection For men, the doctor will examine the prostate by putting a gloved, lubricated finger in the man's rectum If the prostate is enlarged, a blood test (prostate specific antigen, or PSA, test) and sometimes a prostate ultrasound are done The doctor usually checks the urine for glucose (suggesting diabetes mellitus) and bacteria or excess white blood cells (indicating infection) If the cause is not clear, the doctor may measure levels of electrolytes in the blood and urine and sometimes perform imaging tests of the kidney, ureters, or bladder (such

as CT, ultrasound, or magnetic resonance imaging [MRI])