Urinary System Diseases

Urinary Tract Infection –

A patient, mostly a female, presents with urgency and frequency of urination, pain in urethra while urinating (sometimes severe) and feeling of incompleteness after the act, one can suspect urethritis and or cystitis due to urinary tract infection. It is more common in female, as the urethra is shorter. It may be associated with fever, malaise and general weakness.

The diagnosis is clinical. However, if there is no response to treatment or if there is a recurrence, it is necessary to do urine examination. Presence of leucocytes and sometimes RBCs are indicative of infection.

If the fever and other general symptoms are severe, pyelonephritis can be suspected wherein; the infection ascends to the kidney.

In few cases, recurrent or persistent U.T.I. occurs due to renal calculus, E.coli as a causative agent or with prostatic enlargement.

Occasionally a patient may continue to have symptoms in spite of urine being normal. The exact cause is not known.

Urinary Calculi –

Calculi or stones, mostly of calcium oxalate, occasionally of phosphates, urates etc. are formed in the kidney. The exact cause is not known. A stone may be in the kidney, ureter or bladder. It may remain asymptomatic. Renal colic occurs when the stone gets impacted especially in the ureter. A patient presents with severe pain in the loin (i.e. middle of the back on both sides of spine) radiating to front and lower down till the groin or testes. If the pain is severe patient may have sweating, vomiting, coldness of the body, painful urination and hematuria may be present. Diagnosis is arrived at after careful history and finding of hematuria. Most of the stones are visible on plain abdominal X-ray. Sometimes tiny oxalate crystals in the urine cause mild symptoms mimicking renal colic. Recurrent stone formation is not uncommon. Pain is to be differentiated from acute appendicitis, intestinal colic, cholecystitis, and pancreatitis.

Proteinuria, Hematuria, Oedema –

Any of these observable symptoms / signs is most of the time detected accidently or during the examination for certain other conditions.

Minor loss of albumin in urine is common after exercise, during fever etc. and sometimes even normally during the day. Persistent proteinuria in the morning samples should be investigated further. Twenty-four hours urinary protein should be measured. If substantial (more than 1g / day), it indicates renal disease / damage.

Occasional red blood cells in the urine may be normal. Glomerular inflammatory, destructive or degenerative processes cause hematuria. Macroscopic (visible) hematuria is likely to be due to tumor. Oedema is accumulation of fluid in interstitial spaces. Whenever it is present renal, hepatic or cardiac causes should be considered.

Nephrotic Syndrome –

It occurs when large amount of proteins are lost in the urine. One notice swelling of face and upper limbs especially in children. Later on, oedema occurs in lower limbs, genitalia and ascites may be seen. The diseases that cause nephrotic syndrome affect the glomeruli in various ways.

Glomerulonephritis –

The word denotes inflammation of glomeruli. Most of the time it is immune meditated and sometimes inflammation may not be apparent. The injury may be minimal to severe and the diagnosis is histopathological.

Minimal change glomerulonephritis occurs mostly in children. It is acute with severe nephrotic syndrome and responds well to therapy.

Focal segmented glomerulosclerosis presents as idiopathic nephritic syndrome and is less responsive to treatment.

Membranous nephropathy is a common cause of adult idiopathic nephritic syndrome, usually idiopathic.

Renal Failure –

Acute renal failure refers to acute kidney injury and manifested by oliguria, wherein a patient complains of very scanty urine and high creatinine level is noticed.

Chronic renal failure or chronic kidney disease (CKD) represents irreversible damage to kidney function and deterioration can occur over the years. Many times, it is found accidently as raised blood urea and creatinine often with hypertension, proteinuria or anaemia.