RENAL DISORDERS 1. INVESTIGATlONS IN RENAL DISEASE. The Urine I. GENERAL CHARACTERS

leucodystrophy Cockayne's syndrome (b) Paraproteinemia Myeloma Waldenstorm's rnacroglobulinemia (c) Drugs Amidarone (d) Chronic inflammatory damyelinating neuropathy. Autonomic neunopathy - 1. Diabetes melitlus. 2. Uramia 3. Guillain-Barre syndrome. 4.Alcoholic liver disease. 5. Amyloidosis. 6. Idiopethic Congenital Riley-Day syndrome. Acquired Shy-Drager syndrome. 7. RENAL DISORDERS 1. INVESTIGATlONS IN RENAL DISEASE. The Urine I. GENERAL CHARACTERS - A. Volume - varies with amount of fluids ingasted, perspiration,etc. Normal average for adult 1,200-1,500 ml. (40-50 oz.) Polyuria -A. Transient polyuria -(1) Induced or therapeutic- (a) ingestion of large amounts of fluids. (b). Alcohol, tea, coffee, acidifying salts like citrates or tartrates, spices, large amounts of sugar (c) Diuretics. (d) High protein diet. (2) Spontaneous- (a) Due to nervousness or after a nervous attack, e.g. examination, neurasthenia, after an attack of epilapsy. migraine. asthma, angina pectoris or paroxysmal tachycarda. (b) Hydronephrosis with periode emptying of renal sac. (c) Attack of malaria, during the cold stage. (d) During convalescence from fevers like enteric. (e) Diminution or disappearance of oedema, e.g. recovery from acute naphirtis, cirrhosis of Iiver. (f) Post-anuric duresis. (g) Crisis of chronic nephrosis. B. Continued polyuria - (1)Cranial diabetes insipidus. (2) Nephrogenic diabetes insipidus. (3) Primary polydypsia - (See Chapter 5). Oliguria - Diarrhoea, fever. decompensated heart disease. glomerulonephritis, during accumulation of fluid in serous cavities, uremia Nocturia - 1. Prostatism. 2. Oedematou states. 3 Polyuric states - Diabetes mellitus/insipidus, primary polydipsia. Post-ATN 4. Salt-losing naphropathies - Analgesic nephropathy, medullary sponge kidneys, sickel call disease 5. Bladder disease - Tumour, infection (TB, fungal, schistosoma), loss of reflex inhibition (e.g. MS), vesicoureteric reftux ('double micturition') in children B Transparency - Freshly passed normal urine is clear and transparent. Cloudiness - (a) Amorphous phosphates - form white sediment in neutral or alkaline urine which disappears on addition of acid, (b) Amorphous urates -White or pink cloud which disappeare on heating (c) Blood - Bright red blood from lower urinary tract, dark red or brown from upper tract. Dipstick testing for haemeglobin is a sensitive method of detecting sigfuficant microscopic haematuria particularly when the Sp gr of urine specimen is low. (d) Bacteria - Uniform cloud or opalescence. (e) Chyluria or milky urine - due to blocking of thoracic duct by filaria or inflammatory or naoplastic conditions, with consequent rupture of lymphatics of the bladder. (f) Spermatozoa and prostatic fluid. C. Colour - Depends on volume of urine voided and varies roughly with specific gravity. (a) Colourless -in polyuria and diabetes insipidus. (b) Dark colour - concentration as in fevers. (c) Dark yellow - bile, riboflavin. carotene containing foods. (d) Red -Drugs. (1) Excretion products - Rifampicin, matronidazole, sulphasalazinsr doxrubicin. desferrioxamine. (ii) Drug toxicity -Barbiturates (acute intermittent porphyria), clofibrate, heroin (rhabdomyolysis), wartarin, urokinase (hematuria) (2) Beeturia. (3) Favism (e) Red brown - Urates. porphyria. rnyoglobinurla. (f) Dark brown to black - Alkaptonuria, tyrinosis. melanosis (g) Green to greenish blue - Methylene blue, Ps. aerginosa infection, indigo compounds (h) Cloudy - Laucocytes, bacteria, urates (acid urine), oxalates (alkaline urine), (i) Smoky - Trace of erythrocytes. (j) Bloody - Frank hematuria. D. Odour - Characteristic 'aromatic' odour most marked in concentrated urine. Odour becomes ammonical during decomposition, a cloudy urine with an ammoniacal odour suggests cystitis or pyelitis, usually with obstruction in the urinary tract. Fruity odour in diabetes. Urine containing cystine may develop odour of sulphuretted hydrogen during decomposition. Articles of diet and drugs impart peculiar odour.e.g. asparagus and turpentine E. Reaction - of fresh urine usually acidic (blue litmus paper turns red) with an average pH about 60 pH paper range is from 4. 5-7 F. Specific gravity -Generally varies with quanlity of urine. Normal range 1.017ti 1,020. Diseased kidneys lose partially or campletely their ability to respond to the need of the body with the result that the urine has about the same specific gravity throughout the day II. CHEMICAL EXAMINATION - 1 Proteins - Urine may contain mostly albumin (selective proteinuria) or may contain larger molecules as well (non-selective proteinuria). Excretion mainly of albumin signifies a glomerula lesion. Causes of proteinuria-(1) PHYSIOLOGICAL- Amount of protein excreted is small and the condition is temporary (a) Orthostatic benign - usually in older children and adolescence (i) Urine sample passed on waking is negative for proteinuria while urine passed after 2 hours ambulation is positive. Usually increased by exercise (ii) Proteinuria 'tubular' in character i.e it contains small molecular weight proteins which normally pass through the glomerulus and are reabsorbed by (the proximal tubule. (iii) <1g/day.>