Renal

GENITOURINARY AND RENAL SYSTEM REVIEW

DANGER SIGNALS

ACUTE KIDNEY INJURY (ACUTE RENAL FAILURE)
  • Definition: Acute Kidney Injury (AKI) is characterized by sudden onset of oliguria (reduced urine output), edema, and weight gain due to fluid retention. Symptoms include lethargy, nausea, and loss of appetite.
  • Clinical Features:
    • Rapid decrease in renal function
    • Elevated serum creatinine levels
  • Renal Function Indicators:
    • Initial stages may show serum creatinine and estimated glomerular filtration rate (eGFR) which may not accurately reflect true renal function.
  • Common Causes:
    • Drug-induced AKI: Aminoglycosides, contrast agents, NSAIDs, ACE inhibitors, and protease inhibitors.
ACUTE PYELONEPHRITIS
  • Presentation: Patient presents with acute onset of:
    • High fever
    • Chills
    • Nausea/vomiting
    • Dysuria and frequent urination
    • Unilateral flank pain (described as a deep ache)
  • Indicators for Hospitalization: Include inability to maintain oral hydration, fever >101.0°F (>38.4°C), toxic appearance, immune compromise, or suspicion of sepsis.
BLADDER CANCER
  • Epidemiology: Median age at diagnosis is 69 years in males and 71 years in females.
  • Presentation: Elderly smoking patients with painless hematuria (blood in urine), which may be microscopic or gross (pink to reddish urine).
  • Symptoms: May have irritative voiding symptoms not related to UTI (dysuria, frequent urination, nocturia). Advanced disease can present with lower abdominal/pelvic pain, perineal pain, low-back pain, or bone pain.
  • Diagnostic Tests: Urinalysis (UA), urine culture and sensitivity (C&S), urine cytology.
RHABDOMYOLYSIS
  • Symptoms: Patient experiences an acute onset of:
    • Muscle pain (not related to exertion)
    • Muscle weakness
    • Dark urine (myoglobinuria)
  • Classic Triad: Muscle pain, weakness, dark urine. Tenderness and swelling may indicate this condition, but compartment syndrome is ruled out.
  • Complications: AKI can occur due to kidney damage.
  • Laboratory Findings: Markedly elevated serum creatine kinase levels (≥5 times normal), electrolyte abnormalities, elevated aldolase, and lactate dehydrogenase.
  • Precipitating Factors: Severe exercise, crush injuries, high fever, high-dose statin use.

NORMAL FINDINGS IN KIDNEYS

  • Anatomy: Kidneys are located in the retroperitoneal area; the right kidney is lower than the left due to liver displacement.
  • Functional Units: Nephrons contain glomeruli and are responsible for maintaining electrolyte