Work Book. Semiotics of Urinary System disease.

Mark structures in which there are changes in pyelonephritis and glomerulonephritis:

A B

C
D

E
F
URINE
in to
colligati
on
tubules

A. – ___afferent arteriole_______________________________________________________
B. – ______efferent arteriole____________________________________________________
C. – ___Bwomen’s capsule_______________________________________________________
D. – ___proximal convoluted tubule_______________________________________________
E. – ______loop of henle_____________________________________________________
F. – ____distal convoluted tubule_______________________________________________

Semiotics of urine syndrome in diseases of nephron (complete the chart)

The diuresis is _____urinary excretion volume in time___________________.
The daily diuresis? __25-50___ml/kg of body weight per day
The hourly diuresis? __1-2__ml/kg of body weight per hour
What is data (characteristic) of urinalysis (complete the chart):

What is hematuria __it is the presence of red blood cells erythrocytes in the urine more than
normal date.____
What is leucocyteuria__is the presence of more than 5 leukocytes in visual field during the
microscopic investigation of urine sediment._____,
What is proteinuria ___it is pathological date of proteins in urine as result of GM usually
and other elements of renal filter lesions_____
What is glycosuria __abnormal excretion of glucose in the urine.________
Define the terms diuresis disorder in and note changes in pyelonephritis and
glomerulonephritis:
oliguria - insufficient urinary excretion is urine output less than 1 ml per kg of body weight
per hour in small children and less than total 500 ml per day in adults.
polyuria – it is a condition of successive production and passage of urine.more than 3 litres
a day compared to normal daily urine output in adults of about 1 to 2 litres.
anuria - is severe decreasing of daily diuresis less than 1 /15 from minimal normal level or
inpatient which does not void long time having the empty bladder
dysuria – the sensation of pain ,burning or discomfort on urination.
enuresis - night time loss of bladder control or bedwetting usually in children ,in
adults it can be cause of alcohol intoxication.

What are symptoms of toxic, pain, dysuria, edema, urinary syndrome?

_Inoxication syndrome. Fever, vomiting, headache.
Disuric syndrome.
Pain syndrome: pain in abdomen and loin_
Urinary syndrome: bacteriuria, leukocyturia, pyuria, postrenal microhematuria

What are clinical manifestation and laboratory tests of pyelonephritis in child?

___(a) High temperature (first 3-4 days of the disease). (b) Weakness, flaccidity. (c)
Headache. (d) Poor appetite. (e)In connection with intoxication there can be vomiting,
in small children – cramps and other signs of meningeal syndrome. The skin –
paleness, shadow under eyes. The pain in the beginning of the disease is often localized
in different sites of abdomen (suprapubic area, hypochondrium, in right and left
flanks). Pain in lumbar area is characteristic as the complaint Or as the outcome of
examination (Pasternatsky’s symptom, etc.)._
Laboratory test – a) common urinanalysis
b) urinalysis by Nechipurenko
c) Echourography
d) urine analysis on bacteuria
e)General analysis of
blood____________________________________________________________________
What are criteria of bacteriuria? __is detected as the considerable increase in the amount
of pathogenic flora. Attention! The analysis can be close to normal values, if the urine
passed on the background of the reception of
antibiotics.________________________________________________________________
_________________________________________________________________________
_______
What are the results of X-ray examination, ultrasound examination, excretory urography for
pyelonephritis in children? _
An intravenous pyelogram (PIE-uh-low-gram), also called an excretory urogram, is an X-ray
exam of your urinary tract. An intravenous pyelogram lets your doctor view your kidneys, your
bladder and the tubes that carry urine from your kidneys to your bladder (ureters). __
_Ultrasound, however, can easily detect the presence of obstruction as well as
demonstrate characteristic findings suggestive of acute pyelonephritis, and thus allows
differentiation.____________________________________________________________
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_________________________________________________________________________
_________________________________________________________________________
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_________

Clinical Signs of Renal Diseases (glomerulonephritis) (complete the chart):

The urination frequency _______and

change color of urine _______

What test can you use for diagnostic bacteriuria? __Urinalysis with microscopic exam
for bacteria is a useful, but non-quantitative, way to identify bacteriuria. Pregnant
women should be screened for asymptomatic bacteriuria with a urine
culture.____________________________
_________________________________________________________________________

What are clinical manifestation and laboratory tests of glomerulonephritis in

child? ___ (a) Flaccidity, weakness, malaise. (b) The fever usually up to sub-
febrile. (c) Paleness of dermal integuments. (d) Vomiting. (e) Hepatomegaly
(sometimes). (f) Edema __g) High BP_
_Laboratory__tests include-
 ______ Protein spectrum of blood: • Hypoproteinemia. Disproteinemia. •
Hypoalbuminemia. • Decrease of A:G coefficient. • Hyper-a,-globulinemia and
hyper-y-globulinemia.
___Functional renal tests – in the initial period at oligoanuria there can be a
small rise of rest-nitrogen, urea and creatinine.
_____General analysis of blood: • Decrease in the amount of erythrocytes and
hemoglobin – normochromal anemia. • Low neutrophilic leukocytosis. •
Eosinophilia. • Acceleration of ESR (up to 30-40
mm/hr)._______________________________________________________________
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Where on the patient's body are edema localized in kidney disease? What is the skin
color? What is the skin temperature to the touch? What is the time of the onset of edema
during the day?
_Edema a very important symptom of great diagnostic value: at the beginning pasty, and
then small edema which gradually increases, in the morning mainly on the face (a pale
dropsical face, probable bloating of cervical veins all this results in characteristic look –
Facies nephritica). In the evening the edema appears on the legs. Then the edema can
gain generalized character, down to accumulation of fluid in pleural and abdominal
cavities. The pathogenesis of edema is stimulated by many factors, on the basis of which
they can be:
• Osmotic edema – if in a patient the filtering in glomerules reduces (it raises the amount
of sodium and water in blood). If the reabsorption of water in tubules increases (under
the influence of higher synthesis of antidiuretic hormone and sodium (under the
influence of ADH and Aldosterone), the sodium, which has collected in blood, goes from
vessels with the purpose of support of the osmotic homeostasis into tissues and water
there; the developed hypertension also is the cause of transıtion of water into hypodermic
cellular tıssue – so ADH) 661 661 / 816 osmotic edema appears being a characteristic
synipsUI Ur ine nephritic form of glomerulonephritis.
• Oncotic edema – a characteristic sign of the nephrotic form of glomerulonephritis,
when in connection with the defeat of tubules the reabsorption of protein is vIolated
(considerable hyperproteinuria), therefore hypoproteinemia develops, and the
decreasıng of the oncotic pressure results in going of water tissues so the oncotic edema
develops.____________________________________________________________________
____________________________________________________________________________
_______
____________________________________________________________________________
____________________________________________________________________________

What are clinical and laboratory signs of acute renal failure in child?
In prerenal failure, clinical history should reveal causes of volume depletion, such as
dehydration due to vomiting or gastroenteritis, hemorrhage, cardiac failure, or third-
space fluid losses. Laboratory findings indicative of prerenal failure include decreased
urine output, normal urinary sediments, increased urine osmolality (>400.0 mOsm in the
older child and >350.0 mOsm in the neonate), low urinary sodium (<10.0 mEq/L [10.0
mmol/L]), low fractional excretion of sodium (<1% in the older child and <2.5% in the
newborn), and an increased BUN-to-creatinine ratio. Renal ultrasonography and renal
scan findings should be normal.
Increased levels of blood urea nitrogen (BUN) and creatinine are the hallmarks of renal failure;
the ratio of BUN to creatinine can exceed 20:1 in conditions that favor the enhanced
reabsorption of urea, such as volume contraction (this suggests prerenal AKI)

Indications for biopsy in children with acute and chronic glomerulonephritis. _This
procedure involves using a special needle to extract small pieces of kidney tissue for
microscopic examination to help determine the cause of the inflammation. A kidney
biopsy is almost always necessary to confirm a diagnosis of
glomerulonephritis.___Indications for kidney biopsy include the following: Failure to
document a recent streptococcal infection by a rise in ASO or streptozyme titer.
Normocomplementemia. Renal insufficiency, especially if the glomerular filtration rate
remains less than 30 mL/min/1.73 m2 for more than 1 week._Associated with GFR and
CKD stage at the time of kidney biopsy (p < 0.001 for all). Patients with CKD stage 1 and
2 at kidney biopsy had fewer endpoints compared to patients with a GFR of <60 ml/min
(p < 
0.001).______________________________________________________________________
____________________________________________________________________________
_

How is a child with kidney disease cared for? _haemodialysis, kidney

transplantation_____________________________________
____________________________________________________________________________
How much water is allowed per day? __healthy kidney in our example would require a
daily fluid intake of only 470 ml to maintain fluid balance (8,9). The patient who has
CKD and a maximal concentrating capacity of 600 mOsmol/kg would need only 1140 ml
of free fluid
drinking____________________________________________________________________
______
____________________________________________________________________________
_
How much table salt is allowed per day? __1-4 mg/ kg / 24
hr________________________________________
____________________________________________________________________________

What are clinical and laboratory signs of chronic renal failure in child
 Poor appetite.
 Vomiting.
 Bone pain.
 Headache.
 Stunted growth.
 Malaise.
 Lots of urine or no urine.
 Repeated urinary tract infections.
Laboratory signs-
 A long-term blockage in the urinary tract
 Alport syndrome
 Nephrotic syndrome
 Polycystic kidney disease
  Cystinosis
 Untreated diabetes
 Untreated high blood pressure
 Untreated acute kidney disease

What is data of serum creatinine and serum К, Nа, рН, protein?

Creatinine- 70 μmol/L 
 serum potassium and sodium levels were 4.47 ± 0.35 mEq/L
and 142.67 ± 2.64 mEq/L, respectively
 The normal serum protein level is 6 to 8 g/dl. Albumin makes up 3.5 to 5.0
g/dl, and the remainder is the total globulins

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What are the clinical and laboratory signs of acute and chronic renal failure in a child?

 Acute kidney disease. Acute kidney disease starts suddenly. In

some cases, it may be reversed and the kidneys can work normally
again.
 Chronic kidney disease. This type gets worse slowly over at least 3
months. It can lead to permanent kidney failure.
Acute kidney disease may be caused by:

 Less blood flow to the kidneys for a period of time, such as from blood
loss, surgery, or shock
 A blockage in the urinary tract
 Taking medicines that may cause kidney problems
 Any condition that may slow or block oxygen and blood to the kidneys,
such as cardiac arrest
 Hemolytic uremic syndrome. This is usually caused by an E. coli
 infection. Kidney failure develops because small structures and
vessels in the kidney are blocked.
 Glomerulonephritis. This is a type of kidney disease that happens in
parts of the kidneys called glomeruli. The glomeruli become inflamed
and harm how the kidney filters urine.
Chronic kidney disease may be caused by:

 A long-term blockage in the urinary tract

 Alport syndrome. This is an inherited disorder. It causes deafness,
kidney damage that gets worse over time, and eye defects.
 Nephrotic syndrome. This is a condition that causes protein in the
urine, low protein in the blood, high cholesterol levels, and tissue
swelling.
 Polycystic kidney disease. This is a genetic disorder. It causes
many cysts filled with fluid to grow in the kidneys.
 Cystinosis. This is an inherited disorder. The amino acid cystine
collects in cells in the kidney called lysosomes.
 Other chronic conditions. Conditions such as diabetes or high blood
pressure can lead to kidney problems. If these aren't treated, less
oxygen and blood can get to the kidneys.
 Untreated acute kidney disease. Acute kidney disease may turn into
chronic kidney disease if not treated.
A child is more at risk for acute kidney disease if he or she has:

 Blood loss, surgery, or shock

 A blockage in the urinary tract
 Been taking medicines that may cause kidney problems
 A condition that may slow or block oxygen and blood to the kidneys,
such as cardiac arrest
 Hemolytic uremic syndrome
 Glomerulonephritis
A child is more at risk for chronic kidney disease if he or she has:

 A long-term blockage in the urinary tract

 Alport syndrome
 Nephrotic syndrome
 Polycystic kidney disease
 Cystinosis
 Untreated diabetes
 Untreated high blood pressure
 Untreated acute kidney disease

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Examine Urinary System in chronic renal failure in children (enter the data):
Inspection of lumbar region: __In the corner between lower rib and vertebral
column.____________________________________________________

Bimanual palpation of kidneys: _ one hand is placed in the renal angle, behind the
patient, and used to elevate the abdomen, while the other explores the anterior
surface of the abdomen. ___________________________________________________

Palpation and percussion of the urinary bladder: _ Specific attention should be paid in
palpation of the suprapubic area for pain, distended bladder, and midline
masses. Percussion of the suprapubic area may aid in recognizing the
distended bladder. ________________________________________

Painful points: ___Some one or two side the patient feels

pain._______________________________________________________________

Pasternak’s sign _Positive sign from one or two size of patient feel pain is indicated for the
kidney
inflammatory._________________________________________________________________

Pain on urination __ Burning or pain during urination is typically caused by inflammation

of the urethra or bladder.  
_______________________________________________________________

Frequency__ Urinating frequently and/or urgently. Pain or burning while urinating

_____________________________________________________________________

hematuria___ Kidneys that contain cysts (fluid-filled sacs) or are blocked may lead

to any type of hematuria
_____________________________________________________________________

nocturia ____ Nocturia is the frequent symptom in chronic kidney

disease (CKD) patients. Nocturnal polyuria, which is one of the main causes
of nocturia, is generally thought to be associated with renal dysfunction leading to
impaired ability to concentrate urine.
_____________________________________________________________________
polyuria___ Many patients with kidney failure make urine, and in some forms of
kidney disorders, urine output may be increased
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