МИНИСТЕРСТВО ОБРАЗОВАНИЯ И НАУКИ

РОССИЙСКОЙ ФЕДЕРАЦИИ
ПЕНЗЕНСКИЙ ГОСУДАРСТВЕННЫЙ УНИВЕРСИТЕТ
МЕДИЦИНСКИЙ ИНСТИТУТ
КАФЕДРА «Внутренние болезни»

Курсовая работа
по дисциплине «Госпитальная терапия, эндокринология»
на тему
«Urinary Syndrome»

Выполнил студент: ПАНГАЛЕ ТЕДЖАС

Группа 15ЛЛ1А

Руководитель:
к.м.н., доцент
 DEFINITION

The term "urinary syndrome" includes moderate proteinuria (up to 3-3.5

g per day), hematuria, leukocyturia, cylindruria. The listed indicators of
urinary syndrome can be observed with one or another combination
(proteinuria with leukocyturia) or manifested by the prevalence of one or
another indicator (for example, pronounced erythrocyturia with minor
proteinuria and vice versa).

PATHOGENESIS

 The pathogenesis of urinary syndrome is complex: the

occurrence of one or another of its signs is determined by the
nature of morphological and functional disorders in the
kidneys and is to some extent identical for a wide variety of
reasons.

 DISEASES PROCESSING WITH CHANGES IN THE

COMPOSITION OF URINE

1. Diffuse kidney diseases (primary and secondary) - acute and

chronic glomerulonephritis, amyloidosis, pyelonephritis.
 2. Tumors of the kidneys.
3. Urological diseases (urolithiasis, inflammatory and neoplastic
diseases of the urinary tract).
4. Systemic vasculitis (hemorrhagic vasculitis, periarteritis nodosa
and others).
5. Hemoblastosis.
6. Arterial hypertension.
7. Diabetes mellitus.
8. Vascular lesions of the kidneys (veins, arteries), incl.
atherosclerosis of the renal arteries.

 CAUSES OF URINE COLOR CHANGES:-

1. Intake of some pigment impurities

2. Hematuria
o Initial, Terminal, Total
o Persistent, Recurrent
o Painful, Painless
3. Medications
o Hemoglobinuria
o Myoglobinuria
o Uroporphyrinuria
 o Melaninuria.

 CAUSES OF PROTEINURIA

1. False
o Disintegration of cells contained in the urine
2. Pathological
o Glomerular
o Tubular
o Overflows
3. Functional

FUNCTIONAL PROTEINURIA :-

1. Orthostatig
2. Marching
3. Alimentary
4. Feverish.
5. Emotional.
6. Idiopathic.
 Orthostatic (lordotic, postural) proteinuria - the appearance of
protein in the urine only in the standing position and its
disappearance in the supine position. Orthostatic proteinuria
occurs during puberty and usually disappears by 20-22 years of
age, more often in males of an asthenic constitution with dorsal
kyphosis and lumbar lordosis
 Proteinuria of stress (marching, working) occurs after a sharp
physical exertion. Protein is detected in the first collected urine.
Proteinuria is tubular in nature. It is assumed that the mechanism
of proteinuria is associated with redistribution of blood flow and
relative ischemia of the proximal tubules.
 Alimentary proteinuria occurs after eating abundant protein
foods. Emotional proteinuria occurs after stress
 Feverish proteinuria is observed in acute febrile conditions,
especially in children and elderly people. It has a glomerular
character. The mechanisms of this type of proteinuria are poorly
understood, probably, an increase in glomerular filtration, along
with a transient damage to the glomerular filter by immune
complexes, plays a large role. With a decrease in body
temperature, proteinuria also disappears.
 Idiopathic transient proteinuria is observed in adolescence and
is found in healthy individuals during medical examination and its
absence during subsequent urine tests;
Pathological Proteinuria:-

1. Globular Proteinuria
Mechanism: Increased glomerular permeability
o Glomerulonephritis.
o Nephrotic syndrome.
o Diabetic glomerulosclerosis.
o Congestive kidney.
o 5. Atherosclerotic nephrosclerosis.
o 6. Hypertension.

2. Tubular Proteinuria

Mechanism: Reduction of tubular protein reabsorption.

o Pyelonephritis.
o Interstitial nephritis.
o Acute tubular necrosis.
o Congenital and acquired tubulolathies.
 3. Overflow Proteinuria

Mechanism: excessive formation and secretion of protein.

o Multiple Myeloma
o Waldenstrom's disease.
o Other dysproteinemias.

 MAIN URINARY SYNDROMES

1. Nephritic.
2. Nephrotic.
3. Hematuric.
4. Leukocyturic.
5. Non-specific.

Nephrotic syndrome: It can develop with any kidney disease (not an

independent nosological form) Albuminuria more than 3.0 g / day
(selective proteinuria) Hypoalbuminemia Hypercholesterolemia,
hypertriglyceridemia. Lipoiduria (detection of birefringent lipid crystals
by microscopy)
Hematuric and Leukocyturic: In the presence of severe leukocyturia
and especially hematuria, a positive reaction to protein may be a
consequence of the disintegration of blood corpuscles during prolonged
standing of urine; in this situation, proteinuria exceeding 0.3 g / day is
pathological. Sedimentary protein samples can give false positive
results in the presence of iodine contrast agents in the urine, a large
number of analogs of penicillin or cephalosporin, sulfonamide
metabolites.

Syndrome of Non-Specific changes: (minimal proteinuria,

microhematuria) Can be observed with a large number of diseases (as a
manifestation of initial kidney damage), as a reaction of the kidneys to
external influences or a certain state of the body