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Endo and Renal
Clinical Signs and Symptoms of Renal and Endocrine Pathology
Sign/Symptom | Pathology |
---|---|
Haematuria, dysuria, fever, suprapubic pain, moderate flank or back pain | Urinary tract infection |
Fever | Prostatitis, pyelonephritis |
Severe loin pain | Renal calculi |
Yellow urine | Tetracycline |
Red urine | Rifampicin, severe muscle breakdown |
Brown urine | Nitrofurantoin |
Orange urine | Danthron laxatives |
Falsely negative urine blood test | Vitamin C intake |
Nitrites in the urine specimen | Gram negative bacterial infection |
Leucocytes in the urine specimen | Urine infection or contamination with vaginal secretion |
Ketones in the urine specimen | DKA, starvation |
Easily palpable bladder with dullness in suprapubic region | Bladder outlet obstruction |
Hesitancy, dribbling, strangury and pis-en-deux | Prostatism |
Leakage of urine during times of exertion | Stress incontinence |
Overactivity of the detrusor muscle resulting in the intense urge to urinate and leakage of urine. | Urge incontinence |
Increased frequency, nocturia and leaking of small amounts of urine | Underactivity of the detrusor muscle |
GFR = 90-120ml/min | Normal GFR |
GFR > 90ml/min | Stage 1 CKD - normal GFR but some kidney damage |
GFR = 60-89ml/min | Stage 2 CKD - mild GFR reduction |
GFR = 30-59ml/min | Stage 3 CKD - moderate GFR reduction |
GFR = 15-29ml/min | Stage 4 CKD - severe GFR reduction |
GFR = <15 ml/min | Stage 5 CKD - End stage renal failure |
Hyperventilation | Metabolic acidosis in late renal failure |
Hiccuping | Uraemia |
Myoclonic jerks and tetany | Hypocalcaemia in late renal failure |
Leuconychia | Hypoalbuminaemia |
Ecchymoses | Nitrogen retention causing impaired prothrombin consumption. |
Scratch marks and pruritis | Uraemia and hyperphosphataemia |
Renal bruit | Renal artery stenosis |
Carotid bruits | Generalised atherosclerotic disease |
Costovertebral angle tenderness | Renal infection (perinephric abscess, pyelonephritis, renal calculi) |
Resonant suprapubic area | Normal |
700-2500mls of urine per day | Normal adult urine output |
Less than 400mls per day | Oliguria |
Increased frequency with normal volume | High fluid intake, glycosuria, diuretics, defects in urinary concentration, renal disease, diabetes insipidus. |
Increased frequency with reduced volume | Bladder outlet obstruction, small bladder, urinary tract infection. |
Perineal pain | Prostatitis, prostadynia, urethral trauma |
Dysuria | UTI or lower urinary tract trauma |
Less than 50mls per day | Anuria |
Abnormal smelling urine | UTI, antibiotics, asparagus |
Urinary infections/enuresis as a child | Vesicoureteric reflux |
Elevated JVP | Right sided heart failure caused by fluid overload from renal failure |
Bilateral pitting oedema | Hypoalbuminaemia or cardiac disease |
Capillary refill of 2-3 seconds in adults | Normal capillary refill |
Capillary refill of 2-4 seconds in the elderly | Normal capillary refill |
Sunken fontanelles | Dehydration |
Increase of 8-12 bpm | Normal postural increase in heart rate |
Increase of more than 30bpm | Hypovolaemia |
A reduction of SBP of at least 20mmHg or diastolic of at least 10mmHg. | Orthostatic hypotension |
A systolic reduction of 3-4mmHg when standing | Normal |
A diastolic increase of 3-7mmHg when standing | Normal |
Waist:hip of 1.0 | Increased risk for men |
Waist:hip of 0.85 | Increased risk for women |
Waist circumference of 94cm | Increased risk for men |
Waist circumference of 80cm | Increased risk for women |
Waist circumference of 102cm | Greatly increased risk for men |
Waist circumference of 88cm | Greatly increased risk for women |
Polyuria, polydipsia, hyperglycaemia, Kussmaul respiration (laboured and deep), abdominal pain, nausea and vomiting. | Diabetic ketoacidosis |
Severe dehydration, decreased mental function, sensory or motor impairments, increased risk of thrombosis, highly elevated BG. | Hyperosmolar, Hypertonic State |
Weakness, lethargy, tremors, morning headaches, irritability, dizziness, hunger, sweating, numbness around the lips and fingers. | Hypoglycaemia |
Bronze diabetes and haemochromatosis | Deposition of iron in the pancreas |
Charcot's joints | Diabetic neuropathic arthropathy |
Symmetrical plaques on the shins with a yellow appearance and waxy feel in diabetic patients | Necrobiosis lipoidica |
Increased appetite with weight loss | Hyperthyroidism or uncontrolled diabetes mellitus |
Increased appetite with weight gain | Cushing's syndrome |
Decreased appetite with weight loss | Adrenal insufficiency or Addison's disease |
Decreased appetite with weight gain | Hypothyroidism |
Constipation | Hypothyroidism, hypercalcaemia |
Diarrhoea | Hyperthyroidism, adrenal insufficiency |
Hirsutism | Excess androgens in females |
Loss of axillary and pubic hair in females and males | Decrease in adrenal androgens caused by hypogonadism, hypopituitism or adrenal insufficiency |
Lethargy | Hypothyroidism, Addison's disease, diabetes mellitus |
Xanthelasma | Hypothyroidism, diabetes mellitus |
Coarse,pale and dry skin | Hypothyroidism |
Spontaneous ecchymoses and purple striae | Cushing's syndrome |
Onycholysis and pretibial myxoedema | Graves' disease |
Dry and scaly skin | Hyperparathyroidism |
Acanthosis nigricans | Insulin resistant states - Cushing's syndrome, diabetes mellitus, acromegaly |
Increased pigmentation | Adrenal insuffiency, acromegaly, cushing's disease (excess ACTH) |
Decreased pigmentation | Hypopituitism |
Vitligo | Autoimmune conditions such as Hashimoto's disease and Addison's disease as well as hypothyroidism |
Impotence | Primary hypogonadism, diabetes mellitus, hyperprolactinaemia, hypopituitism, thiazide diuretics, beta blockers |
Amenorrhoea | Hyperthyroidism, excess androgen production, pituitary dysfunction |
Menorrhagia | Hypothyroidism |
Carpal tunnel syndrome | Acromegaly, hypothyroidism |
Increased sweating | Hyperthyroidism, phaeochromocytoma, hypoglycaemia or acromegaly |
Exophthalmos | >18 mm, specific to Graves' disease |
Proptosis | <18mm, specific to Graves' disease |
Lid lag and lid retraction | Signs of hyperthyroidism not specific to Graves' disease |
Pallor of the palmar creases and peripheral neuropathy | Hypothyroidism - due to vitamin B12 deficiency |
Systolic murmurs | Hyperthyroidism |
Pericardial effusion and pleural effusion | Hypothyroidism |
Dull percussion of upper manubrium | Retrosternal goitre |
Soft thyroid | Normal |
Firm goitre | Simple goitre |
Rubbery hard goitre | Hashimoto's thyroiditis |
Stony hard goitre | Carcinoma, calcification in a cyst, fibrosis or Riedel's thyroiditis |
Neck lump rises during swallowing | Goitre or thyroglossal cyst |
Neck lump moves upwards if the patient pokes their tongue out | Thyroglossal cyst |
Thyroid bruits | Hyperthyroidism |
Hung up ankle reflex | Hypothyroidism |
Non-pitting ankle oedema | Hypothyroidism |
Chvostek's and Trousseau's sign | Hypocalcaemia |
T10-T11 | Renal colic |
T11-L1 | Ureteric pain |
Reduced visual field and headache | Acromegaly |
Hepatomegaly, splenomegaly and renal enlargement | Acromegaly |
Yellow skin | Hypercarotenaemia in hypothyroidism |
Galactorrhoea | Hyperprolactinaemia |
Tapping gently over the 7th cranial nerve results in tetany | Hypocalcaemia |
Virilisation | The appearance of male secondary sexual characteristics due to excessive androgens |