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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 |
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