Hx of GenitoUrinary System Urinary Symptoms Hematuria at beginning or end of micturition urethral inflam. trauma prostatic dis. on standing porphyria other causes drugs (rifampicin) severe muscle trauma change in urine volume or stream polyuria, nocturia, anuria hisetancy size of stream dribbling urine retention strangury (recurrent slow, painful urination) pis-en-doux: desire to urinate after having done double voiding (incomplete bladder emptying) Urinary incontinence Causes UTI delerium diuretics immobility atrophic urethritis or vaginitis types stress incontinence after sudden in intra-abdominal pressure overactivity of detruser urge to urinate then leakage underactivity of detruser frequency, nocturia urethral obstruction dribbling after incomplete urination urinary obstruction common in elderly men (prostatism) micturition hesitancy (difficult starting) size of stream terminal dribbling strangury, pis-en-doux Causes calculus blood clot prostatic mass retroperitoneal fibrosis uterine prolapse dysuria renal colic fever, loin pain urethral discharge Genital Symptoms Menses impotence loss of libido infertility pregnancy urethral or vaginal discharge genital rash Chronic Renal Failure (CRF) symptoms are due to uremia Causes Glomerulonephritis DM systemic vascular dis. analgesic nephropathy reflux nephropathy hypertensive nephrosclerosis polycystic kidneys obstruction amyloid Pathophysiology dehydration >>nocturia fail excrete Na>>hypertension renal tubule damage >>Na loss >>hypotension oliguria >>hyperkalemia (K excretion depend on urine volume) fail acid excretion >>metabolic acidosis fail hydroxylate vit. D3 >>vit. D deficiency >>2ry hyperparathyroidism >> Ca & P >>bone dis. fail excrete erythropoietin >>normochromic normocytic anemia Renal function normal GFR 90-120 mL/min. (estimated by creatinine clearance) serum creatinine serum urea Symptoms anuria (<50 mL/d), oliguria (<400 mL/d) nocturia, or polyuria anorexia vomiting fatigue, hiccup, insomnia pruritus, itching, edema complications bone pain fractures hypercalcemia pericarditis hypertension cardiac failure, ischemic heart dis. neuropathy peptic ulcer ask about dialysis ask about renal transplantation features suggesting chronic rather than acute small kidney size renal bond dis. anemia peripheral neuropathy Menstrual & Sexual Hx menarche regularity of periods dysmenorrhea, menorrhagia vaginal discharge gravidity, parity contraception Past Hx recurrent UTI renal calculi pelvic surgery Family Hx polycystic kidney dis. (autosomal dominant) Alport's syndrome (deafness with renal impairment) Done by: Mohammad Al-Marhoon [email protected] Reference: Clinical Examination (Talley) WWW.SMSO.NET