History taking tactics and general symptoms
In renal diseases, a physician must apply the tactic of active questioning. The specific feature of this patient cohort is that their well-being remains satisfactory for a long time. Patients may completely fail to associate their emerging symptoms with impaired renal function, which is why the specialist's task is to proactively identify concealed signs.
One of the most frequent manifestations is asthenic syndrome. It includes general weakness, rapid fatigue, and a marked decrease in working capacity. This syndrome occurs in patients of absolutely any age. Furthermore, the severity of asthenia directly correlates with the acuity of the pathological process: the most prominent symptoms of weakness are observed in acute kidney injury.
One must always remember the association with comorbid conditions. Kidney damage is very frequently secondary in nature. The physician is obligated to look in the medical history for signs of systemic diseases, such as diabetes mellitus, gout, or systemic lupus erythematosus (SLE).
Homeostasis disorders and systemic manifestations
The kidneys perform the critical function of a homeostasis organ. In their pathology, symptoms are frequently determined by the loss of critically important substances in the urine:
- Albumin loss: leads to the development of pronounced edema.
- Trace element and enzyme loss: in particular, iron loss causes the development of anemia and all associated complaints.
Special attention is warranted for the signs of the terminal stage of damage — uremia. It can manifest with extremely nonspecific symptoms: nausea, vomiting, diarrhea, and persistent skin pruritus. The presence of such complaints often points to a long-standing, latent disease whose existence the patient was unaware of until the development of pronounced renal failure.
The evaluation of fever, which is divided into two types according to its origin, is also important:
- Infectious genesis: in urinary tract infections (e.g., pyelonephritis), fever accompanied by severe chills and profuse sweating is characteristic. The kidneys may also be secondarily involved in a generalized infection (sepsis, infective endocarditis).
- Non-infectious (immune) genesis: fever is observed in systemic autoimmune diseases, such as rheumatoid arthritis or SLE. For differential diagnosis here, the presence of extrarenal syndromes (articular, cutaneous, muscular) is critically important. For example, a specific articular syndrome clearly points to urate (gouty) nephropathy.
Differential diagnosis of renoparenchymal arterial hypertension
Clear criteria help distinguish hypertension caused by renal parenchyma damage from other types of blood pressure (BP) elevation:
- Anamnesis: the patient reveals indications of past renal diseases.
- Chronology of the process: this is a crucial marker. Changes in urinalysis typically precede a persistent rise in BP.
- Laboratory data: proteinuria exceeding 2 g/day, as well as cylindruria, hematuria, and leukocyturia, are detected in the urine. An elevated creatinine level is recorded in the blood test.
- Instrumental data: ultrasound examination (ultrasound) reveals characteristic signs of renal pathology.
Atypical clinical "masks"
Symptoms of renal diseases can reliably mimic the pathology of entirely different organ systems. Because of this, patients often initially seek help from non-specialist physicians. Several main masks are distinguished:
- Ophthalmological mask: may manifest as sudden blindness. This formidable complication arises secondary to severe nephrogenic arterial hypertension characteristic of malignant nephritis.
- Traumatological or surgical mask: patients encounter pathological bone fractures. The cause is nephrogenic osteopathy developing due to severe disorders of phosphorus-calcium metabolism.
- Cardiological and neurological mask: manifests as headaches, dizziness, palpitations, and dyspnea. These symptoms, caused by nephrogenic hypertension, are often mistakenly interpreted by physicians as conventional hypertension, overlooking the primary kidney damage.
Briefly: answers to topical questions
Which patient complaints indicate diuresis disorders and urination disturbances?
Complaints of altered diuresis volume and urination disturbances indicate diuresis disorders and urination disturbances.
The main complaints include:
- polyuria;
- oliguria;
- oliguria/anuria as a decrease in the volume of excreted urine;
- nicturia/nocturia, including nighttime urges;
- pollakiuria, i.e., frequent urination or frequent urges;
- cystalgia;
- imperative urges.
Pain upon urination, urinary incontinence, or decreased urination frequency down to acute urinary retention may also be noted.
What is the technique for performing bimanual kidney palpation?
Kidney palpation is performed exclusively by the bimanual (two-handed) method using respiratory excursion.
The examination is performed with the patient lying supine (most commonly) or standing. The technique requires good relaxation of the patient's abdominal wall muscles. The character of palpation should be deep, gliding, and strictly synchronized with respiration. On inhalation, the palpating hand sinks deeper into the abdominal cavity, striving to meet the fixing hand located on the lumbar side.
How is the percussion symptom (Pasternatsky sign) checked, and what does its positive result indicate?
The techniques for checking the percussion sign and the Pasternatsky sign differ.
- Percussion symptom: the physician places the palm of the left hand on the lumbar region and strikes moderate blows with the ulnar edge or fist of the right hand against the back of the left hand. The positivity criterion is the appearance of pain in the corresponding half of the lower back.
- Pasternatsky sign: sharp displacement of the patient's body from the "standing on tiptoes" position to the "standing on heels" position. The positivity criterion is the onset of pain in the lumbar region upon impact of the heels against the floor.
The appearance of pain upon percussion of the lumbar region indicates a pathological process. The main causes of a positive percussion symptom: inflammation or distension of the renal pelvis in pyelonephritis or hydronephrosis, inflammation of the perirenal adipose tissue in purulent perinephritis, and distension of the renal capsule during significant organ swelling.
Class and exam questions
Why is active questioning specifically required in kidney diseases?
Patients often feel quite satisfactory and do not associate nonspecific symptoms, such as general weakness and rapid fatigue, with urinary system pathology.
What do nausea and skin pruritus indicate in a nephrology patient?
These are nonspecific signs of uremia development — the terminal stage. They often indicate that the disease has been proceeding for a long time and latently, while the patient was unaware of it.
How to distinguish nephrogenic arterial hypertension based on the anamnesis?
The main chronological sign is that pathological changes in urinalysis (e.g., proteinuria or hematuria) appear before blood pressure begins to rise.
How to differentiate immune fever from infectious fever in renal diseases?
Immune fever is accompanied by extrarenal syndromes (articular, cutaneous, muscular), whereas chills and profuse sweating are more characteristic of infection (pyelonephritis).
What else to study on this topic
- Mechanisms of drug pharmacokinetics alteration in hypoalbuminemia
- Criteria and prognosis of the complete recovery stage
- Pathogenesis of nephrogenic osteopathy and fractures
- Association of enzyme loss with the development of nephrogenic anemia
- Diagnostics of secondary renal involvement in gout and SLE
Master the entire topic in the "Propaedeutics" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "History Taking and Physical Examination in Renal Diseases" and 3,152 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 113 video lessons on the subject
Other topics in the "Urinary System" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.