Urinary Syndrome in Adults and Children

At present, one of the most common symptoms of the development of kidney and urinary tract pathology is the urinary syndrome. Under this pathology, it is necessary to mean a violation of the composition, consistency and basic functions of urine. The main way to detect such a pathology is urine analysis. It requires treatment because it is often a sign of a serious illness.

There are a large number of urinary syndromes. The most common form of pathology is the urinary syndrome, which develops against the background of glomerulonephritis, pyelonephritis, nephritis, cystitis, urethritis and other diseases of the kidney and urinary system.

Epidemiology

As the main factors that contribute to the development of the disease, there are age and sex characteristics, lifestyle. So, according to statistics, most often the urinary syndrome occurs in women, since the development of the disease is facilitated by the specific structure of the urogenital system of the woman, which contributes to rapid penetration and spread of the infection through the genitourinary tract. The risk increases in patients aged 17-35 years, since this is a reproductive age that is associated with puberty, sexual intercourse, pregnancy, childbirth. All this creates an increased burden on the kidneys. In addition, a special role is played by the change in the hormonal background that occurs at this age.

[1], [2], [3], [4], [5],

Causes of the urinary syndrome

As the main reasons, consider the inflammatory and infectious process, as well as the development of irreversible damage to the kidneys and urinary tract. As the main etiological factors are supercooling, infection, stones and sand in the kidneys, congenital and acquired pathologies in the organs of the urinary system.

Urinary syndrome with glomerulonephritis

Glomerulonephritis should be understood as an inflammatory kidney disease, which has the character of an immune pathology, and is both acute and chronic. At the same time, a characteristic feature is a violation of filtration and absorption processes in the kidneys at the level of the glomerular apparatus. Renal tubules, interstitial tissue, kidney vessels are involved in the pathological process. The manifestations of this disease can be both of renal origin and extrarenal.

Most often, the cause of glomerulonephritis is a recent streptococcal infection. In most cases, the cause of the pathology is angina. As a rule, glomerulonephritis is considered as a complication of angina and manifests itself 2-3 weeks after the disease.

There are several varieties of glomerulonephritis, depending on the leading symptom. So, if a person is dominated by swelling - this is a nephrotic form of the disease. If the traveling pathology is an increase in blood pressure, it is advisable to talk about the hypertensive form of the disease. The most dangerous are common swelling, which progress from face to other parts of the body, and cover even internal organs.

[6], [7], [8], [9], [10], [11]

Urinary syndrome with pyelonephritis

Pyelonephritis is acute and chronic. It is a disease of an infectious and inflammatory genesis, the essence of which is reduced to the defeat of the cup-and-pelvic system of the kidneys, tubules, interstitial tissue. In the acute course of the disease, the process stops at this, whereas in the chronic course, a nonspecific infectious and inflammatory process develops, in which glomeruli and kidney vessels are also involved.

Risk factors

The risk of kidney disease increases if a person is often sick, especially if he is prone to infectious, chronic diseases of bacterial origin, often has angina, pharyngitis, tonsillitis if the body has untreated foci of infection, for example, caries, sinusitis. Pathology is exacerbated by violations in the immune system, hypothermia. Exacerbate pathology and related factors, such as diabetes mellitus, anemia, the presence of stones, sand in the kidneys, urinary tract diseases. The risk increases with malnutrition, hypothermia, in the presence of concomitant pathologies of the immune and endocrine systems. Of course, the risk is extremely high in the event that a person undergoes an operation on the kidneys, and also if the kidney is partially or completely removed.

The risk also increases if there is a congenital pathology of the kidneys, including its duplication, structural abnormalities, impaired renal function. Also, elderly people fall into the risk group, as they have an outflow of urine, degenerative processes in the kidneys, deposits of stones and sand. An aggravating factor is the development of prostate adenoma in men. Also, in children aged 6-7 years, pathology develops much faster because of anatomical features.

[12], [13]

Pathogenesis

First of all, the infection gets into the urinary tract and kidneys. This contributes to the development of the inflammatory process, the activation of the immune system, the inflow of leukocytes to the site of development of the inflammatory process. There is accumulation of exudate, the formation of the focus of the infection, its progression. As a result, it develops a painful nature, which also spread to other sites, including the waist region. All this is accompanied by the fact that the exudate, together with leucocytes pus, the deposition of salts and stones, the bacterial mass, gets into the urine. Accordingly, urine acquires a murky shade.

As the inflammatory and infectious process progresses, the properties of urine change, it acquires an unpleasant odor and color. The process is accompanied by further progression and spread of the infectious and inflammatory process. Symptoms such as a discharge of urination, pain when urinating, develop edema, the body temperature rises. Often the pain radiates to neighboring sites, so much so that it is almost impossible to determine its source.

Further progression leads to a violation of metabolic processes and the state of the immune system: there is pallor of the skin, swelling of the face and legs, cyanosis of the lips and the area around the eyes. Also characteristic feature is the symptom of Pasternatsky, which boils down to the fact that pain appears in the lower back. The disease occurs with characteristic phases of remission and exacerbation, which can successively replace each other. There is progressive leukocyturia.

[14], [15], [16]

Symptoms of the urinary syndrome

Clinical manifestations of this disease can be very diverse. First of all, for convenience, you can divide all the manifestations of the disease into two groups - manifestations of renal and extrarenal origin.

The color and composition of the urine also changes. A characteristic feature is that urine acquires the color of "meat slops". Concomitant pathologies include tachycardia, increased blood pressure, swelling. First of all, edema appears on the face, in the area around the eyes. Gradually, swelling can spread to other areas, in particular, on the hands, feet. All this is accompanied by a rather severe headache. A person may have a visual impairment, hearing loss. Many have nausea, vomiting, diarrhea, insomnia, fear, increased anxiety, motor hyperactivity and anxiety.

First signs

As early signs, the forerunners of the urinary syndrome, tend to be soreness in the region of the kidneys and lower back, which is especially amplified by tapping, pressing, and also with sudden movements and inclinations. There is a chill, there may be a rise in body temperature, and also develops weakness, increased sweating.

Proteinuria is an increased protein content in the urine, which indicates the development of an inflammatory process in the area of the kidneys, urinary tract. The appearance of the protein is explained by the violation of filtration processes in the kidneys, in particular. So, the primary urine that enters the kidneys is normally absorbed, various useful substances are absorbed from it, which can still be of some value to the human body. Urine is reabsorbed through the mucosa. The kidneys receive secondary urine, already devoid of protein, and other structural components. In it there are only surpluses of inorganic substances. If in the final urine there is a high content of protein (proteins), speech and children about the violation of absorption and filtration. This can mean that the kidneys do not cope with their functions, because they are overloaded. Also, this may indicate an inflammatory or infectious lesion of the glomerular tubules, in which these processes occur. A similar pattern of pathology is most often observed with glomerulonephritis and pyelonephritis.

[17], [18], [19], [20], [21]

Urinary Syndrome in Children

In children, the urinary syndrome develops much faster than in adults, because it is facilitated by the anatomical and physiological features of the structure and functioning of the kidneys and urinary system in children. So, in children, the infection penetrates into the kidneys and spreads through them much faster due to the fact that the genitourinary tract is shortened, the mucous membranes are thinner, and the microflora of the urogenital tract is not yet fully formed. All this contributes to the fact that the inflammatory and infectious process is faster and easier to develop, proceeds much more difficultly, causes more severe complications. Principles of diagnosis and treatment of urinary syndrome are the same as in adults. For children, compulsory hospitalization is required.

Stages

There are four stages of urinary syndrome. At the first stage, there is a development of mild disruption of the composition, amount of urine. Also, significant changes occur in the concentration of substances dissolved in it, the color, transparency, viscosity of urine changes. This indicates functional impairment in the kidneys, increased stress.

In the second stage, the urinary sediment is significantly altered. Often, it shows a high protein content, which indicates the development of the inflammatory process, as well as the presence of infection in the kidneys. At this stage, mandatory hospitalization, comprehensive examination and treatment is required.

At the third stage, pus develops, the source of inflammation and infection progresses, resulting in severe pain, and often foci of tissue necrosis.

The fourth stage is the outcome of the disease. This is either a recovery (comes with timely and proper treatment), or the transition of the disease into a chronic form. It occurs if the treatment is not selected correctly, or if the disease has not been cured completely. There may also be a worsening of the condition, which is accompanied by the progression of the condition, up to the development of severe renal failure, which eventually can end with a fatal outcome, or complete disability and disability.

[22], [23], [24], [25], [26], [27], [28]

Forms

There are many varieties of urinary syndrome, depending on which classification is taken as a basis, and on the basis of which criteria this classification is maintained. So, conditionally it is possible to distinguish nephrotic and nephritic syndrome. At the heart of the nephrotic syndrome is the development of edema, while the nephritic syndrome is accompanied by an intensive increase in blood pressure.

An isolated urinary syndrome can develop which is based only on a disruption in the composition and function of the urine, or a dysuric syndrome that is accompanied by a violation of urine excretion (it may be less or it does not stand out at all). Often painful urination occurs, which can occur with minimal urinary syndrome or with a painful bladder syndrome. Syndrome of a hyperactive bladder can be accompanied by an increase in the amount of urine, or frequent urge to urinate, many of which are false.

Isolated urinary syndrome

A characteristic feature is proteinuria, which develops against the background of leukocytosis and elevated ESR. Also often accompanied by soreness, lethargy and fever. Complex diagnostics is required. The treatment is carried out mainly in a hospital environment, since monitoring of the patient in dynamics is required, which makes it possible to monitor the effectiveness of the treatment process. In severe cases, there is an increase in the number of erythrocytes and the development of anemia, as well as an increased content of bacteria in the urine, and accordingly, an inflammatory-infectious process that tends to constant progression.

For diagnosis it is necessary to pass clinical and biochemical analyzes of blood and urine, which will show the general picture of pathology and allow to predict the further course of the disease, to select the optimal diagnostic scheme, and in the future - and treatment. So, OAM - the general analysis of urine will show a high content of leukocytes, and sometimes red blood cells, as well as the presence of protein and bacteria in the urine. This gives all grounds to assume that the kidneys and urinary tract develop an inflammatory and infectious process.

The severity of the infection process can be judged by the number of bacteria in the urine. Most often, additional tests are prescribed - a bacteriological analysis of urine (conducted by the Gould method). It allows you to accurately identify the microorganisms that caused the development of the inflammatory process, and also provides an opportunity to determine their quantitative indicators.

In addition, an antibiotic susceptibility test can be performed, in which the pathogen is isolated into a clean colony, and then samples are taken with antibiotics and antibacterial drugs, thereby isolating the drug that is most effective. Then determine its optimal dosage, which will kill the pathogen. Based on the results of the analysis, the treatment is prescribed.

[29], [30], [31], [32], [33]

Minimal urinary tract syndrome

The disease is caused by infection, in particular, bacterial, viral and fungal infection. Paths of penetration are predominantly the hematogenous pathway, which implies that the infection enters the kidney through the blood. The second way is ascending (urinogenous), in which the infection penetrates the body through the urinary channels.

Dysuric urinary syndrome

It is a violation of the kidneys and urinary system, which affects the state of urine. First of all, the quantitative and qualitative parameters of urine change, as well as the actual urinary process breakdown occurs. There is a violation of the amount of urine. Often it becomes less, but sometimes there is a complete absence of urine. It is also worth noting that often the process of urination is accompanied by pain.

[34], [35], [36], [37], [38], [39],

Complications and consequences

Often the complication is a progressive inflammatory process, the development of infection, as well as a violation of the kidneys, ureters, bladder. Common complications are such diseases as glomerulonephritis, pyelonephritis, nephritis, cystitis, urolithiasis. The most serious pathology is renal failure, which can result in even a fatal outcome (or there is a need for kidney transplantation).

[40], [41], [42]

Diagnostics of the urinary syndrome

Diagnosis is engaged in a nephrologist (a doctor who deals directly with diagnosis and treatment of kidney diseases), urologist (deals with the diagnosis and treatment of urinary tract diseases, bladder). At occurrence of any pathologies, pains. Delays in urine, or vice versa, frequent urination, you need to immediately go to the therapeutic, nephrologic or urological department.

As a rule, in the presence of primary pathology, diagnosis is carried out within the nephrological department, with secondary, or recurrent morbidity, treatment and diagnosis are assigned to the urological department. It is best to undergo a survey in a hospital or hospital, since the diagnosis of kidney and urinary tract diseases is a very complex phenomenon that requires an integrated approach.

[43], [44], [45], [46]

Analyzes

The main analysis is the analysis of urine. There are its various varieties. It should begin with an analysis of the clinical, with the help of which the main processes that take place in the body are determined. You can identify possible pathologies of the kidneys, bladder, ureter, and pick up methods for further research.

Important information can be given even such indicators, which, at first glance, seem to be completely unimportant and, at times, even irrelevant to medicine. But the amount of urine, for example, can indicate the speed with which the kidneys work and how they manage their work. In normal kidney activity, at least 100 ml of urine is usually taken for analysis. But it happens that the urine stands out much less. There are even cases in which urine is not released at all. This can be many reasons: urine may for some reason not stand out from the bladder, and may not enter the bladder at all. This can also be many reasons: both the defeat of the kidney itself, and the violation of regulatory processes, violation of absorption.

As for color - this is also an important feature. For example, if urine of light yellow color is cause for concern, it is obvious. No (but you need to look at the complex with other indicators). If the urine acquires a different shade - this may indicate the development of any reaction to the body, and a competent diagnostician or biochemist, a shade of urine can tell us a lot of secrets that occur in the human body. In particular, in its excretory system.

For example, a brown or red tint should alert - this may indicate that there are various impurities in the urine, or a large amount of by-products of metabolism, metabolites of incompletely withdrawn, not fully cleaved or processed substances. For example, this shade can give a high content of bilirubin.

Green is a warning sign. This is often a sign of a progressive severe infection, which is close to bacteremia and sepsis in its level, requires immediate treatment. The appearance of red color, impurities of blood - the most alarming sign. Can indicate that there is bleeding, tissue decay, necrosis, or even the development of polyps, malignant and benign tumors, erosion.

Transparency is also an important diagnostic feature. First of all, it is important to remember that urine should be transparent. But if it becomes cloudy, then there are various impurities, including sediment. For further manifestation of the pattern of pathology, it is important to determine the content of this sediment, the composition of impurities. Further microscopic examination of urine and urinary sediment is carried out.

If there is a suspicion that a bacterial infection develops in the urine, further bacteriological examination of urine and urinary sediment is carried out. For this purpose, bacteriological culture is carried out, with further identification of the grown culture, determination of its systematic position, basic biochemical and immunological characteristics. Various methods of research are used for this, but Gould's method of planting has proved to be the best. This method allows you to accurately identify individual single cultures and conduct further research.

It is also important to determine such an indicator as the relative and absolute density of urine, which indicates the amount of substances dissolved in the urine. The higher the density, the more substances are dissolved in the urine, and this is not always good.

Also, different chemical reactions, biochemical composition are investigated separately. It is also important to determine the acidity / alkalinity of the medium, which is easy to do with litmus paper, this feature can be very informative. It is worth paying attention to the amount of protein, bilirubin, glucose, bile acids, ketone bodies, urobilinoids, indica in the urine. These are all biochemical markers of the intensity of the processes occurring in the kidneys.

When microscopy of urinary sediment, the important indicators are the amount of epithelium, leukocytes, mucus, bacterial cells, cylinders. For example, a large amount of epithelium may indicate that dying of the mucous membrane of the urinary tract, kidneys, or other areas occurs. This may be a sign of degenerative processes, destruction, as well as the disintegration of individual structures, including tumors, neoplasms. On the epithelium it is also possible to determine in which particular area the development of the inflammatory process takes place. If a large number of renal epithelium is found. This may indicate the localization of the inflammatory process directly in the kidneys. While the presence of an inflammatory process in the ureters and bladder is manifested in the analysis by impurities of a transitional or flat epithelium.

For example, the presence of a large number of red blood cells indicates that there is bleeding, or the destruction of individual structures, the development of erosion, damage to cell walls, vessels. The presence of leukocytes indicates the development of the inflammatory process. Cylinders are also signs of inflammation and kidney damage.

In addition, many more methods of urine testing are used: this is the sample of three glasses, and the analysis according to Zimnitskiy, according to Nechiporenko. In parallel, a clinical and biochemical blood test, and even stool analysis, can be prescribed.

[47], [48], [49], [50], [51], [52], [53], [54], [55], [56]

Instrumental diagnostics

The main research method is renal ultrasound. This is one of the most convenient and often used methods, but not the only one. Under various circumstances, the method of X-ray examination, urography, uroscopy, and even kidney biopsy can be applied. To study the functional state of the kidneys, radioisotope renography is used.

Differential diagnosis

Differential diagnosis is based on the differentiation of various diseases that can be manifested in the same way and accompanied by a urinary syndrome. So, it is necessary first of all to differentiate among themselves signs of such similar diseases as glomerulonephritis, pyelonephritis, nephritis, as well as diseases of the ureter, bladder, urinary tract.

• Painful bladder syndrome

As a rule, the disease begins with a violent course, after which a triad of symptoms appears, characteristic of this disease. So, there is development of arterial hypertension, edema and urinary syndrome. Pain quite easily irradiates to different parts of the body, in particular, you can find pain in the lumbar region, which is often taken for lumbulgia, neuralgia, sciatica. Also, the body temperature rises substantially, and oliguria or anuria appears. Pain, as a rule, is localized on both sides of the waist.

• Irritable Bladder Syndrome

A characteristic feature is a feeling of discomfort, burning with urination, frequent urge to urinate. Diagnosis includes urine and blood tests, microscopic examination of urinary sediment, bacteriological and microbiological urinalysis, antibiotic sensitivity analysis, biochemical studies, in particular, aimed at determining the level of protein, creatinine and urea in the urine.

If the information is insufficient to diagnose, ultrasound or radiological examination of the kidneys may be required to detect deformations in the structure of the kidneys, changes in the tone of the muscles of the urinary organs.

• Syndrome of a hyperactive bladder

To remove the syndrome, it is recommended to massage the lumbar region, or take a bath with the addition of a bath gel. The duration of the treatment bath is 15-20 minutes. The water temperature should be about 50 degrees. After the bath it is recommended to wrap yourself in a warm blanket, drink a glass of warm tea or milk with cognac.

• Syndrome of a full bladder

The disease is accompanied by frequent urge to urinate, which can be either real or false. Often the cause is a violation of the tone of the urinary organs, which are overly tense (they are in hypertonia), and therefore the receptors react too strongly to the irritation.

• Nephrotic syndrome

It is a form of kidney disorders, in which edema is the leading symptom. They appear mainly in the morning. The main place of localization is directly the face, the zone around the eyes. Gradually, the swelling begins to progress and spread to the area of the clavicles, the thorax, cover the internal organs, and at the last stage appear on the limbs. Such swelling was called "renal edema." A distinctive feature is that even after a night's sleep, edema does not go away. Can spread to the foot. After the edema, there are other symptoms of kidney pathology: protein in the urine, inflammation, violation of urination.

• Nephritic syndrome

A characteristic feature of this form of renal pathology is an increase in blood pressure. This is because the kidneys are part of the sympathoadrenal system and produce renin, which acts as a regulator of blood pressure. If the renal function is impaired, the normal functioning of this system is also disturbed, in particular, the synthesis of renin is reduced. The consequence is an increase in blood pressure.

• Syndrome of the lower urinary tract

Quite well eliminated by massage and lubrication of the mucous membranes. You can also use a variety of medications and balms for oral administration, aimed at removing the inflammatory process.

• Dysuric syndrome

Implied is one of the symptoms of kidney pathology, which is accompanied by a violation of urination. Urine is either excreted in smaller amounts, or not excreted at all. In this case, urine either does not enter the ureter from the kidneys, or is not removed from the bladder. Requires urgent treatment, mainly in a hospital.

• Glomerulonephritis

It is a pathology in which absorption or filtration of the kidneys is impaired. An important condition is drug treatment, and strict adherence to the diet. It is important to comply with bed rest. Treatment is carried out in a hospital, because at home, treatment is ineffective.

• Pyelonephritis

It is a lesion of the kidney tissue, which is accompanied by inflammation and the development of infection. The therapy is based on the use of antibiotic therapy. Well-proven drugs such as amoxiclav, ciprofloxacin. Apply uroseptics, fluoroquinolones. Treatment is mostly complex. Physiotherapeutic procedures, phytotherapy, homeopathy, alternative recipes are used. But all treatment must be under the strict supervision of a doctor.

• Chronic Renal Failure

It is a pathological process in which the normal functioning of the kidney tissue is disrupted. The function of maintaining homeostasis of the internal environment is disrupted. It is a consequence of various diseases, including diseases of the heart, lungs. The disease is accompanied by the death of nephrons and renal stroma, which inevitably leads to a violation of the functional activity of the kidneys. This is the final stage, which ends any kidney disease, if not treated. Today, science knows more than 90 diseases, the final stage of which is CRF. The duration of this stage can be different, and depends on what disease it was provoked. Often ends with a fatal outcome.

• Acute kidney failure

It is an acute necrotic process, which is accompanied by the death of nephrons. The cause can be any kidney disease that progresses or is not treated. It is an irreversible process in the kidneys, after which regeneration is no longer possible. In the morphological study, there is a proliferation of connective tissue, which subsequently replaces the kidney tissue. Accordingly, the kidneys cease to perform their functions.

The clinical picture is very heavy. The disease is accompanied by severe swelling of the limbs, face. Progression of muscle weakness, demineralization of bones occurs, which leads to the development of osteoporosis. Quite quickly develops pleurisy, which is accompanied by pulmonary edema, chest pain. One of the hardest stages is the appearance of wet wheezing in the lungs, noises in the heart, which ends with pericarditis.

Then thirst develops. Violated acid-base balance, dehydration occurs. In the blood and urine there is a high content of creatinine, the level of the residual content of nitrogen, urea is increased. All this causes severe intoxication, hyperkalemia. At the last stage of the defeat is already polyorganism, all organs are rejected, Kussmaul breathes, bleeding in the stomach, intestines develops, then cardiovascular insufficiency develops, and ends with all death.

• Edema Syndrome

It is one of the forms of kidney damage, in which the kidneys can not cope with the load. A characteristic feature is the development of edema, which begin with the face, then spread throughout the body. The final stage is edema of the feet.

[57], [58], [59], [60], [61], [62],

Prevention

The essence of prevention is reduced to eliminating the causes that can lead to the development of diseases of the kidneys, urinary tract. For this, it is always necessary to fully cure acute kidney diseases, sanitize foci of infection, eliminate urinary tract infections, prevent dysbiosis. Also it is necessary to eliminate bends, damages and excesses of the ureter, to control urodynamics, to normalize the state of the immune system.

Timely diagnosis is also important. To do this, it is necessary to take as a rule not to delay the visit to the doctor, but to seek help promptly when the first signs of the disease occur. Important and medical examination. You can not overcool. It is necessary to avoid infectious diseases, reduce immunity, poisoning. It is also important to eat properly, drink enough.

[63], [64], [65], [66], [67], [68]

Forecast

If you take the necessary measures in time to undergo a full course of treatment, then adhere to all the recommendations, the urinary syndrome may disappear. After the hospital treatment, the patient is transferred to a dispensary account. It is important to undergo preventive examinations, to be treated in a timely manner, to observe the diet. Then in about 2 years they can transfer to a group of healthy people. Without treatment and adherence to doctor's recommendations, the condition usually worsens. The disease can progress up to the development of renal failure, and even death.

[69], [70], [71], [72], [73], [74],

Army

The decision is made by the commission. Everything depends on the severity of the pathological process, the stage of the disease, on how long the urinary syndrome has appeared. If there is no violation of ability to work, there are no structural disorders of the kidneys, the young man can be admitted to the army. With an average and a difficult stage, as a rule, they do not take part in the army.

[75], [76], [77]