Urinary syndrome in adults and children

Currently, one of the most common symptoms of kidney and urinary tract pathology is urinary syndrome. This pathology should be understood as a violation of the composition, consistency and basic functions of urine. The main way to detect such pathology is urine analysis. It requires treatment, since it is often a sign of a serious disease.

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

Epidemiology

The main factors that contribute to the development of the disease are age and gender characteristics, lifestyle. Thus, according to statistics, urinary syndrome most often occurs in women, since the development of the disease is facilitated by the specific structure of the female genitourinary system, which facilitates the rapid penetration and spread of infection along the genitourinary tract. The risk increases in patients aged 17-35 years, since this is the reproductive age, which is associated with puberty, the onset of sexual activity, pregnancy, childbirth. All this creates an increased load on the kidneys. In addition, a special role is played by the change in hormonal levels, which is observed at this age.

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Causes urinary syndrome

The main causes are considered to be inflammatory and infectious processes, as well as the development of irreversible damage to the kidneys and urinary tract. The main etiological factors are hypothermia, infection, kidney stones and sand, congenital and acquired pathologies in the organs of the urinary system.

Urinary syndrome in glomerulonephritis

Glomerulonephritis is an inflammatory kidney disease that is characterized by immune pathology and can be either acute or chronic. A characteristic feature is the disruption of filtration and absorption processes in the kidneys at the level of the glomerular apparatus. The pathological process involves the renal tubules, interstitial tissue, and renal vessels. The manifestations of this disease can be of both renal and extrarenal origin.

Most often, the cause of glomerulonephritis is a recently suffered streptococcal infection. In the vast majority of cases, the cause of the pathology is tonsillitis. As a rule, glomerulonephritis is considered a complication of tonsillitis and appears 2-3 weeks after the disease.

There are several types of glomerulonephritis, depending on the leading symptom. So, if a person has predominantly edemas, we are talking about the nephrotic form of this disease. If the leading pathology is increased blood pressure, it is appropriate to talk about the hypertensive form of the disease. The most dangerous are widespread edemas that progress from the face to other parts of the body, and even affect internal organs.

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Urinary syndrome in pyelonephritis

Pyelonephritis can be acute or chronic. It is a disease of infectious and inflammatory genesis, the essence of which is reduced to the defeat of the renal pelvis, tubules, and interstitial tissue. In the acute course of the disease, the process stops there, while in the chronic course, a non-specific infectious and inflammatory process develops, which also involves the glomeruli and vessels of the kidneys.

Risk factors

The risk of kidney disease increases if a person is often ill, especially if he is susceptible to infectious, chronic diseases of bacterial origin, often suffers from sore throats, pharyngitis, tonsillitis, if there are untreated foci of infection in the body, for example, caries, sinusitis. The pathology is aggravated by disorders in the immune system, hypothermia. Associated factors such as diabetes, anemia, the presence of stones, sand in the kidneys, and diseases of the urinary tract also aggravate the pathology. The risk also increases with improper nutrition, hypothermia, and the presence of concomitant pathologies of the immune and endocrine systems. Of course, the risk is extremely high if a person has undergone kidney surgery, as well as if his kidney has been partially or completely removed.

The risk also increases if there is a congenital kidney pathology, including its duplication, structural anomalies, and impaired renal function. Elderly people are also at risk, since they have impaired urine flow, degenerative processes in the kidneys develop, and stones and sand are deposited. An aggravating factor is the development of prostate adenoma in men. Also, in children aged 6-7 years, the pathology develops much faster due to anatomical features.

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Pathogenesis

First of all, the infection gets into the urinary tract and kidneys. This contributes to the development of the inflammatory process, activation of the immune system, and the influx of leukocytes to the site of the inflammatory process. There is an accumulation of exudate, the formation of a focus of infection, and its progression. As a result, aching pain develops, which spreads to other areas, including the lumbar region. All this is accompanied by the fact that the exudate, together with leukocytes, pus, salt and stone deposits, and bacterial mass, gets into the urine. Accordingly, the urine acquires a cloudy 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 urinary disorder, pain during urination appear, edema develops, and body temperature rises. Often the pain radiates to neighboring areas, so much so that it is almost impossible to determine its source.

Further progression entails disruption of metabolic processes and the state of the immune system: paleness of the skin, swelling of the face and legs, cyanosis of the lips and the area around the eyes appear. Another characteristic feature is Pasternatsky's symptom, which boils down to the fact that pain appears in the lumbar region. The disease proceeds with characteristic phases of remission and exacerbation, which can successively replace each other. Progressive leukocyturia is noted.

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Symptoms urinary syndrome

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

The color and composition of urine also changes. A characteristic feature is that urine takes on the color of "meat slops." Associated pathologies include tachycardia, increased blood pressure, and swelling. Swelling primarily appears on the face and around the eyes. Swelling can gradually spread to other areas, in particular, to the arms and legs. All this is accompanied by a fairly severe headache. A person's vision may be impaired, and hearing may be reduced. Many experience nausea, vomiting, diarrhea, insomnia, fear, increased anxiety, motor hyperactivity, and restlessness.

First signs

Early signs that act as harbingers of urinary syndrome include pain in the kidneys and lower back, which is especially aggravated by tapping, pressing, and also by sudden movements and bends. Chills appear, body temperature may rise, and weakness and increased sweating develop.

Proteinuria is an increased protein content in the urine, which indicates the development of an inflammatory process in the kidneys and urinary tract. The appearance of protein is explained by a violation of filtration processes in the kidneys, in particular. Thus, primary urine, which 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 mucous membrane. Secondary urine, already devoid of protein and other structural components, enters the kidneys. Only excess inorganic substances remain in it. If the final urine contains a high content of protein (proteins), we are talking about a violation of the absorption and filtration processes. This may indicate that the kidneys are not coping with their functions, since they are subject to excessive stress. It may also indicate an inflammatory or infectious lesion of the glomerular tubules, in which these processes occur. A similar picture of pathology is most often observed in glomerulonephritis and pyelonephritis.

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Urinary syndrome in children

In children, urinary syndrome develops much faster than in adults, since this is facilitated by the anatomical and physiological features of the structure and functioning of the kidneys and urinary system in children. Thus, in children, the infection penetrates the kidneys and spreads through them much faster due to the fact that their 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 develops faster and easier, is much more difficult, and causes more severe complications. The principles of diagnosis and treatment of urinary syndrome are the same as in adults. Children require mandatory hospitalization.

Stages

There are four stages of the urinary syndrome. At the first stage, a slight disturbance in the composition and quantity of urine develops. Also, significant changes occur in the concentration of substances dissolved in it, the color, transparency, and viscosity of urine change. This indicates functional disturbances in the kidneys, increased load.

At the second stage, the urinary sediment undergoes significant changes. Often, it contains a high protein content, which indicates the development of an inflammatory process, as well as the presence of an infection in the kidneys. At this stage, mandatory hospitalization, comprehensive examination and treatment are 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 recovery (occurs with timely and correct treatment), or the transition of the disease into a chronic form. It occurs if the treatment is not chosen quite correctly, or if the disease was not completely cured. There may also be a deterioration in the condition, which is accompanied by progression of the condition, up to the development of severe renal failure, which ultimately can end in death, or complete disability and incapacity for work.

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Forms

There are many types of urinary syndrome, depending on which classification is taken as a basis and on what criteria this classification is based. Thus, it is possible to conditionally distinguish nephrotic and nephritic syndrome. Nephrotic syndrome is based on the development of edema, while nephritic syndrome is accompanied by an intense increase in arterial pressure.

An isolated urinary syndrome may develop, which is based only on a violation of the composition and function of urine, or a dysuric syndrome, which is accompanied by a violation of urine excretion (there may be less urine, or it is not excreted at all). Painful urination often occurs, which can occur with minimal urinary syndrome or with painful bladder syndrome. Overactive bladder syndrome may be accompanied by an increase in the amount of urine, or frequent urges to urinate, many of which are false.

Isolated urinary syndrome

A characteristic feature is proteinuria, which develops against the background of leukocytosis and increased ESR. It is also often accompanied by pain, lethargy and fever. Comprehensive diagnostics are required. Treatment is carried out mainly in a hospital setting, since dynamic observation of the patient is required, which allows monitoring the effectiveness of the treatment process. In severe cases, it is accompanied by an increase in the number of red blood cells 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 constantly progress.

For diagnostics, it is necessary to pass clinical and biochemical blood and urine tests, which will show the general picture of the pathology and allow to predict the further course of the disease, select the optimal diagnostic scheme, and later - treatment. Thus, OAM - general urine analysis will show a high content of leukocytes, and sometimes erythrocytes, as well as the presence of protein and bacteria in the urine. This gives every reason to assume that an inflammatory and infectious process is developing in the kidneys and urinary tract.

The severity of the infectious process can be judged by the number of bacteria in the urine. Most often, additional tests are prescribed - bacteriological analysis of urine (conducted using the Gould method). It allows for the precise identification of microorganisms that caused the development of the inflammatory process, and also makes it possible to determine their quantitative indicators.

Additionally, an antibiotic sensitivity test can be performed, in which the pathogen is isolated in a clean colony, and then tests are carried out with antibiotics and antibacterial drugs, thus isolating the drug that will be most effective. Then its optimal dosage is determined, which will allow killing the pathogen. Based on the results of the analysis, treatment is prescribed.

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Minimal urinary syndrome

The disease is caused by an infection, in particular, bacterial, viral and fungal infection. The routes of penetration are mainly the hematogenous route, which means that the infection enters the kidney through the blood. The second route is ascending (urinogenous), in which the infection enters the body through the urinary tract.

Dysuric urinary syndrome

It is a disorder of the kidneys and urinary system, which affects the state of urine. First of all, the quantitative and qualitative indicators of urine change, and the process of urination itself is also disrupted. A violation of the amount of urine is noted. Often it becomes less, but sometimes a complete absence of urine is noted. It is also worth noting that the process of urination itself is often accompanied by pain.

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Complications and consequences

Often complications include progressive inflammation, infection, and dysfunction of the kidneys, ureters, and bladder. Frequent complications include diseases such as glomerulonephritis, pyelonephritis, nephritis, cystitis, and urolithiasis. The most severe pathology is renal failure, which can even result in death (or require a kidney transplant).

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Diagnostics urinary syndrome

Diagnosis is carried out by a nephrologist (a doctor who directly deals with the diagnosis and treatment of kidney diseases), a urologist (who deals with the diagnosis and treatment of diseases of the urinary tract, bladder). If any pathologies, pains, urinary retention, or, conversely, frequent urination occur, you should immediately contact the therapeutic, nephrological or urological department.

As a rule, in the presence of primary pathology, diagnostics are carried out within the nephrology department, in case of secondary or repeated morbidity, treatment and diagnostics are assigned to the urology department. It is best to undergo examination in a hospital or hospital setting, since diagnostics of kidney and urinary tract diseases is a very complex phenomenon that requires a comprehensive approach.

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Tests

The main analysis is urine analysis. There are different types of it. You should start with clinical analysis, which determines the main processes occurring in the body. It is possible to identify possible pathologies of the kidneys, bladder, ureters, and select methods for further research.

Important information can be provided even by such indicators that, at first glance, seem completely unimportant and sometimes even have no relation to medicine. But the amount of urine, for example, can indicate the speed and intensity with which the kidneys work, how well they cope with their work. With normal kidney function, at least 100 ml of urine is usually taken for analysis. But it happens that much less urine is excreted. There are even cases in which urine is not excreted at all. There can be many reasons for this: urine may not be excreted from the bladder for some reason, or may not enter the bladder at all. There can also be many reasons for this: both damage to the kidneys themselves, and a violation of regulatory processes, a violation of absorption.

As for the color, this is also an important sign. For example, if the urine is light yellow, there is obviously no reason to worry. No (but you need to look at it in combination with other indicators). If the urine takes on a different shade, this may indicate the development of some reaction in the body, and to a competent diagnostician or biochemist, the shade of urine can tell many secrets that occur in the human body, in particular, in its excretory system.

For example, a brown or reddish tint should be a warning sign - this may indicate that the urine contains various impurities, or contains a large number of by-products of metabolism, metabolites that are not completely excreted, not completely broken down or processed substances. For example, such a tint may indicate a high bilirubin content.

Green color is an alarming sign. It is often a sign of a progressive severe infection, which is close to bacteremia and sepsis in its level, and requires immediate treatment. The appearance of red color, blood impurities is the most alarming sign. It may indicate that bleeding, tissue decay, necrosis, or even the development of polyps, malignant and benign tumors, erosions are occurring.

Transparency is also an important diagnostic sign. First of all, it is important to remember that urine should be transparent. But if it becomes cloudy, it means that there are various impurities, including sediment. For further manifestation of the pathology picture, 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 is developing in the urine, further bacteriological examination of the urine and urinary sediment is carried out. For this, bacteriological seeding is carried out, with subsequent identification of the grown culture, determination of its systematic position, basic biochemical and immunological characteristics. Various research methods are used for this, but the best proven method is the Gould seeding method. This method allows for the most accurate isolation of individual cultures and 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 urine. The higher the density, the more substances are dissolved in urine, and this is not always good.

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

When examining urine sediment microscopy, important indicators are the amount of epithelium, leukocytes, mucus, bacterial cells, and cylinders. For example, a large amount of epithelium may indicate that the mucous membrane of the urinary tract, kidneys, or other areas is dying off. This may be a sign of degenerative processes, destruction, and disintegration of individual structures, including tumors and neoplasms. The epithelium can also be used to determine in which area the inflammatory process is developing. If a large amount of renal epithelium is detected, this may indicate the localization of the inflammatory process directly in the kidneys. Whereas the presence of an inflammatory process in the ureters and bladder is manifested in the analysis by admixtures of transitional or squamous epithelium.

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

Additionally, many different methods of urine testing are used: this includes the three-glass test, and the Zimnitsky and Nechiporenko tests. In parallel, a clinical and biochemical blood test, and even a stool test, can be prescribed.

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Instrumental diagnostics

The main method of examination is ultrasound of the kidneys. This is one of the most convenient and frequently used methods, but far from the only one. Under various circumstances, the method of X-ray examination, urography, uroscopy, and even renal biopsy can be used. Radioisotope renography is used to study the functional state of the kidneys.

Differential diagnosis

Differential diagnostics is based on differentiating various diseases that can manifest themselves in the same way and be accompanied by urinary syndrome. Thus, it is necessary to differentiate, first of all, the signs of such similar diseases as glomerulonephritis, pyelonephritis, nephritis, as well as diseases of the ureter, bladder, and urinary tract.

• Painful Bladder Syndrome

As a rule, the disease begins with a rapid course, after which a triad of symptoms characteristic of this disease appears. Thus, arterial hypertension, edema and urinary syndrome develop. The pain quite easily irradiates to various parts of the body, in particular, pain in the lumbar region can be detected, which is often mistaken for lumbago, neuralgia, radiculitis. The body temperature also increases significantly, and oliguria or anuria appears. The pain is usually localized on both sides of the lumbar region.

• Irritable bladder syndrome

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

If there is insufficient information to make a diagnosis, an ultrasound or X-ray examination of the kidneys may be required to detect deformations of the kidney structure and changes in the tone of the muscles of the urinary organs.

• Overactive bladder syndrome

To relieve the syndrome, it is recommended to massage the lumbar region or take baths with the addition of bath gel. The duration of a therapeutic bath is 15-20 minutes. The water temperature should be approximately 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.

• Full bladder syndrome

The disease is accompanied by frequent urges to urinate, which can be both real and false. Often the cause is a violation of the tone of the urinary organs, which are overly tense (are in hypertonicity), and therefore the receptors react too intensely to the irritation that has arisen.

• Nephrotic syndrome

It is a form of kidney disorders, in which the leading symptom is edema. They appear mainly in the morning. The main place of localization is the face itself, the area around the eyes. Gradually, the edema begins to progress and spread to the collarbone area, chest, covers the internal organs, and at the last stage appears on the limbs. Such edema is called "renal edema". A distinctive feature is that even after a night's sleep, the edema does not go away. It can spread to the foot. Following the edema, other symptoms of kidney pathology appear: protein in the urine, inflammation, urination disorders.

• Nephritic syndrome

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

• Lower urinary tract syndrome

It is eliminated quite well by massage and lubrication of the mucous membranes. You can also use various medications and balms for internal use, aimed at relieving the inflammatory process.

• Dysuric syndrome

This refers to one of the symptoms of kidney pathology development, which is accompanied by urination disorders. Urine is either excreted in smaller quantities or is not excreted at all. In this case, urine either does not enter the ureter from the kidneys or is not excreted from the bladder. It requires urgent treatment, mainly in a hospital setting.

• Glomerulonephritis

It is a pathology in which the absorption or filtration of the kidneys is impaired. An important condition is drug treatment and strict adherence to a diet. It is important to stay in bed. Treatment is carried out in a hospital setting, since treatment at home 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. Such drugs as amoxiclav and ciprofloxacin have proven themselves well. Uroseptics and fluoroquinolones are used. The treatment is mainly complex. Physiotherapy procedures, herbal medicine, homeopathy, and folk recipes are used. But all treatment should be carried out under strict medical supervision.

• Chronic renal failure

It is a pathological process in which the normal functioning of the renal tissue is disrupted. The function of maintaining homeostasis of the internal environment is disrupted. It is a consequence of various diseases, including heart and lung diseases. The disease is accompanied by the death of nephrons and renal stroma, which inevitably entails a violation of the functional activity of the kidneys. This is the final stage, which any kidney disease ends with if left untreated. Today, science knows over 90 diseases, the final stage of which is CRF. The duration of this stage may vary, and depends on what disease provoked it. Often ends in death.

• Acute renal 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. Morphological examination reveals the growth of connective tissue, which subsequently replaces the renal tissue. Accordingly, the kidneys cease to perform their functions.

The clinical picture is characterized by an extremely severe course. The disease is accompanied by severe swelling of the extremities and face. Muscle weakness progresses, demineralization of bones occurs, which leads to the development of osteoporosis. Pleurisy develops quite quickly, which is accompanied by pulmonary edema and chest pain. One of the most severe stages is the appearance of moist rales in the lungs, heart murmurs, which ends in pericarditis.

Then severe thirst develops. The acid-base balance is disturbed, dehydration occurs. High creatinine content is observed in the blood and urine, the level of residual nitrogen and urea increases. All this causes severe intoxication, hyperkalemia. At the last stage, the damage is already multi-organ, all organs fail, Kussmaul breathing appears, bleeding in the stomach and intestines develops, then cardiovascular failure appears, and everything ends in death.

• Edema syndrome

It is one of the forms of kidney damage, in which the kidneys cannot cope with the load. A characteristic feature is the development of edema, which begins with the face, then spreads throughout the body. The final stage is swelling of the feet.

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Prevention

The essence of prevention comes down to eliminating the causes that can lead to the development of kidney and urinary tract diseases. To do this, it is always necessary to fully treat acute kidney diseases, sanitize infection foci, eliminate urinary tract infections, and prevent dysbacteriosis. It is also necessary to eliminate bends, damage, and kinks in the ureter, control urodynamics, and normalize the state of the immune system.

Timely diagnostics are also important. To do this, you need to make it a rule not to delay a visit to the doctor, but to seek help promptly when the first signs of the disease appear. Medical examination is also important. You cannot overcool. You should avoid infectious diseases, decreased immunity, poisoning. Proper nutrition and sufficient drinking regime are also important.

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Forecast

If you take the necessary measures in a timely manner, undergo a full course of treatment, and then follow all the recommendations, the urinary syndrome may disappear completely. After hospital therapy, the patient is transferred to a dispensary register. It is important to undergo preventive examinations, undergo treatment in a timely manner, and follow a diet. Then, after about 2 years, they can be transferred to the group of healthy people. Without treatment and following the doctor's recommendations, the condition usually worsens. The disease can progress to the point of developing renal failure, and even death.

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Army

The decision is made by the commission. Everything depends on the severity of the pathological process, the stage of the disease, how long ago the urinary syndrome appeared. If there are no impairments in working capacity, no structural disorders of the kidneys, the young man can be admitted to military service. At a moderate and severe stage, as a rule, they are not taken into the army.

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