Internal Medicine (Practical) · MU Sofia

16. Clinical symptoms and syndromes of renal diseases. Physical methods of examination of the kidney

Covers the general, urinary and systemic symptoms of kidney disease, then the main renal syndromes: nephritic, nephrotic, acute kidney injury, chronic kidney disease, urinary tract infection and tubular syndromes. Ends with physical examination of the kidney by inspection, palpation, percussion and auscultation, including what each finding may suggest such as palpable kidney, costovertebral angle tenderness and renal artery bruits.

Inside: 4 sections · 6 labelled pictures · 15 flashcards · 3 min

Topic 15 of 30 in the MU Sofia syllabus for Internal Medicine (Practical) (Medicine, Year 3). The free AceMed note covers it in 4 sections, about 412 words (3 min of reading), with 15 flashcards.

In this note

  1. 16 – Clinical Symptoms and Syndromes of Renal Diseases & Physical Methods of Kidney Examination
  2. I. Clinical Symptoms of Renal Diseases
  3. II. Clinical Renal Syndromes
  4. III. Physical Methods of Examination of the Kidney

I. Clinical Symptoms of Renal Diseases

Renal (kidney) diseases manifest through a combination of general, urinary, and systemic symptoms. These symptoms vary depending on whether the pathology is acute, chronic, glomerular, or tubular in nature.

1. General Symptoms

  • Fatigue, malaise: Due to anemia (↓ erythropoietin).
  • Loss of appetite, nausea, vomiting: Uremic toxins irritate the GI tract.
  • Weight loss: Chronic catabolism in chronic kidney disease (CKD).
  • Pallor: Normochromic normocytic anemia.
  • Pruritus: Due to high urea or phosphate.
  • Edema: Especially periorbital (around eyes), legs; from salt/water retention or proteinuria.

2. Urinary Symptoms

  • Oliguria (<400 mL/day): Seen in acute kidney injury (AKI).
  • Anuria (<100 mL/day): Late-stage obstruction or cortical necrosis.
  • Polyuria: Often in early CKD or in tubulointerstitial nephritis.
  • Nocturia: Impaired urine concentrating ability.
  • Dysuria, frequency: Suggests infection.
  • Hematuria (blood in urine): Seen in glomerulonephritis, stones, or tumors.
  • Foamy urine: Proteinuria.
  • Dark urine: Hemoglobinuria or myoglobinuria.

3. Systemic Signs

  • Hypertension: Due to fluid overload or RAAS activation.
  • Uremic signs: Pericarditis, encephalopathy, asterixis (flapping tremor).
  • Bone pain or fractures: Renal osteodystrophy.
  • Gout or arthropathy: Due to impaired uric acid excretion.
  • Electrolyte imbalance: Hyperkalemia, hypocalcemia, metabolic acidosis.

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