Renal diseases Clinical manifestations Renal disease can be manifested in many ways The clinical manifestation divided in two steps 1.symptoms : defined as the complaints that patient mention to his doctor like ,pain ,nausea, fever ,etc. These symptoms may be :
A.subjective mean that things which patient feels B. objective mean things that the patient feels and the doctor sea them Examples of subjective symptoms as headache, nausea,anorexia Examples of objective symptoms ,fever here the patient complain of fever and you can test that by thermometer
The subjective symptoms can be not true and can not be discovered while objective complaint could be true and discovered through examination and could be not true. 2. signs: those are the features that canbe seen and discovered through the clinical examination like edema, jaundice,obesity etc. Here the signs discovered by examionation can not make the patient mislead the doctor
What are the clinical features (symptoms and signs) that make the dentist suspect that his patient who is treating him has renal problem
In the face :1.earthy colour : here the colour of the skin in the face looks pale and dark and hyper-pigmented and called sallow –face mostly seen in chronic renal failure
2. puffiness of the face : here there is edema mainly in skin around the eyes called peri orbital edema seen mostly in nephrotic syndrome and in acute renal failure
3.uremic frost : here there is whitish sposts like snow on the face due deposition of materials as urea, uric acids, seen mostly in late stage of chronic renal failure
4. pallor: pallor is due to anemia which is a common feature of uremia . pallor seen in face in in the conjuctavia and tongue and gums Anemia in renal failure may be due to iron deficiency or B12 defficiency or folic acid deficiency or may be due to hemolytic causes.
5.tounge : here the tongue may show a.glossitis here indicate inflammation of the tongue ,here the patient complain of pain in the togue b.pallor as we said due to anemia and we may see pale and smooth seen in iron deficiency ,or we may see red and smooth tongue d seen in B12 and folic acid deficiency
6. gums : here we see the gums pale due to anemia .some times we see hypertrophy of the gums seen as complication of therapy in patient with kidney transplantation due cyclosporine therapy
7. mouth odor: in patient with renal failure here we smell the odor of ammonia ammonicial odor or fishy odor
8. the nose: here we may notice. a.boils in the nose due to infection due to impaired immunity b. repeated epistaxis due to uremic toxin and due to impaired platelets function
7.subcutenous bleeding in the hands and arms : here we see spots of subcutenous bleeding in the forms a. petechial hemorahge b.purpura c.brueises d.Ecchymoses all due to bleeding tendency
8.iching : here we scrath marking mainly seen in the hands and can be seen at any site in the body .The cause of iching is multi-factorial may be due uric acid deposition or urea or due phosphate and mostly troublesome and resistant to treatment
9. dyspnea : means shortness of breath and defined as awareness of breath action here seen in renal failure and may be multifactorial due to heart failure ,anemia ,fluid overload ,and due to acidosis and here called air – hunger or kausmaul breathing
10. palpitation : means awareness of heart beats here due to anemia , heart failure, and hypertention or hypotention
4-Urinary truct infection : here there is fever which is some times associated with rigor , also there is dysuria (burning micturition) and loin pain and suprapubic pain.
5-Renal failure: which may be a-Acute renal failure ,manifested as acute onset of deterioration of renal functions with fluid over load , hypertention ,oliguria b-Chronic renal failure, manifested as gradual deterioration of renal function with feature of uremic gastropathy , bone pain , myopathy ,neuropathy and cardiac and c.n.s affection