Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 99
• Stages ○ Decreased reserve (60% nephron loss): Decreased GFR; no other symptoms/ signs ○ Renal insufficiency (75% nephron loss): Change in blood chemistry ■ GFR to 20% of normal, significant retention of wastes (urea and creatine), erythropoiesis decreased and HTN ○ Uremia: End-stage renal disease; (90% loss) GFR negligible, anuria Renal/Urologic Pain • Renal pain is usually dull and aching in nature—not altered by positional changes • Urologic pain is typically associated with urinary urgency, and dysuria—in groin area • Murphy’s test: Gently tapping the area of the back overlying the kidney produces pain ○ Kidney lies directly below this area, known as the costovertebral angle; tapping disturbs the kidney and produces pain • Pseudo renal pain: Usually acute with some type of trauma to area ○ Aggravated by prolonged sitting and relieved by changing positions Renal Calculi (kidney stones) Solid mineral deposits that accumulate in the urinary tract • According to the National Institutes of Health, 10% of Americans experience kidney stones during their lifetime • Seven to 10 hospital admissions out of every thousand are related to kidney stone symptoms • Signs/symptoms ○ Pain is sudden, severe, and sharp when it begins and later will come and go over time as the stone moves ○ Pain in lower portion of back or in flank on one side; frequently, it will shoot toward groin on the same side ○ N/V ○ Diaphoresis
○ Hematuria ○ Fever • Urine appearance ○ Cloudy—presence of large amounts of protein, blood cells, bacteria, pus ○ Dark—hematuria, increased bilirubin, or highly concentrated urine ○ Unpleasant odor—infection Diuretics/Dialysis • Diuretics—used to remove excess sodium ions and water from body; usually given in am and prescribed for renal disease, HTN, edema, CHF, and pulmonary edema • Dialysis—“artificial kidney” with renal failure ○ Demanding procedure—usually twice a week for three to four hours ○ Modification in diet—restriction in protein, electrolytes, and fluids ○ Two types 1. Hemodialysis: Performed in hospital or outpatient center; heparin usually administered – About 8% to 9% of patients on dialysis receive home dialysis, up from about 5% a decade ago – Three to seven times per weeks – Six to eight hours (nightly) 2. Peritoneal dialysis: At outpatient center or home – Can be done at night or continuously during day – Done through peritoneal membrane/cavity – Requires more time – Antibiotics maybe given prophylactically Indications for Urogenital Screen • History of serious urogenital disease or disorder • Pain ○ Flank: Unilateral thoracolumbar region ○ Costovertebral angle at level of thoracolumbar junction ○ Lumbopelvic area
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