Patients' Complaints and Methods of physical exam of Kidney

The test of kidneys is impossible without laboratory Urine tests. So in this article, the data of physical test and interpretation of Urine tests will be located together for favorable use. All symptoms in case of Kidney disorders are divided into renal and extra-renal.

Renal symptoms are such clinical signs that directly show on the disorders of Kidneys and any part of the collecting system. They are lumbar region pains (costovertebral angle tenderness, flank pain), dysuria and syndrome of Urine changes. Only children after 2 years can complain on Lumbar region pains because in this age, cortex tissue and renal capsule reach their mature form. The "Kidney" pain is caused by expanded capsule. This pain can be found by palpation of Kidneys and by pasternasky's sign. Very often, children at 2 till 5 years of age complain on abdominal pain in case of renal problems, In infants, "Kidney" pain can be clear as constant squirming, irritability. Dysuria means problems with urination. This term is most often used like a synonym to painful urination, but it also included such changes as:
• Frequent or infrequent voiding
• urination urgency
• Incomplete voiding
• Enuresis

Frequency of urination is age- dependent and closely related with fluid intake and surrounding climate (hot or cold). Voiding of the bladder is more frequent in infancy, when it equals almost the amount of feeding x 3. For example, a 6 months baby almost empties the bladder 5x3=15 times a day. At the age of 1, urination frequency ranges from 9 to 12 times a day, later it decreases to 6-8 times at 3 years, 5-6 times at 10 and 3-4 in adolescence. Normal limits range within 1 to 3 times more or less.

Enuresis (urination incontinence) is physiological in children up to 1.5-2 years. Enuresis can be anytime and night time. Toilet trained child can accomplish incontinence in case of Urinary tract infection or Cns disorders.

Syndrome of Urine changes includes the interpretation of qualitative and quantitative laboratory data of Urine tests. Urine is "a mirros" of renal system. If reflects the changes in functional processes of kidneys and collecting structures as well as some other systems.

Extra-renal symptoms
These are the signs, the cause of which is kidneys disorders, but the developing pathological changes concern other Organs and systems. These are:
• Edema develops as a consequent of fluid keeping and disbalance of intracapillary and tissue hydrostatic pressure. Visual evidence of fluid accumulations appears when the volume of interstitial fluids strengthen more than on 15%. The peculiarities of renal edema are:
1. Localization (puffiness of face, especially nearby the eyes);
2. Time of manifestation (they are more apparent in the morning and subsides while the day).
3. Spreading (as the patient's condition is getting worse edema spreads to involve extremities and genital organs (labial or scrotal swelling), abdomen (ascites), thoracic cavity (hydrothorax). Edema of intestinal mucosa causes diarrhea, anopexia, poor intestinal absorption. The total edema is called anasarka.
4. Face and consistency (skin above swelling is pale, warm and soft by touch).

• Hypertension
• Cardiac pain
• Skin pallor is often in case of nephritic syndrome and acute poststrptococcal glomerulonephritis. When the continuing kidney disorder develops paleness is related with decreased output of erythropoietin and developing of anemia
• Intoxication syndrome includes fever, chills, anorexia, fatigue, irritability, lethargy, headaches and vomiting, In infants, kidney disorders can manifest with feeding problems and failure to thrive.

Taking patient's condition history is very foremost and must be done carefully. Pay attentiveness to new weight gain, renal dysfunction, facts relative to evidence of new streptococcal infection, exposure to or ingestion of toxic chemicals (including heavy metals, carbon tetrachloride, or other organic solvents; nephrotoxic drugs). Take literal, information about fluid intake and output, feeling of thirst, appearance of Urine, quantity of voiding, child's behaviour while urination or hesitancy, urgency, urine incontinence in toilet-trained children. Unpleasant odor of Urine, direction and force of stream, change in size of scrotum, For teenage it is foremost to find out evidence of sexually transmitted disease, type of treatment. Ask teenage male about testicular self-examination. Narrative in case history the date of last Urinalysis.

Physical estimate includes Visual inspection, palpation and percussion. while Visual inspection, detect evidence for:
• Fluid retention: nearnessy of edema, puffiness of face, enlargement of abdominal girth at umbilicus. test of swelling is made by pressing with fingertip; on the limbs, face, sacral region, lower abdomen. peruse for prominence, redness, Light swelling in lumbar region.
• Pain syndrome: constant squirming, irritability, characterized position (child lies on the sick side with legs bent in hip and knee joints and hold near the body), behavior while voiding.
• Pallor
• Signs of intoxication
• Extrusion of Urinary bladder upon the symphysis in case of bladder neck obstruction.
• Noisy breathing hemorrhages on the skin, nasal bleeding, smell of Urine and ammonium from the mouth, muscle tremor in case of continuing renal failure.

Kidneys must be palpated in vertical and horizontal positions. Ordinarily they are palpable in older in infants and young children. Usually, kidneys are not palpable in infants and young children. Usually, kidneys are not palpable in older children except in cases of their enlargement more than in 1.5-2 times and nephroptosis. Correlate shape, size, consistency, mobility, level of ptosis (palpable kidney, movable kidney,:migrating" Kidney) and painfulness while palpation.

Percussion of renal region helps to Correlate Pasternasky symptom by Light beating in costovertebral angle. Narrative the results as obvious in the right, obvious in the left or on both sides, negative. Percuss for the upper border of the bladder starting from umbilicus and going down. Ordinarily the dull sound is not found when the bladder is voided. The opposite seeing is evidence of bladder neck obstruction.

---