2.  pain in kidney area: blunt, uni- or bilateral (at acute kidney inflammation)  acute extreme pain, unilateral in kidney area with duration of several hours (at kidney ischemia)  kidney colic - intensive pain with irradiation to abdomen, from ureter to the bladder, amplify after physical loadings (run, walk), after drinking, at jolting (at obstruction of urinary tract by stone or tumor). Pain has increasing character, decrease after injection of atropin or after hot bath.  pain on area of ureter, on area of bladder (at damage of ureter, bladder)

3.  transferred urinary tract infection  trauma of flank area  damage of kidney vessels  tumor of kidneys  vaccination  insolation  radiation

4.  Kidney pain can be defined at palpation of abdomen and area of costovertebral corner. Sometimes there is enough pressing by fingers for revealing pain in this area.  Pain at palpation on a course of ureter.  Pain at palpation of area of bladder (lower abdomen)

5. Symptom of Pasternatsky - doctor puts the left hand on area of costovertebral corner and percuss by edge of palm (right hand). In positive symptom the patient feels pain.  Positive symptom of Rofilo: at situaton on a back the patient bends a leg in iliofemoral joint and presses thigh to a stomach. At presence of inflammation of kidney pelvis the pain amplifies in lumbar area, especially in deep sigh.

7.  Difficulties of urination: ishuria - delay of urine in the bladder  Pollakiuria - frequent urination, more than 6 times per day in variouse quantities  Nocturia - prevalence of night diuresis above day time (usually day time diuresis in3-4 times exeeds night)

8.  Stranguria - urination by small portions of urine (drops) accompanied by feeling incomplete urine output, false desires on urination, painful and frequent urination  Main complaints: often imperative desires, pain at urination, itch in urinary tract

9.  Earlier transferred infection of urinary system  radiation  endoscopic manipulation in urinary tract

10.  The painful points are defined at pressing on lumbar area in the field of kidneys, bladder, in projection of ureter  Percussion  Positive symptom of Pasternatsky on the side of injury or on both sides.  Positive symptom of Rofilo.

11.  Common blood analysis - increase of WBCs, increase of ESR  urinalysis - presence of WBCs (leucocyteuria) and bacteria in urine, it is possible RBCs (hematuria), proteinuria, increase of number of epithelial cells

12.  Test of Nechiporenko - WBCs more than 4000 and bacterial counts - 100 000 organisms or higher per 1 milliliter of urine, presence of RBCs  culturing bacteria in the urine specimen to determine which bacteria are present and sensitivity test to antibiotics

13.  Ultrasound imaging of bladder - a thickening of bladder’s walls, heterogenity of contents  Ultrasound imaging of prostate - increase of size, heterogenity of structure, stones and sites of fibrosis  Cystoscopy - hyperemia and edema of mucouse layer of bladder

14.  Urethroscopy - reveals infiltration of urethra’ s walls  Urethrography - spend at scarring strictures  X- rays - demonstrate scarring of the kidneys and ureters resulting from long- standing infection

15. Syndrome of urinary tract infection

16.  A urinary tract infection (UTI) is an infection that can happen anywhere along the urinary tract - the kidneys, the ureters, the bladder, or the urethra

17.  General: weakness, loss of appetite, headache  Specific: pain in lumbar area, often unilateral, blunt character, with irradiation in the lower abdomen, fever, difficulties of urination, output of cloudy urine sometimes with unpleasant smell.

18.  Information about early transferred acute urinary tract infection  Women tend to get UTIs more often because their urethra is shorter and closer to the anus.  Elderly people and people with diabetes also get more UTIs  Pregnancy and menopause  Kidney stones  Sexual intercource

19.  Prostate inflammation or enlargement  Narrowed urethra  Immobility  Catheterization  Inspection  Pallor of the skin and mucouse layers, lost of weight, swelling of the face

20.  pain at palpation of lumbar area or at palpation on a course of ureter  Percussion  Positive symptom of Pasternatsky on the side of injury. Expansion of the heart border to the left (at presence of arterial hypertesion).  Auscultation  Deafness of heart tones, accent of 2-nd tone above aorta, arterial hypertension

21.  Common blood - anaemia, leucocytosis, shift of WBSs formula to the left, increase of ESR  Urinalysis- urine cloudy, alcaline reaction of urine, low density, moderate proteinuria, microscopic hematuria, expressed leucocyteuria, presence of bacteria in urine

22.  Bacterial counts in urine - 100 000 organisms or higher per 1 milliliter of urine  Prevalence of WBCs above RBCs - WBCs more than 4000 in 1 milliliter of urine (test of Nechiporenko)  Test of Zimnitsky - decrease of urine density within day  3-glass test

23.  Damage of urethra – pathological urine sediment (leucocytes, erythrocytes) revealed in first portion of urine.  Damage of kidneys, calices and pelvis or ureter – pathological urine sediment in all (3) portions of urine or in second and third portions.  Damage of the bladder – hematuria or leucocyturia revealed in 3-rd portion of urine

25.  Reberg-Tareev`s test - estimation of glomerular filtration rate (GFR)  GFR = (CrU/CrP)VxS. (N = 90-120ml/min)  Test with prednisolon for detecting of latent inflammation  Intravenouse urography, pyelography - reveal reduction of upper urinary tract tone`s, narrowing and deformation of calices, pyeloectasiaes, presence of pyelorenalis refluxes

26.  Ultrasound imaging of the kidneys - asymmetry of the kidney sizes, expansion and deformation of calyces and pelvis, diffuse acustic heterogenity of renal parenchyma, sometimes reduction of thickness of renal parenchyma, kidney stones, cysts.

28.  Syndrome of arterial hypertension – is a complex of clinical signs and symptoms connected with high blood pressure (systolic b p - more than 140 mmHg, diastolic b p – more than 90 mm Hg

29.  The basic reason of arterial hypertension in kidney disease – acute and chronic glomerular inflammation.

30.  Headache, heaviness, noise in ears,  later- difficulties of breath, deterioration of vision, weakness, fog before eyes, pain in the field of heart  Anamnesis: presence of accompanying kidney damage. Transferred inflammation of urinary tract, anomaly of kidney development

31. Edema on the face and around eyes Palpation Apical beat is amplified and displaced to the left, the pulse firm, intense and complete Percussion Displacement of heart borders to the left

32. Deafness of I tone on the apex, accent of II tone above aorta, systolic murmur in projection of renal arteries (at stenosis), increase of the level of blood pressure

33.  In blood: increase of ESR, leucocytosis, anemia, hypoproteinemia, hypoalbuminemia  In urine: change characteristic for the basic disease (glomerulonephritis, pyelonephritis)  X-ray methods: renal angiography (stenosis and atherosclerosis of renal arteries, anomaly of development of renal vessels).  Chest radiography: increase of heart sizes due to left ventricular hypertrophy. Aorta is extended.

34. ECG: Left ventricular hypertrophy (LVH) There are many different criteria for LVH. Sokolow + Lyon (Am Heart J, 1949;37:161) S V1+ R V5 or V6 > 35 mm Cornell criteria (Circulation, 1987;3: 565- 72) SV3 + R avl > 28 mm in men SV3 + R avl > 20 mm in women Framingham criteria (Circulation,1990; 81:815-820) R avl > 11mm, R V4-6 > 25mm S V1-3 > 25 mm, S V1 or V2 + R V5 or V6 > 35 mm, R I + S III > 25 mm

35. Left atrial abnormality (dilatation or hypertrophy) - M shaped P wave in lead II - prominent terminal negative component to P wave in lead V1

36. .

37.  Ultrasound research of kidneys: changes of calices and pelvis, revealing of tumours, stones, increase of kidney sizes, anomalies of kidney development, kidney cysts  EchoCG – signs of LVH, cardiac doppler allows the assessment of diastolic filling and can suggest the presence of diastolic disfunction, which may be associated with signs and symptoms of heart failure.