positive symptom Pasternatsky
1. Urinalysis:
A) Leukocyturia;
B) Bacteriuria.
2. Bacteriological examination of urine:
Urine culture for culture media, determination of the sensitivity of the isolated microflora to antibiotics.
3. Proteinuria does not exceed 2 g/day.
1. Ultrasound, intravenous urography - diagnosing the expansion of the pelvis, the outlines of which become uneven.
2. Plain radiography of the genitourinary system - (there may be the presence of stones).
3. One-sidedness (damage to one kidney) or asymmetry (damage to both kidneys) is confirmed by ultrasound, renography, scanning.
7. Syndrome of renal colic.
A syndrome observed in a number of kidney diseases, the main manifestation of which is acute pain in the lumbar region.
Etiology and pathogenesis.
The causes of colic are nephrolithiasis, hydronephrosis, nephroptosis, obstruction of the ureter by a blood clot, caseous masses in kidney tuberculosis, a tumor, and polycystic kidney disease. Spasm plays a leading role in the development of pain. urinary tract with their ischemia, stretching of the fibrous capsule of the kidney and pelvic-renal reflux.
Pain most often occurs suddenly after intense physical activity (running, walking);
After taking a large amount of liquid (beer);
Driving on bumpy road.
Most often, pain is localized in the lumbar region. Along with this localization, pain can also be in the abdomen (sometimes resembling acute appendicitis) or in the region of the right or left hypochondrium. Localization of pain depends on the level of damage to the ureter. The pains are cutting, sharp. Accompanied by increased urge to urinate.
There are periods of calm and exacerbation.
Complaints:
Pain radiates along the ureter to the side Bladder and genital organs, in the abdomen and in the hypochondrium;
Change in the color of urine-red ("meat slop") due to the passage of the stone through the ureteral mucosa;
Rarely, reflex anuria can be observed.
History of present illness:
Establish a connection with gout, kidney injuries, etc .;
Clarify possible presence past kidney disease and urinary tract– pyelonephritis, cystitis, as well as symptoms suspicious of such – bloody urine, dysuric phenomena.
Clinical Study
General inspection.
The position of the patient in bed.
Forced - patients rush about in bed, changing position all the time.
The skin is normal.
Edema, language changes, convulsions are absent.
local inspection
Inspection of the abdominal wall.
When a stone passes through the ureter, reflex bloating, stool retention (defecation) can be observed.
Percussion.
Lumbar region.
Pasternatsky's symptom is positive.
Analysis of urine:
Red blood cells and protein are found. Often the stone is excreted in the urine.
Instrumental research.
1. Plain radiograph of the abdominal organs (stones - phosphates, oxalates, carbonates) - with a stone diameter of more than 5 mm.
Ultrasound - expansion of the cups, pelvis and ureters.
intravenous excretory urography(urate or X-ray negative stones).
CT is necessary for differential diagnosis between stones.
Test tasks.
Test number 1.
What symptom is not typical for CRF?
A. Pericardial rub
B. Scratching, skin itching.
C. Visual impairment
D. Nasal, gastrointestinal bleeding
Test #2
Which symptom is not characteristic of kidney and urinary tract disease?
A. Increased blood pressure
B. Pain in the lumbar region
C. Visual impairment
D. Puffiness of the face
E. Cyanosis of visible mucous membranes and skin
Test #3
1. What sign is not typical for ureteral colic?
A. Positive Pasternatsky's sign
B. Irradiation of pain down the abdomen
C. Dysuria
D. Pain in the lumbar region
E. Stopping pain after vomiting
Test #4
Pain syndrome in nephritic syndrome is caused by: A. violation of urine outflow B. inflammatory edema of the ureter C. distension of the renal pelvis D. spastic contraction of the ureter E. distension of the renal capsule
Test #5
All of the following are characteristic of nephrotic syndrome, except for one: A. Massive edema B. Oliguria C. Hyperlipidemia D. Hypoproteinemia E. Increased albumin-globulin ratio
Test number 6.
Nephrotic syndrome is characterized by all of the following with the only exception: A. Facial edema in the morning B. Increased blood pressure C. Polyuria D. Nocturia E. Increased relative density of urine
Test #7 An attack of very severe pain in the lumbar region, usually unilateral, with irradiation along the ureter, in the groin, weakening after the appointment of antispasmodics, is characteristic of one of the following diseases: A. Nephritic syndrome B. Renal pelvis syndrome C. Arterial renal hypertension D. Renal colic E. Nephrotic syndrome
Test #8 The predominance of nocturnal diuresis over daytime is called: A. Oliguria B. Anuria C. Nocturia
D. Pollakiuria E. Stranguria
Test #9 Daily proteinuria over 3.5 g is characteristic of one of the following diseases: A. Acute pyelonephritis B. Nephrotic syndrome C. Uremia D. Acute renal failure E. Fever
Test #10 Bacteriuria, leukocyturia, fever, chills, dysuric disorders are characteristic of: A. Nephritic syndrome B. Renal colic syndrome C. Renal pelvis syndrome D. Kidney tumors E. Nephrotic syndrome
Situational tasks
Task #1
A 53-year-old patient complains of pain in the lumbar region on the left, subfebrile condition for two weeks. The examination revealed blood pressure of 120/80 mm Hg. Art., pulse 76 in 1 min. Pasternatsky's symptom is positive, the kidneys are not palpable. In urine - relative density 1.019, leukocytes - 50-60 in the field of view. With ultrasound abdominal cavity- expansion of the pelvis and deformation of the cups in the left kidney.
What syndrome are we talking about?
What is an increase in the number of white blood cells in the urine called?
Which additional method should the patient be examined to clarify the quantitative content of leukocytes, erythrocytes and cylinders in the urine?
Task #2
The patient is 63 years old. He complained about the appearance of swelling of the face, lower extremities.
On examination: pale skin, no cyanosis, swelling of the face, lower extremities, torso. They are soft and move easily. BP - 120/70 mm Hg, pulse - 78 beats in 1 minute. The liver is not enlarged, Pleshe's symptom (-). Urinalysis: relative density - 1.035, protein - 4.3 g/l, crystals of cholesterol esters.
2. Loss, most often of which proteins in the urine is observed in this syndrome?
3. What changes in lipid metabolism are observed in the biochemical analysis of blood?
Task #3
A 17-year-old patient, 2 weeks after suffering a sore throat, developed aching pains in the lower back, headaches, urine of the color of "meat slops".
On examination: pale skin, eyelid pastosity, no cyanosis. Blood pressure 160/100 mm Hg. Art., pulse -60 beats per minute. Urine: reddish in color, relative density - 1.020, protein - 2.0 g / l, leukocytes 1-2 in the field of view, erythrocytes - up to 50 in the field of view.
What syndrome are we talking about?
What functional units of the kidneys are affected in this disease?
How much blood is needed for the appearance of a symptom - gross hematuria.
Task #4
Patient 56 years old long time suffering from chronic glomerulonephritis. I felt well and continued to work. Deterioration over the last 3 months, when edema on the face began to appear, weakness, headaches, nausea, sometimes vomiting, diarrhea, skin itching appeared.
On examination: pale skin, swelling of the face, lower extremities, no cyanosis. BP -150/110 mm Hg. Art., pulse 66 beats per minute. In the field of hair follicles - "white dust". The smell of ammonia from the mouth. The liver is not enlarged. In urine: relative density -1.011, protein -0.2 g/l, leukocytes -2-4 in the field of view, erythrocytes -2-4 in the field of view. Blood test: hemoglobin - 90 g / l, creatinine - 560 μmol / l.
What syndrome are we talking about?
The nature of dysproteinemia?
How to explain the presence of nausea, sometimes vomiting, diarrhea in a patient?
Task number 5
The patient is 38 years old. 4 years suffering from gouty arthritis ( thumb left foot). The last time he was examined was 2 years ago - no pathology was found in the internal organs. Suddenly, in public transport there were intense sharp pains in the lower back on the right, radiating to the inguinal region. Hospitalized.
On examination: excited, tossing about in bed, unable to find a place for himself, frequent urge to urinate. Sharply positive symptom of Pasternatsky on the right, blood in the urine, soreness of the ureteral points on the right.
What syndrome should be considered?
What factors are provoking?
Specify the cause of gross hematuria in the patient?
Task number 6
The patient has a sharp weakness, headache, increased blood pressure, blurred vision, swelling of the face, decreased urine output and a change in its color. I fell seriously ill. It is possible to suspect: A. Renal pelvis syndrome B. Renal colic C. Nephritic syndrome D. Nephrotic syndrome E. Uremia
Task number 7
Patient V., 55 years old, has an acute sharp pain in the lumbar region on the right, the pain radiates to the lower abdomen.
Repeated vomiting is noted, which does not lead to relief general condition. The pains then weaken, then sharply increase. The patient's body temperature is 36.7. The patient complains of frequent urge to urinate. Urine of the "meat slop" type. Pasternatsky's symptom is sharply positive on the right.
A. Syndrome of the renal pelvis.
B. Nephritic syndrome.
C. Nephrotic syndrome.
D. Renal colic.
Task number 8
The patient is a driver by profession, after cooling he began to notice dull, aching pain in the lower back, decreased urine output, headaches, nausea.
On examination: lethargy, lethargy. Puffy face. The skin is pale.
Urine "the color of meat slops." Pulse 62 beats per minute. Blood pressure 170/100 mm. rt. pillar. Pasternatsky's symptom is positive on both sides.
Which of the following syndromes is characterized by this clinical picture?
A. Syndrome of the renal pelvis.
B. Nephritic syndrome.
C. Nephrotic syndrome.
D. Renal colic.
E. Syndrome of renal hypertension.
Task number 9.
Patient S., aged 58, complains of headaches, drowsiness, dizziness, severe weakness, dull aching pain in the lumbar region. He considers himself ill for the last 10 years, worsening for the last 2 months.
About - but: The smell of ammonia from the mouth is determined. The skin is pale. High levels of creatinine in the blood. Blood pressure 210/110 mm Hg. pillar. On auscultation, the accent of the 2nd tone on the aorta is heard.
Which of the following syndromes is characterized by this clinical picture?
A. Syndrome of the renal pelvis.
B. Nephritic syndrome
D. Renal colic.
E. Syndrome of renal hypertension.
Task number 10.
A 35-year-old patient fell ill with follicular tonsillitis and started taking ampicillin. At the end of the 2nd week, she began to notice a change in the color of urine in the form of "meat slops", headaches, a sharp decline vision, decreased urine output. Arterial pressure increased to 240/115 mm Hg. There were massive swelling of the face, sacrum, lower extremities.
At the end of the month, the edema gradually disappeared, and blood pressure returned to normal.
Which of the following syndromes is characterized by this clinical picture?
A. Syndrome of the renal pelvis.
B. Nephritic syndrome
C. Nephrotic syndrome with chronic renal failure.
D. Renal colic.
E. Syndrome of renal hypertension.
Answers to tests:
Test No. 1-E
Test No. 2-E
Test No. 3 - E
Test No. 4 - E
Test No. 5 - E
Test No. 6 - E
Test #7 - D
Test #8 - C
Test #9 - B
Test #10-C
Answers to clinical situational tasks
Task #1
1. Syndrome of the renal pelvis.
2. Leukocyturia (pyuria)
3. Urinalysis according to Nechiporenko.
Task #2
1. Nephrotic syndrome.
2. Albumin
3. Hyperlipidemia (hypercholesterolemia and hypertriglyceridemia)
Task #3
1. Nephritic syndrome.
2. Glomeruli of the kidneys.
3. More than 1 ml of blood in 1 liter of urine.
Task #4
1. Syndrome of chronic renal failure (CRF)?
2. Dysproteinemia (hyper-alpha 2-globulinemia, hypo-gamma-
globulinemia)
3. Removal of nitrogenous wastes through the gastrointestinal tract.
Task number 5
1. Renal colic.
2. Public transport (shaking)
3. Injury to the urinary tract mucosa
Task number 6
Task number 7
Task number 8
Task number 9
Pyelonephritis is infectious inflammatory disease, in which the renal pelvis, parenchyma of the kidney and calyx are affected.
Pyelonephritis is provoked by any microorganisms, in particular, coli, enterococci and staphylococci. The pathogen enters the kidney from the focus chronic infection in the body or through the ureter, when the outflow of urine is disturbed.
Pyelonephritis: signs
Acute pyelonephritis appears common symptoms such as weakness, pain throughout the body, chills with high fever (up to 40 ° C), nausea, loss of appetite. Along with this, there are local symptoms- pain in the lumbar region, dysuria. Urine becomes cloudy and flakes may appear in it. Palpation in the region of the kidney becomes painful, the muscles of the anterior wall of the peritoneum tense up, a positive symptom of Pasternatsky (tapping) occurs, and blood counts worsen.
Soreness that occurs when tapping the lumbar region is one of the most frequent. It is determined by applying light blows to the lumbar region alternately from two sides in the rib-muscular angle. Pasternatsky's symptom is usually determined when the patient is standing or sitting. Pain indicates that the symptom is positive, which is explained by concussion of the paranephria and the affected kidney. However, a positive symptom of Pasternatsky may also appear in diseases neighboring bodies.
An ultrasound examination can detect an increase in the size of the kidney, compaction and thickening of its parenchyma, while the pelvis and calyces expand.
Complications of acute pyelonephritis
The acute course of the disease is often accompanied by bacterial shock due to the massive effects of toxins on the body, necrosis of the renal papillae, paranephritis, urosepsis.
The patient should be urgently hospitalized in the urological or surgery department and appoint bed rest. Treatment is aimed at restoring the violation of the outflow of urine and relieving inflammation.
With timely diagnosis and treatment acute course pyelonephritis is recovering.
Chronic pyelonephritis
Pathology becomes chronic after suffering an acute course. The disease is detected in the study of urine by chance or during a detailed examination due to suspicion of urolithiasis. When asked, patients are diagnosed with past cystitis and other acute illnesses urinary tract. Periodic exacerbations appear subfebrile temperature body, weakness fatigue, lack of appetite, nausea, vomiting, anemia, sallow complexion, dry skin, arterial hypertension, pain in the lumbar region, impaired urination and urination. Urine changes are indicative: leukocyturia, pyuria, bacteriuria, proteinuria, hematuria, cylindruria.
During treatment chronic pyelonephritis eliminate foci of chronic infection, restore the full outflow of urine from the kidney. A lengthy antibiotic treatment, prescribe diuretics and immunostimulating agents. Timely diagnosis and long-term therapy often lead to full recovery.
Children's pyelonephritis
It is considered the most common disease after respiratory diseases.
Pyelonephritis in a child can be unilateral and bilateral, secondary and primary, acute and chronic.
Acute pyelonephritis in a child is serous and purulent, which occurs in the form of a carbuncle, or abscess. Its outcome may be recovery or chronic form. Pathology is often complicated by pyonephrosis or wrinkling of the kidney.
With pyelonephritis, a sick child complains of pain in the kidney, which manifests itself on the side of the lesion. The pain is often dull, sometimes acute attacks, which indicates the development of calculous pyelonephritis. The child has a positive symptom of Pasternatsky and general intoxication. To diagnose pyelonephritis, blood and urine are examined, ultrasound of the kidneys is performed, and x-rays are taken. Pyelonephritis is treated in children with antibiotics, detoxification and physiotherapy.
Increasingly, patients come to the doctor with complaints of lumbar pain, which reflexively spread to the area of the legs and small pelvis. Many people, out of ignorance and inexperience, attribute their condition to osteochondrosis or sciatica and try to get rid of their self-diagnosis, exacerbating the situation.
In most cases discomfort indicate kidney disease. In order to correctly diagnose, a competent doctor is required to carry out a number of procedures, including a test (symptom) of Pasternatsky. Lower back pain may be a symptom various pathologies, in particular, nearby organs.
Definition of SP
This is a research method that allows you to identify certain pathologies of the kidneys. different stages(chronic, acute). The information content of this method is based not only on tapping and patting in the area of \u200b\u200bthe ribs, but also on a urine sample. With existing diseases in the analysis will be increased amount erythrocytes and leukocytes, protein may also be present (indicates pyelonephritis).
Positive Pasternatsky's symptom does not always indicate the presence of urolithiasis. It occurs with a disease of the musculoskeletal system. Localization of pain occurs in the spinal column, increases with physical activity, lifting weights and moving. Advanced diagnostics will be required: consultation with an orthopedist, neurologist, CT and MRI.
Definition technique
It is impossible to independently evaluate Pasternatsky's symptom, this should only be done by a specialist. The method is carried out at rest in a sitting or standing position. fingers right hand the doctor lightly taps the area of the ribs, thus assessing the intensity and localization of the pain syndrome. If the sensations are too pronounced, then a positive symptom is put. In addition, urine is taken for microscopic examination.
Symptom of Pasternatsky: a sign of pathologies
Often a positive result indicates the presence of an inflammatory process in the urinary tract and kidneys. Pain can spread throughout spinal column, with no numbness skin and heat. Pasternatsky's symptom partly helps in making a diagnosis, it is necessary to conduct a blood test, urine test and instrumental examination.
On examination, the specialist observes accompanying signs, such as puffiness of the face. Puffiness appears at any stage of pyelonephritis. The chronic stage is characterized by hypertension, fatigue, fever. In pregnant women, the elderly and patients with diabetes, the disease is extremely severe - severe pain in the back and when urinating, the presence of blood and pus in the urine.
It should be noted that such sensations appear in diseases of the abdominal cavity (pancreas, gallbladder, etc.). Sometimes they point to pathological process occurring in the lumbar muscles, gastrointestinal tract, spleen and blood vessels.
Should I be worried if Pasternatsky's symptom is negative?
It is customary to think that if, with weak blows or a pat in the area of \u200b\u200bthe ribs pain syndrome is absent or does not increase, then renal colic and inflammation are excluded. In fact, this is an erroneous opinion. Many chronic diseases are situated in latent form and do not give themselves away until a certain point, so a more thorough diagnosis is required:
X-ray examination;
Ultrasound of the bladder and kidneys for inflammation, stones and other abnormalities;
Samples for blood and urine.
Do not ignore the pain and discomfort in the spine and hope for a sudden cure. It is advisable to seek help from a therapist.
Pasternatsky's symptom is not evidence of the presence of a disease, but rather a method of diagnostic research. It is done when kidney disease is suspected or genitourinary system. The essence of the method is quite simple, but it includes a combination of several features. Availability similar symptom may indicate that a person has a disease not only of the genitourinary system, but also of other organs. However, first things first.
The essence of the method
A positive symptom of Pasternatsky implies the presence of several signs at the same time.
The essence of the method is as follows:
- The doctor taps the patient's back.
- Determines the presence of pain in the kidney area.
- It also determines the number of red blood cells in the urine.
Doctor puts his hand back side to the back of the patient and conducts tapping in the lumbar region. If the patient responds to pain when tapping, then the symptom is considered positive. Immediately after tapping, a person should pass urine into a container for fairing. If there are red blood cells in the urine in an altered form, without hemoglobin content, then this may be a sign of several diseases of the kidneys and other organs.
Pasternatsky's symptom is detected in the presence of the following diseases:
- nephritis or prolapse of the kidneys;
- or ;
- glomerulonephritis and other pathologies.
A symptom on both sides indicates that the disease has affected both kidneys, that is, bilateral pyelonephritis, for example, or the presence of stones in both kidneys. But not always a similar symptom speaks specifically about the disease of the genitourinary system.
Pasternatsky's symptom positive on both sides may indicate the presence of pathologies in the following organs:
- Spleen.
- Lungs.
- Liver (in rare cases).
- Intestines.
Urinalysis will help clarify the situation, if there are no red blood cells in the urine, then it is worthwhile to additionally examine all of the above organs.
Pasternatsky's symptom positive on the right characterizes itself with a sharp pain in right side, while the pain can be of varying intensity:
- mild;
- middle;
- And sharp.
Pasternatsky's symptom is determined by the degree of intensity, if the pain is not too pronounced, then we are talking about a false positive symptom.
If pain expressed in medium degree severity, then we are talking about a positive symptom, but the patient needs to undergo a number of additional examinations.
Pasternatsky's symptom with pyelonephritis is pronounced, when tapping on the lower back, the patient frowns. At the same time, the patient walks carefully and, when changing position, experiences pain in the back.
Confusion in concepts
The symptom of Pasternatsky and the symptom of tapping are somewhat different concepts. Although they have a certain similarity.
This symptom is detected by tapping on the lower back and determining the presence of red blood cells in the urine. Only tapping is not considered a sign of a particular disease.
The tapping syndrome does not include a urine test and a determination of the number of mutated red blood cells in it. The symptom of tapping includes only pain, carried out in the same way, the doctor puts his hand on the lower back and also taps on it with his fist.
If With Pasternatsky's symptom is negative, and the tapping symptom is positive, that is, there are no red blood cells in the urine, but the pain still worries - this may be a sign:
- Diseases of the musculoskeletal system.
- Stomach or intestines.
Often, the symptom of tapping can occur against the background of an injury to the ribs. In this case, the person is also able to complain of back pain.
If Pasternatsky's symptom is negative on both sides, then a series of additional examinations is necessary, since it is difficult to accurately determine the diagnosis based only on these signs.
The value of the method
lower back pain The definition of Pasternatsky's symptom arose in the 19-20th century, the method was named after the Russian therapist doctor F. I. Pasternatsky. The description of the symptom initially included pain in the lumbar region and the presence of erythrocytes in the urine that do not contain hemoglobin.
Previously, a combination of symptoms was perceived as a sign of kidney disease. In the absence additional research The diagnosis was based on the collection of an anamnesis, a description of the clinical picture.
Pasternatsky's symptom in children and adults can be positive not only in the presence of diseases of the kidneys and the genitourinary system, a positive result can also be obtained in the presence of diseases of the abdominal cavity. But if we specifically talk about the appearance of red blood cells in the urine, then today doctors regard this symptom as a sign urolithiasis. Kidney stones cause microscopic injuries to the organs, resulting in red blood cells appearing in the urine.
To date, the symptom of Pasternatsky is determined by the method of tapping and evaluating urine for the presence of red blood cells. The method is still relevant, despite the fact that today there are a number of diagnostic methods which are able to give the patient a more accurate diagnosis.
How is research done on this symptom today:
- the patient is in a sitting or standing position;
- the study is also relevant for those patients who are in the supine position;
- the patient's muscles should be relaxed.
This is followed by tapping on the lower back, and after the person is sent for a urine test. The essence of the method has not changed significantly over the years. The doctor evaluates the patient's reaction and on this basis determines the intensity of the pain syndrome.
As a rule, after the diagnostic method, the doctor sends the patient for an additional examination, it is necessary for staging accurate diagnosis. If we talk about kidney diseases, then it is carried out;
- Ultrasound of the kidneys and bladder.
- Urography.
The results of ultrasound will be quite enough, especially when it comes to pyelonephritis, urolithiasis and other diseases of the genitourinary system.
The use of the method today makes it possible to suspect the presence of pathologies in the patient. However, the appearance of back pain should not be considered an unequivocal sign of ICD or pyelonephritis. This is not enough to make such a diagnosis.
Symptom of Pasternatsky's tapping in the video:
Do not leave Pasternatsky's symptom unattended; the presence of the corresponding signs in the patient can be perceived as an alarming indicator. If we talk about men, then their lower back pain is capable of appearing as a result of diseases of the pelvic organs, that is, in inflammatory process not only the kidneys, but also the organs of the reproductive system may be involved.
Despite the fact that this symptom has been known for a long time, it is still used today. It is not possible to self-diagnose yourself using tapping; a doctor is needed to carry out the procedure.
Pasternatsky's symptom (erroneously called the tapping symptom) is one of the the most important features indicating pathology and anomalies of the kidneys, characterized by painful sensations and the appearance of blood in urine tests with light tapping of the lower back.
In 1876, the famous Russian therapist Fedor Ignatievich Pasternatsky drew attention to common manifestations various diseases detected by percussion examination of the kidney area, which became the object of his careful study and subsequently led to the creation of a named symptom.
5 main reasons causing a symptom are characterized by their diversity and specificity. The most significant should include:
- Traumatic injury to the kidneys.
- Inflammatory diseases of the kidneys (glomerulonephritis, pyelonephritis).
- Purulent diseases of the kidneys (nephritis, paranephritis).
- Tumors and tumor formations.
- Contusions of retrorenal tissue.
The tapping symptom is not a symptom of Pasternatsky, and differs from it in that the patient does not have to give a urine test after percussion, and the diagnosis is limited solely to describing how quickly the pain occurs.
The only correct method
There are a great many methods for examining the kidneys, but it is Pasternatsky's symptom that remains the first and most important way to determine diseases. If the symptom is not carried out correctly, a false positive or negative result, which will negatively affect the treatment that the patient takes. In hospitals, the tapping symptom is currently checked in two positions: sitting and lying down, which guarantees the maximum reliable result. Doctor or nurse set the palm on the lumbar region in the projection of the kidneys on one side, and with the other hand, clenched into a fist, strikes with moderate force on its palm. If there is doubt about the location of the pain, the patient should take a urine test.
Interpretation of the results
If the patient experiences pain after a blow, it should be said that the symptom of effleurage is positive, and this may be associated with both disorders of the genitourinary system and pathology of the musculoskeletal system and muscular system. When blood appears in urine tests, it should be considered that Pasternatsky's symptom is positive.
A negative result on both sides characterizes the absence of pain and the appearance of red blood cells in the patient's urine. Sometimes there is a false negative result, when pain and discomfort in the lumbar and renal region are almost imperceptible, which indicates the initial or final stage of an acute or chronic disease.
A false positive result occurs in 3% of cases if the patient has a combined pathology of the musculoskeletal or muscular apparatus and the genitourinary system, with displacement or anomalies in the development of the renal pelvis, bladder or ureter, injuries of the urethra.
Additional research methods
In doubtful cases, one should rely on laboratory and instrumental methods studies to verify the source, painful and determine the stage of the disease. When visiting a nephrologist or urologist, a a full range of highly sensitive tests that allow you to determine the disease at various stages. From laboratory methods, general and biochemical analysis urine, analyzes according to Nechiporenko and Zimnitsky, determination of the speed glomerular filtration, determination of creatinine and urea in blood serum. Instrumental diagnostics famous for its diversity, of which the greatest advantage is given to radiography of the lumbar region, ultrasound pelvicalyceal system, renal biopsy, magnetic resonance and computed tomography, allowing to identify almost all known diseases.
If there is suspicion of kidney disease you should immediately contact a specialist, without self-medication. A positive symptom of Pasternatsky may indicate the presence of pathology, but not its localization, which requires immediate and thorough examination kidneys.
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