Diagnosis of kidney disease is based on a patient's survey, clarifying its complaints, on data of physical, laboratory, radiological and instrumental research.
During the survey, the localization and nature of pain, their irradiation, the presence of urinary disorders, the result of the appearance in the urine of blood or pus. Carefully find out the history of the disease, the presence of injury suffered diseases.
When examining the patient, it is sometimes possible to determine the protrusion of the front-side wall of the abdomen in the field of hypochondrium due to an increase in (tumor, hydronephrosis). Tearing the kidneys is carried out with the position of the patient on the back with semi-bent legs at the moment of deep breath of the patient. Tearing is made by two hands - when ticking the left kidney, the right hand is supplied under the lumbar region of the patient, and the left - put on the region of the hypochondrium and brings the fingers of the hands on the breath.
Tearing the kidneys can be performed when the patient is positioned on the side. This technique helps to diagnose kidney omission. Healthy people have a kidney; The lowered kidney is defined as a movable, elastic oval body, shifting up. The kidney tumor is defined as a dense, a bitter admiration, painful at. Increased smooth painful kidney is determined by palpatorial during hydronephrosis; Increased bug-in kidneys - with polycystosis.
A large diagnostic value is painful when the lumbar region is determined below the XII rib.
In the diagnosis of kidney diseases, the method of studying the water sequence and concentration functions of the kidneys is used. An indicator of the water sequence function is the amount of urine dedicated during the day (daily diuresis) compared to the amount of liquid consumed per day. The concentration function is determined by measuring the proportion of urine in one-time three-hour portions. A significant decrease in the amount of urigour released (see), the absence of urinary isolae is anorya (see) or an increase in urine release - (see) serve as an indicator of the renal function.
The reduced proportion of urine (1008-1014) - hypoxenuria, as well as the proportion of urine without oscillations - Isostenuria serve as a sign of a disruption of the concentration function of the kidneys, which is usually manifested by a combination of both symptoms, that is, isoopostenuria. To clarify these functions, functional samples are carried out - an aqueous sample (sample for breeding) and a concentration sample. The aqueous sample is the following - the patient drinks an empty stomach of 1.5 liters of water, then after 30 minutes. They begin to measure the number of urine released for 4 hours. The sample on the concentration function of the kidneys: the patient consumes only dry food, rich in proteins (meat, eggs, etc.) during the day, during this time in the morning it is assembled by urine every 2 hours, measuring its number and proportion in each portion.
With normal kidney function, the water test shows the rapid allocation of the entire drilled liquid with a low specific weight - 1002-1004; In the sample on a concentration, the amount of urine in each subsequent portion decreases, and the proportion increases to 1030 or more.
More physiological is the functional sample of Zimnitsky; With it, it is not necessary to carry out loads with plenty of liquid or completely deprive it. The patient with normal nutrition collects urine every 3 hours (8 servings); Separately night and day portions, measuring the amount of urine and the proportion of each portion. With the normal function of kidney fluctuations and the amount of urine in various portions, most of the urine is highlighted in the afternoon. Equally low share in all portions indicates a violation of the kidney function.
An important study of the kidney function is to determine in the blood serum of nitrogen slags - the so-called residual nitrogen, which is in the norm no more than 40 mg%. With the amount of residual nitrogen, it may increase to 100 mg% and above - azotemia (see). Currently, in clinical conditions, the kidney function is determined by more subtle biochemical studies: a clearance test and with radioisotope studies - isotopic renography and kidneys. The principle of the method of isotope renography is that the concentration in the kidneys of the intravenously introduced radioactive substance is recorded by an outer measurement using a detector located in the kidney side from the lower back. Radioactive kidney scan allows them to establish their shape, dimensions and presence in kidneys of focal lesions using a special device -. The leading importance in the diagnosis of urological diseases has kidneys, which must be started from the visibility of the urinary system. Before a picture of the patient, it is necessary to carefully prepare a diet and cleansing enemas. By sightseeing, you can define kidney contours, their location, presence or urinary tract. To identify the kidney function, an excretory (see) is made, in which the X-ray radiological substance is introduced into a vein: 20 ml of 40% solution
The kidneys is a very important pair body that is responsible for the elimination of toxins.
Various diseases lead to a violation of the functioning of all organism systems.
That is why anyone should know how to check the kidneys, what tests must be passed and which doctor checks the kidneys.
If a person has any problems with the work of the kidneys, it will be expressed by the following symptoms:
- regular increase in blood (arterial) pressure;
- change in urine color, the appearance of impurities in it (including blood) and unpleasant odor;
- constant urination to urination (at night - especially);
- reducing or increasing the volume of urine produced;
- pain when urination;
- sharp or pulling back pains;
- swelling of legs and faces;
- constant thirst and decline in appetite;
- the appearance of shortness of breath.
When the above symptoms appear, it is recommended to undergo a survey. With it, it is possible to identify the development of diseases in a timely manner. Also, the prerequisite for the examination may be the reception of medicines that violate the work of the kidneys (acyclovir, bispetol, diuretic drugs, etc.).
Pains in the limb area are more intensively manifested after supercooling or in the development of viral disease.
Who is in the risk group?
The people who regularly use alcohol-containing drinks can be worried about the proper work of the kidneys, they take a large number of different medicine preparations.
Improper nutrition can also provoke the development of diseases. Kidney disease is often observed in excess weights and diabetes.
Diagnostic methods at home
How to check the kidneys at home? Accurate diagnostics at home is impossible, but some events will help determine if you have any kidney disease. First, remember whether pain in the area of \u200b\u200bthe waist is concerned: a sharp and acute pain is a symptom of renal colic, and the noviching indicates a chronic course of the disease.
Collect the morning urine into a clean container. It is desirable that it be white, but you can use transparent. Carefully examine the urine: there should be no extraneous suspense in it, normal color is yellow. If you notice the change in the color of urine or the presence of flakes - immediately contact your doctor! Especially dangerous urine coloring in brown or red.
Another diagnostic method is the calculation of the daily volume of the urine allocated. To do this, over the course of 24 hours, we repel into one container, then measure the amount of its contents.
Normally, a person allocates about 2 liters of urine. If this number is greater than - this indicates a polyuria, if less is Oliguria.
When Anuuria, the kidneys do not produce urine at all. For any deviations, immediately consult a doctor.
Another sign of the disorder of the kidneys - swelling on the face. They are easy to detect on increased centuries and a little swollen face. Edema for kidney diseases are formed very quickly, the skin is pale. They can occur not only on the face, but also on other parts of the body.
Edems are often accompanied by general malaise. If you have noticed such a symptom - consult a doctor!
What tests need to pass to check the kidneys?
In order to recognize kidney disease and check their work, it is necessary to undergo a survey in the clinic. First of all, the specialist will suggest to pass urine and blood tests.
Each person must donate urine for analyzing once every six months. Uriman studies in the laboratory, the number of leukocytes and erythrocytes is calculated, the color, transparency and acidity are determined. Also, experts identify the presence of pathogenic impurities.
What is the urine analysis to pass to check the kidneys? In addition to overall analysis, there are two more types of urine study that is used in kidney diseases:
- in Nechiporenko - will allow to identify pyelonephritis, cystitis and other inflammatory processes;
- on Bens-Jones protein - with its help you can find malignant neoplasms in the kidneys.
General blood analysis
Blood is taken in the laboratory from Vienna and from the finger.
In the first case, the analysis will show the amount of creatinine and uric acid, in the second - the degree of inflammation (if available).
During the day before surrendering blood, it is prohibited to use alcohol-containing drinks and drugs.
Ultrasound examination of the bladder is the most efficient and safe method for studying the pathologies of the authority. And that includes preparing for research, read further.
How to bring stones from the ureter, you will learn. And also consider preventive measures to prevent relapse.
Neurogenic bladder - a disease associated with a violation of the nervous system. Under this reference, we consider the causes and symptoms of pathology in female people.
Additional examinations
Based on the results of urine tests and blood, additional surveys may be appointed to the patient:
- With this method, the specialist evaluates the structure of the kidneys. Ultrasound is safe even for young children.
- X-ray. It allows you to identify various tumors in the kidneys. In some cases, the patient is rapidly carried out. To do this, the procedure introduces a contrast agent.
- Scintigraphy. This method, unlike ultrasound, allows you to identify not only the size of the organs, but also functional disorders.
All listed methods will give a complete picture of the renal status of the scattered.
Scintigraphy kidney
The most common diseases of the kidneys and their symptoms
There are many diseases that lead to a violation of the kidney work, but some of them are especially common.
Urolithiasis disease
The main symptom of this ailment is renal colic. It is the consequence of the outlet of the stone from the kidney into the ureter, which leads to a violation of the outflow of urine and injuries of the walls of the urinary tract. Acute pain may spread to the entire pelvic region, and sometimes on the inner surface of the hip.
A man suffering to renal colume cannot find such a position in which the pain would have retreated. In the urine there is a blood admixture, sometimes visible sand.
Inflammation (cystitis, pyelonephritis)
The most common diseases, accompanied by inflammation of the kidneys and urinary tract, is cystitis and pyelonephritis.
With these ailments, the patient has severe heat, lethargy and decline in appetite.
The pain can be both nothing and sharp. In the area of \u200b\u200bthe belt felt heaviness. Often cystitis and pyelonephritis are accompanied by frequent and painful urine.
Infections (glomerulonephritis)
Glomerulonephritis is an infectious disease. At the first stages of the disease in the urine, a blood flow is noticeable, and as an anoururia may be observed (cessation of urin production). When glomerulonephritis, the electrolyte balance is disturbed, extensive swelling develops, but there are no pain characteristic of renal diseases. The most serious complication is the swelling of the brain and the lungs.
Preventive measures
The kidneys is a natural filter of our body, so it is very important to take care of their condition and pre-warn the development of possible pathologies.For this, it suffices to comply with simple tips and recommendations, mainly relating to the daily diet and lifestyle.
Here is a list of preventive measures that will help avoid the development of kidney ailments:
- Limit in your diet the number of products with a high protein content, because of which stones are formed in the kidneys. The norm of the protein per day for an adult is 0.7 grams per kg of weight.
- It is necessary to stop the use of alcoholic beverages.
- Eat more renal products: berries (lingonberry, cranberry, strawberry, blueberries), watermelon and melon, rosehip, fresh greens, vegetables (cabbage, cucumbers, pumpkin, bell pepper), apples, fish (preferably sea).
- Observe drinking mode. If you do not have chronic kidney disease, drink a day to 1.5 liters of water, in the heat, with dehydration (diarrhea and vomiting), with intensive loads this volume increases.
- Exclude any hypothermia, as they contribute to the increase in the burdens.
- Engage in sports (but it is not necessary to load yourself, dancing and yoga are suitable for the prevention of kidney diseases).
- Start and strengthen immunity.
- Watch for your weight.
The kidneys is a fairly sensitive organ, so they should be treated with increased attention. If you have noticed any symptoms pointing to the development of kidney disease, be sure to consult a doctor. Remember that the disease is easier to cure at the initial stage.
Sometimes the presence of urinary system pathologies can be suspected independently. If you saw white flakes in the urine, you need to consult a doctor for diagnosis. Can this phenomenon be the norm?
Why kidney sore during pregnancy and what can be taken as treatment, you will learn by following the link.
Video on the topic
What kind of kidney surveys need to go through the patient's complaints on the pain in the lumbar region and suspicion of the presence of one or another pathology, a nephrologist will also be promoting.
The main methods are ultrasound and computer research, chromocystoscopy, radiography and urography are also carried out. But everything begins with the inspection of the doctor and passing urine on a general analysis.
In detail how to check the kidneys, and what major surveys need to go through, it is described in this material.
As a doctor examines the kidney: inspection of the patient
The examination of the patient is carried out by a doctor if complaints are predominantly on pain in the lumbar region to the right or to the left of the spine and dysuric disorders.
The primary kidney survey method is palpation. The doctor holds it in the patient's position lying on his back or on the side, while determining the location and size of the kidneys, as well as the strengthening of soreness during palpation.
In patients with overweight and significant fatty tissue in the field of the front abdominal wall, this inspection is significantly difficult or even impossible.
The symptom of Pasternatsky during the survey of the kidney is observed (sometimes positive) with many inflammatory and unusual diseases, damage to the kidneys and an octoral fiber.
This symptom is not specific and may be due to the disease of the adjacent organs and tissues: Lumbar muscles, ribs, pleura, liver, gallbladder, pancreas, intestines, appendix, spleen, large vessels.
The essence lies in the appearance of pain in easy-to-lumbays in the lumbar region. The study is better to spend in the sitting position or standing.
Kidney examination chromocystoscopy
With full examination of the kidney, chromocystoscopy is required. This method was introduced into practice in 1903 by Felker and Joseph and is used as an additional functional method of study with surgical diseases of the kidneys and upper urinary tract, as well as for the differential diagnosis of renal colic with other acute diseases of the abdominal organs.
Contraindications are acute inflammatory diseases of the urethra, scrotum organs, prostate gland.
This method of examination is based on the removal of kidneys 2-5 ml of the patient administered by a 0.4% solution of indigocarmin intravenously or 15 ml intramuscularly. Start with the introduction of a cystoscope in the bladder and inspection of the bladder.
With the normal function of the kidneys and the upper urinary tract in the bladder, the urine jet (with intravenous administration of the drug is 3-5 minutes, and with intramuscular - by 8-15) arrives in the bladder. The intensity of the color of urine, the frequency of reducing the mouth of the ureter, the nature of the thrust of the stained urine is noted.
Radiography during the examination of the kidneys
Also, with a comprehensive kidney examination, a review radiography is carried out. This method, first introduced in 1896, did not lose the relevance today. It gives an idea of \u200b\u200bthe location of the kidneys, their size, the presence of stones that do not pass X-rays.
For this, the cleaning enema is predetermined in the evening before the survey, in the morning on the day of examination to clean water so that the contents of the intestine and gases do not give extraneous shadows.
Contrast kidney examination: excretory urography
The kidney examination method Excretory urography is based on kidney ability to identify certain substances (X-ray-contrast, iodine-containing), introduced into the body, resulting in radiographs the image of the kidneys and urinary tract.
The testimony for an excretory urography is the need to determine primarily anatomical and functional (to lesser extent) the state of the kidneys, loosening, ureters, bladder. Contrast substances during the survey of the kidneys are introduced mainly intravenously.
The main contraindication to the excretory urography is the intolerance to the iodide preparations.
Before examining the kidneys in this way, the preparation of the patient is carried out as the same as during a reveal radiograph.
But nevertheless, these types of surveys have a number of shortcomings, in particular require the preparation of the patient, and the patient itself receives, albeit a small but dose of radiation by X-rays. Therefore, more modern types of surveys come to replace.
Ultrasonic kidney survey (ultrasound)
On such a method of examination of the kidneys, as an ultrasound (ultrasound examination) is to stop more.
It's no secret for a long time that ultrasound studies (ultrasound) are used quite widely in medicine, as they are harmless to the patient and among others are most accessible. Naturally, the ultrasound is used to assess the condition of the urinary system, in particular the kidneys.
The study includes measuring the size of the kidney, evaluating its structure, position, mobility. It is estimated, if there is, the degree of expansion of the renal izhanki and cups, the presence of stones.
Modern ultrasound devices allow renal blood flow to explore. So, measuring blood flow rate in the kidney vessels, one can judge its functional state.
Separately, it must be said about the possibility of identifying kidney tumors. And what is very important, the tumors of small sizes, when no complaints with the patient. The detection of such tumors, as a rule, occurs when ordinary preventive inspections.
Unfortunately, when the tumor begins to show (pain, blood in the urine), it already has significant sizes and the danger of metastases appears. Therefore, the ultrasound of the kidneys is recommended to almost everyone for the purpose of prevention, similar to the fluorography of the lungs, to which we have been used to everything for a long time.
Special preparation of the patient for ultrasound kidneys is not required.
Methods of kidney survey: CT and general urine analysis
Computer tomogram (CT) is the most accurate method of kidney survey, which gives an idea of \u200b\u200bthe state of these organs at certain levels of cut, diagnosing even the smallest formation of stones. It is carried out both without administration and with the introduction of intravenously contrast agent (spiral computed tomogram with a bolus amplification).
Total urine analysis is the most common method of survey. When analyzing during a general or dispensary examination, it allows you to identify renal pathology even in the absence of complaints from the patient.
In particular, the presence of crystals in the sediment of urine speaks of urolithiasis or predisposition to it, which requires additional examination. The overall urine analysis also serves to control the effectiveness of the treatment.
The diagnostic survey of the kidneys helps on time and in the early stages to identify pathology in the work of the pair body, and this means that the chances of successful cure increase. There are various methods for studying the functions of the pair body, which are painless and in the shortest possible time give an accurate result. Consider diagnostic measures that are shown in suspected of a pair body disease, which they represent, and what they differ from each other.
Collecting anamnesis and inspection of the patient
The primary study of the kidneys and the inspection of the disease begins in the doctor's necologist's office, which collects information about the patient's state, is interested in concomitant symptoms, as long ago, they arose how sharply worried. Next, the patient needs to be undertaken so that the doctor put the body.
First, the lumbar department is investigated, further, palpuring the organ, determine soreness at easy pressing. After the study, a bladder is subject to the urinary bubble and at the end of the doctor examines the external genitals. When palpation, the patient needs to lie down and relax the abdominal muscles. At first one kidney is palpable, right and then left. When tugging the kidneys, the size, consistency, form, also the doctor examines the organ for the presence of neoplasms. After the doctor is convinced that a person develops a kidney disease, the sick is sent to a more detailed diagnosis that will help reveal the root cause of the appearance of ailment, to put the final diagnosis and begin drug treatment.
Laboratory diagnostics
Urine tests
For a more accurate result you need to use morning urin. Laboratory diagnosis of kidney disease includes a study of blood samples and urine. Urine tests help determine whether inflammation is in the kidneys as far as it is running if there are other problems. It is important to collect a sample correctly for research. To make the results as accurate as accurate as possible, it is shown to collect the morning urine into a sterile clean container. Need an average portion, before pressing, a person should carry out hygienic procedures of external genital organs and wipe dry. In the normal state in the urine, a healthy person should have no more than 4-6 leukocytes, and the red blood cells and protein must be completely absent. If these indicators exceed the norm, the patient is shown to re-pass the sample. When and for the second time the picture will not change, additional methods of examination are appointed.
Blood test
In pathological diseases of the pair body in blood tests, indicators of leukocyte levels, erythrocytes, ESRs are significantly increased. Biochemical diagnostics in problems will show an increase in the concentration of urea and creatine indicators. If the results of laboratory tests will have such a picture, the doctor will not have doubts that a person has a kidney problem. To explore the body in more detail, instrumental diagnostic methods are prescribed.
Functional methods of disease diagnosis
Functional research will help determine the performance of the organ. Such research methods help determine the level of the functional state of the kidneys, how fully they can perform their functions. Diagnostics of the pair body ability to independently regulate their functions. If there was a failure in the operation of nephrons, the organ is badly supplied with blood, while general geodynamics is violated, the pathology of the kidneys is developing.
Methods for studying the functions of the kidneys in the wintering system help to evaluate the density of urin, and if it is raised, meaning, the kidneys do not function well. It is important to determine how functionally the kidney is cleaned by the body. To do this, conduct a study of the cleansing functions of the pair organ, and if the level of creatine and urea will be greater than the norm, the sick suspected renal failure or other ailments.
Ultrasound procedure
With the help of ultrasound research, the doctor determines which sizes and forms of kidneys. In real time, you can see the presence of kidney inflammation, as far as it is developed, is there any neoplasms on the tissues. Ultrasound with the use of dopplerography will help you learn whether there are problems with the blood supply to organs and how developed they are.
X-ray Methods of Kidney Survey
The diagnosis is aimed at identifying deviations of the kidney function. X-ray methods of renal research make it possible to assess the state of the organ, whether there is inflammation in the tissues and the presence of pathological inclusions. The study is carried out using a contrast agent, which is administered intravenously in front of the procedure itself. At the very beginning, a review shot is made on which all organs of the patient's urogenital system can be seen. The contrast helps to get more accurate and clear pictures, and that the results are reliable, before studying the disease, it is shown to clean the intestines and exclude from the diet products provoking increased gas formation. Scintigraphy makes it possible to diagnose the disease in the earliest stages.
The kidney scintigraphy is shown to patients with suspected problems with the organs of the urogenital system. There are dynamic, static and radionuclide angiography. With static scintigraphy, the doctor determines how fully the kidneys are functioning, and there are areas with pathological disorders. Dynamic scintigraphy will help evaluate the work of the kidneys, to learn the affected areas localized, evaluate the degree. Radionuclide method is used in conjunction with static and dynamic research as an additional way to diagnose.
7.1. Distribution, inspection, palpation and percussion in diagnosis of kidney and urinary tract
Distribution. The main complaints of patients with diseases of the kidneys and the urinary system: pain, edema, polyuria, oliguria, dizuriy, niccountura, etc.
Inspection of the kidney area. Change in coloring and swelling of the skin in the lumbar region.
Palpation of the kidneys and bladder. Rule and technique of kidney palpation. Identification of increasing, omission and soreness of the kidney. Palpation of the upper and lower ureter points.
Percussion. Determination of the symptom of Pasternatsky and its diagnostic value. Percussion of the upper border of the bladder.
7.2. Basic laboratory and instrumental research methods for kidney diseases and urinary tract
Laboratory and instrumental methods for studying the urinary system. Laboratory studies of urine. Study of urine on Nechiporenko, Zimnitsky. Rebarg's test. Radiological and endoscopic methods of renal research. Radioisotope and ultrasound examination of the kidneys. Biopsy kidney.
7.3. Main clinical syndromes for kidney diseases and the foundation of private kidney pathology.
Main clinical syndromes for kidney diseases: renal colic, renal arterial hypertension, renal eclampsia, urinary syndrome, nephrotic syndrome, acute and chronic renal failure.
Fundamentals of private pathology of kidneys and urinary tract. Symptomatology and diagnosis of acute and chronic glomerulonephritis, pyelonephritis, urolithiasis.
8. Methods of research of patients with blood diseases
Inspection, palpation, percussion and auscultation in the study of the blood system. Laboratory and instrumental research methods (morphological examination of blood, puncture of blood-made organs, hemolysis estimation). The study of hemorrhagic syndrome.
Basic clinical syndromes for blood diseases (anemia syndrome, lymph and myeloproliferative syndromes). The foundations of the private pathology of the blood system (iron deficiency and in 12-identical anemia; acute and chronic leukemia).
9. Methods of research of patients with diseases of the endocrine system
Methods of research of the endocrine system. Palpation of thyroid gland. Laboratory and instrumental research methods (determination of thyroid hormones, glycemic blood profile, test for glucose tolerance, radioisotope and ultrasound study of the thyroid gland). Main clinical syndromes for diseases of the endocrine system and the foundation of private pathology (diffuse toxic goiter, hypothyroidism, diabetes mellitus).
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