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Module 2: Symptoms and syndromes in diseases of internal organs.doc
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Additional methods of examination

Clinical blood analysis: moderate leukocytosis and increase of accelerated ESR (in stage of aggravation), anemia.

Clinical urine analysis: in initial stage - poliuria, in late - olyguria with low specific gravity and significant proteinuria: in microscopic study observed non-constant hematuria, cylinders (hyaline) and leucocytes (non-constant).

Zimnitsky's test: olyguria, nocturia, hypo- or izostenuria.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels, decrease of creatinin clireance, non-constant - hypoproteinemia and dyspro-teinemia.

ECG: the signs of left ventricle hypertrophy and impaired repolarization.

Renal biopsy: use for differential diagnosis and determination of the glomerulonephritis origin.

Chronic glomerulonephritis (latent form)

Chronic glomerulonephritis (latent form) is the variant of glomerulus's injury that characterized by the non-symptomatic duration or clinical manifestation with isolated urinary syndrome.

Clinical features

As usual the patients don't have any complaints.

Objective examination: General patient’s condition is from satisfactory to moderate grave. During general examinations in the early stages of disease aren't detect any particularities. In later stages may appears clinic of nephritic and hypertensive syndromes.

Complications: development of chronic renal failure.

Additional methods of examination

Clinical blood analysis: anemia.

Clinical urine analysis: in initial stage - normal specific gravity and non-significant proteinuria: in microscopic study observed non-constant hematuria, cylinders (hyaline) and leucocytes (non-constant).

Nechiporenko's method: prevalence of erythrocytes under leucocytes; casts more 250 per ml.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels and decrease of creatinin clireance detect in 25 % of patients, non-constant - hypoproteinemia and dysproteinemia.

Renal biopsy: use for differential diagnosis and determination of the glomerulonephritis origin.

Pyelonephritis

Pyelonephritis - inflammatory renal disease with obligatory renal parenchyma and pelvis injury.

Classification

I. According to the duration:

- acute;

- chronic.

II. According to the complication development:

- complicated;

- non-complicated.

Etiology

I. Primary infection of renal structures (more frequently bacterial, protozoa, fungus).

II. Secondary to the:

1. Renal system pathology:

- urine tract infection and injury (cystitis, urethritis, strangulation of stones or foreign bodies in the urethra; phimosis);

- prostate gland diseases (prostatitis, prostate adenoma, prostate tumor);

- uterus and uteri cervical diseases.

2. Extra renal pathology:

- sepsis;

- diabetes;

- inflammatory process with different localization;

- immune deficiency states;

- post operative period.

Pathogenesis

Infectious agents may be transmitted by contact, hematogenous or lymphatic ways in obligatory presence of urodynamic abnormalities. Acute pyelonephritis

Acute pyelonephritis - acute non-specific inflammatory process that characterized by primary affection of renal parenchyma, renal pelvis and tubules with futher involvement to the pathological process of glomerulus and vessels.

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