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Module 2: Symptoms and syndromes in diseases of internal organs.doc
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Clinical features

The main complaints in patients with acute pyelonephritis are fever, dull, constant and increasing in intensity pain in the back, perspiration, headache, nausea, vomiting and pain in the muscles, arthralgia and disorders of urination.

Objective examination: General patient's condition is from moderate grave to extremely grave. The temperature is constant increase to 38-39,5°С or has hectic type. May observed the clinic of bacterial shock. Pasternatsky's symptom is positive on one or bilateral, may detect tenderness of the muscles in loin region.

Complications: renal abscess, urosepsis, paranephritis.

Outcomes of disease: complete recovery, transformation to the chronic form.

Additional methods of examination

Clinical blood analysis: leukocytosis and accelerated ERS.

Clinical urine analysis: in macroscopic study - urine is yellow color, cloudiness, without odor, high specific gravity and non-significant proteinuria: in microscopic study observed large amount of leucocytes, pyuria, non-concstant microhematuria, cylindruna, in bacteriological study - bacteriuria.

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

Biochemical blood analysis: without changes.

Additional instrumental methods: excretory urographia, ultrasound examination.

Chronic pyelonephritis

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

Clinical features

The main complaints in patients with chronic pyelonephritis are subfebrile fever, dull, constant loin pain, perspiration, headache, nausea, arthralgia and disorders of urination.

Objective examination: General patient's condition is from moderate grave to extremely grave. The temperature is periods of progression increase to 38-39,5° C or has hectic type. May observed lost of weight. Pasternatsky's symptom is positive on one side or bilateral, may detect tenderness of the muscles in loin region.

Additional methods of examination

Clinical blood analysis: leukocytosis and accelerated ERS, anemia, erythropenia.

Clinical urine analysis: in macroscopic study - urine is yellow color, cloudiness, without odor, high specific gravity; in microscopic study observed large amount of leucocytes, non-constant microhematuria, cylindruria, in bacteriological study - bacteriuria.

Zimnitsky's test: in normal limited.

Nechiporenko's method: prevalence of leucocytes under erythrocytes.

Biochemical blood analysis: may observed increase of creatinin level.

Additional instrumental methods: excretory urography, ultrasound examination, renography, computed tomography, magnetic resonance imaging.

Syndrom of chronic renal failure

Syndrome of chronic renal failure - clinical-laboratory symptomocomplex that occurs due to the significant decrease of nephrones quantity and quality that leads to the impaired secretory and excretory renal function, homeostasis disbalance, disturbances of all substances exchange, acid-alkaline disorder and abnormal all organs and systems work.

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