Additional methods of examination

Clinical blood analysis: anemia, erythropenia.

Biochemical blood analysis: increase of creatinin and ammonium levels, hyperuricemia (non-constant sign). Blood electrolytes detection: - decrease of sodium and calcium concentration, the level of chloral normal or decreased, the level of potassium normal or increased, concentration of magnum and phosphorus increased. Specific is development of metabolic acidosis.

Determination of the glomerulus's filtration rate:

- radiological method - with use of inulini iotalamatis, EDTA;

- classic method - according to plasma's creatinin level, its 24h urine excretion and diuresis per minute;

Decrease of glomerulus's filtration (GF) - is the earliest sign of renal failure.

Clinical urine analysis: at the initial stage observed polyuria, nocturia, isuria and hypostenuria, low specific gravity (less than 1.018), in late stages - oliguria till anuria, hypostenuria and isuria stay be present.

Additional instrumental methods of examination: plain radiography of the urinary tract, excretion urography (synonyms: intravenous pyelography; IVP; IVU), retrograde pyelography/ureterography, renal arteriography, renal venography, computed tomography (CT scanning), magnetic resonance imaging (MRI).

Nuclear renal imaging. The value of radiolabeled traces in the investigation of renal disease lies in the ability to obtain important information about organ function as opposed to the predominantly structural information obtained from the previously described imaging procedures. In particular, nuclear imaging of the kidneys provides the only non-invasive quantitative assessment of individual kidney function. Radionuclides (such as ^l23I, ⁹⁹Tc^m) are linked to compounds that depend on either glomerular filtration alone, tubular excretion, or a combination of both for excretion from the body. These compounds can therefore provide quantitative information on these functions of the kidney, in addition to dynamic images.

Renal biopsy: use for differential diagnosis and determination of the chronic renal failure cause.

Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

The Contents of Module 9. Endocrine Diseases, Blood System Pathology and the Interpretation of Laboratory Methods of Examination Results.

Concrete aims:

- to generalize the results of asking, physical and instrumental examination of patients with concrete endocrine disease or blood system pathology and to differentiate the main symptoms and syndromes of affection;

- to identify the main syndromes in endocrine and hemopoietic systems` diseases to explain the mechanisms of their development;

- to interpret the changes of the main laboratory data in the pathology of endocrine and hemopoietic systems;

- to choose the adequate methods of examinations in the concrete endocrine diseases and blood system pathology.

Topic 14. The Main Symptoms and Syndromes in Anemia. General Clinical Blood Tests.

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: The definition and modern classification of anemia. The mechanism of developing iron insufficiency in the body and the occurring of iron deficiency anemia. The main clinical signs of syderopenic and general hypoxic syndromes in iron deficiency anemia. Laboratory criteria of iron deficiency anemia. The reasons and the pathogenesis of B¹² - folia deficiency anemia. The manifestations of general anemia syndrome, the syndromes of affected digestive organ, funicular myelosis and affected peripheral blood in B¹² – folic deficiency anemia. The main laboratory signs of B¹² - folic deficiency anemia. Congenital and acquired hemolytic anemias. The signs of general anemia and icteric syndromes, splenomegaly and hemosiderosis of inner organs. The main laboratory criteria of hemolytic anemias and the peculiarities of bilirubin metabolism disorder. The complete blood count and the interpretation of general and clinical blood test.