Examination of the kidneys is impossible without laboratory urinalysis. So in this article, the data of the physical examination and the interpretation of the urine tests will be put together for convenient use. All the symptoms in case of kidney disorders are divided into renal and extrarenal.

Kidney symptoms They are clinical signs that manifest directly in disorders of the kidneys and in any part of the collecting system. They are pain in the lumbar region (tenderness in the costovertebral angle, pain in the side), dysuria and urinary disorders syndrome. Only children after 2 years can complain of pain in the lumbar region because at this age, the cortex tissue and the renal capsule reach their mature form. “Kidney” pain is caused by expansion of the capsule. This pain can be found by palpation of the kidneys and by the pasternsky sign. Very often children 2 to 5 years of age complain of abdominal pain in case of kidney problems. In babies, “kidney” pain can be apparent as constant fussiness and irritability. Dysuria means trouble urinating. This term is most often used synonymously with painful urination, but it also includes changes such as:

� Frequent or infrequent urination

� Urgency to urinate

� Incomplete emptying

� Enuresis

The frequency of urination depends on age and is closely related to fluid intake and the surrounding climate (hot or cold). Urination of the bladder is more frequent in childhood, when it is approximately equal to the number of feedings x 3. For example, a 6-month-old baby empties the bladder approximately 5×3 = 15 times a day. At the age of 1 year, the frequency of urination varies from 9 to 12 times a day, then decreases to 6-8 times at 3 years, 5-6 times at 10 and 3-4 times in adolescence. Normal limits range from 1 to 3 times more or less.

Enuresis (urinary incontinence) is physiological in children up to 1.5-2 years. Enuresis can be at any time and during the night. A toilet-trained child may be incontinent for urinary tract infection or CNS disorders.

The urine changes syndrome includes the interpretation of qualitative and quantitative laboratory data from urine tests. Urine is “a mirror” of the renal system. If it reflects changes in the functional processes of the kidneys and collecting structures, as well as some other systems.

Extrarenal symptoms

These are the signs, the cause of which is kidney disorders, but the developing pathological changes affect other organs and systems. These are:

� Edema develops as a result of fluid retention and imbalance of intracapillary and tissue hydrostatic pressure. Visual evidence of fluid accumulation appears when the volume of interstitial fluids increases by more than 15%. The peculiarities of renal edema are:

1. localization (swelling of the face, especially around the eyes);

2. time of manifestation (they are most evident in the morning and subsidies during the day).

3. Spread (as the patient’s condition worsens, the edema spreads to affect the extremities and genital organs (labial or scrotal swelling), abdomen (ascites), thoracic cavity (hydrothorax). Edema of the intestinal mucosa causes diarrhea, anopexy, intestinal malabsorption, total edema is called anasarka.

4. surface and consistency (the skin above the swelling is pale, warm and soft to the touch).

� Hypertension

� Heart bread

ï ¿½ Pale skin is often seen in nephritic syndrome and acute postptococcal glomerulonephritis. When chronic kidney disease develops, paleness is related to decreased erythropoietin production and the development of anemia.

ï ¿½ The intoxication syndrome includes fever, chills, anorexia, fatigue, irritability, lethargy, headaches, and vomiting. In babies, kidney disorders can manifest with feeding problems and growth retardation.

Taking the patient’s medical history is very important and should be done carefully. Pay attention to recent weight gain, kidney dysfunction, facts related to evidence of recent streptococcal infection, exposure or ingestion of toxic chemicals (including heavy metals, carbon tetrachloride, or other organic solvents; nephrotoxic drugs). Get accurate information about fluid intake and output, feeling of thirst, appearance of urine, amount of urine, child’s behavior when urinating or hesitation, urgency, urinary incontinence in children who know go to the bathroom. Unpleasant smell of urine, direction and force of the stream, change in the size of the scrotum, for the adolescent it is important to find evidence of sexually transmitted disease, type of treatment. Ask the male adolescent about testicular self-exam. Report the date of the last urinalysis in the case history.

Physical evaluation includes visual inspection, palpation, and percussion. During visual inspection, look for evidence of:

� Fluid retention: presence of edema, swelling of the face, enlargement of the abdominal circumference at the navel. Examination for swelling is done by pressing with the fingertip; in the extremities, face, sacral region, lower abdomen. Notice prominence, redness, slight swelling in the lower back.

� Pain syndrome: constant writhing, irritability, characterized position (the child lies on the sick side with the legs bent at the hip and knee joints and stays close to the body), behavior during urination.

Pallor

� Signs of intoxication

� Urinary bladder extrusion over the symphysis in case of bladder neck obstruction.

� Noisy breathing, skin bleeding, nasal bleeding, smell of urine and ammonia from the mouth, muscle tremors in chronic kidney failure.

The kidneys should be palpated in a vertical and horizontal position. They are usually palpable in infants and young children. The kidneys are usually not palpable in infants and young children. The kidneys are generally not palpable in older children, except in cases of enlargement greater than 1.5-2 times and nephroptosis. Assess the shape, size, consistency, mobility, level of ptosis (palpable kidney, mobile kidney: “Migratory kidney”) and pain during palpation.

Percussion of the renal region helps to assess the symptoms of Pasternasky by light tapping at the costovertebral angle. Report results as positive on the right, positive on the left, or both sides negative. Percussion for the upper edge of the bladder starting from the navel and going down. Normally, the dull sound is not found when the bladder empties. The opposite finding is evidence of bladder neck obstruction.