The examination of kidneys is impossible without laboratory Urine tests. So in this article, the data of physical examination and interpretation of Urine tests will be located together for convenient use. All symptoms in case of Kidney disorders are divided into renal and extra-renal.
Renal symptoms are such clinical signs that directly show on the disorders of Kidneys and any part of the collecting system. They are lumbar region pains (costovertebral angle tenderness, flank pain), dysuria and syndrome of Urine changes. Only children after 2 years can complain on Lumbar region pains because in this age, cortex tissue and renal capsule reach their mature form. The "Kidney" pain is caused by expanded capsule. This pain can be found by palpation of Kidneys and by pasternasky's sign. Very often, children at 2 till 5 years of age complain on abdominal pain in case of renal problems, In infants, "Kidney" pain can be evident as constant squirming, irritability. Dysuria means problems with urination. This term is most often used like a synonym to painful urination, but it also included such changes as:
• Frequent or infrequent voiding
• Urination urgency
• Incomplete voiding
Frequency of urination is age- dependent and closely connected with fluid intake and surrounding climate (hot or cold). Voiding of the bladder is more frequent in infancy, when it equals approximately the number of feeding x 3. For example, a 6 months baby approximately empties the bladder 5x3=15 times a day. At the age of 1, Urination frequency ranges from 9 to 12 times a day, later it decreases to 6-8 times at 3 years, 5-6 times at 10 and 3-4 in adolescence. Normal limits range within 1 to 3 times more or less.
Enuresis (urination incontinence) is physiological in children up to 1.5-2 years. Enuresis can be anytime and night time. Toilet trained child can perform incontinence in case of Urinary tract infection or CNS disorders.
Syndrome of Urine changes includes the interpretation of qualitative and quantitative laboratory data of Urine tests. Urine is "a mirros" of renal system. If reflects the changes in functional processes of kidneys and collecting structures as well as some other systems.
These are the signs, the cause of which is kidneys disorders, but the developing pathological changes concern other Organs and systems. These are:
• Edema develops as a result of fluid retention and disbalance of intracapillary and tissue hydrostatic pressure. Visual evidence of fluid accumulations appears when the volume of interstitial fluids enlarge more than on 15%. The peculiarities of renal edema are:
1. localization (puffiness of face, especially around the eyes);
2. time of manifestation (they are more apparent in the morning and subsides during the day).
3. spreading (as the patient's condition is getting worse edema spreads to involve extremities and genital organs (labial or scrotal swelling), abdomen (ascites), thoracic cavity (hydrothorax). Edema of intestinal mucosa causes diarrhea, anopexia, poor intestinal absorption. The total edema is called anasarka.
4. surface and consistency (skin above swelling is pale, warm and soft by touch).
• Cardiac pain
• Skin pallor is often in case of nephritic syndrome and acute poststrptococcal glomerulonephritis. When the chronic kidney disorder develops paleness is connected with decreased production of erythropoietin and developing of anemia
• Intoxication syndrome includes fever, chills, anorexia, fatigue, irritability, lethargy, headaches and vomiting, In infants, kidney disorders can manifest with feeding problems and failure to thrive.
Taking patient's health history is very important and must be done carefully. Pay attention to recent weight gain, renal dysfunction, facts relative to evidence of recent streptococcal infection, exposure to or ingestion of toxic chemicals (including heavy metals, carbon tetrachloride, or other organic solvents; nephrotoxic drugs). Take accurate information about fluid intake and output, feeling of thirst, appearance of Urine, quantity of voiding, child's behaviour during urination or hesitancy, urgency, urine incontinence in toilet-trained children. Unpleasant odor of Urine, direction and force of stream, change in size of scrotum, For adolescent it is important to find out evidence of sexually transmitted disease, type of treatment. Ask adolescent male about testicular self-examination. Report in case history the date of last Urinalysis.
Physical assessment includes visual inspection, palpation and percussion. During visual inspection, detect evidence for:
• Fluid retention: presence of edema, puffiness of face, enlargement of abdominal girth at umbilicus. Examination of swelling is made by pressing with fingertip; on the limbs, face, sacral region, lower abdomen. Observe for prominence, redness, light swelling in lumbar region.
• Pain syndrome: constant squirming, irritability, characterized position (child lies on the sick side with legs bent in hip and knee joints and hold near the body), behavior during voiding.
• Signs of intoxication
• Extrusion of Urinary bladder upon the symphysis in case of bladder neck obstruction.
• Noisy breathing hemorrhages on the skin, nasal bleeding, smell of Urine and ammonium from the mouth, muscle tremor in case of chronic renal failure.
Kidneys must be palpated in vertical and horizontal positions. Normally they are palpable in older in infants and young children. Usually, kidneys are not palpable in infants and young children. Usually, kidneys are not palpable in older children except in cases of their enlargement more than in 1.5-2 times and nephroptosis. Assess shape, size, consistency, mobility, level of ptosis (palpable kidney, mobile kidney,:migrating" Kidney) and painfulness during palpation.
Percussion of renal region helps to assess Pasternasky symptom by light beating in costovertebral angle. Report the results as positive in the right, positive in the left or on both sides, negative. Percuss for the upper border of the bladder starting from umbilicus and going down. Normally the dull sound is not found when the bladder is voided. The opposite finding is evidence of bladder neck obstruction.