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79 General inspection During the examination of the patient, various variants of the collapse of con- sciousness can be revealed. Thus, in acute glomerulonephritis and nephropathy of pregnant women, agitation, short – term convulsive seizures with tongue biting, visual impairment-the so-called renal eclampsia associated with nephrotic syn- drome, hypervolemia and brain edema can be observed. Severe nephrotic syn- drome can be complicated by collapse with loss of consciousness-a nephrotic crisis caused by severe hypovolemia. Patients with chronic renal failure who are on pro- gram hemodialysis sometimes experience psychosis, and long-term treatment may develop a kind of dementia. Patients with end-stage renal failure develop uremic coma, accompanied by the smell of ammonia from the mouth. Edema is an important sign of kidney disease: from pasty face, feet to anasarca with cavity effusions. It is characterized by pallor of the skin, which develops in the early stage of nephropathy in the absence of anemia, associated with edema of the subcutaneous tissue and spasm of small blood vessels of the skin. The combination of edema with pallor and dryness of the skin is especially characteristic of nephrotic syndrome. Anemic pallor, dryness and slight jaundice (staining with delayed urochromes) of the skin are observed in patients with severe chronic renal failure. In the nephrotic variant of nephritis, painful migrating erysipelas may appear. Patients with glomerulonephritis with disseminated intravascular coagulation syn- drome and especially uremia are characterized by an abundance of skin bruises in combination with increased bleeding of the mucous membranes. Other skin lesions (photodermatitis, dermatitis, vasculitis, alopecia, spoon nail) are more common in systemic diseases. Joint syndrome is observed in systemic kidney damage; primary amyloidosis, paraneoplastic kidney damage, gout, which is characterized by damage to small joints and the presence of tofuses. When examining the patient, it is necessary to pay attention to the stigmas of dysembryogenesis characteristic of genetic nephropathies: high palate, abnormali- ties of the bone system (syndactyly, dysplasia of the kneecap and nails), cleft lip, cleft palate, hearing and vision disorders. Blood pressure should be measured on both hands (lying and standing). In patients with high hypertension, abdominal auscultation is mandatory. Systolic murmur in the epigastric region, in the navel area, combined with blood pressure asymmetry in the extremities is an important sign of renal artery stenosis. Additional research methods laboratory tests-General blood analysis, blood chemistry (creatinine, urea, re- sidual nitrogen, total protein and fractions, cholesterol);
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