Text A Stones in the Kidneys

1. Clinical manifestation. In many instances stones are carried in the kidneys for years producing no symptoms. More commonly, a mild in­fection develops in the pelvis about the stone and gradually involves the cortex of the kidney until a severe pyelonephritis develops. If the stone is laige, or several are present, the infection may progress to a pyelonephro-sis, resulting in the destruction and ultimate loss of the kidney. Mild fever, pain, malaise and anorexia are usually present. Pus and a variable amount of albumin are present in the urine. Such symptoms as frequency of urination and mild burning pain usually accompany infection of this type. The diagnosis of renal calculi can be made by an X-ray film since most of these stones contain sufficient calcium to be radiopaque.

2. The most dramatic manifestation of renal calculi is renal colic brought about by the entrance of a stone into the ureter and its passage downward to the bladder. The pain described usually radiates downward toward the thigh. Hematuria is a constant symptom and is an important diagnostic sign.

3. While passing slowly, the stone may develop infection and pus as well as bacteria will be found in the urine. Fever is absent except the

Lesson 19 ♦ 197

instances when the obstruction is present long enough to allow the de­velopment of infections. On rare occasions the stone produces sufficient ulceration in the ureter during its passage. Differentiation of renal colic From other acute abdominal conditions can usually be made by urine examination, and X-ray.

4. Treatment. Unless the renal stone is «silent», treatment should be directed toward its removal. Most stones having entered the ureter will pass spontaneously into the bladder by the prescuption of conservative treatment such as forcing fluid, sedation, etc. During the attack of colic analgetics may be required to control the pain; if after many days, there is no evidence of progression in the descent of the stone, ureteral catheterisation may be used in dislodging it. On rare occa­sions an operation (usually extra-peritoneal with incision into the ure­ter) should be performed to remove the stone. Large stones in the kidney cannot be passed by way of the ureter and if symptoms are produced operation is necessary. If the stones are present in both kid­neys, it is usually preferable to operate first on the kidney with the poorer function, since the operation may produce a temporary anuria; if the better kidney is the one operated on first, and temporary anuria results, a fatal outcome may follow.

Упражнение 5. Просмотрите текст А еще раз и перечислите основные симптомы и способы лечения мочекаменной болезни.

Упражнение 6. Найдите в тексте А ответы на следующие вопросы и считайте их.

1. Do stones in kidneys usually produce pyelonephritis? 2. What symp-(oms help to diagnose renal calculi? 3. What is renal colic and how does it manifest? 4. When is conservative treatment used in cases of renal calculi? 5. What kidney is operated on first if the stones are present in both of them and why?

Упражнение 7. Напишите возможные сочетания: а) глаголов и существи­тельных; б) прилагательных и существительных.

a) to produce the cortex b) large amount

to involve X-ray film mild calculi

to progress to anuria severe loss of kidney

to make a pain ultimate stones

to control symptoms variable pyelonephritis

198 ♦ Learning to Understand a Medical Text

Упражнение 8. Прочтите и переведите аннотации. Скажите, какая из них передает содержание текста наиболее адекватно и более полно отвечает требованиям, предъявляемым к аннотации.