Nephrology to train in pediatric nephrology, and internal medicine (adult) trained physicians may enter general (adult) nephrology fellowships. History and physical examination are central to the diagnostic workup in nephrology. The history typically includes the present illness, family history, general medical history, diet, medication use, drug use and occupation. The physical examination typically includes an assessment of volume state, blood pressure, heart, lungs, peripheral arteries, joints, abdomen and flank. Examination of the urine (urinalysis) allows a direct assessment for possible kidney problems, which may be suggested by appearance of blood in the urine (haematuria), protein in the urine (proteinuria), pus cells
Four Organs work, each tone sounds almost in sequence. A continuous maraca beat serves as a rhythmic framework. Reich describes the piece as "the longest V–I cadence in the history of Western Music," the V and I chords being contained within the one chord. "You'll find the chord in Debussy and Thelonious Monk – the tonic on top and the dominant on the bottom." He has cited the music of Pérotin and other twelfth and thirteenth century composers as suggesting the technique of note augmentation used in "Four Organs". For performances of the piece, Reich recommended using electronic organs with as plain