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
Transplantable organs and tissues cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ. The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate at first - this occurs because the cardiac muscle fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm. Once the donor organs are functioning normally, the heart-lung machine