1.What is renal hypertension Abnormally high blood pressure caused by parenchymal lesions of the kidney or renal artery is called renal hypertension, which is divided into two types: volume-dependent hypertension and renin-dependent hypertension according to the etiology. Most of the hypertension caused by parenchymal renal lesions belongs to the volume-dependent hypertension type. The cause is related to water and sodium retention and volume expansion, while elevated renin and angiotensin II levels in the blood are not the main cause. Renin-dependent hypertension is common in renal vascular disease and in a few cases of renal parenchymal hypertension, due to abnormal secretion of renin—angiotensin—aldosterone. In such cases, the administration of diuretic therapy for dehydration does not control blood pressure, but leads to increased renin secretion due to decreased blood flow in the renal unit, making blood pressure higher. The two types of renal hypertension mentioned above can co-exist and sometimes may transform into each other. 2, how to properly palpate the kidneys The kidneys are mostly examined using the two-handed palpation method. During the examination, the examiner should be located on the right side of the patient, with the right hand on the patient’s right quarter rib, with the left hand holding the back waist, pay attention to the patient’s breathing as the right hand gradually presses deeper into the abdominal cavity, while using the left hand to push the posterior abdominal wall forward. This way the kidneys are examined through the cooperation of the two hands. When palpating the left kidney, the left hand can be used to go around the front of the patient’s body and hold the patient’s left posterior lumbar region with the palm of the left hand, while the palm of the right hand is squared on the left quarter of the rib cage with the fingers slightly bent and the end of the fingers placed below the rib arch. The kidneys are then examined in the same way. The normal kidneys are located bilaterally in the retroperitoneum and are difficult to palpate. Because the right kidney is lower than the left, the lower pole of the right kidney may be palpable in a few long, thin individuals. A prolapsed kidney is considered to be prolapsed if more than one-half of the kidney can be palpated during deep inspiration. Palpation of the kidney should pay attention to the size, shape, hardness, surface condition, and mobility of the kidney. A normal kidney is characterized by a smooth, blunt, rounded surface, firm texture, elasticity, and a sense of floating and sinking. When the kidney is touched, the patient has an uncomfortable feeling similar to nausea. 3, the kidney and ureter each have those pressure points The lesions in the upper urinary tract, including stones, acute inflammation, etc. are able to find some parts of pressure pain during the body check. Diseases such as renal tuberculosis, renal abscess or pyelonephritis can often be detected as pressure pain at the point of the rib ridge at the apex of the angle between the 12th rib and the spine or the point of the rib lumbar at the apex of the angle between the 12th rib and the outer edge of the psoas muscle. Diseases of the ureter, such as acute purulent inflammation, tuberculosis, or stones, can result in pressure pain at the upper or middle ureteral point. The former is located at the outer edge of the rectus abdominis muscle at the level of the flat umbilicus; the latter is located at the intersection of the vertical line made by the line connecting the anterior superior iliac crest and the pubic symphysis on both sides, which is equivalent to where the ureter enters the pelvis. 4, how to properly palpate the bladder A normal adult cannot palpate the bladder when it is empty. Palpation on the pubic bone is only possible when the volume of urine in the bladder exceeds 150 ml. Palpation of the bladder is usually performed by a one-handed glide. The patient is placed in a supine position and with legs bent. The examiner palpates with the right hand starting from the umbilicus and moving towards the pubic bone. The distended bladder is a cystic mass that cannot be pushed, is transversely oval or spherical in shape, the lower border is hidden behind the pubic bone and cannot be palpated, there is urination when the bladder is pressed, and the mass disappears after catheterization. The bladder should be differentiated from some suprapubic region masses such as ovarian cysts and uterus. Larger tumors of the bladder with a thin and soft abdominal wall can be palpated posterior to the pubic symphysis with the help of two-handed palpation. If combined with anesthesia, the extent, texture, and mobility of the bladder tumor can be estimated more accurately. In women, the examiner places one hand on the abdomen and the other in the patient’s vagina. In men, the examiner places the hand on the abdomen and the rectum respectively. 5. How to differentially diagnose percussion in the suprapubic area A circular percussion area can be found in the suprapubic area when the bladder is filled with urine. However, in women, a pregnant uterus, uterine fibroids, ovarian cysts, etc. can also appear in this area and should be differentiated. If the cloudy area disappears after urination or catheterization, it is due to distended bladder. Ascites can also cause a percussive zone in the supra-ulnar region, but the shape is different from that of the bladder. The arcuate upper edge of the percussion zone in ascites is concave toward the umbilicus, whereas the arcuate upper edge of the turbinate zone in distended bladder is convex toward the bladder, which can be used to differentiate.