Symptoms of chronic glomerulonephritis with isolated urinary syndrome. Glomerulonephritis

The content of the article:

Glomerulonephritis is a diffuse multifactorial disease of the glomerular apparatus of the kidneys of immune or allergic origin.

A chronic inflammatory process in the glomeruli leads to the loss of the functional ability of the kidneys to rid the blood of toxins.

A long-term pathology is always complicated by the development of chronic renal failure.

Chronization of the process is discussed when immune inflammation in the kidneys exists for a year.

Code according to the international classification of diseases ICD-10:

N03 Chronic nephritic syndrome

Pathogenesis

1. The following changes occur in the walls of the vessels of the renal glomeruli:

The permeability of the vascular wall of the renal glomerulus for cellular elements increases.

The formation of microthrombi occurs, followed by blockage of the lumen of the vessels of the glomerular apparatus.

Blood circulation in the modified vessels is disturbed, up to complete ischemia.

Erythrocytes settle on important renal structures of the nephron: Bowman's capsule, renal tubules.

The process of filtering the blood and the production of primary urine is disrupted.

Violation of blood circulation in the renal glomerulus entails the desolation of the lumen and the gluing of the walls, followed by the transformation of the nephron into connective tissue. The gradual loss of structural units leads to a decrease in the volume of filtered blood (one of the causes of CRF). There are fewer and fewer nephrons capable of performing their work normally, which leads to poisoning of the body with metabolic products, while the necessary substances are returned to the blood in an incomplete volume.

Etiology and provoking factors

The etiology of CGN is as follows:

Infectious agents - bacterial (Str, Staf, Tbs, etc.), viral (hepatitis B, C, cytomegalovirus, HIV)

Toxic agents - alcohol, drugs, organic solvents, mercury

The cause in most cases is group A beta-hemolytic streptococcus.

Diseases that contribute to the development of pathology:

Angina and chronic tonsillitis,
Scarlet fever,
infectious diseases of the heart,
Sepsis,
Pneumonia,
mumps,
rheumatic diseases,
Autoimmune pathology.

Classification of chronic glomerulonephritis

Form of glomerulonephritis	The activity of the renal process	Status of kidney function
1. Acute glomerulonephritis With nephritic (hematuric) syndrome - with nephrotic syndrome - with isolated urinary syndrome - with nephrotic syndrome, hematuria and hypertension	1. The period of initial manifestations (peak) 2. Period of reverse development 3. Transition to chronic glomerulonephritis	3. Acute renal failure
2. Chronic glomerulonephritis Hematuric form - nephrotic form - mixed form	1. Period of exacerbation 2. Period of partial remission 3. The period of complete clinical and laboratory remission	1. No kidney dysfunction 2. With impaired renal function 3. Chronic renal failure
3. Subacute (malignant) glomerulonephritis		1. With impaired renal function 2. Chronic renal failure

Morphological classification of CGN

diffuse proliferative

With half moons

Mesangioproliferative

Membrane-proliferative (mesangiocapillary)

membranous

With minimal changes

Focal segmental glomerulosclerosis

Fibrillar-immunotactoid

fibroplastic

The classification is based on an assessment of clinical and laboratory syndromes, pathogenesis (primary, secondary), functional ability of the kidneys (with loss, without loss, CRF) and morphology.

The course of CG is:

Recurrent (remission is replaced by an exacerbation).
Persistent, (constant activity of immune inflammation in the glomeruli with the preservation of the functional abilities of nephrons for a long time).
Progressive (constant activity of the process with a tendency to renal failure, and a gradual decrease in glomerular filtration).
Rapidly progressive (the process is so active that after a short period of time CRF is formed).

Clinical manifestations

In most cases, the pathology is characterized by slow development. Many patients cannot remember when the onset was and after which they fell ill.

The most typical signs:

Diuresis depends on the severity of chronic renal failure: a decrease in daily diuresis (oliguria) at the initial stage, with progression - polyuria (a lot of urine) with an outcome in anuria in the terminal stage of CRF, in the clinical analysis of urine, the pathological content of protein and erythrocytes.
Urination predominates, mainly at night: nocturia.
Edema: from minor to severe, localization is different.
Weakness, fatigue.
Increasing the temperature response.
development of persistent hypertension.
Thirst, the smell of acetone in the exhaled air, skin itching indicate the neglect of the disease and the progress of CRF.

There are several forms of chronic glomerulonephritis

Glomerulonephritis with isolated urinary syndrome

Isolated urinary syndrome is characterized by the following features:

Asymptomatic hematuria

Asymptomatic proteinuria

No complaints

No edema, AH

The most common variant is characterized by a benign course (aggressive treatment is not prescribed). The patient has no complaints with this form.

When examined in the urine, a small amount of protein and erythrocytes are found.

Since the disease proceeds secretly, and the progression of renal failure is slow but constant, sometimes all laboratory and clinical signs of chronic renal failure are found in first-time patients.

The latent form of chronic glomerulonephritis, despite the benign course with timely diagnosis, can be the cause of renal failure.

Nephrotic form of glomerulonephritis

Occupies a little over 20% of cases. It differs by pronounced clinical manifestations, the leading symptom is the appearance of significant edema.

In the clinical analysis of urine, the loss of protein (mainly albumin) is more than 3 g / day, due to which, on the contrary, there is not enough protein substances in the plasma.

Increased blood cholesterol, triglycerides and low-density lipoproteins.
The nephrotic form of glomerulonephritis is an indication for emergency hospitalization of the patient, since his condition is regarded as severe due to the development of ascites, pleurisy, etc. against the background of massive edema. In addition, the patient has a risk of developing a secondary infection against the background of reduced immunity, osteoporosis, thrombosis, hypothyroidism, atherosclerosis, heart attack, stroke.

All of the above pathology is a consequence of a violation of water and electrolyte balance (loss of zinc, copper, vitamin D, calcium, thyroid-stimulating hormones, etc. in the urine).

The most formidable complications of the nephrotic form of glomerulonephritis are cerebral edema and hypovolemic shock.

Mixed variant or hypertensive form of glomerulonephritis

It is characterized by a combination of nephrotic syndrome and persistent hypertension (increased blood pressure). Typically, rapid progression with an outcome in chronic renal failure, due to the detrimental effect of hypertension on the renal vessels.

Hematuric form of glomerulonephritis

Chronic glomerulnephritis in men is more often in the hematuric form.

Edema does not appear, there is no increase in blood pressure.

There is no pronounced proteinuria (no more than 1g/day), but there is hematuria (erythrocytes in the urine).

Factors provoking hematuric chronic glomerulonephritis include:

alcohol intoxication,
poisoning with any substance
colds in Berger's disease.

Nephrologists note the following pattern: the brighter the clinical manifestations, the greater the chances of a complete restoration of the functional ability of the kidneys.

It must be remembered that any form of CG, under certain circumstances, can go into an acute stage with a clinic typical of acute glomerulonephritis.

Chronic glomerulonephritis in the acute stage will be treated according to the scheme used in the treatment of acute immune inflammation of the kidneys.

How to diagnose chronic glomerulonephritis

An important role in the diagnosis of CG is assigned to clinical and laboratory studies. During the conversation between the doctor and the patient, attention is paid to the presence of infectious diseases in the anamnesis, comorbidities, in particular, systemic diseases, and the urological history is clarified.

General clinical analysis of urine

Urine in chronic glomerulonephritis is variable, it depends on the morphology of the pathological process. Typically, a decrease in specific gravity; the greater the amount of protein in the urine (up to 10 g / day), the more data for the nephrotic form.

Erythrocytes are present: gross hematuria or microhematuria. In the urine sediment, hyaline and granular casts (nephrotic and mixed form), fibrin are found.

For the hypertensive form, a decrease in glomerular filtration is typical.

Biochemistry of blood

1. increase in the level of cretinin, urea,
2. hypoproteinemia and dysproteinemia,
3. hypercholesterolemia.
4. increase in the titer of antibodies to streptococcus (ASL-O, antihyaluronidase, antistreptokinase),
5. decrease in the level of C3 and C4,
6. increase in all immunoglobulins M, G, A
7. electrolyte imbalance.

Urine culture for flora and sensitivity to drugs.
Zimnitsky test.
Nechiporenko test.
Rehberg's test.

Instrumental diagnostics

Doppler ultrasound of the kidneys
At the initial stages, ultrasound diagnostics does not reveal pronounced changes.
If there is a progression of chronic glomerulonephritis, sclerotic processes in the kidneys with a decrease in their size are possible.

Survey and excretory urography, radioisotope scintigraphy allow to evaluate the function of each kidney separately and the general condition of the parenchyma.

ECG
If the patient has persistent hypertension, electrocardiography will confirm hypertrophy (enlargement) of the left ventricle.

Fundus examination

The symptoms are similar to those of hypertension:

1. narrowing of the arteries,
2. varicose veins,
3. pinpoint hemorrhages,
4. microthrombosis,
5. puffiness.

To determine the morphological component of the form of chronic hepatitis, it is possible to conduct a diagnostic biopsy. According to the results of the morphological conclusion, the treatment tactics are chosen.

The procedure is considered invasive and has a number of contraindications:

Solitary kidney or no collateral kidney function.
Coagulopathy.
Right ventricular failure.
infectious processes.
Hydronephrosis.
Polycystic.
Thrombosis of the renal arteries.
Kidney cancer.
Heart attacks, acute stroke.
Confusion of consciousness.

Differential diagnosis is carried out with the following diseases:

chronic pyelonephritis,
hemorrhagic fever with renal syndrome,
nephrolithiasis,
hypertension,
tuberculous lesions of the genitourinary organs, etc.

Treatment for chronic glomerulonephritis

The treatment regimen will depend on the form of the disease, clinical manifestations, comorbidities, and the presence of complications.

The main aspects of treatment for chronic glomerulonephritis are to normalize blood pressure, eliminate edema and maximize the lengthening of the pre-dialysis time period.
It is recommended to normalize the regime of work and rest, to avoid hypothermia, work with toxic substances.

Pay attention to the timely sanitation of foci of possible infection: caries, tonsils, throat, etc.

Diet for chronic glomerulonephritis

Great importance is attached to the correct diet.

Chronic renal failure leads to a violation of the electrolyte balance of the blood, self-poisoning of the body as a result of the accumulation of toxic substances.

Properly selected nutrition is able to correct the adverse effects of toxins on the body at the initial stage of CRF. Yes, and at all other stages of chronic renal failure without a diet, nowhere.

What can you eat with glomerulonephritis - unites diet (table number 7).

Her main theses:

Rejection of salt.
Reducing the amount of fluid consumed.
Introduction to the diet of foods with a high content of potassium and calcium.
Limiting the intake of animal proteins.
Introduction to the diet of vegetable fats and carbohydrates.

Proper nutrition with chronic hepatitis will allow you to do without hemodialysis or kidney transplantation for longer

Medicines for chronic glomerulonephritis

Immunosuppressive drugs

First line drugs are immunosuppressive agents. Due to the overwhelming effect on the activity of the immune system, the pathological processes in the glomerular apparatus of the kidney are slowed down.

Steroids

The dosage of prednisolone is calculated individually, 1 mc / kg per day, for 2 months, with a gradual decrease in order to avoid withdrawal syndrome. Periodically prescribed pulse therapy (the introduction of corticosteroid drugs in a high dose for a short time). With irregular intake, incorrect dosage, untimely therapy, and with a severe degree of immune disorders, the effectiveness is reduced.

Contraindications for treatment with nonsteroidal hormones are the following conditions:

Tuberculosis and syphilis in active form,
viral ophthalmic diseases,
infectious processes,
lactation,
pyoderma.

Steroids are used with caution in diabetes mellitus, thromboembolism, herpes,
systemic candidiasis, hypertension, Itsenko-Cushing's disease, severe chronic renal failure.

Cytostatics

Applied with progressive forms of chronic pyelonephritis in men and women, and in all cases where there are contraindications to the appointment of steroid drugs, or the appearance of complications, or in the absence of the effect of therapy.

Sometimes hormonal drugs and cytostatics are included in the treatment regimen at the same time.

Contraindications: pregnancy and the active phase of infectious processes.

With caution: severe violations of the liver and kidneys, blood pathology.

List of cytostatics for chronic glomerulonephritis in men and women:

Cyclophosphamide,
Chlorambucil,
Cyclosporine
Azathioprine

Complications: hemorrhagic cystitis, pneumonia, agranulocytosis (pathological changes in the blood, oppression of hematopoiesis).

With developed side effects, cytostatic therapy for chronic glomerulonephritis in men and women is canceled.

Non-steroidal anti-inflammatory drugs

It was believed that Indomethacin, Ibuklin, Ibuprofen are able to suppress the autoimmune response. Not all nephrologists prescribe NSAIDs, since drugs from the NSAID group have a toxic effect on the kidneys and often provoke the development of drug-induced nephropathy even without glomerulonephritis.

Anticoagulants and antiplatelet agents

Contribute to the improvement of the rheological properties of blood. They prevent the processes of thrombosis in the renal glomeruli and the adhesion of blood vessels. Heparin is most often used in a course of 3 to 10 weeks in individual dosages, which depend on many factors, including coagulation parameters.

Symptomatic therapy

Symptomatic therapy depends on the clinical manifestations of chronic glomerulonephritis and includes:

Antihypertensive drugs.
Diuretics.
Antibiotics.

Antihypertensive drugs

Some forms of GM are characterized by a persistent increase in blood pressure, therefore, the appointment of antihypertensive drugs from the group of ACE inhibitors is justified:

captopril,
enalapril,
ramipril.

Diuretics

To activate the flow of fluid in the nephron, diuretics are used:

Antibacterial drugs

Sometimes chronic hepatitis occurs against the background of any infections, in which case antibacterial drugs are prescribed to prevent secondary infection. Protected penicillins are more often prescribed, since the drugs are less toxic and effective against group A beta-hemolytic streptococcus.

In case of intolerance to penicillins, cephalosporin antibiotics can be used. The use of antibiotics is justified when there is a proven connection between the development of glomerulonephritis and an infectious process, for example, in a man or woman, glomerulonephritis after streptococcal tonsillitis appeared 14 days later.

The outcome of chronic diffuse glomerulonephritis is always secondary wrinkling of the kidneys and the onset of chronic renal failure.

If chronic renal failure has led to significant disturbances in the functioning of the body, when the creatinine level reaches 440 µmol/l, program hemodialysis is indicated. In this case, the direction of the patient for examination for disability is justified. By itself, the diagnosis of CG, without impaired renal function, does not give the right to disability.

Hypercholesterolemia is treated with statins to lower cholesterol levels.
There are good reviews from the use of plasmapheresis for glomerulonephritis.

Chronic glomerulonephritis in children

In pediatrics, glomerulonephritis in children ranks second after urinary tract infections. Most often, children aged 3 to 9 years are affected.

Boys experience immune inflammation in the kidneys 2 times more often than girls. In some cases, the pathology develops 10-14 days after the childhood infection. As well as in adult men and women, chronic glomerulonephritis is the outcome of an acute immunological process in the kidneys.

Clinical manifestations, forms, signs are identical.

Treatment is less aggressive due to age.

Chronic glomerulonephritis in children is treated by a nephrologist.

Prevention of exacerbations in chronic glomerulonephritis comes down to timely sanitation of foci of inflammation, regular monitoring of clinical and laboratory parameters, diet, avoidance of hypothermia, timely treatment.

Prognosis for chronic glomerulonephritis depending on the morphological variant

GN minimal changes - the safety of kidney function after 5 years - 95%;

Membranous GN - preservation of kidney function after 5 years - 50-70%

FSGS - preservation of kidney function after 5 years - 45 -50%

Mesangioproliferative - preservation of kidney function after 5 years - 80%

Membrano-proliferative - preservation of kidney function after 5 years - 45 - 60%

Life expectancy depends on the clinical variant of the disease and the characteristics of the functional state of the kidneys.

Favorable prognosis for the latent variant (subject to timely treatment), doubtful for hematuric and hypertonic variants.

The prognosis is unfavorable for nephrotic and mixed forms of glomerulonephritis.

- This is an immunoinflammatory disease characterized by the involvement of the structural units of the kidneys - nephrons and a predominant lesion of the glomerular apparatus. Pathology proceeds with the development of extrarenal syndromes (edematous and hypertensive) and renal manifestations (urinary syndrome). In the diagnosis, urinalysis is used (general analysis, Reberg, Zimnitsky, Nechiporenko test), ultrasound of the kidneys, biochemical and immunological blood tests, biopsy of the kidney tissue. Treatment requires adherence to bed rest and diet, the appointment of steroid hormones, antihypertensives, diuretics.

General information

Diagnostics

When diagnosing acute glomerulonephritis, the presence of typical clinical syndromes, changes in the urine, biochemical and immunological blood tests, ultrasound data and kidney biopsy are taken into account. Urinalysis is characterized by proteinuria, hematuria, cylindruria. For the Zimnitsky test, a decrease in the amount of daily urine and an increase in its relative density are typical. Reberg's test reflects a decrease in the filtration capacity of the kidneys.

Changes in blood biochemical parameters may include hypoproteinemia, dysproteinemia (decrease in albumin and increase in the concentration of globulins), the appearance of CRP, and sialic acids, moderate hypercholesterolemia and hyperlipidemia, hyperazotemia. In the study of the coagulogram, shifts in the coagulation system are determined - hypercoagulation syndrome. Immunological analyzes reveal an increase in the titer of ASL-O, antistreptokinase, antihyaluronidase, antideoxyribonuclease B; increase in the content of IgG, IgM, less often IgA; hypocomplementemia C3 and C4.

Ultrasound of the kidneys usually shows unchanged organ sizes, decreased echogenicity, and decreased glomerular filtration rate. Indications for a kidney biopsy are the need to differentiate acute and chronic glomerulonephritis, the rapidly progressive course of the disease. In the acute form of the disease, signs of cell proliferation, glomerular infiltration by monocytes and neutrophils, the presence of dense deposits of immune complexes, etc. are determined in the nephrobioptate. In hypertensive syndrome, it is necessary to conduct an examination of the fundus and ECG.

Treatment of acute glomerulonephritis

Therapy is carried out in a urological hospital and requires the appointment of strict bed rest, salt-free dietary nutrition with restriction of the consumption of animal proteins, liquids, the appointment of "sugar" and fasting days. A strict record of the amount of fluid consumed and the volume of diuresis is made. The main therapy consists in the use of steroid hormones - prednisolone, dexamethasone, with a course of up to 5-6 weeks.

With severe edema and arterial hypertension, diuretic and antihypertensive drugs are simultaneously prescribed. Antibiotic therapy is carried out with the existing signs of infection (tonsillitis, pneumonia, endocarditis, etc.). In acute renal failure, it may be necessary to prescribe anticoagulants, hemodialysis. The course of inpatient treatment is 1-1.5 months, after which the patient is discharged under the supervision of a nephrologist.

Forecast and prevention

In most cases, the pathology responds well to therapy with corticosteroid hormones and ends in recovery. In 1/3 of cases, a transition to a chronic form is possible; deaths are extremely rare. At the stage of dispensary observation, the patient needs a dynamic examination of urine.

Prevention of the development of primary acute glomerulonephritis and its relapses consists in the treatment of acute infections, the rehabilitation of chronic foci in the nasopharynx and oral cavity, increasing the body's resistance, preventing cooling and prolonged exposure to a humid environment. Persons with an increased allergic background (urticaria, bronchial asthma, hay fever) preventive vaccinations are contraindicated.

Acute glomerulonephritis with nephrotic syndrome - Inflammation of the kidneys (nephritis), Glomerulonephritis (glomerular nephritis)

Recently, the nephrotic form of glomerulonephritis is rare: 1-6 cases per 10,000 people, people under the age of 40 are susceptible to it, it occurs more often in men and in children from 5 to 14 years old, persons whose profession is associated with hypothermia are at risk . In old age, the disease is less common, but it is difficult and often becomes chronic.

general information

Acute glomerulonephritis (AGN) is a group of diseases of an infectious-allergic nature, different in origin, outcomes and features of developmental mechanisms. The reasons why most of them occur remain unclear. At the moment, only the infectious factor has been well studied. Together with malfunctions of the immune system, it is the basis for the onset of the disease. The main difference between this group of diseases is the defeat of the glomerular apparatus of both kidneys.

Causes in children

A common cause of acute glomerulonephritis in children is infectious diseases caused by group A streptococcus, especially its 12th strain. The entrance to the infection is most often the tonsils, less often inflammation of the paranasal sinuses and middle ear. Parents need to take seriously the treatment of influenza, pharyngitis, sinusitis, otitis media, scarlet fever and carefully monitor the child's condition for 2-3 weeks after recovery, it is during this period that glomerulonephritis appears. There is a risk of developing the disease with allergies, after repeated serum vaccination and the use of drugs intolerable to the body.

Pathogenesis

Depending on the disturbances in the functioning of the body's defense system, two types of disease development are distinguished: autoimmune and immune complex. In the first variant, antibodies are produced against the body's own renal tissues, mistaking them for an antigen and creating immune complexes. Growing, these formations change the structure of the membranes and glomerular capillaries of the kidney. In the second variant, antibodies begin to interact with bacteria and viruses, also creating associations that circulate through the blood, and then settle on the membranes of the kidneys. Both in the first and in the second case, the growth of complexes leads to a change in the structure of the glomerular apparatus of the kidneys and a violation of filtration. This leads to the excretion of protein from the body and fluid retention.

Types of glomerulonephritis

There are several types of the course of the disease: typical (classic), atypical (monosymptomatic) and nephrotic. With a monosymptomatic variant, edema is poorly manifested and moderate disturbances in urination and changes in the composition of urine are slightly visible. In this regard, there is a high probability of a protracted course of the disease and the transition to chronic glomerulonephritis. The nephrotic variant provides, along with other signs, the presence of a nephrotic syndrome. This variant exhibits a variety of features that are related to other nephrotic diseases, making diagnosis difficult. The classic variant is associated with infectious diseases and is clearly expressed by a number of signs, they can vary and be expressed by several syndromes. All variants are characterized by the following types of syndromes:

uric;
hypertensive;
hydropic;
nephrotic syndrome.

Main symptoms in children and adults

Important signs that characterize glomerulonephritis include an increase in blood pressure (up to 140 - 160 mm Hg) and bradycardia (heart rate of 60 beats per minute). With a successful course of the disease, both symptoms disappear after 2-3 weeks. The main symptoms of nephrotic syndrome include saturated proteinuria, impaired water-electrolyte, protein and lipid metabolism, band and peripheral edema. Also, the disease is expressed by external signs:

shortness of breath;
nausea;
weight gain;
worried about thirst;

Edema syndrome

Often, edema is the first sign of manifestation of glomerulonephritis. In nephrotic syndrome, they are characterized by a rapid ubiquitous distribution, they appear on the trunk and limbs. There are hidden edema, they can be detected by periodically weighing the patient and monitoring the ratio of the volume of fluid drunk and the amount of urine excreted.

Edema in glomerulonephritis has complex mechanisms. Due to a violation of filtration in the membranes of the capillaries of the renal glomeruli, water and sodium are not excreted from the body. And due to the increase in the permeability of the capillaries, fluid and protein come out of the bloodstream into the tissues, which makes the edema dense. The accumulation of fluid occurs in the pleural plane of the lungs, the pericardial sac, in the abdominal cavity. Edema occurs quickly and disappears on the 14th day of treatment.

Diagnostic measures

Diagnostic procedures include laboratory studies of general and special urine and blood tests, immunological tests. In nephrotic syndrome, the study of renal tissue using a kidney biopsy is often used. Important data for differential diagnosis can be obtained by ultrasound, computed tomography and x-rays.

Nephrotic form of acute glomerulonephritis

Nephrotic syndrome is a characteristic sign of the nephrotic form of glomerulonephritis. This form is often found in children. The disease begins gradually, proceeds in waves, temporary weakening (remissions) are replaced by exacerbations. For quite a long time, the state of the kidneys remains within acceptable limits, the edema disappears, the urine is cleared, only moderate proteinuria remains. In some cases, nephrotic syndrome persists during remissions. This course of the disease is dangerous and can lead to the development of renal failure. There are also transitions from the nephrotic form to the mixed one.

Treatment of AGN

The principle of treatment is aimed at eliminating the cause of the disease and preventing complications. All patients with suspected acute glomerulonephritis with nephrotic syndrome should be immediately hospitalized with mandatory bed rest, as restriction in physical activity helps to normalize renal circulation and filtration. A strict diet is also prescribed. In severe cases of the disease, the rule of hunger and thirst is applied for 1-2 days, you can only rinse in your mouth or consume a very small amount of liquid, in this case, children are allowed some sweet water.

Diet for glomerulonephritis is no less important than drugs, as it is aimed at reducing edematous and hypertensive syndromes. The food you eat should not contain sodium. It must contain potassium and calcium in order to restore the balance of these substances in the body. The diet is characterized by a significant reduction in fluid and salt intake, but with the preservation of calories and vitamins. These criteria are met by foods such as rice, potatoes, raisins, dried fruits and pumpkin. The diet changes depending on the disappearance of edema, lowering blood pressure and normalizing the ratio of drunk and excreted fluid. However, a low-salt diet is recommended for quite a long time.

Medical therapy

In the treatment, symptomatic conservative therapy is used. To eliminate edema and hypertension, Reserpine is used with Furosemide, Hypothezad or Veroshpiron. To increase glomerular filtration, Nifidipine or Cardofen are prescribed. Also, "Heparin" has a good deuritic effect, especially in the nephrotic form. To reduce capillary permeability, antihistamines are prescribed, for example, Dimedrol, Suprastin, Tavegil. Due to the infectious cause of the disease, antibiotics are prescribed without a nephrotoxic effect.

Due to the immune origin of acute glomerulonephritis, the use of glucocorticosteroid hormones, such as Prednisolone or Metlprednisolone, is justified. Their use is especially effective in nephrotic syndrome and in the absence of a positive result from symptomatic therapy. Under the influence of these drugs, diuresis, urinary syndrome are significantly reduced, edema practically disappears and the composition of the blood improves. The entire treatment process should be fully controlled by the doctor and adjusted depending on the research data and the patient's condition.

Prognosis and possible complications

Full recovery occurs in most cases. Changes in the glomeruli and tubules undergo reverse development, and the microstructure of the kidney is restored. But minor changes in the glomeruli can persist for up to 2 years and, in case of adverse conditions, can give rise to a chronic form of glomerulonephritis or a recurrence of the disease.

Preventive measures

Patients who have had glomerulonephritis should be carefully monitored by a doctor for another 2-3 years. After suffering an infectious disease, it is required to pass urine for examination 2-3 times within a month in order to be able to notice the symptoms of glomerulonephritis in time. Avoid hypothermia and injury. Be wary of re-vaccination, especially if an allergic reaction was observed, accompanied by changes in the urine.

Acute glomerulonephritis is an immune disease in which the glomerular apparatus of the kidney, small vessels are affected and the filtration capacity of the organ is impaired. With a predominant lesion of the glomeruli, the inflammatory process can spread to the interstitial tissue. Most often, both kidneys are affected at the same time.

Pathology is rare. Mostly adults under 45 years old and children under 11-12 years old get sick. There are more men than women among the patients. Treatment is conservative.

Acute glomerulonephritis can occur after a disease caused by group A β-hemolytic streptococcus. These can be tonsillitis, scarlet fever, tonsillitis and other inflammatory processes of the Pirogov-Waldeyer ring. Also, immune damage to the kidneys can be a complication of typhus, diphtheria, brucellosis, streptococcal pneumonia. An important point in the pathogenesis of the development of glomerulonephritis is hypothermia, it is especially worth paying attention to the effect of "wet cold".

In a small percentage of cases, acute glomerulonephritis occurs as a response to the administration of sera and vaccines. Non-infectious causes also include individual intolerance to drugs, reactions to alcoholic beverages and their surrogates, toxic substances, and some allergens.

In addition, in some patients, the cause of the formation of pathology may be a genetic predisposition.

The pathogenetic mechanisms of the formation of the clinical picture of acute glomerulonephritis are associated with the fact that circulating immune complexes enter the glomerular apparatus of the kidney with the bloodstream and affect it. There is an increased growth of the endothelial tissue of the capillaries of the vessels, swelling of the endothelial cells, which leads to a narrowing of the lumen of the vessels. The basement membrane is also affected. Treatment with steroid hormones is aimed at eliminating these mechanisms.

Symptoms

The classic picture of acute glomerulonephritis is manifested by nephritic syndrome. It is characterized by the appearance of protein in the urine (up to 2 g / l), a large number of red blood cells (urine may have the color of meat slops), and extrarenal manifestations include spontaneous arterial hypertension and edema.

Acute glomerulonephritis begins acutely, on average 21 days after a streptococcal infection. Patients complain of severe weakness, fatigue, cranialgia, decreased appetite, palpitations, pain in the heart and lower back. On examination, the doctor notes the pallor of the skin, swelling or puffiness of the face, which is most pronounced in the morning after waking up.

Edema is the most characteristic symptom of glomerulonephritis. They come on quickly and are permanent. With an aggressive course of the disease, ascites (the presence of free fluid in the abdominal cavity), hydrothorax (fluid in the pleural cavity) or hydropericardium (fluid in the pericardial cavity) may develop. The edematous syndrome is pathognomonic and occurs in 90% of patients.

Hypertensive syndrome can also serve as a marker of glomerulonephritis. The increase in pressure is short-lived. The systolic component is more elevated than the diastolic component. Often associated with bradycardia. If hypertension reaches high numbers and is stable, then the prognosis of the disease is unfavorable.

flow shapes

Acute glomerulonephritis can manifest itself in two clinical forms. The cyclic form is characterized by a rapid onset and rapid development. The patient abruptly, against the background of complete well-being, develops edematous syndrome, complaints of cranialgia and back pain, the amount of urine excreted suddenly decreases, systolic and diastolic pressure increases. Productive symptoms increase rapidly and last about 20 days. After this period in the clinical course of the disease, a "fracture" is planned and the patient's condition gradually stabilizes.

With a latent form, the clinical manifestations are not so obvious, which makes it difficult to make a timely diagnosis. The onset of glomerulonephritis in this form is gradual, without pronounced subjective complaints. The patient may notice slight swelling or slight shortness of breath. Due to the scarcity of symptoms in the latent form, acute glomerulonephritis can become chronic. The duration of the active period of the disease can be up to several weeks. It is important to recognize glomerulonephritis in time and start pathogenetic and symptomatic treatment.

Diagnostics

Diagnosing acute glomerulonephritis is not so difficult. Important for this disease is a combination of history, complaints and changes in the urine. Changes in peripheral blood and biochemical parameters are not specific. Most often, patients have a slight anemia, an increase in the level of leukocytes with a predominance of young forms and eosinophils. A marker of inflammation is an increase in ESR up to 45 mm/hour. The higher this indicator, the more aggressive the inflammatory process.

With severe edematous syndrome, the level of total protein in the blood decreases.

Changes in urine tests help to make an accurate diagnosis. Acute glomerulonephritis is characterized by oliguria (up to 500 ml of urine per day) in the first days of the disease. Almost all patients have proteinuria from 1 g/l to 20 g/l. The highest concentration of protein in the urine is typical for the first days of the disease, and with proper and timely treatment, it slowly but surely decreases. The protein in the urine completely disappears and the work of the kidneys is restored 6-8 weeks after the relief of all symptoms.

Also in the first days of the disease appears blood in the urine. More often it is microhematuria, when the number of erythrocytes in the field of view does not exceed 50-60 g / l. But in some patients, hematuria reaches high numbers, and red blood cells fill half or the entire field of view.

Diagnostic criteria

Acute glomerulonephritis has its own diagnostic criteria. They are convenient to use for a quick diagnosis. It must be remembered that this disease occurs 1-3 weeks after a streptococcal infection, vaccination or medication. This period is necessary for the sensitization of the body and the development of the CEC.

Also, acute glomerulonephritis is characterized by a triad of syndromes: edematous, nephritic and hypertensive. In the urine in a laboratory study, hematuria, proteinuria, cylindruria are determined. In the blood, there are changes characteristic of the inflammatory process: C-reactive protein, increased ESR, blood hypercoagulation is possible.

Therapy Methods

All types of treatment of acute glomerulonephritis can be divided into basic, symptomatic and pathogenetic. Each of these methods of treatment has its own goal and is aimed at improving the general condition of the patient and a speedy recovery.

Basic therapy includes a special diet with salt restriction. This is a diet table according to Pevzner No. 7 or 7a. It is recommended to use cottage cheese, eggs to ensure the need for protein. It is important to calculate the amount of fat (up to 80 mg / day). Basic antibiotic therapy is indicated in the presence of a history of an infectious disease (tonsillitis, carditis, and others).

Symptomatic therapy consists of taking antihypertensive drugs for severe arterial hypertension and diuretics for severe edema (furosemide, lasix).

With severe damage to the glomerular apparatus of the kidneys, intravenous administration of steroid hormones (prednisolone, dexamethasone) is sometimes prescribed. They are prescribed for nephrotic syndrome, a significant deterioration in kidney function, or a prolonged course of the disease. Treatment with steroid hormones is indicated for the relief of edematous and urinary syndrome, as well as to prevent the transition of acute glomerulonephritis to chronic.

Complications and prognosis

The most dangerous complication of glomerulonephritis is the transition of the disease into a chronic form. Chronicization of the disease is possible in 30% of patients. However, the timely administration of corticosteroids helps to reduce this ratio.

Glomerulonephritis can be complicated by such formidable conditions as: eclampsia, acute heart or kidney failure.

Due to a sudden and severe increase in blood pressure and an increase in circulating blood volume, the load on the left ventricle of the heart increases markedly. Clinically, this may manifest as cardiac asthma or pulmonary edema. In older and older people, this complication can be fatal.

With late seeking medical help for glomerulonephritis with severe edematous syndrome, eclampsia may develop. Clinically, this appears as a sudden loss of consciousness, tonic-clonic convulsions and a sharp increase in blood pressure. This condition is dangerous with the possibility of developing a stroke. With the development of complications, drugs are added to the treatment regimen to relieve these conditions.

With timely seeking medical help and following the doctor's recommendations in full, full recovery can occur in 2-3 months. We can talk about complete recovery when the data of laboratory tests of urine correspond to the age norm.

If the symptoms or changes in laboratory tests do not disappear within a year, then we can talk about the transition of the disease to a chronic form.

Glomerulonephritis- kidney disease of an immunoinflammatory nature.

It affects mainly the renal glomeruli. To a lesser extent, interstitial tissue and renal tubules are involved in the process. Glomerulonephritis occurs as an independent disease or develops with some systemic diseases (infective endocarditis, hemorrhagic vasculitis, systemic lupus erythematosus).

In most cases, the development of glomerulonephritis is due to an excessive immune response of the body to antigens of an infectious nature. There is also an autoimmune form of glomerulonephritis, in which kidney damage occurs as a result of the destructive effects of autoantibodies (antibodies to the cells of one's own body).

With glomerulonephritis, antigen-antibody complexes are deposited in the capillaries of the renal glomeruli, worsening blood circulation, as a result of which the process of producing primary urine is disrupted, water, salt and metabolic products are retained in the body, and the level of antihypertensive factors decreases. All this leads to arterial hypertension and the development of renal failure.

Prevalence of glomerulonephritis

Glomerulonephritis ranks second among acquired kidney diseases in children after urinary tract infections. According to the statistics of domestic urology, glomerulonephritis is the most common cause of early disability in patients due to the development of chronic renal failure.
The development of acute glomerulonephritis is possible at any age, but, as a rule, the disease occurs in patients under the age of 40 years.

Symptoms of glomerulonephritis

Symptoms of acute diffuse glomerulonephritis appear one to three weeks after an infectious disease, usually caused by streptococci (tonsillitis, pyoderma, tonsillitis). Acute glomerulonephritis is characterized by three main groups of symptoms:

urinary (oliguria, micro- or macrohematuria);
hydropic;
hypertensive.

Acute glomerulonephritis in children, as a rule, develops rapidly, flows cyclically and usually ends in recovery. When acute glomerulonephritis occurs in adults, an erased form is more often observed, which is characterized by changes in urine, the absence of general symptoms, and a tendency to become chronic.

Glomerulonephritis begins with fever (significant hyperthermia is possible), chilling, general weakness, nausea, loss of appetite, headache and pain in the lumbar region. The patient becomes pale, his eyelids swell. In acute glomerulonephritis, there is a decrease in diuresis in the first 3-5 days from the onset of the disease. Then the amount of urine released increases, but its relative density decreases. Another constant and mandatory sign of glomerulonephritis is hematuria (the presence of blood in the urine). In 83-85% of cases, microhematuria develops. In 13-15%, the development of gross hematuria is possible, which is characterized by urine of the color of "meat slops", sometimes black or dark brown.

One of the most specific symptoms of glomerulonephritis is swelling of the face, expressed in the morning and decreasing during the day. It should be noted that the retention of 2-3 liters of fluid in the muscles and subcutaneous adipose tissue is possible without the development of visible edema. In overweight preschool children, the only sign of edema is sometimes some thickening of the subcutaneous tissue.

In 60% of patients with acute glomerulonephritis, hypertension develops, which in severe forms of the disease can last up to several weeks. In 80-85% of cases, acute glomerulonephritis causes damage to the cardiovascular system in children. Possible violations of the function of the central nervous system and enlargement of the liver.

There are two main variants of the course of acute glomerulonephritis:

typical (cyclic). A rapid onset and a significant severity of clinical symptoms are characteristic;
latent (acyclic). Erased form of glomerulonephritis, characterized by a gradual onset and mild symptoms.

Represents a significant danger due to late diagnosis and a tendency to transition to chronic glomerulonephritis.

With a favorable course of acute glomerulonephritis, timely diagnosis and initiation of treatment, the main symptoms (edema, arterial hypertension) disappear within 2-3 weeks. Complete recovery is observed after 2-2.5 months.

The following variants of the course of chronic glomerulonephritis are distinguished:

nephrotic(urinary symptoms predominate);
hypertensive(an increase in blood pressure is noted, urinary syndrome is mild);
mixed(a combination of hypertensive and nephrotic syndromes);
latent(a fairly common form, characterized by the absence of edema and arterial hypertension with mild nephrotic syndrome);
hematuric(the presence of red blood cells in the urine is noted, other symptoms are absent or mild).

All forms of glomerulonephritis are characterized by a relapsing course.

Clinical symptoms of exacerbation resemble or completely repeat the first episode of acute glomerulonephritis. The probability of recurrence increases in the spring-autumn period and occurs 1-2 days after exposure to an irritant, which is usually a streptococcal infection.

About the reasons

The first manifestations of the disease are fixed 1-4 weeks after the provoking effect.

FORMS OF GLOMERULONEPHRITIS

Glomerular lesions always develop bilaterally: both kidneys are affected simultaneously.

Acute glomerulonephritis- rapidly developing nephritic syndrome. This option gives the most favorable prognosis with appropriate treatment, rather than an asymptomatic course of pathology. Recovery after 2 months.

Subacute(rapidly progressive) damage to nephrons - acute onset and aggravation of the condition after 2 months due to the development of renal failure.

chronic course- asymptomatic onset of the disease, often pathological changes are detected with already developed renal failure. A long-term pathology leads to the replacement of nephrons with connective tissue.

Glomerulonephritis during pregnancy

In most cases, during pregnancy, women have an acute form of this disease. It occurs in pregnant women for the same reasons as in all other cases. The most common cause of the development of this pathology is considered to be infections of the ENT organs, as well as the throat, which could not be completely eliminated before the conception of the baby. It is not easy to identify the presence of this pathology in a pregnant woman, and all because this disease has symptoms that can occur even in healthy expectant mothers. This is excessive fatigue, and swelling, and pain in the lumbar region, and so on. The main method for detecting this disease in a pregnant woman is still a general urine test, which reveals an excessive amount of red blood cells and protein.

Glomerulonephritis, as well as the complications that arise against the background of this pathology, tend to greatly complicate the course of pregnancy. That is why there are cases when, in order to save the life of a mother suffering from this pathology, it is necessary to interrupt the course of pregnancy. We note right away that this happens extremely rarely.

Therapy of this disease during pregnancy involves:

therapy of edema and hypertension,
suppression of infection with antibiotic drugs that can be used during pregnancy,
maintaining kidney function until they are restored.

Therapy of this pathology during pregnancy should be carried out under the strict supervision of nephrologists and gynecologists.

DIAGNOSTICS

Diagnosis of the acute form of the disease we are considering is based on the appearance of the corresponding symptoms that occur after the previous transfer of SARS or tonsillitis. In addition, laboratory tests (blood and urine) are carried out, the following are distinguished as the main factors corresponding to the disease:

The presence of blood in the urine (hematuria). Urine, as previously noted, is similar to "meat slop" or becomes dark brown / black. Microhematuria is not always accompanied by a change in the color of urine. The onset of the disease is characterized by the appearance of fresh erythrocytes in the blood, followed by the release of alkaline erythrocytes.
Proteinuria is predominantly characterized by moderation (of the order of up to 6%), the duration is about three weeks.
Microscopy of the urinary sediment determines the presence of granular and hyaline casts, in the case of macrohematuria, erythrocyte casts.
During the study of clearance for endogenous creatinine, a pronounced decrease in the ability of the kidneys to filter is determined.
During the Zimnitsky test, nocturia and a decrease in diuresis are determined. Based on the high degree of relative density of urine, it can be assumed that the kidneys have retained their own concentration abilities.
A blood test determines an increase in its composition of residual nitrogen (which is defined as acute azotemia), as well as urea and some other elements. The content of cholesterol and creatinine is also increased.
In the blood, the analysis also reveals leukocytosis in combination with an acceleration of ESR, acidosis, and a decrease in the composition of alpha / beta globulins.
If there are doubts about the results of the analyzes, it is possible to consider a kidney biopsy, after which a morphological study of the seized material is performed.

TREATMENT OF GLOMERULONEPHRITIS

The main goal of therapy is to eliminate the infectious agent and suppress immunological reactions, as a result of which the body's own tissues suffer. Requires inpatient treatment. Measures include diet #7, medication, and bed rest.

The composition of drug therapy includes:

antibiotic agents;
immunomodulators;
corticosteroids;
non-steroidal anti-inflammatory drugs;
antihypertensive drugs.

The treatment regimen for glomerulonephritis is prescribed by a doctor. Complex therapy helps to eliminate both etiological factors and symptoms of the disease. After recovery, it is necessary to regularly take tests for the early diagnosis of possible recurrences of glomerulonephritis.

PREVENTION

Hypothermia should be avoided. It is also necessary to prevent the occurrence of infectious diseases, and when they develop, take timely therapeutic measures. In addition, it is necessary to monitor the diet, avoid excessive consumption of salt, as well as spicy and acidic foods.

Early diagnosis will help to avoid deterioration and complications.

FORECAST

Favorable when all therapeutic measures are observed. In some cases, serious complications can occur, leading to kidney failure and requiring urgent action. To prevent them, it is worth following the prescribed treatment and monitoring the dynamics of laboratory parameters. It is also necessary to prevent hypothermia and other etiological factors that can provoke a deterioration in the condition.