Ultrasound in renal failure (lecture on Diagnostic). What is glomerulonephritis
Glomerulonephritis is an inflammatory disease of the kidneys. The inflammatory process extends to the glomeruli and renal tubules. The disease is independent, but sometimes accompanied by infective endocarditis, lupus, or hemorrhagic vasculitis. Diagnosis of glomerulonephritis is based on ultrasound of the kidneys and urine tests according to Zimnitsky.
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When the disease occurs, both kidneys are affected. It quickly turns into an acute form. In case of timely seeking medical help, it is treated within 2 months. Subacute nephron injury is acute at the onset of the disease and worsens over time. Possible development kidney failure. The chronic form is asymptomatic at the onset of the disease. Gradually develop pathological changes. They lead to replacement connective tissue nephrons.
Diagnostics
Diagnosis of glomerulonephritis disease involves laboratory confirmation using urine and blood tests. In case of rapid development or occurrence chronic stage a kidney biopsy is required. An important factor is instrumental examinations for the correct diagnosis and differential diagnosis. Timely diagnostic procedures have a beneficial effect on treatment.
Basic Research
The first visual examination of the patient is aimed at determining external. Next, the doctor finds out the presence of recently transferred infectious diseases, measures the pressure.
The symptoms of glomerulonephritis have many similar symptoms with acute pyelonephritis, so the doctor always directs the patient to diagnostic procedures.
The patient is examined in the clinic, after which he is placed in a hospital. The attending physician determines his bed rest and prescribes strict diet. When conducting medical examinations, doctors often, after patients pass tests for laboratory tests, find they have glomerulonephritis, which occurs without characteristic symptoms.
Urinalysis
Laboratory studies are required to formulate the correct diagnosis. Examinations for glomerulonephritis include a dynamic study of the composition of urine. Such examinations give a correct picture of the change and course of the inflammatory process. Appointed general analysis urine, according to Nechiporenko and according to the Kakovsky-Addis method.
The characteristic signs of the disease are:
- oliguria - a decrease in urine volume;
- hematuria - an increase in blood cells in the urine;
- proteinuria - an increased content of protein compounds in urine.
Glomerulonephritis always proceeds with proteinuria, which is typical in violation of filtration in the kidneys. Diagnosis of hematuria is an important consideration. It occurs due to inflammation of the glomeruli and, along with proteinuria, most qualitatively reflects the course of the disease and the dynamics of recovery. According to these symptoms, one can judge the preservation of the inflammatory process. On the 3rd day, oliguria can be observed, which is subsequently replaced by polyuria. If this symptom persists for more than 6 days, there may be a danger to the patient's life.
Other Research Methods
It is permissible to hold a special instrumental diagnostics. Inspection with the help of technical devices greatly simplifies the setting, especially in young children. For a more detailed study of the process of the course of the disease, its treatment and the determination of the onset of dangerous consequences for the patient's health, various technical tools are used: endoscopy, X-ray, computed tomography and ultrasound radiation.
Blood analysis
With the help of a blood test, you can find out the level of nitrogen in protein compounds. The composition begins to change in the case of an increase in the amount of water. To exclude the diagnosis of acute pyelonephritis, a special immunological test is used to determine the true cause of the disease. It is two-level - the first helps to identify violations in the body's immune system, and the second - to find out changes.
Differential Diagnosis
Diagnosis of differential is based on the study using the method of exclusion. The presence of symptoms and laboratory tests performed allows you to compare data using logical analysis algorithms and separate diseases that are similar in symptoms. Glomerulonephritis in its symptoms is similar to many kidney diseases. This is the difficulty of determining the differential diagnosis. Tuberculosis, pyelonephritis, kidney tumor and nephropathy should be excluded by exclusion.
ultrasound
The diagnosis of glomerulonephritis using ultrasound is quite easy to distinguish from other diseases by some specific signs: changes in the tubules and connective tissues, tissue thickening, diffuse transformations of the glomeruli, an increase in volume. characteristic feature is also a cluster excess fluid in internal organs which confirms the diagnosis.
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Glomerulonephritis in adults and children: its causes, signs and symptoms, diagnosis, and effective methods of therapy
Glomerulonephritis is a bilateral inflammatory pathology of the kidneys. accompanied by damage to small renal vessels. With the development of this disease, there is a violation of the main work of this organ: the formation of urine, the cleansing of the body from both toxic and unnecessary substances. This disease can affect a person of any age, however, in most cases, this pathology is observed in people under the age of forty. In the representatives of the stronger sex, glomerulonephritis is observed much more often than in the representatives of the weaker sex. In childhood, this disease is observed very often. In terms of its prevalence, it ranks second after infectious pathologies of the urinary system among all renal ailments. The most common cause of the development of this pathological condition is considered to be the reaction of the body to a variety of allergens and infections.
This disease is considered to be one of the most serious diseases of the kidneys. Acute glomerulonephritis is almost always completely cured. As for the chronic form of this pathology, it tends to cause the development of chronic renal failure. Patients with chronic renal failure require kidney transplantation and hemodialysis.
Glomerulonephritis - what is it?
Glomerulonephritis is an acute or chronic inflammation of the renal tissues, accompanied primarily by damage to the small vessels of the kidneys, as well as a violation of the function of the kidneys to form urine. If we compare this disease with pyelonephritis, then we can immediately pay attention to the fact that during its development, not one, but both kidneys are affected at the same time.
Glomerulonephritis - what are the causes of its occurrence?
Among the most common causes contributing to the development of this pathology, one can rank:
Infections. In most cases, the development of this pathology is a consequence of the impact on the human body of beta hemolytic streptococcus group A twelfth type. The same ailment can make itself felt as a result of scarlet fever. sore throats. pharyngitis. as well as some other pathologies that are inflammatory and infectious in nature. In the population of countries with a hot climate, this disease occurs, as a rule, due to streptococcal lesions of the skin, namely conflicts, as well as bullous streptococcal impetigo. Most often, with the development of this pathology, doctors manage to identify the source of the infection.
toxic ingredients. Among the main toxic components that tend to cause the development of this disease, one can rank both lead and alcoholic beverages, mercury, as well as organic solvents such as acetone, ethyl alcohol, gasoline, xylene, and so on.
The introduction of vaccinations. drugs, sera also quite often provokes the occurrence of this disease.
hypothermia in most cases, it becomes the cause of the development of "trench" nephritis. With hypothermia, there is a violation of the blood supply to the kidneys, as well as the development of an inflammatory process in this area.
Glomerulonephritis accompanies a huge number of systemic pathologies, namely infective endocarditis . systemic lupus erythematosus. hemorrhagic vasculitis and many others.
The main mechanism for the development of glomerulonephritis in adults and children
play an important role in the development of this disease immune reactions the human body to certain allergens or infections. Already two to three weeks after the impact of the infection on the body, antibodies begin to be produced in the human blood, which tend to resist the infection, while forming complexes of the so-called antigen-antibody. If the patient's blood shows a large number of infection antigens, then, together with the same amount of antibodies, they form heavy antigen-antibody complexes, which in turn move to the area of inflammation and initiate it.
This kind of inflammatory processes tend not only to damage the kidneys, but also disrupt their performance. As a result, glomerulonephritis occurs not so much due to infection, but as a result of the reaction of the human body to it. Allergic reactions, as well as inflammatory diseases such as chronic tonsillitis, can also provoke the occurrence of this pathology. angina and others.
In childhood, this ailment in most cases makes itself felt about two to three weeks after scarlet fever or sore throats. With this disease, unlike pyelonephritis. Both kidneys are affected, and always.
Glomerulonephritis in children and adults - what can it be? Forms of glomerulonephritis
The main forms of this disease can be considered:
Signs and symptoms accompanying glomerulonephritis in adults and children
All signs and symptoms of this pathology are determined by its form.
Acute glomerulonephritis and its symptoms
Signs and symptoms of this pathology can be very diverse. They can be both subtle and pronounced.
The main symptoms and signs include:
As soon as certain signs of this pathology are made known about themselves, a person should sign up for a consultation with a nephrologist as soon as possible and undergo all the necessary examinations.
Parents whose children have been ill scarlet fever or sore throat. special attention should be paid to general condition baby health. Signs of this pathology in children can make themselves felt only two to four weeks after suffering a sore throat or scarlet fever.
Subacute glomerulonephritis and its symptoms
This form of glomerulonephritis is considered to be the most difficult. In most cases, it occurs in adults. This disease is accompanied by serious changes in the urine ( erythrocytes and protein are observed in the urine), constant increase blood pressure, and edema. Signs and symptoms of subacute glomerulonephritis are similar to those of the acute form of this pathology. the only hallmark in this case, it is customary to consider a lower, but longer temperature. Plus, this form of this disease tends to cause the development of certain complications much faster.
In this case, after a few weeks, the patient has a complete loss of kidney function. As a result, the patient undergoes dialysis and kidney transplant.
Chronic glomerulonephritis and its symptoms
This form of glomerulonephritis tends to develop for a fairly long period of time. Sometimes this pathology is not accompanied by absolutely no symptoms, which is why it is not possible to identify it in a timely manner. In this case, the development of the disease is most often not interconnected with one or another acute inflammatory process. This pathology is accompanied by a very slow decrease in the efficiency of the kidney, as well as a gradual increase in blood pressure.
Prolonged lack of treatment of this pathology can cause chronic renal failure. In the case of chronic renal failure, there is a significant deterioration general well-being patient. As a result, without a course of therapy, a person dies. In most cases, chronic renal failure contributes to the development uremia. Uremia is a pathology accompanied by the accumulation of a large amount of urea in the blood, as well as damage to various systems and organs of the human body. The brain is particularly affected.
Signs and symptoms of uremia include:
Methods for diagnosing glomerulonephritis
The main diagnostic methods for this pathology include:
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 this pathology during pregnancy should be carried out under the strict supervision of nephrologists and gynecologists.
Therapy of glomerulonephritis in adults and children
Therapy of this disease is carried out in the nephrology department of the hospital. In most cases, patients enter this department in a very serious condition.
Therapy for acute glomerulonephritis
Therapy for this form of this disease involves the use of both diuretics and antibiotics. In addition, patients are advised to follow a special diet. The course of therapy in this case takes about ten days. Given the fact that this pathology most often occurs due to a streptococcal infection of the throat, penicillin preparations such as Amoxicillin may also be prescribed to the patient. benzylpenicillin procaine. and Phenoxymethylpenicillin. The exact dosage will be indicated by a specialist. For children whose body weight does not exceed thirty kilograms, this medication is prescribed in the amount of two hundred and fifty milligrams every eight hours. If the body weight of the child is from thirty to fifty kilograms, then he is prescribed two hundred and fifty - five hundred milligrams this drug every eight hours. Adolescents, as well as adults whose weight is less than eighty kilograms, are prescribed five hundred milligrams every eight hours. In the case of edema, it is very important to use diuretics such as Ethacrynic acid. Hypothiazide. Furosemide. With the development of arterial hypertension, one cannot do without the help of angiotensin-converting enzyme inhibitors, as well as diuretics. These pharmaceuticals include: Berlipril. so Captopril. and Enalapril .
Diet for acute glomerulonephritis
In the fight against this pathology, it is very important to adhere to special diet. Patients are advised to reduce to a minimum the amount of fluid consumed, as well as salt and protein. During the day, the patient can eat no more than two grams of salt. Of the foods that contain protein, you should give preference to egg white and cottage cheese. As for fats, you can eat no more than fifty grams per day. The normal daily amount of liquid in this case is considered to be six hundred - one thousand milliliters. Such patients are strictly prohibited from using meat soups. In most cases, the correct and timely course of therapy makes it possible not only to heal the patient, but also to completely restore the functioning of his kidneys.
Treatment of subacute and chronic glomerulonephritis
If we take into account information regarding the mechanism of development of glomerulonephritis, therapy for both subacute and chronic forms of this pathology provides for getting rid of the three most important links in the occurrence of this disease. In this case, attention is paid to the immune response, immune inflammation and sclerotic processes in the kidneys.
Suppression of the immune response
Most often, to suppress the immune response, doctors prescribe to their patients immunosuppressants .
Among them can be counted:
The effectiveness of therapy for the chronic form of this pathology is determined by the moment of initiation of treatment. In general, the sooner therapy is started, the more likely the patient is to heal completely. Even if the patient manages to completely get rid of this disease, he will in any case have to visit the doctor regularly for a very long period of time. In order to prevent the development of this pathology, it is necessary to timely treat infectious pathologies of the nasopharynx, as well as harden the body.
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Tests for glomerulonephritis
Timely diagnosis of glomerulonephritis and treatment is very important. They are able to prevent the severe course of this disease, in which the development of chronic renal failure is possible. The causes of glomerulonephritis often remain unclear. This is such a collective definition of unequal outcomes, course and origin of kidney disease. At this time, only infectious signs are well studied.
What is a disease?
Glomerulonephritis is an immunoinflammatory, immunoallergic group of diseases associated with damage to the vessels of the glomerular apparatus of both kidneys, changes in the structure of capillary membranes and impaired filtration. This leads to toxicity and excretion through the urine. necessary for the body components of protein, blood cells. The disease occurs in people under 40 years of age and in children. The course of the disease is divided into the following types:
- spicy;
- subacute;
- chronic;
- focal nephritis.
- swelling;
- shortness of breath;
- flakes and particles of blood in urine;
- cyanosis of the lips;
- significant weight gain;
- slow heartbeat;
- small amount of urine.
- proteinuria - high protein content;
- hematuria - the presence of excess blood particles;
- oliguria - a sharp decrease in the volume of excreted fluid.
Causes
Sinusitis can provoke the occurrence of glomerulonephritis.
This immune-inflammatory disease is possible after diphtheria, bacterial endocarditis, malaria, typhoid fever different types of pneumonia. It can develop due to repeated administration of serum vaccines, under the influence of drugs, alcohol, drugs, trauma and hypothermia, especially in a humid environment. The occurrence of glomerulonephritis in children is a consequence of past streptococcal infections, such as scarlet fever, inflammation of the tonsils (tonsillitis), otitis media, sinusitis and dental granuloma. It proceeds quickly and in most cases is completely cured.
external symptoms
External signs in chronic glomerulonephritis depend on the course of the disease. There are two options: classic (typical) and latent (atypical). With an atypical variant, edema is poorly manifested and moderate urination disorders are slightly visible. The classic variant is associated with infectious diseases, the symptoms with it are pronounced:
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Diagnostic procedures and tests for glomerulonephritis
Diagnosis of acute glomerulonephritis requires serious laboratory tests of blood and urine. With the rapid development of the disease and the chronic form, a kidney biopsy may be needed to study the kidney tissue and immunological tests. An important factor in the diagnosis are instrumental examinations and differential diagnosis. Timely diagnostic procedures facilitate the treatment of chronic glomerulonephritis.
First reception
At the first appointment, the patient is examined for external signs of acute glomerulonephritis. Then the transferred 10-20 days before the examination are clarified infectious diseases, hypothermia, the presence of kidney disease, blood pressure is measured. Because the visible symptoms similar to the signs of acute pyelonephritis, to establish the correct diagnosis, the doctor prescribes additional diagnostic procedures. The person is immediately sent to the hospital, bed rest and diet are attributed.
Laboratory research
Laboratory tests help to make an accurate diagnosis.
Laboratory diagnostics is an opportunity to make the correct diagnosis. Examination for glomerulonephritis includes a systematic study of the composition of urine and blood, which gives a correct idea of inflammatory processes in the body. For the study, a general urine test is prescribed, according to Nechiporenko and according to the Kakovsky-Addis method. Signs of acute glomerulonephritis:
Urinalysis
Proteinuria is the main symptom of glomerulonephritis. This is due to a violation of the filtering. Hematuria is an important symptom for diagnosis, it is a consequence of the destruction of glomerular capillaries. Along with proteinuria, it accurately shows the dynamics of the disease and the healing process. Enough for a long time these symptoms persist, signaling an unfinished inflammatory process. Oliguria is observed on the 1-3rd day, then it is replaced by polyuria. The persistence of this symptom for more than 6 days is dangerous.
Blood studies
At the beginning of the disease, a blood test shows a moderate increase in nitrogen-containing protein processing products. Additionally, its composition changes due to the high water content in the blood. An immunological two-level test is carried out, which indicates the cause of the disease and excludes the diagnosis of acute pyelonephritis. The first level checks gross violations in the immune system, the second is carried out to clarify the detected changes.
Instrumental diagnostics
This type of diagnostics is carried out on special medical equipment. Examination with the help of technology simplifies the procedure for diagnosing glomerulonephritis in children, because it is painless. X-rays are used to study the course of the disease, treat, detect dangerous changes in the kidney tissue, ultrasound scan, computed tomography, various ways endoscopy.
ultrasound diagnostics
Chronic glomerulonephritis on ultrasound can be distinguished from other nephrotic diseases by the following features: a sharp thickening of the tissue, an increase in volume with even and clear contours, diffuse changes in the glomeruli, connective tissues and tubules. These indicators differ from the signs of acute pyelonephritis, which simplifies differential diagnosis. Ultrasound examination shows the accumulation of fluid in the organs, which also defines acute glomerulonephritis.
Kidney biopsy
A nephrobiopsy or kidney biopsy is a procedure in which a small piece of kidney tissue is plucked off for examination. This method accurately classifies immune complexes, which allows you to determine the type, shape, cause, nature of changes and the severity of the disease. The difficult definition of chronic glomerulonephritis makes a biopsy an indispensable examination.
Differential Diagnosis
Differential diagnosis operates by the method of exclusion. A doctor, having a mosaic of symptoms and laboratory tests, using a combination of logical and diagnostic algorithms, can distinguish between similar diseases. Acute and chronic glomerulonephritis is similar in symptoms to many diseases. This makes the differential diagnosis more difficult. Acute pyelonephritis, nephropathy in diabetes, tuberculosis and tumors of the kidneys or urinary tract and many other nephroses will have to be ruled out.
Chronic glomerulonephritis - description, causes, symptoms (signs), diagnosis, treatment.
Short description
Chronic glomerulonephritis(CGN, slowly progressive glomerular disease, chronic nephritic syndrome) is a group concept that includes diseases of the glomeruli of the kidney with a common immune mechanism of damage and a gradual deterioration of renal functions with the development of renal failure.
Code by international classification ICD-10 diseases:
- N03 Chronic nephritic syndrome
CLASSIFICATION
Clinical(Tareev E.M. Tareeva I.E. 1958, 1972) . According to the forms .. Latent form .. Hematuric form (see Berger's disease) .. Hypertonic form .. Nephrotic form .. Mixed form. By phases.. Aggravation ( active phase) - an increase in changes in the urine (proteinuria and / or hematuria), the appearance of acute nephritic or nephrotic syndrome, a decrease in kidney function .. Remission - improvement or normalization of extrarenal manifestations (edema, arterial hypertension), kidney function and changes in urine.
Morphological(Serov V.V. et al. 1978, 1983) includes eight forms of CGN. Diffuse proliferative glomerulonephritis (see Acute glomerulonephritis). Glomerulonephritis with crescents (see Rapidly progressive glomerulonephritis). Mesangioproliferative glomerulonephritis. membranous glomerulonephritis. Membrano-proliferative (mesangiocapillary) glomerulonephritis. Focal segmental glomerulosclerosis. Fibroplastic glomerulonephritis.
Statistical data. The incidence is 13-50 cases per 10,000 population. Primary CGN occurs 2 times more often in men than in women, secondary - depending on the underlying disease. It can develop at any age, but most often in children 3-7 years old and adults 20-40 years old.
Causes
The same etiological factor can cause different morphological and clinical options nephropathy and vice versa different reasons can cause the same morphological variant of damage.
Diffuse proliferative - see Acute glomerulonephritis.
Glomerulonephritis with crescents (see Rapidly progressive glomerulonephritis).
Mesangioproliferative glomerulonephritis - hemorrhagic vasculitis, chronic viral hepatitis B, Crohn's disease, Sjogren's syndrome, ankylosing spondylitis, adenocarcinomas.
Membranous glomerulonephritis - carcinomas of the lung, intestines, stomach, mammary glands and kidneys (paraneoplastic glomerulonephritis), non-Hodgkin's lymphoma, leukemia, SLE (see Lupus nephritis), viral hepatitis B, syphilis, filariasis, malaria, schistosomiasis, exposure to drugs (drugs of gold and mercury, as well as trimethadione and penicillamine).
Membrano-proliferative glomerulonephritis - idiopathic, as well as secondary to SLE, cryoglobulinemia, chronic viral (HCV) or bacterial infections, drugs, toxins.
CGN with minimal changes- idiopathic, as well as acute respiratory infections, vaccinations, NSAIDs, rifampicin or a - IFN, Fabry disease, diabetes mellitus, lymphoproliferative pathology (Hodgkin's lymphoma).
Focal segmental glomerulosclerosis is idiopathic and also sickle cell anemia, renal transplant rejection, cyclosporine, surgical excision of part of the renal parenchyma, chronic vesicoureteral reflux, heroin use, congenital pathology (nephron dysgenesis, advanced Fabry disease), HIV infection.
Immune mechanisms are involved in the development and maintenance of inflammation.
In addition to immune and non-immune mechanisms are involved in the progression of CGN.. Intraglomerular hypertension and hyperfiltration.. Proteinuria (nephrotoxic effects of proteinuria have been proven).. Hyperlipidemia. urinary tract.
Pathomorphology depends on morphological form CGN. In any form, signs of sclerosis are revealed varying degrees in the glomeruli and interstitium - synechiae, sclerosed glomeruli, tubular atrophy. Proliferation and activation of mesangial cells play a key role in the accumulation and changes in the structure of the extracellular matrix, which ends with sclerosis of the glomerulus. Pathological changes are of exceptional importance for the diagnosis of glomerulonephritis, because. Diagnosis almost always requires a biopsy of the kidney tissue.
Diffuse proliferative - diffuse magnification the number of glomerular cells due to infiltration by neutrophils and monocytes and proliferation of glomerular endothelium and mesangial cells.
Crescentic glomerulonephritis (rapidly progressive) - see Rapidly progressive glomerulonephritis.
Mesangioproliferative - proliferation of mesangial cells and matrix.
Membrano - proliferative - diffuse proliferation of mesangial cells and infiltration of glomeruli by macrophages; mesangial matrix enlargement, thickening and doubling basement membrane.
CGN with minimal changes - light microscopy without pathology, with electron microscopy - the disappearance of the legs of podocytes.
Focal - segmental glomerulosclerosis - segmental collapse of capillaries in less than 50% of the glomeruli with the deposition of amorphous hyaline material.
Membranous - diffuse thickening of the basement membrane of the glomeruli with the formation of subepithelial protrusions surrounding deposits immune complexes(serrated view of basement membrane).
Fibroplastic glomerulonephritis is the outcome of most glomerulopathies, characterized by the severity of fibrotic processes.
Symptoms (signs)
Clinical manifestations. Symptoms appear 3-7 days after exposure to the trigger (latent period), and they may also be detected incidentally during a medical examination. Recurrent episodes of hematuria. Edema, urinary syndrome, arterial hypertension in various variants - nephrotic or acute nephritic syndrome (nephrotic form, mixed form - up to 10%, hypertonic form - 20-30%). A combination of manifestations of acute nephritic and nephrotic syndromes is possible. Complaints of headache, dark urine, edema and decreased diuresis. Objectively - pastosity or edema, increased blood pressure, expansion of the borders of the heart to the left. Body temperature is normal or subfebrile.
Clinical manifestations in various clinical forms
Latent CGN (50-60%) .. There are no edema and arterial hypertension .. In the urine, proteinuria is not more than 1-3 g / day, microhematuria, leukocyturia, casts (hyaline and erythrocyte) .. It can transform into nephrotic or hypertonic forms .. The development of CRF occurs within 10-20 years.
Hypertensive CGN .. Clinical manifestations of arterial hypertension syndrome .. Slight proteinuria in the urine, sometimes microhematuria, cylindruria .. CRF is formed within 15-25 years.
Hematuric CGN .. In the urine - recurrent or persistent hematuria and minimal proteinuria (less than 1 g / day) .. Extrarenal symptoms are absent .. CRF develops in 20-40% within 5-25 years.
Nephrotic form - clinical - laboratory manifestations nephrotic syndrome.
Mixed form .. Combination of nephrotic syndrome, arterial hypertension and / or hematuria .. Usually it is noted in secondary CGN, systemic diseases (SLE, systemic vasculitis) .. CRF is formed within 2-3 years.
Clinical picture depending on the morphological form
Mesangioproliferative CGN.. Isolated urinary syndrome.. Acute nephritic or nephrotic syndrome.. Macro - or microhematuria - Berger's disease.. CRF develops slowly.
Membranous CGN is manifested by nephrotic syndrome (80%).
Membrane-proliferative CGN .. Begins with acute nephritic syndrome, 50% of patients have nephrotic syndrome .. Isolated urinary syndrome with hematuria .. Arterial hypertension, hypocomplementemia, anemia, cryoglobulinemia are characteristic.
Glomerulonephritis with minimal changes. Nephrotic syndrome, in 20-30% of cases with microhematuria. Arterial hypertension and renal failure are rare.
Focal - segmental glomerulosclerosis.. Nephrotic syndrome.. Erythrocyturia, leukocyturia in the urine.. Arterial hypertension.. Chronic renal failure is natural.
Fibroplastic glomerulonephritis .. Nephrotic syndrome (up to 50%) .. CRF .. Arterial hypertension.
Diagnostics
Laboratory data
In the blood - moderate increase in ESR(with secondary CGN, it is possible to identify a significant increase, which depends on primary disease), an increase in the level of the CIC, antistreptolysin O, a decrease in the blood complement (immunocomplex CGN), with Berger's disease, an increase in the content of IgA is detected.
Reduced concentrations of total protein and albumin (significantly - in nephrotic syndrome), increased concentrations of a 2 - and b - globulins, hypogammaglobulinemia in nephrotic syndrome. With secondary CGN caused by systemic diseases of the connective tissue (lupus nephritis), g - globulins can be increased. Hyper - and dyslipidemia (nephrotic form).
Decreased GFR, increased levels of urea and creatinine, anemia, metabolic acidosis, hyperphosphatemia, etc. (ARF against the background of chronic renal failure or chronic renal failure).
In the urine, erythrocyturia, proteinuria (massive with nephrotic syndrome), leukocyturia, cylinders - granular, waxy (with nephrotic syndrome).
instrumental data. With ultrasound or survey urography, the size of the kidneys is normal or reduced (in chronic renal failure), the contours are smooth, echogenicity is diffusely increased. X-ray of organs chest- expansion of the boundaries of the heart to the left (with arterial hypertension). ECG - signs of left ventricular hypertrophy. Kidney biopsy (light, electron microscopy, immunofluorescent study) allows you to clarify the morphological form, CGN activity, exclude kidney diseases with similar symptoms.
Diagnostics. With a decrease in diuresis, the appearance dark urine, edema or pastosity of the face, an increase in blood pressure (may be the norm), a set of studies is carried out: measurement of blood pressure, total KLA, OAM, determination of daily proteinuria, total protein concentration and evaluate the proteinogram, blood lipids. Advanced physical and clinical laboratory examination aimed at identifying possible cause CGN - common or systemic disease. Ultrasound (radiography) of the kidneys allows you to clarify the size and density of the kidneys. Assessment of kidney function - Reberg-Tareev test, determination of the concentration of urea and / or creatinine in the blood. The diagnosis is confirmed by kidney biopsy.
Differential diagnosis: with chronic pyelonephritis, acute glomerulonephritis, nephropathy of pregnancy, chronic tubulo-interstitial nephritis, alcoholic kidney damage, amyloidosis and diabetic nephropathy, as well as kidney damage in diffuse connective tissue diseases (primarily SLE) and systemic vasculitis.
Treatment
General tactics. Hospitalization in a hospital with exacerbation of CGN, newly diagnosed CGN, newly diagnosed CRF. Diet with restriction of salt (with edema, arterial hypertension), protein (with CRF, exacerbation of CGN). Impact on the etiological factor (infection, tumors, drugs). Immunosuppressive therapy - GC and cytostatics - with exacerbation of CGN (shown in azotemia, if it is due to the activity of CGN). Antihypertensive drugs. Antiaggregants, anticoagulants. Antihyperlipidemic drugs. Diuretics.
Immunosuppressive therapy
GCs are indicated for mesangioproliferative CGN and CGN with minimal glomerular changes. In membranous CGN, the effect is indistinct. With membrane-proliferative CGN and focal-segmental glomerulosclerosis, GCs are ineffective. Prednisolone is prescribed at 1 mg / kg / day orally for 6-8 weeks, followed by rapid decline up to 30 mg / day (5 mg / week), and then slow (2.5-1.25 mg / week) up to complete cancellation. mg IV drip 1 r / day for 3 days in a row. After a decrease in CGN activity, monthly pulse therapy is possible until remission is achieved.
Cytostatics (cyclophosphamide 2-3 mg / kg / day orally or intramuscularly or intravenously, chlorambucil 0.1-0.2 mg / kg / day orally, as alternative drugs: cyclosporine - 2.5- 3.5 mg/kg/day orally, azathioprine 1.5-3 mg/kg/day orally) are indicated for active forms CGN with high risk progression of renal failure, as well as in the presence of contraindications for the appointment of GCs, inefficiency or complications when using the latter (in the latter case, combined use is preferred, which allows to reduce the dose of GCs). Pulse therapy with cyclophosphamide is indicated for high CGN activity, either in combination with pulse therapy with prednisolone (or against the background of daily oral prednisolone), or in isolation without additional prescription of prednisolone; in the latter case, the dose of cyclophosphamide should be 15 mg/kg (or 0.6-0.75 g/m2 of body surface area) IV monthly.
The simultaneous use of GC and cytostatics is considered more effective than GC monotherapy. It is common to appoint immunosuppressive drugs in combination with antiplatelet agents, anticoagulants - the so-called multicomponent schemes: .. 3 - component scheme (without cytostatics) ... Prednisolone 1-1.5 mg / kg / day orally for 4-6 weeks, then 1 mg / kg / day through day, then reduced by 1.25-2.5 mg / week until canceled ... Heparin 5000 IU 4 r / day for 1-2 months with the transition to phenindione or acetylsalicylic acid at a dose of 0.25-0.125 g / day, or sulodexide at a dose of 250 IU 2 times / day inside ... Dipyridamole 400 mg / day inside or in / in. 1-2 months, then dose reduction by 1.25-2.5 mg/week until withdrawal ... Cyclophosphamide 200 mg IV daily or double dose every other day for 1-2 months, then half the dose until remission decreases (cyclophosphamide can be replaced with chlorambucil or azathioprine) ... Heparin 5000 IU 4 times / day for 1-2 months with the transition to phenindione or acetylsalicylic acid, or sulodexide ... Dipyridamole 400 mg / day orally or intravenously .. Ponticelli scheme: started on therapy with prednisolone - 3 days in a row at 1000 mg / day, for the next 27 days prednisolone 30 mg / day orally, 2nd month - chlorambucil 0.2 mg / kg .. Steinberg's scheme ... Pulse - therapy with cyclophosphamide: 1000 mg IV monthly during the year ... In the next 2 years - 1 time in 3 months ... In the next 2 years - 1 time in 6 months.
Symptomatic therapy
Antihypertensive therapy.. ACE inhibitors have antiproteinuric and nephroprotective effects, tk. reducing intraglomerular hyperfiltration and hypertension, slow down the rate of progression of chronic renal failure: captopril 50-100 mg / day, enalapril 10-20 mg / day, ramipril 2.5-10 mg / day .. Calcium channel blockers of the non-hydropyridine series: verapamil in a dose 120-320 mg/day, diltiazem at a dose of 160-360 mg/day, isradipine, etc.
Diuretics - hydrochlorothiazide, furosemide, spironolactone.
Antioxidant therapy (vitamin E), but there is no convincing evidence of its effectiveness.
Lipid-lowering drugs (nephrotic syndrome): simvastatin, lovastatin, fluvastatin, atorvastatin at a dose of 10-60 mg / day for 4-6 weeks, followed by dose reduction.
Anticoagulants (in combination with GCs and cytostatics, see above) .. Heparin 5000 IU 4 r / day s / c (under the control of international normalized ratio [INR]) for at least 1-2 months; before cancellation, the dose is reduced 2-3 days before. Low molecular weight heparins: calcium nadroparin at a dose of 0.3-0.6 ml 1-2 r / day s / c, sulodexide intramuscularly 600 IU 1 r / day for 20 days, then inside 250 IU 2 r / day.
Antiplatelet agents (in combination with GCs, cytostatics, anticoagulants; see above) .. Dipyridamole 400-600 mg / day .. Pentoxifylline 0.2-0.3 g / day .. Ticlopidin 0.25 g 2 r / day.. Acetylsalicylic acid 0.25-0.5 g / day.
In the treatment of CGN, the following therapeutic measures are also used (the effect of which has not been proven in controlled studies).
NSAIDs (an alternative to prednisolone for low clinical activity CGN): indomethacin 150 mg/day for 4-6 weeks, then 50 mg/day for 3-4 months (contraindicated in arterial hypertension and renal failure).
Aminoquinoline derivatives (chloroquine, hydroxychloroquine) are prescribed in the absence of indications for active therapy with sclerosing forms, 0.25-0.2 g orally 2 r / day for 2 weeks, then 1 r / day.
Plasmapheresis in combination with pulse therapy with prednisolone and/or cyclophosphamide is indicated for highly active CGN and the absence of the effect of treatment with these drugs.
Treatment of individual morphological forms
Mesangioproliferative CGN .. With slowly progressive forms, incl. with IgA - nephritis, there is no need for immunosuppressive therapy .. At a high risk of progression - GC and / or cytostatics .. 3 - and 4 - component schemes .. The effect of immunosuppressive therapy on the long-term prognosis remains unclear.
Membranous CGN.. Combined use of GCs and cytostatics.. Pulse — therapy with cyclophosphamide 1000 mg IV monthly.. In patients without nephrotic syndrome and normal function kidneys - ACE inhibitors.
Membrano-proliferative (mesangiocapillary) CGN.. Treatment of the underlying disease.. ACE inhibitors.. In the presence of nephrotic syndrome and decreased kidney function, HA and cyclophosphamide therapy with the addition of antiaggregants and anticoagulants is justified.
CGN with minimal changes .. Prednisolone 1-1.5 mg / kg for 4 weeks, then 1 mg / kg every other day for another 4 weeks .. Cyclophosphamide or chlorambucil if prednisolone is ineffective or it is impossible to cancel it due to relapses. With continued relapses of nephrotic syndrome - cyclosporine 3-5 mg / kg / day (children 6 mg / m2) 6-12 months after achieving remission.
Focal segmental glomerulosclerosis. Immunosuppressive therapy is not effective enough.. GC is prescribed for a long time - up to 16-24 weeks. Patients with nephrotic syndrome are prescribed prednisolone at 1-1.2 mg / kg daily for 3-4 months, then every other day for another 2 months. , then the dose is reduced up to cancellation .. Cytostatics (cyclophosphamide, cyclosporine) in combination with GC.
Fibroplastic CGN .. In a focal process, treatment is carried out according to the morphological form that led to its development .. diffuse form- contraindication to active immunosuppressive therapy.
Treatment by clinical forms carried out when it is impossible to perform a kidney biopsy.
Latent form. Active immunosuppressive therapy is not indicated. With proteinuria> 1.5 g / day, ACE inhibitors are prescribed.
Hematuric form .. Intermittent effect of prednisolone and cytostatics .. Patients with isolated hematuria and / or slight proteinuria - ACE inhibitors and dipyridamole.
Hypertonic form. ACE inhibitors; the target level of blood pressure is 120-125/80 mm Hg. For exacerbations, cytostatics are used as part of a 3-component scheme. GC (prednisolone 0.5 mg/kg/day) can be prescribed as monotherapy or as part of combined regimens.
The nephrotic form is an indication for the appointment of a 3- or 4-component scheme.
Mixed form - 3 - or 4 - component treatment regimen.
Surgery. Kidney transplantation is complicated by graft recurrence in 50%, and graft rejection in 10%.
Features of the course in children. More often than in adults, post-streptococcal nephritis with an outcome in recovery. Nephrotic syndrome up to 80% is due to CGN with minimal changes.
Features of the course in pregnant women. The effect of pregnancy on the kidneys: the function decreases, the frequency of secondary preeclampsia increases. The effect of CGN on pregnancy - three degrees of risk (Shekhtman M.M. et al. 1989): .. I degree (minimum) - pregnancy can be resolved ( latent form) .. II degree (severe) - high risk (nephrotic form) .. III degree (maximum) - pregnancy is contraindicated (hypertonic and mixed forms, active CGN, CRF).
Complications. Renal failure, left ventricular failure, acute cerebral circulation, intercurrent infections, thrombosis.
Current and forecast. The frequency of progression to CRF depends on the morphological form of CGN. Diffuse proliferative - 1-2%. Mesangioproliferative - 40%. Rapidly progressive - 90%. Membrane - 40%. Focal and segmental glomerulosclerosis - 50-80%. Membrano-proliferative - 50%. IgA - nephropathy - 30-50%.
Reduction. CGN - chronic glomerulonephritis.
ICD-10. N03 Chronic nephritic syndrome
Let three classic symptom: edema, reddish urine and increased blood pressure, which may be accompanied by a headache or not bother the patient, determined only when measured. The appearance of these symptoms for the first time in young people is likely to lead to a diagnosis of acute glomerulonephritis. In old age, these changes in most cases will be attributed to primary chronic glomerulonephritis. Chronic glomerulonephritis is also exhibited in the presence of acute within 12 months from the onset of the disease.
The diagnosis of rapidly progressive glomerulonephritis is usually made if, just a month and a half after the onset of an acute process, the density of urine decreases, nephrotic syndrome develops, and blood pressure rises. This is accompanied by an increase in the content of urea and creatinine in the blood.
Confirm the diagnosis of glomerulonephritis by testing urine, blood and, if necessary, a kidney biopsy. In the general analysis of urine, protein, a large number of erythrocytes, cylinders (casts of the renal tubules) are detected. A biochemical blood test for glomerulonephritis shows a decrease in total protein and an increase in its individual types.
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Often, kidney failure and other kidney problems are detected through a routine urinalysis. A blood test may also be added to laboratory diagnostics. More complex instrumental diagnostic methods are used only to track the dynamics of changes in the structure of the kidneys. So, for example, glomerulonephritis on ultrasound, depending on the form of the pathology, may not give visible changes at all. About how pathology is formed and what can be seen with ultrasound, in the material below.
Glomerulonephritis: a general picture of the disease and its causes
Glomerulonephritis is a malfunction of the glomerular filtration in the kidneys. In this case, as a rule, both kidneys are affected at once. As a result of a decrease in the efficiency of the glomeruli, the volume of urine and its quality decrease. That is, kidney failure is formed.
Most often, the onset of the disease is caused by infectious diseases such as tonsillitis, scarlet fever, tonsillitis, or purulent skin infection. In all these cases, the causative agent is a streptococcal bacterium. The process of onset of glomerulonephritis in this case looks like this:
- The patient is ill with the above infections. After 10-14 days, a visible complete recovery occurs.
- However, during the period of illness, the human body begins an internal struggle, which is expressed in an allergic reaction. As a result, antibodies are produced, which subsequently bind pathogenic microbe cells and carry them throughout the body along with the bloodstream.
- Further, the bound bacterial cells settle in glomerular apparatus kidneys, which are responsible for filtering the blood. Thus, glomerulonephritis begins.
In addition, the causes of the onset of the disease can be:
- Banal and prolonged hypothermia in water;
- Past illnesses such as malaria or tuberculosis;
- Also, vaccination can become a provocateur of glomerulonephritis (if the body is weakened);
- An allergic reaction to certain groups of medicines or to toxins that have entered the body.
Forms of glomerulonephritis and their symptoms
The course of the disease is divided into two forms - chronic and acute. In the first case, the patient may not be bothered by anything. Only occasionally weakness and headache, as well as loss of appetite and fatigue will accompany the patient. But most often, such symptoms are attributed to fatigue, vitamin deficiency and stress. It is possible to identify the disease at this stage only through a general urine test.
Important: that is why it is necessary to regularly take urine for a general analysis in order to diagnose possible pathological changes in time.
If glomerulonephritis manifests itself in an acute form, then here all the symptoms will already be present. So, the general picture during exacerbation of renal failure will be as follows:
- Drawing pain in the lumbar region.
- Reducing the daily volume of urine.
- Morning puffiness, which disappears by dinner.
- Coloration of urine in a reddish tint. Moreover, urine can have both a barely visible color of red, and have the appearance of meat juice.
- Nausea, vomiting, loss of appetite are possible.
- A headache and an increase in body temperature up to 37.5 degrees are also manifested.
Important: if such symptoms appear, you must immediately go to the hospital to receive further treatment. Since acute glomerulonephritis has a negative effect on the cardiovascular system and the brain.
Diagnosis of glomerulonephritis: blood and urine tests, ultrasound
In order to select the most effective treatment tactics, it is necessary to identify the nature of the disease (infectious / non-infectious) and establish the severity of its course (how much the kidneys cannot cope with their function). The main laboratory tests in the diagnosis of glomerulonephritis are:
- General urine analysis. Here, experts will detect the level of protein, which will indicate an inflammatory process in the urinary system. Also, during the analysis, the laboratory assistant will determine the concentration of red blood cells in the patient's urine. Their presence indicates that there is a loss of blood along with urine. Moreover, red blood cells can be seen with the naked eye in the urine (gross hematuria), and can only be seen under a microscope (microhematuria). Determining the concentration of protein and erythrocytes in the urine allows the attending physician to adjust the patient's diet with glomerulonephritis. The diet will be aimed at reducing the amount of salt and protein, as well as correcting the drinking regimen.
Important: during acute period the patient must be on bed rest. This will relieve spasm of blood vessels and reduce pressure. As a result, the pressure on the kidneys will be minimal, and the volume of urine will increase. This, in turn, neutralizes swelling.
- A general blood test in inflammatory processes will show an increased ESR (erythrocyte sedimentation rate).
- In addition, a biochemical blood test will be performed to diagnose the nature of the disease. And if it is established that streptococcus has become the provocateur of the pathology, then antibiotic therapy is used to treat the patient.
Ultrasound diagnosis of glomerulonephritis
Holding ultrasound, as a rule, is not particularly informative method diagnostics. In this case, it is only possible to identify structural changes in the kidneys and their location. At the same time, it is worth knowing that if glomerulonephritis is in a chronic form, then the specialist will not see any special changes on ultrasound. The structure of the kidneys and their shape will be unchanged.
If glomerulonephritis is in an acute form, then the following changes can be noted on ultrasound of the kidneys:
- Thickening of the parenchyma of both kidneys;
- Changing the contours of the kidneys to fuzzy;
- It is also possible to identify increased echogenicity, and against its background, the presence of hypoechoic pyramids may be noted;
- Also, if ultrasound angiography is performed, the vascular pattern will be combined;
- If Dopplerography is performed, then a reduced index of peripheral resistance will be noted in the arcuate arteries. At the same time, in the segmental and interlobar arteries, the indices of the resistance index will be normal.
Important: the specialist-nephrologist uses all the data obtained to prescribe the most effective treatment for glomerulonephritis.
To fully recover from the disease, it is necessary to strictly adhere to all the recommendations of the attending physician. Since it is often diet therapy and bed rest for 2-5 weeks that are the key to successful treatment. Medical therapy in this case, it removes only the symptoms of the disease (normalizes pressure, reduces swelling, increases the volume of urine).
After successful treatment, patients who have had glomerulonephritis are contraindicated for at least two years in active sports, severe physical work, hypothermia and overheating, swimming in water bodies and working with chemicals. If possible, sanatorium-resort treatment is indicated.
Ultrasound of the kidneys is a common procedure for diagnosing diseases of the urinary system. Sometimes ultrasound carried out as a preventive measure for early diagnosis possible diseases. In order to be able to distinguish kidney diseases on the ultrasound image, it is necessary, first of all, to know the anatomy and normal image of the kidneys on ultrasound. Ultrasound of the kidneys has its own characteristics for different age periods therefore, ultrasound images are evaluated differently for children and adults. Anatomy of the urinary system and kidneys
Normal and topographic anatomy are at the heart of any study. To compare the data of ultrasound of the kidneys and make a conclusion, it is necessary to know the anatomical data that are the norm. However, it is worth considering that the kidneys are an organ in the structure of which there is the largest number anatomic options.In case of violations of the renal circulation, ultrasound reveals the following signs acute renal failure:
- the kidneys acquire a spherical shape;
- the boundary between the cortical and medulla is sharply emphasized;
- the kidney parenchyma is thickened;
- echogenicity of the cortex is increased;
- Doppler study reveals a decrease in blood flow velocity.
Kidney injury on ultrasound. Contusion ( injury), kidney hematoma on ultrasound
Kidney injury results from the application of an external force to the lower back or abdomen due to hard hit or squeezing. Kidney disease makes them even more susceptible to mechanical damage. Most often, kidney injuries are closed, which is why the patient may not be aware of internal bleeding when the kidneys rupture.There are two types of kidney injury:
- bruise ( contusion). With a bruise, there are no ruptures of the capsule, parenchyma or pelvis of the kidney. This damage usually resolves without sequelae.
- Gap. When a kidney ruptures, the integrity of its tissues is violated. Ruptures of the parenchyma of the kidneys lead to the formation of hematomas inside the capsule. In this case, blood can enter the urinary system and be excreted along with urine. In another case, when the capsule breaks, the blood, together with the primary urine, is poured into the retroperitoneal space. This forms the pararenal ( pararenal) hematoma.
The best diagnostic possibilities for injuries and hematomas are offered by computed tomography and magnetic resonance imaging. Treatment of hematomas up to 300 ml is carried out conservatively. Sometimes, percutaneous puncture of hematomas under ultrasound guidance can be performed. Only in 10% of cases with heavy internal bleeding, surgical intervention is performed.
Chronic renal failure ( CRF) on ultrasound
Chronic renal failure is a pathological decrease in kidney function as a result of the death of nephrons ( functional renal units). Chronic renal failure is the outcome of most chronic kidney diseases. Because chronic diseases are asymptomatic, the patient considers himself healthy until the onset of uremia. In this state, there is a severe intoxication of the body with those substances that are usually excreted in the urine ( creatinine, excess salts, urea).The causes of chronic renal failure are the following diseases:
- chronic pyelonephritis;
- chronic glomerulonephritis;
- urolithiasis disease;
- arterial hypertension ;
- diabetes;
- polycystic kidney disease and other diseases.
There are the following degrees of severity of chronic renal failure, depending on the glomerular filtration rate ( GFR):
- Light. GFR is 30 to 50 ml/min. The patient notices an increase in nocturnal urination, but nothing else worries him.
- Average. GFR is in the range from 10 to 30 ml/min. Increased daily urination and there is a constant thirst.
- Heavy. GFR less than 10 ml/min. Patients complain about constant fatigue, weakness , dizziness . Nausea and vomiting may occur.
Signs of a shriveled kidney ( nephrosclerosis) on ultrasound. Retraction of the parenchyma of the kidneys
The term "shrunken kidney" ( nephrosclerosis) describes a condition in which kidney tissue is replaced by connective tissue. Many diseases cause destruction of the kidney parenchyma, and the body is not always able to replace dead cells identical. The human body does not tolerate emptiness, therefore, with massive cell death, regeneration occurs and they are replenished by connective tissue cells.Connective tissue cells produce fibers that, being attracted to each other, cause a decrease in the size of the organ. In this case, the body shrinks and ceases to perform its function in full.
At acute inflammation the kidneys increase in size, and a hypoechoic edema of the tissues around the organ is formed. Chronic infection gradually leads to a decrease in the size of the kidneys. The accumulations of pus look like hypoechoic areas. With inflammation in the kidney, blood flow can change. This is clearly seen on duplex ultrasound using Doppler mapping.
In addition to ultrasound, contrast agents are used to visualize inflammatory processes in the kidneys. X-ray examination, computed and magnetic resonance imaging ( CT and MRI). If some areas of the kidneys are not available for examination on x-rays, then tomography allows you to get a detailed image of the kidneys. However, there is not always time and appropriate conditions for performing CT and MRI.
Acute pyelonephritis on ultrasound of the kidneys
Pyelonephritis is an infectious and inflammatory disease of the kidneys. In pyelonephritis, the parenchyma of the kidneys and the collecting system of the tubules are affected. With this disease, the infection enters the kidney ascending way through the ureters. Often acute pyelonephritis becomes a complication of cystitis - inflammation of the bladder. Pyelonephritis is caused mainly by opportunistic microflora ( coli) and staphylococci. Pyelonephritis according to the course options can be acute and chronic.Symptoms of acute pyelonephritis are:
- fever, fever, chills;
- pain in the lumbar region;
- urination disorders ( decrease in the amount of urine).
Signs of acute pyelonephritis on ultrasound of the kidneys are:
- an increase in the size of the kidneys more than 12 cm in length;
- decreased mobility of the kidneys less than 1 cm);
- deformation of the medulla with the formation of accumulations of serous fluid or pus.
Kidney carbuncle on ultrasound. kidney abscess
Renal carbuncle and abscess are severe manifestations of acute purulent pyelonephritis. They represent a limited infectious process in the renal parenchyma. During the formation of an abscess, microorganisms enter the kidney tissue through the blood or ascending the urinary tract. An abscess is a cavity surrounded by a capsule, inside which pus accumulates. On ultrasound, it looks like a hypoechoic area in the kidney parenchyma with a bright hyperechoic rim. Sometimes with an abscess, an expansion of the pyelocaliceal system is observed.Kidney carbuncle is more severe than an abscess. Carbuncle is also caused by the multiplication of microorganisms in the tissue of the kidney. However, the vascular component plays the main role in the mechanism of carbuncle development. When entering the vessel, microorganisms block its lumen and stop the blood supply. In this case, the death of kidney cells occurs due to the lack of oxygen. After thrombosis and infarction ( vascular necrosis) of the renal wall follows its purulent fusion.
With a carbuncle of the kidney on ultrasound, the organ is enlarged, its structure is locally deformed. The carbuncle looks like a volumetric formation of high echogenicity with fuzzy contours in the kidney parenchyma. In the center of the carbuncle are hypoechoic areas corresponding to the accumulation of pus. At the same time, there are usually no changes in the pelvicalyceal structure. Carbuncle and kidney abscess are treated surgically with the mandatory use of antibiotics.
Chronic pyelonephritis on ultrasound of the kidneys
Chronic pyelonephritis differs from acute pyelonephritis in a long course and a tendency to exacerbate. This disease is characterized by the persistence of foci of infection in the kidney tissue. It occurs due to a violation of the outflow of urine. This is due to hereditary factors and acquired conditions ( e.g. urolithiasis). Chronic pyelonephritis with each exacerbation affects new and new areas of the parenchyma, due to which the entire kidney gradually becomes non-functional.Chronic pyelonephritis has in its course several phases changing each other:
- active phase. This phase proceeds similarly to acute pyelonephritis, characterized by severe pain, malaise, difficult urination.
- latent phase. The patient is concerned about rare pain in the lower back, while bacteria are always present in the urine.
- remission phase. It is a condition in which the disease does not manifest itself in any way, however, with a decrease in immunity, it can suddenly worsen.
Signs chronic pyelonephritis on ultrasound of the kidneys are:
- Expansion and deformation of the pyelocaliceal system. It becomes rounded, and the cups merge with the pelvis.
- Reducing the thickness of the parenchyma of the kidney. The ratio of the parenchyma of the kidneys to the pyelocaliceal system becomes less than 1.7.
- Reducing the size of the kidney uneven contour edges of the kidney. This deformation is indicative of long course process and wrinkling of the kidney.
Glomerulonephritis on ultrasound of the kidneys
Glomerulonephritis is an autoimmune lesion of the vascular glomeruli located in the renal cortex. Vascular glomeruli are part of the nephron - functional unit kidneys. It is in the vascular glomeruli that blood is filtered and the initial stage of urine formation occurs. Glomerulonephritis is the main disease leading to chronic renal failure. With the death of 65% of nephrons, signs of renal failure appear.Symptoms of glomerulonephritis are:
- increased blood pressure;
- swelling;
- red staining of urine the presence of red blood cells);
- lower back pain.
IN initial stage glomerulonephritis on ultrasound, the following signs are noted:
- increase in kidney volume by 10 - 20%;
- slight increase in echogenicity of the kidneys;
- increase in blood flow velocity in the renal arteries;
- clear visualization of blood flow in the parenchyma;
- symmetrical changes in both kidneys.
- a significant decrease in the size of the kidneys, up to 6 - 7 cm in length;
- hyperechogenicity of kidney tissue;
- the impossibility of distinguishing the cortical and medulla of the kidney;
- decrease in blood flow velocity in the renal artery;
- impoverishment of the bloodstream inside the kidney.
Tuberculosis of the kidneys on ultrasound
Tuberculosis is a specific disease caused by mycobacterium. Kidney tuberculosis is one of the most common secondary manifestations of this disease. The primary focus of tuberculosis is the lungs, then with the bloodstream, Mycobacterium tuberculosis enters the kidneys. Mycobacteria multiply in the vascular glomeruli of the renal medulla.With tuberculosis in the kidneys, the following processes are noted:
- Infiltration. This process means the accumulation of mycobacteria in the cortical and medulla with the formation of ulcers.
- Destruction of tissues. The development of tuberculosis leads to the formation of necrosis zones, which look like rounded cavities.
- Sclerosis ( connective tissue replacement). Vessels and functional cells of the kidneys are replaced by connective tissue. This defensive reaction leads to impaired renal function and to renal failure.
- Calcification ( calcification). Sometimes the foci of mycobacteria turn into stone. This protective reaction of the body is effective, but does not lead to a complete cure. Mycobacteria can regain activity again with a decrease in immunity.
Anomalies in the structure and position of the kidneys on ultrasound. Kidney disease with cyst formation
Kidney anomalies are abnormalities caused by impaired embryonic development. For one reason or another, anomalies genitourinary system are the most common. It is believed that about 10% of the population has various kidney anomalies. Kidney anomalies are classified as follows:
- Anomalies of the renal vessels. They consist in changing the trajectory of the course, the number of renal arteries and veins.
- Anomalies in the number of kidneys. There are cases when a person had 1 or 3 kidneys. Separately, an anomaly of duplication of the kidneys is considered, in which one of the kidneys is divided into two almost autonomous parts.
- Anomalies in the size of the kidneys. The kidney may be reduced in size, but there are no cases of congenital enlargement of the kidneys.
- Anomalies in the position of the kidneys. The kidney can be located in the pelvis, at the iliac crest. There are also cases when both kidneys are located on the same side.
- Abnormalities in the structure of the kidneys. Such anomalies are the underdevelopment of the renal parenchyma or the formation of cysts in the renal tissue.
Doubling of the kidneys and pyelocaliceal system. Signs of duplication of the kidneys on ultrasound
Doubling of the kidneys is the most common anomaly kidneys. It occurs in women 2 times more often than in men. The doubling of the kidneys is explained congenital anomaly germ layers of the ureters. Double kidneys are conditionally divided into upper part and lower, of which the upper kidney is usually less developed. Doubling differs from the accessory kidney in that both parts are bound friend with each other and covered with one fibrous capsule. The accessory kidney is less common, but has its own circulatory system and capsule. Doubling of the kidneys can be complete and incomplete.Doubling of the kidneys can be of two types:
- Full doubling. With this type of doubling, both parts have their own pelvicalyceal system, artery and ureter.
- incomplete doubling. It is characterized by the fact that the ureters of both parts are combined before flowing into the bladder. Depending on the degree of development of the upper part, it may have its own artery and pyelocaliceal system.
Underdevelopment ( hypoplasia, dysplasia) kidneys on ultrasound
Underdevelopment of the kidneys can be observed in two ways. One of them is hypoplasia - a condition in which the kidney is reduced in size, but functions in the same way as normal kidney. Another option is dysplasia. This term refers to a condition in which the kidney is not only reduced, but also structurally defective. With dysplasia, the parenchyma and PCL of the kidney are significantly deformed. In both cases, the kidney on the opposite side is enlarged to compensate functional insufficiency underdeveloped kidney.With hypoplasia of the kidneys, an organ of a smaller size is determined by ultrasound. Its length on ultrasound is less than 10 centimeters. Ultrasound can also determine the function of an underdeveloped kidney. In a functioning kidney, the arteries are of normal width ( 5 mm at the gate), and the pelvicalyceal system is not expanded. However, with dysplasia, the opposite is observed.
Signs of kidney dysplasia on ultrasound are:
- expansion of CHLS more than 25 mm in the area of the pelvis;
- reduction in the thickness of the parenchyma;
- narrowing of the renal arteries;
- narrowing of the ureters.
Kidney prolapse ( nephroptosis) on ultrasound. Wandering kidneys
Nephroptosis is a condition in which the kidney moves down from its bed when the position of the body changes. Normally, the movement of the kidneys during the transition of their vertical to horizontal position does not exceed 2 cm. However, due to various factors (injury, overexertion, muscle weakness ) the kidney may acquire pathological mobility. Nephroptosis occurs in 1% of men and about 10% of women. In cases where the kidney can be displaced by hand, they are called the wandering kidney.Nephroptosis has three degrees:
- First degree. When inhaling, the kidney partially shifts down from the hypochondrium and is palpated, and during exhalation it returns back.
- Second degree. IN vertical position the kidney is completely out of the hypochondrium.
- Third degree. The kidney descends below the iliac crest into the small pelvis.
On ultrasound, nephroptosis is detected in most cases. The kidney may not be found on a routine scan in the upper flanks of the abdomen. If a kidney prolapse is suspected, ultrasound is performed in three positions - lying, standing and on its side. The diagnosis of nephroptosis is made in the case of an abnormally low position of the kidneys, their great mobility when changing body position or when breathing. Ultrasound also helps to identify complications caused by a change in the position of the kidneys.
Kidney cyst on ultrasound
A cyst is a cavity in the kidney tissue. It has an epithelial wall and a fibrous base. Kidney cysts can be congenital or acquired. Congenital cysts develop from cells in the urinary tract that have lost contact with the ureters. Acquired cysts are formed at the site of pyelonephritis, kidney tuberculosis, tumors, infarction, as a residual formation.Kidney cyst usually does not show up clinical symptoms and detected by chance during ultrasound examination. With a kidney size of up to 20 mm, the cyst does not cause compression of the parenchyma and functional disorders. A cyst larger than 30 mm is an indication for its puncture.
On ultrasound of the kidneys, the cyst looks like a round anechoic formation of black color. The cyst is surrounded by a hyperechoic rim fibrous tissue. The cyst may show solid areas that are blood clots or fossils. The cyst may have septa, which are also visible on ultrasound. Multiple cysts are less common and must be differentiated from polycystic kidney disease, a disease in which the kidney parenchyma is almost completely replaced by cysts.
When performing ultrasound with a water or diuretic load, the size of the cyst does not change, in contrast to the pelvicalyceal system, which expands during this study. On color Doppler imaging, the cyst does not give color signals because there is no blood supply to its wall. If vessels are found around the cyst, this indicates its degeneration into a tumor.
Puncture of cysts with ultrasound guidance
Ultrasound examination is indispensable for the treatment of kidney cysts. With the help of ultrasound, the size and position of the cyst, its availability for puncture, are assessed. Under control ultrasound image a special needle is inserted through the skin, which is fixed on the puncture sensor. The location of the needle is checked by the image on the screen.After the cyst wall is punctured, its contents are removed and examined in the laboratory. The cyst may contain serous fluid, urine, blood, or pus. Then a special fluid is injected into the cyst cavity. It destroys the epithelium of the cyst and resolves over time, causing the cyst cavity to be replaced by connective tissue. This method of treating cysts is called sclerotherapy.
For the treatment of cysts up to 6 cm in diameter, cyst sclerotherapy is effective. With certain positions of cysts or their large sizes only surgical removal of cysts is possible.
Polycystic kidney disease on ultrasound
Polycystic is a congenital kidney disease. Depending on the type of inheritance, it can manifest itself in childhood or in the adult population. Polycystic is genetic disease so it doesn't heal. The only treatment for PCOS is kidney transplantation.With polycystic genetic mutation leads to disruption of the fusion of the tubules of the nephron with the primary collecting ducts. Because of this, multiple cysts are formed in the cortical substance. Unlike simple cysts, with polycystosis, the entire cortical substance is gradually replaced by cysts, due to which the kidney becomes non-functional. In polycystic disease, both kidneys are equally affected.
On ultrasound, the polycystic kidney is enlarged in size, has a bumpy surface. In the parenchyma, multiple anechoic formations are found that do not connect with pelvicalyceal system. Cavities on average have a size of 10 to 30 mm. In newborns with polycystic kidney disease, a narrowing of the PCS and an empty bladder are characteristic.
Medullary spongy kidney on renal ultrasound
This disease is also a congenital pathology, however, unlike polycystic cysts, cysts are formed not in the cortex, but in the medulla. Due to the deformation of the collecting ducts of the pyramids, the kidney becomes like a sponge. Cyst cavities in this pathology have a size of 1 to 5 mm, that is, much smaller than with polycystic disease.The medullary spongy kidney functions normally for a long time. Unfortunately, this disease is a provoking factor for urolithiasis and infections ( pyelonephritis). In this case, unpleasant symptoms may appear in the form of pain, urination disorders.
On ultrasound, the medullary spongy kidney is usually not detected, since there are no ultrasound machines with a resolution of more than 2 - 3 mm. In medullary spongy kidney, the cysts are usually smaller. Suspicion may be a decrease in the echogenicity of the renal medulla.
Excretory urography is used to diagnose this disease. This method applies to X-ray diagnostics. With excretory urography, the filling of the urinary tract is observed radiopaque agent. The medullary kidney is characterized by the formation of a "bouquet of flowers" in the medulla on excretory urography.
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