Diagnosis of any disease includes not only the collection of complaints, anamnesis and clinical examination, but also a wide variety of laboratory tests that make it possible to assess the general condition of the patient and determine the leading clinical syndromes. And what tests for glomerulonephritis can tell a doctor about, and what examinations need to be done first: let’s try to figure it out.
Morphological features of kidney damage in glomerulonephritis
Glomerulonephritis is an acute or chronic immunoinflammatory disease of the kidney tissue with a predominant lesion of the glomerular apparatus. As the disease progresses, interstitial tissues and renal tubules may become involved in the pathological process. This causes the development of the following changes:
- increasing the permeability of the glomerular wall for protein and cellular elements;
- the formation of microthrombi that clog the lumen of the feeding arteries;
- slowdown/complete cessation of blood flow in the glomeruli;
- disruption of the filtration process in the main functional element of the kidney (nephron);
- death of the nephron with its irreversible replacement by connective tissue;
- a gradual decrease in the volume of filtered blood and the development of progressive renal failure.
All these pathogenetic aspects cause the appearance of three main syndromes of the disease (edematous, hypertensive and urinary), as well as a characteristic laboratory picture. To confirm the diagnosis of glomerulonephritis, it is necessary to take blood and urine tests.
Blood test
Blood counts reflect the general condition of the body and allow one to judge existing disorders of the internal organs. As a rule, laboratory diagnostics for suspected glomerulonephritis begin with CBC and LBC; if necessary, these studies can be supplemented with immunological tests.
Clinical analysis
A general blood test for glomerulonephritis reflects the body’s response to pathological changes. It is characterized by the following deviations from the norm:
- a slight acceleration of ESR is a sign of immune inflammation;
- a decrease in hemoglobin is a manifestation of relative anemia caused by an increase in blood volume due to a decrease in renal filtration.
Symptoms identified when interpreting the results of a CBC are nonspecific and occur in many diseases. However, a general blood test helps the doctor make the correct diagnosis as part of a comprehensive examination.
Biochemical analysis
A biochemical blood test, or BAC, is a test that can identify signs of nephrotic syndrome against the background of glomerular inflammation. It is manifested by hypoproteinemia and hypoalbuminemia - a decrease in the concentration of total protein and albumin in the blood. It is this process that leads to the development of oncotic edema in patients with glomerulonephritis.
In addition, using a biochemical blood test, the development of chronic renal failure can be diagnosed. It is manifested by an increase in the level of urea and creatinine in the blood.
Immunological study
The autoimmune nature of glomerular inflammation can be confirmed by determining the components of the complement system. The C3 component plays an important role in the pathogenesis of glomerulonephritis, so at the peak of the disease its moderate decrease is observed.
Table: Changes in blood tests for glomerulonephritis
Urine examination
Urine tests are especially demonstrative for glomerulonephritis: their indicators have pronounced deviations from the norm. The standard diagnostic list includes OAM and various tests (Reberg, Nechiporenko, Zimnitsky).
Clinical analysis
The main laboratory method for diagnosing glomerulonephritis remains a general urine test. It allows you to identify urinary syndrome in a patient:
- An increase in the relative density of urine associated with the appearance of a large number of cellular elements in it.
- Decreased transparency, turbidity of the fluid secreted by the kidneys.
- Dark colored urine. With exacerbation of glomerulonephritis, it becomes a dirty brown, rusty color (a shade of “meat slop”).
- Macrohematuria and microhematuria are the release of red blood cells associated with increased vascular permeability in the renal glomeruli.
- Minor or severe proteinuria is the excretion of protein in the urine.
- Leukocyturia is a nonspecific syndrome, slightly expressed.
Test according to Nechiporenko
Urinalysis according to Nechiporenko allows you to determine the degree of erythrocyturia, proteinuria and cylindruria, which usually correlate with the severity of the disease. The combination of protein and red blood cells excreted in the urine with a low level of leukocyturia allows differentiation of glomerulonephritis from other inflammatory kidney diseases.
Zimnitsky test
Urine testing according to Zimnitsky allows you to evaluate the concentrating abilities of the kidneys. Since in acute glomerulonephritis the functioning of the tubular apparatus is not impaired, there will be no pathological changes in this diagnostic test. As sclerotic changes progress in CGN, patients may experience polyuria (or, conversely, oliguria) and nocturia.
Rehberg's test
The Rehberg test is a diagnostic test that assesses the level of effective blood flow in the kidneys (glomerular filtration). With glomerulonephritis, a decrease in creatinine clearance and glomerular filtration rate is observed.
Table: Changes in urine tests for glomerulonephritis
| Index | Norm | For glomerulonephritis |
|---|---|---|
| General urine analysis | ||
| Color | Straw yellow | Meat slop color |
| Transparency | Transparent | Muddy |
| Relative density | 1010-1035 | Promoted |
| Red blood cells | 0-1-2 in p/z | Microhematuria – 10-15 in p/z Gross hematuria – entirely in the subcutaneous area |
| Protein | Less than 0.03 g/l | Sharply increased |
| Leukocytes | In men: 0-3 in p/z In women: 0-5 in p/z | Slightly increased |
| Urine sample according to Nechiporenko | ||
| Red blood cells | Up to 1000 per ml | Promoted |
| Leukocytes | In men: up to 2000 per ml In women: up to 4000 per ml | Promoted |
| Hyaline casts | Up to 20 per ml | Promoted |
| Rehberg's test | ||
| Creatinine clearance | In men: 95-145 ml/min In women: 75-115 ml/min | Reduced |
Changes in urine and blood tests are an important diagnostic indicator: with their help, you can determine the stage of the inflammatory process, suggest the nature of the course of the disease and identify leading syndromes. Despite this, the presence of glomerulonephritis in a patient should be confirmed not only by laboratory tests, but also by clinical and instrumental data. Timely diagnosis and early initiation of therapy can prevent the development of complications, make the patient feel better and speed up recovery.
A timely and correct diagnosis is half of successful treatment. If the classic course of glomerulonephritis - glomerular inflammation of the kidneys - has its own striking characteristic features, then latent forms of the disease can imitate a variety of pathologies. In order for the doctor to make the correct diagnosis, the patient must undergo a comprehensive clinical, laboratory and instrumental examination.
Why early diagnosis is so important
Glomerulonephritis is an acute or chronic infectious-allergic disease with primary damage to the main functional apparatus of the kidneys - the glomeruli. The main role in its development is played by the action of bacteria or viruses, as well as autoimmune processes.
According to statistics, the acute form of glomerulonephritis develops more often in children (3-7 years old) or young people (20-30 years old). Males are more susceptible to the disease. Chronic inflammation of the renal glomeruli occurs among all age groups. This pathology accounts for up to 1% of all therapeutic patients.
In the acute course of glomerulonephritis, clinical diagnosis usually does not cause difficulties. In more than 70% of cases, the pathology responds well to therapy, and patients are completely cured. Without timely medical treatment, the disease becomes chronic, which can cause:
- progressive renal failure;
- heart failure;
- purulent-inflammatory lesions of the skin and internal organs;
- atherosclerosis at a young age.
The sooner a patient with glomerulonephritis addresses his complaints to a doctor, undergoes examination and begins treatment, the higher his chances of recovery with complete restoration of the functional activity of the kidneys.
First stage: conversation and clinical examination
The first thing a patient’s examination begins with is the collection of complaints and anamnesis. Most often the patient is concerned about:
- unstable increase in blood pressure (mainly due to the diastolic component);
- headaches, attacks of dizziness;
- flickering of flies before the eyes;
- noise, ringing in the ears;
- decrease in the number and volume of urination (oliguria, anuria);
- change in urine color: it becomes dirty brown, rusty in color (the color of “meat slop”);
- constant feeling of thirst;
- the appearance of edema, first on the face and upper body, then spreading to the chest and abdominal cavity (hydrothorax, anasarca);
- dull aching pain, discomfort in the lumbar region;
- increase in body temperature to 38.5-39°C;
- signs of intoxication - fatigue, weakness, loss of appetite.
Possible glomerulonephritis is also indicated by a recent bacterial (angina, acute rheumatic fever) or viral infection, vaccination, or interaction with toxic substances.
Then the doctor conducts a clinical examination, including an assessment of the patient’s habitus (the patient’s appearance), palpation and percussion of the kidneys, auscultation of the heart, lungs and blood pressure measurement. Objective signs of glomerulonephritis can be considered swelling (the favorite localization is the eyelids), pain on palpation of the kidneys, a weakly positive Pasternatsky sign, and hypertension.
Based on the data obtained, the specialist makes a preliminary diagnosis and draws up a plan for further examination. Differential diagnosis of glomerular inflammation is carried out with pyelonephritis, amyloidosis, urolithiasis, tuberculous changes and tumors in the kidneys.
Second stage: laboratory tests
If glomerulonephritis is suspected, the following laboratory methods are prescribed:
- general blood analysis;
- blood chemistry;
- clinical urine analysis;
- tests according to Nechiporenko, Zimnitsky, Reberg - according to indications;
- allergy tests;
- immunological blood test.
The results of the CBC of patients with glomerulonephritis show signs of acute inflammation - leukocytosis and accelerated ESR. Also noteworthy are the manifestations of anemia - a decrease in the level of red blood cells (erythrocytes) and hemoglobin.
Biochemistry is accompanied by hypoproteinemia (a decrease in the level of total protein and albumin against the background of an increase in globulins). With the development of renal failure, the level of urea and creatinine progressively increases.
A general urine test is the most important laboratory method in diagnosing exacerbations of glomerulonephritis. The following pathological changes are observed in it:
- increase in relative density of urine;
- color change;
- proteinuria – from microalbuminuria to massive protein excretion in the urine (3 g/day or more);
- hematuria, erythrocyturia.
Immunological examination and allergy tests can identify various disorders in the functioning of the body's defense system and confirm the autoimmune nature of the disease.
Third stage: instrumental examination methods
Instrumental tests allow you to confirm the doctor’s assumptions, determine the morphological form, features of the course of glomerular inflammation and make a clinical diagnosis.
Kidney ultrasound is an effective, safe and non-invasive method for diagnosing diseases of internal organs. Acute or chronic glomerulonephritis has the following signs on ultrasound:
- the kidneys acquire blurry, indistinct contours;
- bilateral thickening of the parenchyma (functional layer);
- increased echogenicity, heterogeneity of the structure of the renal tissues: both hypo- and hyperechoic foci (“pyramids”) appear.
Ultrasound examination of blood flow (Dopplerography) shows a decrease in vascular resistance in the arcuate (arc) arteries. At the same time, blood flow in segmental and interlobar vessels can remain normal.
Confirming the diagnosis and determining the nature of changes in tissues can only be done with the help of a morphological study. The role of kidney biopsy is especially important in chronic glomerulonephritis.
The diagnostic procedure is a minimally invasive surgical procedure and is performed only in a hospital setting. Under local anesthesia, the surgeon inserts a thin, hollow needle through the skin of the lower back, capturing a small piece of kidney tissue. Then microslides are prepared from the resulting biomaterial, which a cytologist carefully examines under a microscope. The obtained histological examination data reflect the morphological features of inflammation, make it possible to determine the type of glomerulonephritis (for example, membranous, mesangioproliferative, mesangial, etc.) and even make a prognosis of the disease.
If complications develop, the diagnostic plan may include additional laboratory and instrumental tests.
With the help of a timely comprehensive examination, it is possible to diagnose glomerulonephritis at an early stage, and begin treatment of the disease before irreversible changes occur in the kidney tissues. This will allow you to quickly get rid of unpleasant symptoms, avoid the development of complications and achieve a full recovery.
Glomerulonephritis and pregnancy - is there a danger to the woman and the fetus? A serious pathological abnormality in the functioning of the filtration apparatus of the kidneys is glomerulonephritis. Pregnancy, as a special condition of a woman’s body, often increases the risk of this pathology. This is primarily due to weakened immunity in pregnant women and their vulnerability to infections. The hormone progesterone, which is actively produced to preserve the fetus, reduces the elasticity of the tissues of the ureters, which leads to disruption of urodynamics and stagnation of urine in the renal pyelocaliceal complex. In addition, the uterus with the growing fetus puts pressure on the organs of the woman’s urinary system, which can also provoke congestion in the urinary tract and cause a coccal infection to enter the body. During pregnancy, it is also natural that the kidneys of the expectant mother work with increased load, cleansing not only the mother’s body, but also the amniotic fluid.
- Causes of glomerulonephritis
- Possible complications of glomerulonephritis
- Symptoms of glomerulonephritis
- Diagnosis and treatment of glomerulonephritis
- Prevention of glomerulonephritis
Causes of glomerulonephritis
Glomerulonephritis is an autoimmune disease that affects the glomeruli of the kidneys, which are responsible for the blood filtration process, and it occurs due to an acute immune response of the human body to a streptococcal infection. The formed antigen-antibody immune complexes settle in the glomeruli and, mistaking the glomerular cells for foreign proteins, begin to destroy them if any infection enters the body. Very often, glomerulonephritis is preceded by a sore throat.
What can become a “impetus” for the occurrence of glomerulonephritis in pregnant women:
Under the influence of these factors, acute glomerulonephritis in pregnant women may occur or an exacerbation of chronic glomerulonephritis may occur.
Possible complications of glomerulonephritis
Glomerulonephritis during pregnancy has an adverse effect on its course and the development of the fetus.
The following complications may occur with glomerulonephritis:
- Preeclampsia, pereclampsia, eclampsia, nephropathy.
- Acute renal failure.
- Heart failure.
- Anemia.
- Arterial hypertension.
- Deterioration of vision.
- Hemorrhages.
Pathological conditions of the mother with glomerulonephritis lead to premature placental abruption, oxygen starvation of the fetus and delays in its development, and also cause severe congenital anomalies, including the genitourinary system.
The risk of an adverse pregnancy outcome is assessed in three levels:
- First, the risk is minimal and no more than twenty percent of women are exposed to it.
- The second is pronounced. There is a real danger of delayed fetal development, intrauterine death or premature birth.
- Third – the degree of risk is maximum. There is a real danger of death of the woman and fetus during childbirth, a high risk of intrauterine death of the child and the birth of a baby with severe anomalies.
Symptoms of glomerulonephritis
With glomerulonephritis, symptoms and treatment depend on the form and severity of the disease. Signs of pathology are very pronounced in the acute form of the disease and less noticeable in the chronic form. With a latent course of glomerulonephritis, the symptoms are very mild, but even in this case the woman needs to be monitored in a hospital.
What signs indicate a developing pathology:
- Nagging pain appears in the lower back.
- The face swells. Fluid accumulates in the subcutaneous fat and pleural area.
- Severe headaches are difficult to relieve with painkillers.
- High body temperature is one of the signs of acute glomerulonephritis.
- Impaired urination (decreased daily diuresis) or its complete absence.
- Bloody impurities in the urine. Urine has the color of “meat slop.”
- High blood pressure.
- Signs of intoxication are nausea and vomiting.
In addition, the woman experiences weakness and dizziness.
The chronic course of the disease depends on the form of the pathology:
- Latent. The symptoms are mild, but urine tests show minor deviations (protein is detected).
- Nephrotic. Pronounced swelling.
- Hypertensive. Persistent high blood pressure, but no changes in urine.
- Terminal. There are signs of renal failure.
Diagnosis and treatment of glomerulonephritis
Before prescribing treatment for the expectant mother, the doctor conducts the necessary diagnostics, which includes:
- general urine analysis - for the content of protein, blood cells (leukocytes, red blood cells) and cylinders;
- bacterial culture of urine when an infection is detected;
- urine analysis according to Nechiporenko;
- blood tests to determine the presence of protein (the absence of albumin confirms the diagnosis), antibody levels, cholesterol levels, fibrinogen;
- ultrasound examination of the kidneys and other organs of the urinary system.
Treatment of pregnant women with glomerulonephritis has a number of features and is carried out in a hospital:
- First of all, the woman is prescribed bed rest to ensure uniform heating of the body and peace.
- Diet. It is expected to strictly limit the amount of salt, control the amount of liquid and protein foods consumed.
- Drug therapy. The doctor prescribes drugs to correct blood pressure, relieve swelling, antibiotics to eliminate infection (currently there are drugs that are completely safe for the fetus), drugs to increase the level of albumin in the blood, drugs to improve blood flow between the mother and the fetus (acetylsalicylic acid).
Without fail, the doctor prescribes vitamins, minerals and antioxidants necessary to strengthen the body of the expectant mother and child. Depending on the effectiveness of the course of therapy, it is subsequently decided how the birth will occur (naturally or via cesarean section).
Prevention of glomerulonephritis
To do this, you need to follow simple rules:
- always dress appropriately for the weather - avoid hypothermia, do not neglect gloves and a hat, and do not allow your shoes to get wet;
- watch your diet, consume less seasonings and salt;
- give up alcohol, smoking and other bad habits;
- promptly and correctly treat colds, diseases of the ENT and genitourinary system;
- plan pregnancy if you have kidney disease after a thorough examination.
Due to the fact that glomerulonephritis is a complex and dangerous disease, you cannot self-medicate, and when the first alarming signs appear, you should seek qualified help from a clinic.
In addition, while carrying a baby, a woman cannot fight the disease using standard methods, since most medications pose a potential danger to the unborn child. Therefore, it is very important to remember that being in a special situation, you cannot neglect precautions and ignore regular visits to the antenatal clinic and timely completion of all tests.
Correct treatment for acute pyelonephritis
Acute pyelonephritis is an inflammatory disease of the kidney tissue and pelvicalyceal system, and is usually recorded in the patient’s card using ICD 10 code. Currently, acute pyelonephritis is the most common kidney disease that occurs in medical practice. This disease often occurs among children when the load on the kidneys is intense, while their development is not yet fully formed.
As for adults, the disease most often affects women under forty years of age, however, in old age it is more common among men, due to the prevalence of prostate adenoma, which creates obstacles to the passage of urine, which, accordingly, is a favorable condition for the proliferation of pathogenic bacteria.
In fifty percent of cases, acute pyelonephritis occurs due to the penetration of E. coli into the kidney tissue. There are three ways of penetration of microorganisms into the urinary system: ascending, hematogenous and contact. The most common among them is considered to be ascending, due to the structural features of the female urethra, pathogenic bacteria easily penetrate the bladder, especially during sexual intercourse, so women who are sexually active are susceptible to the disease much more often than others. As for men, their risk of developing acute pyelonephritis is much lower, due to the structural features of the urinary system.
The course of the disease and the risk of complications are usually determined by the primary and secondary nature of the infection. Uncomplicated acute pyelonephritis responds well to therapy and does not affect kidney tissue; as for secondary infection, severe kidney damage and paranephritis are quite likely. In diagnosing such a disease, the dynamics of the development of symptoms and their nature of occurrence play a very important role.
Usually, during the initial examination, the attending physician asks the patient whether he has recently had any purulent or infectious diseases of the urinary system and genital organs. After which, based on the results, tests performed and data collected, it is already possible to make an adequate diagnosis and appropriate treatment.
Main symptoms
Typically, the initial stage of acute pyelonephritis is characterized by a sharp rise in body temperature to forty degrees. After a certain period of time, the patient experiences aching pain in the lumbar region, frequent and painful urination, which indicates that cystitis has also joined the underlying disease. Doctors usually divide the nature of the symptoms that arise into two types: local and general. Acute pyelonephritis symptoms:
- Excessive sweating;
- Fatigue and general malaise;
- Chills and fever;
- Loss of appetite, vomiting and diarrhea;
- Feeling thirsty;
- Dull pain in the lumbar region, which intensifies during movement or palpation;
- Typically, on the fifth day of the disease, tension in the muscles of the abdominal wall is observed.
At the moment, there are also several forms of acute pyelonephritis that must be taken into account during diagnosis and the correct ICD code:
- The most acute form is characterized by a severe general condition of the patient. The patient experiences an increase in body temperature, accompanied by chills, which repeats up to three times a day;
- Acute - is that the patient experiences pronounced local symptoms of the disease, such as mild intoxication of the body and increasing thirst;
- The subacute form of the disease is characterized by the fact that local symptoms come to the fore, while the general ones practically disappear;
- The latent form occurs with virtually no symptoms and does not pose a direct threat to the patient’s health, but can develop into a chronic condition, exacerbations of which can lead to the development of a shriveled kidney.
It is important to understand that if a person detects at least one of the above symptoms, he should immediately contact a qualified specialist, since untimely treatment of acute pyelonephritis can lead to very serious consequences, including: kidney failure and chronic pyelonephritis.
Necessary treatment
Acute and chronic pyelonephritis is a disease with which people most often turn to doctors, and recovery from the disease largely depends on the correct diagnosis and the correct ICD code. As a rule, patients are prescribed a comprehensive treatment method, which includes: adherence to the regimen, diet and medicinal use of drugs.
Treatment of acute pyelonephritis is carried out only in a hospital under the supervision of the attending physician, who strictly monitors the course of the disease, since the disease can cause many complications. If acute pyelonephritis is suspected, the patient is immediately taken to the hospital, where a medical card is issued for him. Medical history of acute pyelonephritis according to the ICD code is classified as number ten. Treatment is usually aimed primarily at fighting the infection in order to restore kidney function.
Acute pyelonephritis treatment includes: bed rest, which must be strictly observed until the end of fever and chills, diet and drug therapy. Drug therapy plays the main role in treatment, with the main emphasis being on those drugs that can be excreted in the urine in high concentrations. A positive result is also achieved when prescribing certain medicinal herbs and herbs such as St. John's wort, diuretic tea, rose hips.
It is recommended to take four tablespoons of infusions from such medicinal preparations per day for three or more months. Vitamins are also prescribed, and in case of intoxication of the body, intravenous solutions are used. In cases where strong purulent foci are found in the kidneys, surgical intervention is necessary.
With properly prescribed treatment, acute pyelonephritis can be cured in the first days of its occurrence; as a rule, chills and fever disappear first, and then local symptoms.
Despite the fact that the main symptoms may disappear after a few days, antibacterial drugs continue to be taken for at least six weeks with constant changes.
It is worth remembering that self-treatment is extremely dangerous; you should not experiment on yourself and look for reasons; it is better to immediately contact a medical institution to receive qualified help. Correct and timely treatment eliminates the risk of possible complications and has a positive effect on the course of the disease.
To prevent the disease, systematic examination and observation is necessary, especially for pregnant women, who are most susceptible to diseases of the kidneys and urinary system. Urine tests should be taken not only during pregnancy, but also after childbirth, since the possible course of the disease, which began during pregnancy, may not show any symptoms.
As for the prognosis for acute pyelonephritis, in general, with timely assistance and a correct diagnosis using the ICD code, it is very favorable.
Diet for this type of disease
The diet for acute pyelonephritis should include food that is easily absorbed by the patient’s body. In addition to being easily digestible, it should also contain a sufficient amount of vitamins and calories, but it is recommended to minimize salt consumption, since its excessive content causes the kidneys to work harder, which is contraindicated in acute cases of the disease.
In the first days of hospitalization, due to the high probability of intoxication of the body, the patient is recommended to eat fresh vegetables and fruits, and it is also necessary to drink at least two liters of liquid, which helps remove harmful substances from the body. The best solutions for this task are: sweet tea, compotes and infusions of medicinal herbs.
Subsequently, as the patient’s condition improves, the specialist transfers him to a therapeutic diet number seven, with a gradual increase in fluid intake and the inclusion of vegetable, dairy and fermented milk products in the daily diet, usually the appointment is made after about ten days of hospital stay.
In case of acute pyelonephritis, which is recorded in the patient's medical history, according to ICD code 10, the following food products are strictly prohibited: rich broths from meat and fish, canned foods, mustard, horseradish, sorrel and garlic.
After the patient is discharged, a diet is prescribed, which includes the consumption of proteins, fats and carbohydrates; the patient should eat split meals about five times a day. The doctor takes into account the general condition of the patient and, based on this, creates an individual diet, which should include a variety of foods consumed, especially dairy and fermented milk.
Strict adherence to such a dietary diet allows you to maintain the patient’s weakened body and his immunity at the required level, which contributes to a speedy recovery.
Glomerulonephritis with predominant nephrotic syndrome
Glomerulonephritis is a group of diseases that are expressed primarily by damage to the glomerular apparatus of the kidneys. This pathology is inflammatory in nature and manifests itself in different ways. Glomerulonephritis is accompanied by isolated urinary, nephritic or nephrotic syndromes. Progresses rapidly and can develop into nephrosclerosis or chronic renal failure. Most often it affects children of primary school age and adult men.
Glomerulonephritis with nephrotic syndrome accounts for about 20% of all cases of glomerulonephritis. When prescribing therapy, the doctor should pay special attention to diet. A special diet has been developed for nephrotic syndrome.
Reasons for development
The most common cause of acute autoimmune damage to the glomeruli of the kidneys is considered to be group A β-hemolytic streptococcus. But these bacteria do not directly affect the glomerular basement membrane. It's all about the antigen-antibody reaction and the formation of cyclic immune complexes.
When a streptococcal infection enters the body, defense mechanisms are activated. Immune response cells begin to produce antibodies that bind to the antigen and form cyclic immune complexes (CICs). The latter settle on the glomerular membrane, damage to which leads to increased permeability and the formation of an inflammatory focus. As a result, nephrotic syndrome develops, in which blood proteins are excreted in large quantities.
Not only streptococcal infection causes kidney problems. Herpes viruses (herpes simplex, Epstein-Barr virus, cytomegalovirus), staphylococci, enterococci, hepatitis B and many others are capable of this.
Other factors that cause glomerulonephritis include drugs that have a potential nephrotoxic effect. This means that some antibiotics (aminoglycosides, sulfonamides), non-steroidal anti-inflammatory drugs can provoke the development of acute glomerulonephritis. Individual sensitivity to drugs and the presence of concomitant pathologies of the kidneys or other organs play a great role in the occurrence of the dosage form of the disease.
Glomerulonephritis in children with nephrotic syndrome sometimes occurs after childhood infections, tonsillitis, tonsillitis, and in the presence of congenital anomalies of the urinary system.
Nephrotic syndrome in chronic glomerulonephritis often develops with insufficient or untimely treatment of infectious kidney diseases.
Classification
According to nosologies, primary (etiology unknown) and secondary glomerulonephritis are distinguished. The first accounts for about 80% of all cases. If the doctor can accurately identify the cause of the disease, then we can talk about the development of secondary glomerulonephritis.
According to the type of flow there are:
- Acute: duration of the condition is up to 3 months.
- Subacute – from 3 months to 1 year.
- Chronic – the disease progresses for more than a year and there is a possibility of developing kidney failure.
Clinical manifestations
The onset of acute and chronic glomerulonephritis with nephrotic syndrome is usually different. The clinical picture is also different. But in all cases there are changes in the urine, hypertensive and edematous syndromes.
Acute glomerulonephritis begins with a sharp increase in temperature and weakness. The patient complains of severe symptoms of intoxication: dizziness, nausea, loss of appetite, pale skin. Nephrotic syndrome is characterized by the presence of edema, increased blood pressure and certain changes in the urine. In acute glomerulonephritis, this syndrome is considered primary.
An increase in blood pressure occurs due to an imbalance of vasoactive substances (renin, angiotensin), which are produced in the renal parenchyma. An increase in renin production affects the vascular wall, causing spasm. This, in turn, leads to a significant increase in blood pressure. This condition is not typical for children.
The nephrotic form of chronic glomerulonephritis does not have such a violent onset. Its symptoms are more varied and correspond to the form, stage of the disease and the degree of kidney damage. Chronicity of the process in children is very dangerous.
Edema
Extrarenal changes (edema, hypertension) occur gradually. At first, the patient notes the appearance of slight swelling on the face and only in the morning, but then it progresses to anasarca and intracavitary manifestations. A person suffering from the nephrotic form of glomerulonephritis has a characteristic appearance, which will allow the doctor to suspect the development of pathology. Such people are pale, their faces are swollen, puffy. The skin at the site of swelling is cold to the touch, and trophic disturbances are observed (dryness, peeling).
It must be remembered that in children edema appears spontaneously and is already very pronounced at the very beginning. They can be asymmetrical, but more often they are generalized (spread throughout the body).
The release of fluid from the bloodstream is explained by an increase in protein excretion in the urine. A certain amount of proteins in the blood plasma maintains optimal colloid osmotic pressure. If their number decreases noticeably, then the pressure drops accordingly. A compensatory mechanism is activated, which is based on maintaining oncotic pressure. The liquid passes into the intercellular space to restore processes.
As the disease progresses with nephrotic syndrome, swelling increases. They are already localized not only on the upper half of the body. The lumbar region and legs along the entire length swell. In very advanced cases, cracks may form on the lower extremities with leakage of serous fluid.
Intracavitary edema is no less dangerous. Excess fluid accumulates in the abdominal, pleural and cardiac cavities, disrupting the functioning of vital organs. In children, abdominal pain syndrome may develop against the background of ascites.
Diagnostic measures
Defining nephrotic syndrome does not cause great difficulties. The main criterion is characteristic changes in the composition of urine.
When conducting a general analysis, the following is revealed:
- massive proteinuria (from 3 g/day and above);
- the main part of the protein fractions is albumin;
- the excretion of the daily amount of urine decreases due to the formation of edema;
- urine density increases due to increased protein loss;
- under a microscope, hyaline cylinders are detected;
- due to the high permeability of the glomerular membranes, altered red blood cells can be seen in the urine.
- erythrocyturia is characteristic of mixed nephrotic syndrome, which is also accompanied by arterial hypertension.
In the nephrotic form of acute and chronic glomerulonephritis, renal function is assessed to identify renal failure. A signal for this is a decrease in the amount of urine excreted. It is necessary to determine the glomerular filtration rate of creatinine.
A general blood test for nephrotic syndrome reveals a sharp increase in ESR (above 30 mm/hour). More indicative are the data of biochemical analysis. Nephrotic syndrome will be characterized by a decrease in protein fractions, namely albumin (total protein - less than 60 g/l, albumin - less than 40 g/l). Lipid and cholesterol levels increase. The electrolyte balance of the blood is disrupted: potassium is excreted in large quantities in the urine, and sodium is retained.
Ultrasound of the kidneys and renal vessels is prescribed as additional research methods. To find out the exact cause of the development of nephrotic syndrome, a fine-needle biopsy of the damaged organ is prescribed. To exclude congenital pathology of the urinary system, excretory urography with intravenous contrast is used.
Differential diagnosis of nephrotic syndrome in acute and chronic glomerulonephritis is carried out with amyloidosis, diabetic glomerulosclerosis, collagen nephropathy and myeloma of the kidneys.
Therapy methods
Treatment of glomerulonephritis with nephrotic syndrome is carried out in a hospital under the supervision of a physician. In specialized hospitals, therapy is prescribed by a nephrologist. Children are hospitalized in the pediatric nephrology department. The patient must strictly adhere to bed rest and the prescribed diet.
Therapeutic nutrition is aimed at:
- Increasing daily protein intake. The diet must be selected so that the body receives about 1.4 g of protein per 1 kilogram of weight, taking into account its loss in urine. Animal proteins make up 2/3 of this amount. Patients on diet No. 7 B are recommended to eat cottage cheese, egg whites, and lean meats or fish. If kidney function decreases, the amount of protein consumed decreases.
- The diet involves reducing fat consumption. This is associated with an increase in total cholesterol and triglycerides in the blood. On average, the daily intake of fat is about 80 g, of which 35% is vegetable.
- The diet includes a sharp restriction of table salt. All food is prepared without adding it. The use of salty sauces and marinades is contraindicated.
- With food you can restore the missing potassium. The therapeutic diet includes a large amount of vegetables and fruits. The patient is recommended to eat honey, potatoes, legumes, bananas, and greens.
- Despite the swelling, the amount of fluid consumed is limited slightly. The daily norm is about 1 liter. For children it is calculated based on weight. But the doctor must monitor the ratio of absorbed and excreted fluid.
During a therapeutic diet, it is prohibited to eat fresh bread, meat, mushroom broths, fatty meats and offal, spicy and salty types of cheese, and smoked meats. You should not eat chocolate or cream confectionery. A gentle temperature regime is optional. A therapeutic diet is prescribed until complete remission occurs.
Conservative treatment
First of all, it is necessary to prescribe pathogenetic therapy. Glucocorticosteroids, cytostatics, and selective immunosuppressants are used as immunosuppressants.
Glucocorticoids (prednisolone, dexamethasone) are considered the drugs of choice. They prevent the entry of immune complexes into the inflammatory focus. At the beginning of treatment of the nephrotic form of glomerulonephritis, large doses of prednisolone are prescribed, gradually reducing them. This is called pulse therapy. Before starting treatment, the doctor must warn the patient about the development of possible side effects. These include changes in appetite, sleep deprivation, increased blood pressure, the occurrence of steroid diabetes and others. These drugs should be used with great caution in children.
Diuretics are prescribed to reduce swelling. Preference is given to potassium-sparing ones. In case of nephrotic syndrome, in rare cases, forced diuresis is performed using diuretics to sharply reduce edema. The prescription of diuretics occurs under the control of sodium and potassium levels in the blood.
All drug treatment is carried out against the background of diet, bed rest and monitoring of key indicators.
Prognosis and possible complications
In acute and chronic glomerulonephritis, which are accompanied by the occurrence of nephrotic syndrome, it is necessary to take into account the possibility of complications.
With severe swelling, the likelihood of developing pneumonia or pneumonitis increases. If patients develop cracks in the area of pronounced edema, they must be carefully treated to avoid infection.
The most serious complication is nephrotic crisis. It is accompanied by severe pain and a drop in blood pressure. In children and adults, it is necessary to be wary of the formation of chronic renal failure due to glomerulonephritis with nephrotic syndrome.
With timely treatment, compliance with all medical recommendations and diet, the prognosis is favorable.
Glomerulonephritis is a disease in which kidney tissue is damaged. With this disease, the renal glomeruli, in which primary filtration of blood occurs, are primarily affected. The chronic course of this disease gradually leads to the loss of the ability of the kidneys to perform their function - to cleanse the blood of toxic substances with the development of renal failure.
What is the glomerulus and how do the kidneys work?
The blood entering the kidneys through the renal artery is distributed inside the kidney into the smallest vessels, which flow into the so-called renal glomerulus.What is a renal glomerulus?
In the renal glomerulus, the blood flow slows down, as through a semi-permeable membrane, the liquid part of the blood with electrolytes and organic substances dissolved in the blood seeps into Bowman’s capsule (which, like a wrapper, envelops the renal glomerulus on all sides). From the glomerulus, the cellular elements of the blood with the remaining amount of blood plasma are removed through the renal vein. In the lumen of Bowman's capsule, the filtered part of the blood (without cellular elements) is called primary urine.
What is Bowman's capsule and renal tubules (loop of Henle)?
But in addition to toxic substances, many useful and vital substances are dissolved in this urine - electrolytes, vitamins, proteins, etc. In order for everything useful for the body to return to the blood, and everything harmful to be excreted in the final urine, primary urine passes through a system of tubes (loop of Henle, renal tubule). It undergoes constant processes of transition of substances dissolved in primary urine through the wall of the renal tubule. Having passed through the renal tubule, primary urine retains toxic substances in its composition (which need to be eliminated from the body) and loses those substances that cannot be eliminated.
What happens to urine after it is filtered?
After filtration, the final urine is excreted through the renal tubule into the renal pelvis. Accumulating in it, urine gradually flows into the bladder in the lumen of the ureters.
What happens with glomerulonephritis in the kidneys?
Mainly with glomerulonephritis, the glomeruli of the kidneys are affected.
- Due to the inflammatory reaction in the wall of the glomerular vessels, the following changes occur:
- The wall of the vessels of the renal glomerulus becomes permeable to cellular elements
- Microthrombi form, which clog the lumen of the glomerular vessels.
- The blood flow in the vessels of the affected glomeruli slows down or stops altogether.
- Cellular elements of the blood enter the lumen of Bowman's capsule.
- Blood cells in the lumen of Bowman's capsule clog its lumen.
- Blood cells clog the lumen of the kidney tubules.
- The entire process of filtration of blood and primary urine in the affected nephron is disrupted (nephron is a complex: renal glomerulus + Bowman's capsule + renal tubules).
- Due to impaired blood flow in the renal glomerulus, the lumen of its vessels becomes empty and replaced by connective tissue.
- As a result of blockage of the renal tubules by blood cells, their lumen becomes empty and the walls stick together, with the entire nephron being replaced by connective tissue.
- The gradual “death” of nephrons leads to a decrease in the volume of filtered blood, which is the cause of renal failure.
- Kidney failure leads to the accumulation of toxic substances in the blood, and the substances necessary for the body do not have time to return the remaining nephrons of the kidneys to the blood.
From the above, it becomes clear that the cause of kidney dysfunction is the inflammatory process developing in the renal glomeruli. Now briefly about the causes of inflammation of the renal glomeruli.
- Common infectious diseases
- sore throat, tonsillitis
- scarlet fever
- infective endocarditis
- septic conditions
- pneumococcal pneumonia
- typhoid fever
- meningococcal infection
- mumps (mumps)
- chicken pox (chickenpox)
- infections caused by Coxsackie viruses
- Rheumatic and autoimmune diseases:
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Henoch-Schönlein disease
- hereditary pulmonary-renal syndrome
- Vaccination and blood transfusions
- Substance intoxication:
- Organic solvent poisoning
- alcoholic drinks
- mercury poisoning
- Radiation therapy, radiation sickness
Types and symptoms of chronic glomerulonephritis
Based on the course and clinical manifestations, the following types are distinguished:1. Latent– the most common (accounts for about 45% of all cases of chronic glomerulonephritis). Appears not expressed external symptoms: moderate swelling and increased blood pressure. More evident by laboratory examination data: general urine analysis detects increased levels of protein, red blood cells and white blood cells.
2. Hematuric– a rare form (accounts for no more than 5% of the total number of patients). Manifests as follows external signs: Pink or red urine. In general urine analysis an increased number of altered red blood cells is detected.
3. Hypertensive– a common form (accounts for about 20% of the total incidence). Manifests as follows external symptoms: constant increase in blood pressure, increase in the volume of daily urine excreted, night urge to urinate. In general urine analysis an increased content of protein and altered red blood cells is detected, urine density is slightly below normal or within the lower limit of normal.
4. Nephrotic- a common form (about 25%). The disease manifests itself as follows: external signs: increased blood pressure, severe swelling, reduced amount of daily urine excreted. Laboratory signs in general urine test: increased density of urine, increased protein content in urine; blood chemistry reveals: a decrease in total protein (mainly due to albumin), an increase in blood cholesterol.
5. Mixed (nephrotic-hypertensive)– characterized by symptoms of the two forms described above: nephrotic and hypertensive.
Methods for diagnosing chronic glomerulonephritis
To diagnose all types of chronic glomerulonephritis, the following types of examinations are used:
| Type of diagnosis | Why is it appointed? |
| General urine analysis | This analysis reveals changes in the following indicators: urine density, the presence of protein and casts, the presence of leukocytes and red blood cells, the color of urine. |
| Blood chemistry | This analysis examines the following indicators: total blood protein level, blood albumin level, creatinine level, urea level, cholesterol level and all fat fractions (lipidogram). |
| Kidney biopsy and biopsy microscopy | This research method allows you to examine tissue changes in the structure of the glomeruli of the kidneys and identifies various morphological forms of glomerulonephritis. In many ways, the histological form of glomerulonephritis is a criterion for prescribing adequate treatment. |
Stages of chronic glomerulonephritis
Compensation stage Initial stage (compensation stage), the functional activity of the kidneys is not changed.Stage of decompensation- associated with the progression of the disease with impaired renal function (decompensation stage). Stage with impaired renal function and the development of chronic renal failure.
| External signs | Laboratory signs |
| General urine analysis
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Uremia- severe renal failure. At this stage of the disease, the kidneys finally lose their ability to maintain normal blood composition.
Diagnosis of chronic glomerulonephritis
| Laboratory signs of acute glomerulonephritis: | |
| General urine analysis : |  |
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| Zimnitsky test: | |
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| Blood chemistry : | |
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| Immunological blood test: | |
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Treatment of chronic glomerulonephritis
| Type of treatment | Target | Practical information |
| Eliminate the source of chronic inflammation, which is a trigger for autoimmune kidney damage |
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| Reduce the load on the kidneys. Physical activity accelerates metabolic processes, which lead to an acceleration of the formation of nitrogenous compounds toxic to the body. | The patient is recommended to remain in a supine position and not to get out of bed unless absolutely necessary. |
| Impaired kidney function leads to changes in the electrolyte balance of the blood, loss of nutrients needed by the body and accumulation of harmful toxic ones. An adequate diet can reduce the adverse effects of the above factors. | Table number 7 Nutrition Features:
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| Improving blood flow. With inflammation in the renal glomeruli, conditions are created for the formation of blood clots in their vessels and blockage of their lumen. Drugs in this group prevent this process. |
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| Nonsteroidal anti-inflammatory drugs | There is evidence that indomethacin and ibuprofen affect the activity of the immune response. Suppressing immune damage to the kidneys leads to improved kidney health. | Indomethacin
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| Drugs that suppress the activity of the immune system have a beneficial effect in glomerulonephritis. By reducing the activity of the immune reaction, these drugs suppress destructive processes in the renal glomeruli. | Steroid drugs:
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| With the development of renal failure, fluid retention in the body may occur, as well as changes in the concentration of hormones produced by the kidneys. These changes often lead to a persistent increase in blood pressure, which can only be reduced with medication. |
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| Obstructed blood flow in the inflamed glomeruli of the kidneys, accumulation of cellular blood elements in the renal tubules requires activation of fluid flow in the nephron. Therefore, diuretics can have a positive effect in glomerulonephritis. |
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| In the event that a patient with glomerulonephritis has a chronic focus of infection (chronic sinusitis, sinusitis, endometritis, urethritis, tonsillitis), its sanitation with antibacterial drugs is necessary. | In each specific case, the type of antibiotic is selected individually by the attending physician depending on the following factors:
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Health prognosis for chronic glomerulonephritis
In the absence of treatment, the disease steadily leads to the loss of functionally active nephrons by the kidneys with the gradual onset of renal failure.With active treatment with suppression of the activity of the immune system, the course of the disease significantly improves, renal failure does not develop or the timing of its onset is significantly delayed.
There is evidence of complete remission (successful cure of the disease) during treatment with suppression of immune activity.
What are the features of chronic glomerulonephritis in children?
General features of glomerulonephritis in childhood:- The clinical picture of the disease can vary greatly.
- Chronic glomerulonephritis is the most common cause of chronic renal failure in children (except newborns).
- Up to 40% of all cases of hemodialysis and kidney transplantation in children are performed for chronic glomerulonephritis.
The main causes of chronic glomerulonephritis in children:
- In most cases, the causes are unknown. The disease develops as primary chronic, that is, the child did not have acute glomerulonephritis before.
- The role of irrational treatment of chronic foci of infection (sore teeth, inflamed tonsils), severe hypovitaminosis, hypothermia and malnutrition during acute glomerulonephritis cannot be excluded.
- Slow infectious processes play a certain role: cytomegalovirus infection, hepatitis B, parainfluenza, etc.
- Congenital disorders of the structure of renal tissue.
- Hereditary immunodeficiencies(decreased immune system function due to genetic disorders).
- nephrotic (edema-proteinuric);
- hematuric;
- mixed.
- The disease develops acutely after hypothermia, sore throat, acute respiratory infection, vaccinations, or for no apparent reason.
- The main symptoms are swelling and the presence of protein in the urine.
- The disease lasts a long time, periods of improvement are followed by new exacerbations. Chronic renal failure gradually develops.
- Usually there are no complaints - the child feels normal.
- A small amount of red blood cells and protein are found in the urine. Sometimes such changes persist for 10-15 years without any symptoms.
- Many children are found chronic tonsillitis(inflammation of the tonsils) and other chronic foci of infection.
- Swelling, lower back pain, headache, increased fatigue, and abdominal pain may occur periodically.
- In some children, the disease is accompanied by anemia, pallor, and increased blood pressure.
- If symptoms persist for a long time, there is a risk of chronic renal failure.
- A combination of blood and protein in the urine, edema, and increased blood pressure is typical.
- Manifestations of high blood pressure: headaches and dizziness, lower back pain, lethargy, irritability, blurred vision, and sometimes convulsions.
- Anemia and pallor are often noted.
- The disease is severe, and chronic renal failure develops very early.
How is dispensary observation carried out for children suffering from chronic glomerulonephritis?
Dispensary observation is carried out until the child is transferred to an adult clinic:
- Chronic pyelonephritis. A disease in which inflammation predominantly develops in the renal pelvis, calyces, and tubular system of the kidneys.
- Amyloidosis. A disease in which the metabolism of proteins and carbohydrates is disrupted in kidney cancer
Is it possible to drink alcohol if you have glomerulonephritis?
Alcohol consumption negatively affects the condition of all organs and systems, and the kidneys are no exception. Alcohol can aggravate the course of chronic glomerulonephritis, so it is recommended to avoid it completely. The taboo also applies to carbonated drinks. Is it possible to eat watermelons if you have glomerulonephritis?
People suffering from chronic glomerulonephritis can eat watermelons. But since they contain a lot of liquid, the recommended maximum amount of watermelons consumed is determined depending on the form and stage of the disease. Consult your doctor. Sometimes, with chronic glomerulonephritis, it is even recommended to arrange fasting “watermelon” days.
latent form– the prognosis is favorable; - hematuric and hypertensive form– the prognosis is serious;
- mixed and proteinuric form- the prognosis is unfavorable.
is a kidney disease of an immunoinflammatory nature. It primarily affects the glomeruli. To a lesser extent, interstitial tissue and renal tubules are involved in the process. Glomerulonephritis occurs as an independent disease or develops in certain systemic pathologies. The clinical picture consists of urinary, edematous and hypertensive syndromes. Data from urine tests, Zimnitsky and Reberg tests, ultrasound of the kidneys and ultrasound of the renal vessels are of diagnostic value. Treatment includes drugs to correct immunity, anti-inflammatory and symptomatic drugs.
General information
– kidney damage of an immuno-inflammatory nature. In most cases, the development of glomerulonephritis is caused by an excessive immune reaction of the body to antigens of an infectious nature. There is also an autoimmune form of glomeruloronephritis, in which kidney damage occurs as a result of the destructive effects of autoantibodies (antibodies to the body's own cells).
Glomerulonephritis ranks second among acquired kidney diseases in children after urinary tract infections. According to statistics from modern urology, pathology 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.
Causes of glomerulonephritis
The cause of the disease is usually an acute or chronic streptococcal infection (tonsillitis, pneumonia, tonsillitis, scarlet fever, streptoderma). The disease can develop as a consequence of measles, chickenpox or ARVI. The likelihood of pathology occurring increases with prolonged exposure to cold conditions and high humidity (“trench nephritis”), since the combination of these external factors changes the course of immunological reactions and causes disruption of the blood supply to the kidneys.
There is evidence that glomerulonephritis is associated with diseases caused by certain viruses, Toxoplasma gondii, Neisseria meningitidis, Streptococcus pneumoniae and Staphylococcus aureus. In the vast majority of cases, kidney damage develops 1-3 weeks after streptococcal infection, and research results most often confirm that glomerulonephritis was caused by “nephritogenic” strains of group A b-hemolytic streptococcus.
When an infection caused by nephritogenic strains of streptococcus occurs in a children's group, symptoms of acute glomerulonephritis are observed in 3-15% of infected children. When conducting laboratory tests, changes in urine are detected in 50% of children and adults surrounding the patient, which indicates a torpid (asymptomatic or low-symptomatic) course of glomerulonephritis.
After scarlet fever, an acute process develops in 3-5% of children treated at home and in 1% of patients treated in a hospital. ARVI can lead to the development of glomerulonephritis in a child who suffers from chronic tonsillitis or is a carrier of cutaneous nephritogenic streptococcus.
Pathogenesis
Antigen-antibody complexes are deposited in the capillaries of the renal glomeruli, impairing blood circulation, as a result of which the process of primary urine production 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.
Classification
Glomerulonephritis can occur acutely or chronically. There are two main options for the course of the acute process:
- Typical (cyclic). Characterized by a rapid onset and significant severity of clinical symptoms;
- Latent (acyclic). An erased form, characterized by a gradual onset and mild symptoms. It poses a significant danger due to late diagnosis and a tendency to develop into chronic glomerulonephritis.
In chronic glomerulonephritis, the following course options are possible:
- Nephrotic. Urinary symptoms predominate.
- Hypertensive. There is an increase in blood pressure, urinary syndrome is mild.
- Mixed. It is 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.
Symptoms of glomerulonephritis
Symptoms of an acute diffuse process 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), edematous, hypertensive. Acute glomerulonephritis in children, as a rule, develops rapidly, flows cyclically and usually ends with 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.
The disease begins with an increase in temperature (significant hyperthermia is possible), chills, general weakness, nausea, decreased appetite, headache and pain in the lumbar region. The patient becomes pale, his eyelids swell. In acute glomerulonephritis, a decrease in diuresis is observed in the first 3-5 days from the onset of the disease. Then the amount of urine excreted increases, but its relative density decreases. Another constant and mandatory sign of glomerulonephritis is hematuria (the presence of blood in the urine). Microhematuria develops in 83-85% of cases. In 13-15%, macrohematuria may develop, which is characterized by urine the color of “meat slop,” sometimes black or dark brown.
One of the most specific symptoms is facial swelling, pronounced in the morning and decreasing during the day. It should be noted that retention of 2-3 liters of fluid in muscles and subcutaneous fat is possible without the development of visible edema. In obese children of preschool age, the only sign of edema is sometimes some compaction of the subcutaneous tissue.
60% of patients develop hypertension, 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 dysfunction of the central nervous system and liver enlargement. With a favorable course, 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.
All forms of chronic glomerulonephritis are characterized by a relapsing course. Clinical symptoms of exacerbation resemble or completely repeat the first episode of the acute process. The likelihood of relapse increases in the spring-autumn period and occurs 1-2 days after exposure to an irritant, which is usually a streptococcal infection.
Complications
Acute diffuse glomerulonephritis can lead to the development of acute renal failure, acute heart failure, acute renal hypertensive encephalopathy, intracerebral hemorrhage, and transient vision loss. A factor that increases the likelihood of the transition from acute to chronic is hypoplastic kidney dysplasia, in which the kidney tissue develops behind the chronological age of the child.
For a chronic diffuse process, characterized by a progressive course and resistance to active immunosuppressive therapy, the outcome is a secondary shrunken kidney. Glomerulonephritis occupies one of the leading places among kidney diseases, leading to the development of renal failure in children and early disability of patients.
Diagnostics
The diagnosis is made on the basis of anamnesis (recent infectious disease), clinical manifestations (edema, arterial hypertension) and laboratory data. According to the analysis results, the following changes are characteristic:
- micro- or macrohematuria. With gross hematuria, the urine becomes black, dark brown, or takes on the color of “meat slop.” With microhematuria, no change in urine color is observed. In the first days of the disease, the urine contains mainly fresh red blood cells, then leached ones.
- moderate (usually between 3-6%) albuminuria for 2-3 weeks;
- granular and hyaline casts with microhematuria, erythrocyte casts with macrohematuria according to the results of microscopy of urinary sediment;
- nocturia, decreased diuresis during the Zimnitsky test. The preservation of the concentrating ability of the kidneys is confirmed by the high relative density of urine;
- a decrease in the filtration capacity of the kidneys according to the results of a study of endogenous creatinine clearance;
According to the results of a general blood test in acute glomerulonephritis, leukocytosis and an increase in ESR are detected. A biochemical blood test confirms an increase in urea, cholesterol and creatinine, an increase in AST and ASL-O titers. Acute azotemia (increased residual nitrogen content) is characteristic. An ultrasound of the kidneys and an ultrasound scan of the renal vessels are performed. If the data from laboratory tests and ultrasound are doubtful, a kidney biopsy and subsequent morphological examination of the obtained material are performed to confirm the diagnosis.
Treatment of glomerulonephritis
Treatment of pathology is carried out in a hospital setting. Diet No. 7 and bed rest are prescribed. Patients are prescribed antibacterial therapy (ampicillin + oxacillin, penicillin, erythromycin), and immune correction is carried out with non-hormonal (cyclophosphamide, azathioprine) and hormonal (prednisolone) drugs. The complex of therapeutic measures includes anti-inflammatory treatment (diclofenac) and symptomatic therapy aimed at reducing edema and normalizing blood pressure.
Subsequently, sanatorium-resort treatment is recommended. After acute glomerulonephritis, patients are under the supervision of a nephrologist for two years. When treating a chronic process during an exacerbation, a set of measures is carried out similar to the treatment of acute glomerulonephritis. The treatment regimen during remission is determined based on the presence and severity of symptoms.
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