Diagnostics of any disease includes not only the collection of complaints, anamnesis and clinical examination, but also a wide variety of laboratory tests, which make it possible to assess the general condition of the patient and determine the leading clinical syndromes. And what tests for glomerulonephritis can tell the 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 immune-inflammatory disease of the renal tissue with a primary lesion of the glomerular apparatus. As the disease progresses, interstitial tissues and renal tubules may be involved in the pathological process. This leads to the development of the following changes:
- increasing the permeability of the vascular glomerulus 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;
- violation of the filtration process in the main functional element of the kidney (nephron);
- dying off 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 moments cause the appearance of three main syndromes of the disease (edematous, hypertensive and urinary), as well as a characteristic laboratory picture. Blood and urine tests are required to confirm the diagnosis of glomerulonephritis.
Blood test
The blood counts reflect the general condition of the body and make it possible to judge the existing violations of the internal organs. As a rule, laboratory diagnostics for suspected glomerulonephritis begins with the CBC and the LHC; 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 BCC due to a decrease in renal filtration.
Symptoms identified during the interpretation of CBC results are nonspecific and occur in many diseases. Nevertheless, a complete blood count helps the doctor make the correct diagnosis as part of a comprehensive examination.
Biochemical analysis
A biochemical blood test, or LHC, is a test that detects signs of nephrotic syndrome against a 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, with the help of 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 research
The autoimmune nature of glomerular inflammation can be confirmed by determining the components of the complement system. An important role in the pathogenesis of glomerulonephritis is played by the C3 component, therefore, at the peak of the disease, its moderate decrease is observed.
Table: Changes in blood tests for glomerulonephritis
Urine examination
Particularly demonstrative are urine tests for glomerulonephritis: their indicators have pronounced deviations from the norm. The standard list of diagnostics includes conducting OAM and various tests (Reberg, according to Nechiporenko, according to Zimnitsky).
Clinical analysis
The main laboratory method for diagnosing glomerulonephritis remains a general urine test. It allows you to identify a patient with urinary syndrome:
- An increase in the relative density of urine, associated with the appearance in it of a large number of cellular elements.
- Decreased transparency, turbidity of the fluid secreted by the kidneys.
- Dark urine. With exacerbation of glomerulonephritis, it becomes a dirty brown, rusty color (the shade of "meat slops").
- Macrohematuria and microhematuria - the release of erythrocytes associated with an increase in vascular permeability in the renal glomeruli.
- Minor or severe proteinuria - excretion of protein in the urine.
- Leukocyturia is a nonspecific syndrome, it is not very pronounced.
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. Differentiation of glomerulonephritis from other inflammatory kidney diseases allows the combination of urinary excretion of protein and erythrocytes with a low level of leukocyturia.
Zimnitsky test
The study of urine according to Zimnitsky allows you to assess the concentration of the kidneys. Since in acute glomerulonephritis, the tubular apparatus is not impaired, there will be no pathological changes in this diagnostic test. With the progression of sclerotic changes in CGN, patients may experience polyuria (or, conversely, oliguria), nocturia.
Rehberg test
Rehberg's test is a diagnostic test that evaluates the level of effective blood flow in the kidneys (glomerular filtration). With glomerulonephritis, there is a decrease in creatinine clearance and glomerular filtration rate.
Table: Changes in urine tests for glomerulonephritis
| Index | Norm | With glomerulonephritis |
|---|---|---|
| General urine analysis | ||
| Colour | Straw yellow | Meat slop color |
| Transparency | Transparent | Muddy |
| Relative density | 1010-1035 | Increased |
| Erythrocytes | 0-1-2 in f / z | Microhematuria - 10-15 in f / s Macrohematuria - all over the field |
| Protein | Less than 0.03 g / l | Sharply increased |
| Leukocytes | In men: 0-3 in f / s In women: 0-5 in f / s | Slightly increased |
| Urine sample according to Nechiporenko | ||
| Erythrocytes | Up to 1000 ml | Enhanced |
| Leukocytes | In men: up to 2000 ml In women: up to 4000 ml | Enhanced |
| Hyaline cylinders | Up to 20 ml | Enhanced |
| Rehberg test | ||
| Clearance of creatinine | For men: 95-145 ml / min For women: 75-115 ml / min | Reduced |
Changes in urine and blood tests are an important diagnostic indicator: they can be used to determine the stage of the inflammatory process, to suggest the nature of the course of the disease, and to identify the leading syndromes. Despite this, the presence of glomerulonephritis in a patient should be confirmed not only in the laboratory, but also with the help of 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 a successful treatment. If the classic course of glomerulonephritis - glomerular inflammation of the kidneys - has its own vivid characteristic features, then the latent forms of the disease can mimic a variety of pathologies. In order for the doctor to be able to make the correct diagnosis, the patient needs to undergo a comprehensive clinical, laboratory and instrumental examination.
Why early diagnosis is so important
Glomerulonephritis is an acute or chronic infectious-allergic disease with a primary lesion of 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). The disease is more susceptible to males. Chronic inflammation of the renal glomeruli occurs in all age groups. This pathology accounts for up to 1% of all therapeutic patients.
In the acute course of glomerulonephritis, clinical diagnosis is usually straightforward. In more than 70% of cases, the pathology responds well to therapy, and patients are completely cured. Without the timely provision of a medical form, 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 turns to a doctor with his complaints, undergoes examination and begins treatment, the higher his chances of recovery with full restoration of the functional activity of the kidneys.
Stage one: interview and clinical examination
The first thing that begins with the examination of the patient is the collection of complaints and anamnesis. Most often, the patient is worried about:
- unstable increase in blood pressure (mainly due to the diastolic component);
- headaches, dizziness attacks;
- flashing flies before the eyes;
- noise, ringing in the ears;
- decrease in the number and volume of urination (oliguria, anuria);
- discoloration of urine: it becomes a dirty brown, rusty hue (the color of "meat slops");
- constant feeling of thirst;
- the appearance of edema, first on the face and upper body, then spreading to the chest, abdominal cavity (hydrothorax, anasarca);
- dull aching pains, discomfort in the lumbar region;
- an increase in body temperature up to 38.5-39 ° С;
- 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, interaction with toxic substances.
Then the doctor conducts a clinical examination, including an assessment of 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 edema (the favorite localization is the eyelids), pain on palpation of the kidneys, a weakly positive Pasternatsky symptom, 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 kidney tumors.
Stage two: laboratory tests
If glomerulonephritis is suspected, the following laboratory methods are prescribed:
- general blood analysis;
- blood chemistry;
- clinical analysis of urine;
- samples according to Nechiporenko, Zimnitsky, Reberg - according to indications;
- allergy tests;
- immunological blood test.
In the results of the CBC of patients with glomerulonephritis, there are 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.
Urinalysis is the most important laboratory method in diagnosing exacerbations of glomerulonephritis. The following pathological changes are observed in it:
- an increase in the relative density of urine;
- color change;
- proteinuria - from microalbuminuria to massive excretion of protein in the urine (3 g / day or more);
- hematuria, erythrocyturia.
Immunological research and allergy tests can reveal various disorders in the functioning of the body's defense system and confirm the autoimmune nature of the disease.
The third stage: instrumental examination methods
Instrumental tests can 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 vague, indistinct contours;
- bilateral thickening of the parenchyma (functional layer);
- increased echogenicity, heterogeneity of the structure of renal tissues: both hypo- and hyperechoic foci ("pyramids") appear.
With ultrasound examination of blood flow (Doppler), there is a decrease in vascular resistance in the arcuate (arc) arteries. At the same time, blood flow in segmental and interlobar vessels can remain normal.
To confirm the diagnosis and determine the nature of the changes in the tissues, it is possible only with the help of a morphological study. The role of kidney biopsy is especially important in chronic glomerulonephritis.
The diagnostic procedure refers to minimally invasive surgical interventions and is carried out only in stationary conditions. 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, micropreparations are prepared from the obtained biomaterial, which the cytologist carefully examines under a microscope. The obtained data of histological examination reflect the morphological features of inflammation, allow 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, you can 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 complete recovery.
Glomerulonephritis and pregnancy - is there a danger to the woman and the fetus? Glomerulonephritis is a serious pathological abnormality in the functioning of the filtration apparatus of the kidneys. Pregnancy, as a special condition of a woman's body, often increases the risk of this pathology. This is primarily due to the weakening of immunity in pregnant women and their vulnerability to infections. The hormone progesterone, actively produced to preserve the fetus, reduces the elasticity of the ureteral tissues, which leads to impaired urodynamics and stagnation of urine in the calyx-pelvic complex of the kidneys. In addition, the uterus with a growing fetus puts pressure on the organs of the woman's urinary system, which can also provoke stagnation in the urinary tract, and cause a coccal infection to enter the body. Natural during pregnancy is the fact that the kidneys of the expectant mother work with an increased load, cleansing not only the mother's body, but also the amniotic fluid.
- Causes of glomerulonephritis disease
- Possible complications of glomerulonephritis
- Glomerulonephritis symptoms
- Diagnostics and treatment of glomerulonephritis
- Prevention of glomerulonephritis
Causes of glomerulonephritis disease
Glomerulonephritis is an autoimmune disease that affects the renal glomeruli, which are responsible for the blood filtration process, and it occurs due to the acute immune response of the human body to streptococcal infection. Formed immune complexes "antigen-antibody" settle in the renal glomeruli and, mistaking glomerular cells for foreign proteins, begin to destroy them if any infection enters the body. Very often, glomerulonephritis is preceded by tonsillitis.
What can be the "impetus" for the occurrence of glomerunephritis in pregnant women:
Under the influence of these factors, acute glomerulonephritis of pregnant women may occur or an exacerbation of the chronic may occur.
Possible complications of glomerulonephritis
Glomerulonephritis during pregnancy has an adverse effect on its course and fetal development.
With glomerulonephritis, the following complications may occur:
- Gestosis, pereclamsia, eclamsia, nephropathy.
- Acute renal failure.
- Heart failure.
- Anemia.
- Arterial hypertension.
- Deterioration of vision.
- Hemorrhage.
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 organs of the genitourinary system.
The risk of an unfavorable pregnancy outcome is assessed in three grades:
- 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 a lag in the development of the fetus, its intrauterine death or premature birth.
- The third is the maximum degree of risk. There is a real danger of the death of a woman and a fetus during childbirth, a high risk of intrauterine death of a child and the birth of an infant with severe anomalies.
Glomerulonephritis symptoms
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 one. With a latent course of glomerulonephritis, the symptomatology is very slightly expressed, but even in this case, the woman must be monitored in the hospital.
What signs indicate a developing pathology:
- There are pulling pains in the lower back.
- The face is swollen. Fluid accumulates in the subcutaneous fat and pleural area.
- Severe headaches are difficult to relieve with pain relievers.
- High body temperature is one of the signs of acute glomerulonephritis.
- Violation of urination (decreased daily urine output) or its complete absence.
- Blood impurities in the urine. Urine has the color of "meat slops".
- High blood pressure.
- Signs of intoxication are nausea and vomiting.
In addition, the woman experiences weakness, dizziness.
The chronic course of the disease depends on the form of pathology:
- Latent. Symptoms are mild, but there are minor abnormalities in urine tests (protein is detected).
- Nephrotic. Pronounced swelling.
- Hypertensive. Persistent high blood pressure, but no changes in the urine.
- Terminal. There are signs of renal failure.
Diagnostics 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, erythrocytes) 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 content, cholesterol, 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, a woman is assigned to bed rest in order to ensure uniform body heating and rest.
- Diet. It is assumed a strict limitation of the amount of salt, control of the amount of fluid and protein products consumed.
- Drug therapy. The doctor prescribes drugs to correct blood pressure, relieve puffiness, 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 take place (naturally or with the help of a cesarean section).
Prevention of glomerulonephritis
To do this, you must follow simple rules:
- always dress for the weather - prevent hypothermia, do not neglect gloves and hats, do not allow shoes to get wet;
- monitor your diet, eat less seasonings and salt;
- give up alcohol, smoking and other bad habits;
- timely and correctly treat colds, diseases of the ENT and organs of the genitourinary system;
- planning a pregnancy if you have kidney disease after a thorough examination.
In view of the fact that glomerulonephritis is a complex and dangerous disease, one should not self-medicate, and when the first warning signs appear, you should seek qualified help from the 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, one cannot neglect precautions and ignore regular visits to the antenatal clinic and the timely delivery of all tests.
Correct treatment for acute pyelonephritis
Acute pyelonephritis is an inflammatory disease of the kidney tissue and the calyx-pelvic system, and is usually recorded in the patient's card according to the ICB code 10. Currently, acute pyelonephritis is the most common kidney disease that occurs in medical practice. Such a disease is often found among children when the load on the kidneys is intense, while their development has not yet been fully formed.
As for adults, the disease most often affects women up to 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 urine output, which, accordingly, is a favorable condition for the reproduction 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 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 if he has recently had any purulent or infectious diseases of the urinary system and genitals. After that, on the basis of the results, the tests passed and the collected data, it is already possible to make an adequate diagnosis and appropriate treatment.
The main symptoms
Usually, the initial stage of acute pyelonephritis is characterized by a sharp rise in body temperature up to forty degrees. After a certain period of time, the patient develops aching pains 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 feeling;
- Usually, on the fifth day of the course of the disease, there is a tension in the muscles of the abdominal wall.
At the moment, there are also several forms of acute pyelonephritis, which must be taken into account during the diagnosis and the correct ICB code:
- The most acute form is characterized by a severe general condition of the patient. The patient has an increase in body temperature, accompanied by chills, which is repeated up to three times a day;
- Acute - is that the patient has pronounced local symptoms of the disease, such as mild intoxication of the body and increasing thirst;
- For the subacute form of the disease, it is characteristic that local symptoms come to the fore, while general ones practically disappear;
- The latent form proceeds practically without symptoms and does not pose a direct threat to the patient's health, but it 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 discovers at least one of the above symptoms, an immediate appeal to a qualified specialist should follow, since untimely treatment of acute pyelonephritis can lead to very serious consequences, including renal failure and chronic pyelonephritis.
Necessary treatment
Acute and chronic pyelonephritis is a disease with which people most often turn to doctors, and the cure of the disease largely depends on the correct diagnosis and the correctly chosen ICB code. As a rule, patients are prescribed a complex method of treatment, which includes: adherence to the regimen, diet and drug 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 record is drawn up for him. Medical history acute pyelonephritis according to the ICB code is classified at number ten. Treatment usually focuses primarily on fighting infection in order to restore kidney function.
Acute pyelonephritis treatment includes: bed rest, which must be strictly observed until the end of the fever and chills, diet and drug therapy. The main role in the treatment is played by drug therapy, with the main emphasis on precisely those drugs that can be excreted with urine in high concentration. A positive result is achieved with the appointment of certain medicinal herbs and fees, such as St. John's wort, diuretic tea, rose hips.
Reception of infusions from such medicinal fees is recommended to take four tablespoons a day, for three or more months. Vitamins are also prescribed, and intravenous solutions are used in case of intoxication of the body. 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 onset, 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 are continued for at least six weeks with a constant change.
It is worth remembering that it is extremely dangerous to engage in self-treatment, you should not experiment and look for reasons, it is better to immediately contact a medical institution to receive qualified assistance. Correct and timely treatment eliminates the risk of possible complications and has a positive effect on the course of the disease.
For the prevention of disease prevention, 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 gestation, but also after childbirth, since the possible course of the disease that began during pregnancy might not show any symptoms.
As for the prognosis for acute pyelonephritis, in general, with timely assistance and a correctly diagnosed 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 easily digestible, it should also be with a sufficient amount of vitamins and calories, but the use of salt is recommended to be minimized, since its excessive content makes the kidneys work in an enhanced mode, which is contraindicated in the acute course of the disease.
In the first days of being in the hospital, due to the high probability of intoxication of the body, the patient is recommended to consume fresh vegetables and fruits, and it is also necessary to drink at least two liters of liquid, which helps to eliminate harmful substances from the body. The best way to cope with this task is sweet tea, compotes and herbal infusions.
In the future, as the patient's condition improves, the specialist transfers him to a therapeutic diet at number seven, with a gradual increase in the fluid consumed 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, the following food products are strictly prohibited from the ICB 10 code: rich meat and fish broths, canned foods, mustard, horseradish, sorrel and garlic.
After the patient is discharged, a diet is prescribed, which includes the use of proteins, fats and carbohydrates, the patient should eat fractionally about five times a day. The doctor takes into account the general condition of the patient and, on the basis of this, draws up an individual diet, which should include a variety of consumed products, especially dairy and fermented milk.
Strict adherence to such a dietary diet allows you to maintain a weakened patient's body and immunity at the required level, which contributes to a speedy recovery.
Glomerulonephritis with a predominance of nephrotic syndrome
Glomerulonephritis is a group of diseases that are expressed by a predominant lesion of the glomerular apparatus of the kidneys. This pathology is of an inflammatory nature and manifests itself in different ways. Glomerulonephritis is accompanied by isolated urinary, nephritic or nephrotic syndromes. It progresses rapidly and can progress to nephrosclerosis or chronic renal failure. Most often, children of primary school age and adult men suffer from it.
Glomerulonephritis with nephrotic syndrome accounts for about 20% of all cases of glomerulonephritis. When prescribing therapy, the doctor should pay special attention to the 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 β-hemolytic streptococcus group A. But these bacteria do not directly affect the basement membrane of the glomeruli. 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. The cells of the immune response begin to produce antibodies that bind to the antigen and form cyclic immune complexes (CICs). The latter settle on the glomerular membrane, the defeat of which leads to an increase in permeability and the formation of an inflammatory focus. As a result, nephrotic syndrome develops, in which blood proteins are excreted in large quantities.
Streptococcal infections are not the only ones that cause kidney damage. Herpes viruses (herpes simplex, Epstein-Barr virus, cytomegalovirus), staphylococci, enterococci, hepatitis B and many others are capable of this.
Other factors causing glomerulonephritis include drugs with potential nephrotoxic effects. This means that some antibiotics (aminoglycosides, sulfonamides), nonsteroidal anti-inflammatory drugs can provoke the development of acute glomerulonephritis. Individual sensitivity to drugs, the presence of concomitant pathologies of the kidneys or other organs are of great importance in the emergence 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 is 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.
By the type of flow, there are:
- Acute: the 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 rise in temperature and weakness. The patient complains of severe symptoms of intoxication: dizziness, nausea, loss of appetite, pallor of the 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. The 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. Chronization of the process in children is very dangerous.
Edema
Extrarenal changes (edema, hypertension) occur gradually. At first, the patient notes the appearance of small edema on the face and only in the morning, but then they progress up to the anasarca and intracavitary manifestations. A person suffering from a nephrotic form of glomerulonephritis has a characteristic appearance, which will allow the doctor to suspect the development of pathology. Such people are pale, the face is swollen, puffy. The skin at the site of edema is cold to the touch, trophic disturbances (dryness, peeling) are observed.
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 the excretion of protein along with the urine. A certain amount of proteins in the blood plasma maintains the optimal colloid-osmotic pressure. If their number decreases markedly, then the pressure, accordingly, decreases. A compensatory mechanism is activated, which is based on the maintenance of oncotic pressure. The liquid passes into the intercellular space to restore processes.
With the progression of the disease with nephrotic syndrome, the edema increases. They are already localized not only on the upper half of the body. Swelling of the lumbar region, legs along the entire length. In very advanced cases, cracks may form on the lower extremities with the outflow 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. Children with ascites may develop abdominal pain syndrome.
Diagnostic measures
The definition of nephrotic syndrome does not cause great difficulties. The main criterion is the characteristic changes in the composition of urine.
When conducting a general analysis, it is revealed:
- massive proteinuria (from 3 g / day and above);
- the bulk of the protein fractions is albumin;
- the release of the daily amount of urine decreases due to the formation of edema;
- urine density increases due to increased protein loss;
- hyaline cylinders are found under the microscope;
- due to the high permeability of the glomerular membranes, altered erythrocytes 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. The signal for this is a decrease in the amount of urine excreted. It is necessary to determine the rate of glomerular filtration of creatinine.
In the general analysis of blood with nephrotic syndrome, a sharp increase in ESR is found (above 30 mm / h). Biochemical analysis data are more indicative. For nephrotic syndrome, a decrease in protein fractions, namely albumin (total protein - less than 60 g / l, albumin - less than 40 g / l) will be characteristic. The level of lipids and cholesterol increases. The electrolyte balance of the blood is disturbed: potassium is excreted in large quantities in the urine, and sodium is retained.
As additional research methods, ultrasound of the kidneys and renal vessels is prescribed. 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 renal myeloma.
Therapies
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 admitted to the pediatric nephrology department. The patient must strictly adhere to bed rest and the prescribed diet.
Therapeutic nutrition is aimed at:
- Increased 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 the urine. Animal proteins account for 2/3 of this amount. Patients with diet number 7 B are advised to eat cottage cheese, egg whites, lean meats or fish. If kidney function decreases, then the amount of protein consumed decreases.
- The diet involves reducing fat intake. It is associated with an increase in total cholesterol and triglycerides in the blood. On average, the daily rate of fat is about 80 g, of which 35% is vegetable.
- The diet provides for a sharp restriction of table salt. All food is prepared without adding it. The use of salty sauces, marinades is contraindicated.
- With food, you can restore the missing potassium. A healthy diet includes a lot of vegetables and fruits. The patient is advised to eat honey, potatoes, legumes, bananas, and herbs.
- Despite the edema, the amount of fluid consumed is limited slightly. The daily intake is about 1 liter. In children, it is calculated depending on the weight. But the doctor must monitor the ratio of absorbed and excreted fluid.
With a medical diet, it is prohibited to eat fresh bread, meat, mushroom broths, fatty meats and offal, spicy and salty types of cheese, smoked meats. Do not eat chocolate and cream pastries. A gentle temperature regime is optional. A therapeutic diet is prescribed until complete remission occurs.
Conservative treatment
First of all, the appointment of pathogenetic therapy is necessary. Glucocorticosteroids, cytostatics, and selective immunosuppressants are used as immunosuppressants.
Glucocorticoids (prednisone, dexamethasone) are considered drugs of choice. They prevent the entry of immune complexes into the inflammatory focus. At the beginning of treatment for 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 care in children.
Diuretics are prescribed to reduce swelling. The preference is given to potassium-saving ones. In nephrotic syndrome, in rare cases, forced diuresis is performed with the help of diuretics to dramatically reduce edema. The administration of diuretics is controlled by the level of sodium and potassium in the blood.
All drug treatment is carried out against the background of adherence to diet, bed rest and monitoring of key indicators.
Prognosis and possible complications
In acute and chronic glomerulonephritis, which are accompanied by the onset of nephrotic syndrome, it is necessary to take into account the possibility of complications.
With severe edema, the likelihood of developing pneumonia or pneumonitis increases. If patients develop cracks in the area of pronounced edema, then they must be carefully treated to avoid infection.
The most formidable complication is a 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 in glomerulonephritis with nephrotic syndrome.
With timely treatment, compliance with all medical recommendations and diet, the prognosis is favorable.
Glomerulonephritis is a disease in which the kidney tissue is damaged. In this disease, the renal glomeruli are primarily affected, in which the primary filtration of blood occurs. The chronic course of this disease gradually leads to the loss of the kidneys' ability 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 that flow into the so-called renal glomerulus.What is a renal glomerulus?
In the renal glomerulus, the blood flow slows down, as through a semipermeable membrane, the liquid part of blood with electrolytes and organic substances dissolved in the blood seeps into Bowman's capsule (which, like a wrapper, envelops the renal glomerulus from all sides). From the glomerulus, the cellular elements of the blood with the remaining amount of blood plasma are excreted 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 kidney tubules (Henle's loop)?
But in this urine, in addition to toxic substances, many useful and vital substances are dissolved - electrolytes, vitamins, proteins, etc. In order for everything that is useful for the body to return to the blood, and everything harmful to be excreted in the final urine, the primary urine passes through a system of tubes (Henle's loop, renal tubule). In it, there are constant processes of transition of substances dissolved in the primary urine through the wall of the renal tubule. Having passed through the renal tubule, the primary urine retains toxic substances in its composition (which need to be removed from the body) and loses those substances that cannot be excreted.
What happens to the urine after filtering it?
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 in kidney glomerulonephritis?
Mainly with glomerulonephritis, the glomeruli of the kidneys are affected.
- Due to the inflammatory reaction, the vascular wall of the glomeruli occurs the following changes:
- The vascular wall of the renal glomerulus becomes permeable to cellular elements
- Microthrombi are formed, which clog the lumen of the vessels of the glomeruli.
- The blood flow in the vessels of the affected glomeruli slows down or stops altogether.
- The cellular elements of the blood enter the lumen of the Bowman capsule.
- Blood cells in the lumen of the Bowman's capsule block its lumen.
- Blood cells block the lumen of the renal tubules.
- The whole process of filtration of blood and primary urine in the affected nephron is disrupted (a 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 is desolate and replaced by connective tissue.
- As a result of the blockage of the renal tubules by blood cells, their lumen becomes desolate and the walls stick together with the replacement of the entire nephron with connective tissue.
- The gradual "death" of nephrons leads to a decrease in the volume of filtered blood, which is the cause of renal failure.
- Renal 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
- tonsillitis, tonsillitis
- scarlet fever
- infective endocarditis
- septic conditions
- pneumococcal pneumonia
- typhoid fever
- meningococcal infection
- mumps (mumps)
- chickenpox (chickenpox)
- infections caused by Coxsackie viruses
- Rheumatic and autoimmune diseases:
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Schönlein-Henoch disease
- hereditary pulmonary renal syndrome
- Vaccination and transfusion of blood components
- Intoxication by substances:
- Poisoning with organic solvents
- alcoholic drinks
- mercury poisoning
- Radiation therapy, radiation sickness
Types and symptoms of chronic glomerulonephritis
According to 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). Manifested not pronounced external symptoms: moderate swelling and increased blood pressure. More manifested by laboratory examination data: general urine analysis reveals an increased level of protein, erythrocytes and leukocytes.
2. Hematuric- a rare form (not more than 5% of the total number of patients). It manifests itself as follows outward signs: pink or red urine. In the general analysis of urine an increased number of altered erythrocytes is detected.
3. Hypertensive- a common form (about 20% of the total incidence). It manifests itself as follows external symptoms: a constant increase in blood pressure, an increase in the volume of excreted daily urine, nocturnal urge to urinate. In the general analysis of urine revealed an increased content of protein and altered erythrocytes, 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 outward signs: high blood pressure, severe swelling, reduced daily urine output. Laboratory signs in general urine analysis: increased urine density, increased urine protein; 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 above-described forms: nephrotic and hypertensive.
Methods for the diagnosis of chronic glomerulonephritis
To diagnose all types of chronic glomerulonephritis, the following types of examinations are used:
| Diagnostics type | Why is it appointed? |
| General urine analysis | This analysis reveals changes in the following indicators: urine density, the presence of protein and cylinders, the presence of leukocytes and erythrocytes, urine color. |
| Blood chemistry | In this analysis, the following indicators are investigated: total blood protein level, blood albumin level, creatinine, urea, cholesterol and all fat fractions (lipid profile). |
| Kidney biopsy and biopsy microscopy | This research method allows you to investigate tissue changes in the structure of the glomeruli of the kidneys and reveals various morphological forms of glomerulonephritis. In many ways, the histological form of glomerulonephritis is a criterion for the appointment of adequate treatment. |
Stages of chronic glomerulonephritis
Compensation stage The initial stage (stage of compensation), the functional activity of the kidneys is not changed.Decompensation stage- associated with the progression of the disease with impaired renal function (stage of decompensation). 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 a normal blood composition.
Diagnostics of the 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
| Treatment type | Target | Practical information |
| Eliminate the source of chronic inflammation that triggers autoimmune kidney damage |
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| Reduce the burden on the kidneys. Physical activity accelerates metabolic processes, which lead to the acceleration of the formation of nitrogenous compounds that are toxic to the body. | The patient is advised to be in a supine position, without urgent need not to get out of bed. |
| Disruption of the kidneys leads to a change in the electrolyte balance of the blood, the loss of nutrients necessary for the body and the accumulation of harmful toxic ones. An adequate diet can reduce the adverse effects of the above factors. | Table number 7 Power features:
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| Improved 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. The drugs in this group prevent this process. |
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| Non-steroidal 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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| Means that suppress the activity of the immune system have a beneficial effect on glomerulonephritis. By reducing the activity of the immune response, these drugs suppress the destructive processes in the renal glomeruli. | Steroid drugs:
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| With the development of renal failure, fluid retention in the body can be observed, as well as a change 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, the accumulation of cellular elements of the blood in the renal tubules requires the activation of fluid flow in the nephron. Therefore, diuretics can have a positive effect on glomerulonephritis. |
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| In the event that a patient with glomerulonephritis retains a chronic focus of infection (chronic sinusitis, sinusitis, endometritis, urethritis, tonsillitis), it must be sanitized with antibacterial drugs. | In each case, the type of antibiotic is selected by the attending physician individually, 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 improves significantly, 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 suppressed 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 (excluding 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 reasons are unknown. The disease develops as primary chronic, that is, before that, the child did not have acute glomerulonephritis.
- The role of irrational therapy of chronic foci of infection (bad teeth, inflamed tonsils), severe hypovitaminosis, hypothermia and malnutrition during acute glomerulonephritis is not excluded.
- A certain role is played by slowly ongoing infectious processes: cytomegalovirus infection, hepatitis B, parainfluenza, etc.
- Congenital disorders of the structure of the renal tissue.
- Hereditary immunodeficiencies(decreased function of the immune system due to genetic disorders).
- nephrotic (edematous-proteinuric);
- hematuric;
- mixed.
- The disease develops acutely after hypothermia, tonsillitis, acute respiratory infection, vaccinations, or for no apparent reason.
- The main symptoms are edema and the presence of protein in the urine.
- The disease lasts a long time, periods of improvement are replaced 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 these 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.
- Periodically, there may be swelling, back pain, headache, fatigue, and abdominal pain.
- 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 impurities of blood and protein in the urine, edema, increased blood pressure is characteristic.
- Manifestations of high blood pressure: headaches and dizziness, back pain, lethargy, irritability, blurred vision, and sometimes convulsions.
- Anemia and pallor are often noted.
- The disease is difficult, chronic renal failure develops very early.
How is dispensary observation of children suffering from chronic glomerulonephritis carried out?
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 pelvis, calyx, and renal tubular system.
- Amyloidosis... A disease in which the metabolism of proteins and carbohydrates is impaired in kidney cancer
Can I drink alcohol with glomerulonephritis?
Alcohol consumption negatively affects the state of all organs and systems, and the kidneys are no exception. Alcohol can aggravate the course of chronic glomerulonephritis, so it is recommended to completely abandon it. Carbonated drinks are also taboo. Is it possible to eat watermelons with glomerulonephritis?
People with chronic glomerulonephritis can eat watermelons. But since they contain a lot of liquid, the recommended maximum amount of consumed watermelons is determined depending on the form and stage of the disease. Check with your doctor. Sometimes, with chronic glomerulonephritis, it is even recommended to arrange unloading "watermelon" days.
latent form- the forecast is favorable; - hematuric and hypertensive form- the prognosis is serious;
- mixed and proteinuric form- the prognosis is unfavorable.
Is an immune-inflammatory kidney disease. It mainly affects the renal glomeruli. To a lesser extent, the process involves interstitial tissue and kidney tubules. Glomerulonephritis occurs as an independent disease or develops in some systemic pathologies. The clinical picture consists of urinary, edematous and hypertensive syndromes. The data of urine analyzes, samples of Zimnitsky and Reberg, ultrasound of the kidneys and USDG of the renal vessels are of diagnostic value. Treatment includes drugs to correct the immune system, anti-inflammatory and symptomatic drugs.
General information
- kidney damage of an immune-inflammatory nature. In most cases, the development of glomerulonephritis is due to an excessive immune response of the body to antigens of an infectious nature. There is also an autoimmune form of glomeruloronephritis, in which kidney damage occurs as a result of the destructive effects of autoantibodies (antibodies against the cells of one's own body).
Glomerulonephritis ranks second among acquired kidney disease in children after urinary tract infections. According to the statistics of 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.
Glomerulonephritis reasons
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 increases with prolonged exposure to cold in conditions of high humidity ("trench" nephritis), since the combination of these external factors alters the course of immunological reactions and causes impaired 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 overwhelming majority of cases, kidney damage develops 1-3 weeks after streptococcal infection, and the research results most often confirm that glomerulonephritis was caused by "nephritogenic" strains of group A b-hemolytic streptococcus.
When an infection occurs in the children's collective caused by nephritogenic strains of streptococcus, symptoms of acute glomerulonephritis are observed in 3-15% of infected children. When conducting laboratory studies, changes in urine are detected in 50% of the surrounding children and adults, which indicates a torpid (asymptomatic or low-symptom) 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. The development of glomerulonephritis can lead to ARVI 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 be acute or chronic. There are two main options for the course of the acute process:
- Typical (cyclical)... Characterized by a stormy 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 transition to 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 poorly expressed.
- 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, the remaining symptoms are absent or mild.
Glomerulonephritis symptoms
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, loss of appetite, headache and pain in the lumbar region. The patient becomes pale, his eyelids swell. In acute glomerulonephritis, there is a decrease in urine output in the first 3-5 days from the onset of the disease. Then the amount of excreted urine increases, but its relative density decreases. Another constant and obligatory sign of glomerulonephritis is hematuria (the presence of blood in the urine). Microhematuria develops in 83-85% of cases. In 13-15%, the development of gross hematuria is possible, which is characterized by urine of the color of "meat slops", sometimes black or dark brown.
One of the most specific symptoms is facial swelling, pronounced in the morning and decreasing during the day. It should be noted that the retention of 2-3 liters of fluid in the muscles and subcutaneous adipose tissue is possible without the development of visible edema. In obese preschool children, the only sign of edema sometimes becomes some compaction of the subcutaneous tissue.
In 60% of patients, hypertension develops, which, in severe form of the disease, can last up to several weeks. In 80-85% of cases, acute glomerulonephritis causes damage to the cardiovascular system in children. Dysfunctions of the central nervous system and enlargement of the liver are possible. With a favorable course, timely diagnosis and the beginning of treatment, the main symptoms (edema, arterial hypertension) disappear within 2-3 weeks. Full recovery is noted in 2-2.5 months.
All forms of chronic glomerulonephritis are characterized by a recurrent 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, transient loss of vision. A factor that increases the likelihood of a transition from an acute form to a chronic one is hypoplastic renal dysplasia, in which renal tissue develops with a lag behind the chronological age of the child.
For a chronic diffuse process, characterized by a progressive course and resistance to active immunosuppressive therapy, a secondary contracted kidney becomes the outcome. 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 results of the analyzes, the following changes are characteristic:
- micro- or macrohematuria. With gross hematuria, urine becomes black, dark brown, or takes on the color of "meat slops". With microhematuria, no change in urine color is observed. In the first days of the disease, the urine contains mainly fresh erythrocytes, then leached.
- moderate (usually within 3-6%) albuminuria within 2-3 weeks;
- granular and hyaline cylinders with microhematuria, erythrocytic - with gross hematuria according to the results of microscopy of urinary sediment;
- nocturia, decreased urine output during the Zimnitsky test. The preservation of the concentration 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 the study of the clearance of endogenous creatinine;
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 the content of urea, cholesterol and creatinine, an increase in the titer of AST and ASL-O. Acute azotemia (increased residual nitrogen content) is characteristic. Ultrasound of the kidneys and ultrasound of the kidney vessels are performed. If the data of laboratory studies and ultrasound are doubtful, a kidney biopsy is performed to confirm the diagnosis and subsequent morphological examination of the material obtained.
Glomerulonephritis treatment
Treatment of pathology is carried out in a hospital setting. Diet No. 7 is prescribed, bed rest. Patients are prescribed antibiotic therapy (ampicillin + oxacillin, penicillin, erythromycin), the immune system is corrected 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.
In the future, a spa treatment is recommended. After suffering acute glomerulonephritis, patients are under the supervision of a nephrologist for two years. In the treatment of a chronic process during an exacerbation, a set of measures is carried out, similar to the treatment of acute glomerulonephritis. The treatment regimen during the period of remission is determined based on the presence and severity of symptoms.
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