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Glomerulonephritis: forms, diagnosis, symptoms and treatment

Glomerulonephritis is a group of kidney diseases with various clinical manifestations. However, with all the variety of symptoms, the result of untreated glomerulonephritis is the same: the gradual or rapid formation of renal failure with the possible development of uremic coma.

Renal function can only be restored by eliminating the cause of the disease, prolonged symptomatic therapy and a strict regimen. The most radical measure is kidney transplantation.

Content

Glomerulonephritis - what is it?

Glomerulonephritis

Glomerulonephritis is an inflammatory damage to the renal glomeruli (nephrons) that filter blood plasma and produce primary urine. Gradually, the renal tubules and interstitial tissue are involved in the pathological process.

Kidney glomerulonephritis is a long-term current pathology that leads to disability and serious consequences without timely treatment. Most often develops without symptoms and is diagnosed when urinary abnormalities are detected.

Inadequate immune response to inflammation plays an important role in the development of glomerulonephritis.

Immunity produces specific antibodies directed against the kidney's own cells, which leads to their defeat (including vessels), the accumulation of metabolic products in the body and the loss of the necessary protein.

About the reasons

Glomerulonephritis disease develops under the influence of the following factors:

  • hereditary violation of the structure of the glomeruli of the kidneys (primary, international classification of the disease N07);
  • infections (ICD N08.0) - bacterial (angina, scarlet fever, bacterial endocarditis, pneumonia), viral (hepatitis, epidemic parotitis, mononucleosis, chickenpox), parasitic;
  • toxic effects - drugs, alcohol, radiation exposure, often vaccines;
  • autoimmune diseases (ICD N08.2, N08.5) - vasculitis, periarthritis, lupus erythematosus;
  • diabetes mellitus (ICD N08.3) - diabetic vascular disease is spreading to the kidneys and other endocrine diseases (ICD N08.4);
  • tumors (ICD of diabetic glomerulonephritis N08.1);
  • regular hypothermia - “trench nephritis” - is caused by impaired blood flow due to exposure to cold.

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

Glomerulonephritis forms

Glomerular damage always develops bilateral: both kidneys are affected simultaneously.

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

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

Chronic course is an asymptomatic onset of the disease, often pathological changes are found in already developed renal failure. Long-developing pathology leads to the replacement of nephrons with connective tissue.

Symptoms of glomerulonephritis - nephritic syndrome

Symptoms of glomerulonephritis

Nephritic syndrome is a generalized name of 4 syndromes occurring with varying severity in glomerulonephritis:

  • Edematous - swelling of the face, arms / legs;
  • Hypertensive - increased a / d (it is difficult to drug therapy);
  • Urinary - proteinuria (protein) and hematuria (erythrocytes) in urine analysis;
  • Cerebral - an extreme form of toxic damage to the brain tissue is eclampsia (the seizure is similar to epileptic, tonic convulsions are replaced by clonic ones).

Symptomatology of the disease depends on the speed of development of pathological changes in the nephrons and the severity of a particular glomerulonephritis syndrome.

Symptoms of acute glomerulonephritis

The following symptomatic forms of acute glomerulonephritis are distinguished:

  • Edematous - swollen eyelids in the morning, thirst, swelling of the extremities, fluid accumulation in the abdomen (ascites), pleura (hydrothorax) and the pericardium of the heart (hydropericardium), a sudden increase in weight up to 15-20 kg and their elimination after 2-3 weeks;
  • Hypertensive - shortness of breath, hypertension up to 180/120 mm Hg. Art., some decrease in heart tones, point hemorrhages in the eye, in severe cases, symptoms of cardiac asthma and pulmonary edema;
  • Hematuric - blood is detected in the urine without associated symptoms, urine the color of meat slop;
  • Urinary - bilateral lumbar pains, oliguria (small amount of urine excreted), changes in the composition of urine, rarely fever (with the decline of the acute phase of the disease, the amount of urine increases);
  • Deployed - a triad of symptoms (urinary, edematous, hypertension).

Nephrotic glomerulonephritis

Severe nephrotic glomerulonephritis is characterized by pronounced combined symptoms:

  • Severe edema, anasarca (fluid retention in the subcutaneous tissue);
  • Significant loss of protein (up to 3.5 g / day and higher with urine) on the background of hypoalbuminemia (low amount of protein in the blood is less than 20 g / l) and hyperlipidemia (cholesterol from 6.5 mmol / l).

Chronic glomerulonephritis

Chronic pathology is characterized by alternating acute periods and temporary improvement. During the period of remission, only changes in urine and hypertension speak of the disease.

However, this process gradually leads to the proliferation of connective tissue, wrinkling of the kidneys and gradually ending the function of the glomeruli.

In this regard, the following forms of chronic glomerulonephritis are distinguished:

  1. With the preservation of the renal functional — the stage of compensation — against the background of a satisfactory state, cicatricial growth in the kidneys is progressing.
  2. With chronic renal failure - the stage of decompensation - increasing intoxication due to the accumulation of urea and creatinine in the blood. In severe cases of ammoniac breath and cachexia.
  3. Uremic coma - terminal stage of development of chronic renal insufficiency functional: impaired breathing, high a / d, hallucinations / delirium. freezing with periods of excitement, bloom from urea crystals on the skin.

Diagnosis of glomerulonephritis

Tests for glomerulonephritis:

  • Urinalysis - protein and red blood cells (with lesions of nephrons), leukocytes (a sign of inflammation) in the overall analysis, the sample according to Zimnitsky - low specific gravity (no change in specific gravity indicates chronic renal failure).
  • Blood tests - general analysis (anemia, high ESR, leukocytosis), biochemistry (dysproteinemia, hyperlipidemia, hyperazotemia - high rates of urea and creatinine), analysis of streptococcal antibodies.

With the identified changes in the urine and blood to clarify the diagnosis and the severity of the disease prescribe:

  • Ultrasound of the kidneys, x-rays;
  • computed tomography;
  • biopsy (necessary to determine the cause of the pathology);
  • excretory urography (in the acute phase);
  • nephroscintigraphy.

Treatment of glomerulonephritis

Treatment of glomerulonephritis

Symptoms and treatment of glomerulonephritis are closely related - the treatment program depends on the form of the pathological process (chronic or acute) and the severity of symptoms.

Acute treatment

  • Strict bed rest.
  • Antibacterial, antiviral treatment (with the infectious nature of the disease).
  • Symptomatic agents (diuretics, antihypertensives, antihistamines).
  • Immunosuppressive treatment (cytostatics).
  • Dialysis - an artificial kidney connected to the device (with the rapid development of renal failure).

Chronic treatment

  • Restorative means.
  • Anti-inflammatory drugs (NSAIDs, corticosteroids).
  • Anticoagulants (to reduce blood viscosity and prevent blood clots).
  • Regular dialysis for severe renal failure.
  • Kidney transplantation for the ineffectiveness of conservative treatment of chronic glomerulonephritis (does not eliminate further autoimmune destruction).

Diet

Medical nutrition involves important limitations:

  • liquids (preventing puffiness);
  • protein foods (cottage cheese and egg white are allowed, fats up to 80 g / day, calories are added by carbohydrates);
  • salt - up to 2 g / day.

Consequences of kidney glomerulonephritis

Complications of glomerulonephritis are quite serious:

  • Renal colic when the lumen is blocked by the ureter by a blood clot.
  • The development of acute renal failure (with rapidly progressive glomerulonephritis).
  • Chronic renal failure.
  • Uremic coma.
  • Heart attack, heart failure.
  • Encephalopathy / eclampsia attacks due to renal hypertension and hemorrhagic stroke.

Prevention

Recommendations for glomerulonephritis (elimination of complications and prevention of exacerbations) include:

  • Full treatment of streptococcal infections, sanitation of chronic foci.
  • The exclusion of overeating and the subsequent set of extra pounds.
  • Blood sugar control.
  • Physical activity.
  • Salt restriction (this recommendation alone can eliminate the appearance of edema).
  • Quitting smoking / alcohol / drugs.

Glomerulonephritis is the most dangerous disease, comparable to a time bomb. His treatment takes months (with acute form) and years (with chronic). Therefore, kidney disease is easier to prevent than to treat and fight a disability.

Interesting
Katerina
2017-01-26 10:58:52
Mom had glomerulonephritis, as the doctor said, because of diabetes mellitus. We are fighting with diabetes, but nobody canceled kidney disease. We went to a good urologist, he prescribed a diet, the antibiotic Amoxicillin, and Nephrodesis on a vegetable basis to help him. She took the antibiotic for 14 days, Nefrodez for about a month. After the antibiotic, there was only one relapse, she took the antibiotic again, but for 5 days already. and Nefrodez all this time. now about six months everything is fine, there is no relapse, glad that a good doctor was caught.
Olga
2017-02-24 14:32:47
HELLO. And urine tests are normal? Protein and red blood cells are missing?
Vasya
2017-10-02 05:55:21
This is not glomerulonephritis, it is diabetic nephropathy ...

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