Glomerulonephritis

January 27, 2012

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Glomerulonephritis   - Infectious and allergic disease, belonging to the group acquired kidney diseases. Various forms of glomerulonephritis differ in etiology, manifestations, clinical course and its outcome. Most often characterized by inflammation of the immune glomerular as well as further, secondary inflammation of the renal tubules   and interstitial .

Distinguish acute glomerulonephritis . fleeting form of the disease And chronic glomerulonephritis . The acute form of the disease most often can be caused by a streptococcal infection before undergoing - post-streptococcal glomerulonephritis . According to distinguish the etiology primary   glomerulonephritis and secondary That occur in systemic diseases - system lupus erythematosus . rheumatism . periarteritis nodosa   and others.

The causes of the disease are transferred before the infection - streptococcal . staphylococcal   and other bacterial infections. In some cases, the etiological factor in the development of the disease can act hepatitis B   and FROM , and, perhaps cytomegalovirus infection . Glomerulonephritis may develop against the backdrop of the nature of parasitic diseases, under the toxic effects of certain drugs, with alcohol and drugs, especially strong influence these habits are in their teens. Violation in the scheduling of planned preventive vaccination may also contribute to the disease. Therefore, prevention of glomerulonephritis should include strict observance of scheduled vaccinations and health checks.

The development of glomerulonephritis occurs against the reactions of cellular and humoral immunity. Typically, previous infection causes an immune response in the body, the immune complexes are formed. Developed for the antibody carried by the bloodstream to all systems, hitting him sensitive organs. This may be the heart muscle occurs rheumatic heart disease, joints - rheumatism, or as in this case the renal glomeruli - acute glomerulonephritis.

In children, the disease leads to renal failure, and as a consequence of disability. Post-streptococcal glomerulonephritis   Unlike other forms of the disease is more common in children aged 5-12 years, as the disease occurs in adolescents and young adults. The acute form of the disease can develop at any age, the disease occurs less frequently after age 40.

Symptoms of glomerulonephritis

The disease develops, no later than three weeks after a streptococcal infection, for example, sore throat . tonsillitis . pyoderma , Affecting both kidneys. To begin the disease is characterized by common symptoms of weakness, headache , Chills, nausea, back pain, high fever. Acute glomerulonephritis causes the eyelid edema, pallor, reduction in urine output.

Clinical picture is mixed. The disease can be passed to the cyclic form of the rapid development and many of the symptoms, and can be latent, that is worn covertly. Often the diagnosis of glomerulonephritis with the latent form of the disease occurs out of time, which makes it possible to move into a chronic disease.

Typical clinical symptoms of glomerulonephritis is the presence of blood during urination and swelling on the face. Hematuria   It may be small and can detect the symptom only via urine. But more urine has a red-brown color. Swelling is not always noticeable or bags under the eyes and a marked narrowing of the eye, or a sharp increase in body weight of 3-4 kg.

Reducing the amount of urine, so-called oliguria   may take up to 5 days, then urine output returned to normal, but there is a reduced density of urine. Also for acute glomerulonephritis characterized by high blood pressure, which can last for several weeks.

If a positive forecast of the main symptoms of glomerulonephritis disappear within the first month, and recovery occurs in 2-2 5. In cases of late diagnosis, or if the disease can not be cured within a year, the disease becomes severe chronic.

Glomerulonephritis in children often develops in an acute form. More susceptible children older preschool and early school age. Babies do not get sick almost glomerulonephritis. The disease is extremely rapid with the critical rise in body temperature.

Chronic glomerulonephritis distinguish four clinical forms. Whenever during periods characterized by remission Who replaced exacerbations similar to the acute form of the disease. Exacerbations may be seasonal, as well as arising from the re-infection of communicable diseases streptococcal nature.

Necrotic form of glomerulonephritis   characterized generalizovanymi edema may develop to their ascites   and hydrops . In vitro studies show elevated urinary protein and its decrease in the blood. This increases the level of lipids   and globulins Reduced level albumin .

Hypertensive heart disease does not include any pronounced symptoms like glomerulonephritis necrotic For this form of characteristic hypertension . There's also a mixed form of chronic glomerulonephritis. In this case, the symptoms of both forms are present simultaneously.

As well as chronic acute glomerulonephritis can occur almost asymptomatic. The latent form is characterized by a weak violation of urine.

Diagnosis of glomerulonephritis

Suspicion of acute glomerulonephritis is a triad of symptoms: swelling . hematuria . arterial hypertension . When a latent form of the disease indication for further diagnostic data is the previous history of the disease and identification of antistreptokokkovyh antibodies and their concentrations in blood serum.

Appointed rentgenkontrasnoe study   and a number of laboratory tests that would exclude the presence of other kidney diseases. So the differential diagnosis of acute glomerulonephritis should exclude nephritis, including hereditary forms renal tuberculosis . nephrolithiasis . Glomerulonephritis Diagnostics also includes the data previously transferred diseases, long-term monitoring of the patient, consulting ophthalmologist. When there is a change glomerulonephritis fundus. At extremely rapid course of the disease is carried out a study of tissue - biotapta kidney .

In laboratory studies, the presence of urine hematuria   or cylindruria   It is a confirmation of the diagnosis. In the early days of the disease are found in the urine sample lymphocytes . They are a reflection of the immune process in the glomeruli of the kidneys.

Blood test reveals neurophilic leukocytosis . anemia . increased erythrocyte sedimentation rate . The data show a decreased glomerular filtration increase nitrogenous wastes in the blood. Found violations of blood clotting. It is most often represented by degradation products fibrin , and fibrinogen   in serum and urine.

Treatment of glomerulonephritis

Upon confirmation of the diagnosis of the patient should be hospitalized. Treatment of glomerulonephritis in a hospital requires bed rest, the patient requires rest and warmth, which contributes to the normalization of blood circulation in the kidneys and lower blood pressure. Appointed diet with metered fluid intake for the relief of edema. In the early days of the diet is strictly controlled, ruled out the presence of salt in food, its consumption is gradually resumed after the disappearance of edema. Also excludes food rich in potassium, extractives, allergens.

Drug treatment of glomerulonephritis include antibiotic therapy, most commonly prescribed antibiotics penicillin rate of 1.5-2 months. Recommended appointment Heparin   subcutaneously rate 2-4 weeks. The drug prevents the intravascular coagulation of blood. If symptoms include glomerulonephritis hypertension   ACE inhibitors, intravenous infusion aminophylline   glucose in the solution and subsequent infusion furosemide . Acceptable use clonidine . methyldopa .

Forecast treating glomerulonephritis most favorable. 85-90% of patients recover completely, the remaining patients are stored urine changes, which makes it impossible to talk about full recovery. With long-term treatment of the disease can become chronic with symptoms necrotic syndrome . The lethal outcome recorded rarely, most often in untimely detection of latent forms of the disease.

Complications of glomerulonephritis

In the first stage of developing the disease may cause severe complications that are dangerous to the patient's life. Severe disease can cause renal eclampsia , Acute renal and heart failure.

Renal eclampsia   One of the most frequent complications of acute glomerulonephritis. Eclampsia or angiopasticheskaya encephalopathy is cerebral vasospasm, cerebral edema. Signs of complications are tonic-clonic convulsions, followed before the headache, nausea, vomiting, blurred vision. The attack reminds eclampsia epileptic , Accompanied by a jump in blood pressure and can last for several minutes. There has also been a series of attacks. Without timely relief of an attack is bleeding into the brain.

When hyperergic during the acute form of the disease, acute renal failure. Complications of glomerulonephritis caused by the rapid course of the disease. Acute renal failure is accompanied by sudden cessation of urine. As a result, water retention and potassium slag accumulated, thereby causing gipergidratsiyu   and acidosis . With further development of renal failure, symptoms of intoxication - anoreya , Nausea, repeated vomiting, diarrhea . Join hemorrhagic syndrome , The defeat of the cardiovascular system and central nervous system. The patient may fall into uremic who , Who often causes complications in children glomerulonephritis.

Less common, especially in children, complications arise glomerulonephritis from the heart. Acute heart failure is characterized by symptoms like liver enlargement, the growth of peripheral edema and pulmonary edema. That's pulmonary edema, and often becomes the cause of death without prompt assistance.

Prevention of glomerulonephritis

Proper treatment of streptococcal diseases, compliance with the calendar of preventive vaccinations and sanitation of foci of infection in the body is the main preventive measures. Children who experience post-streptococcal glomerulonephritis, should be under medical observation for 5 years after treatment.

Preventive medical examinations and laboratory tests allow early detection of disease and avoid complications. Self-treatment, neglect common symptoms often leads to severe forms of the disease.