Glomerulonephritis - Causes, Symptoms and Treatment .MF .
glomerulonephritis are immunoinflammatory disease mainly affecting the glomeruli of the kidneys, as well as with the involvement of the tubules and intermediate (interstitial) tissue.
Glomerulonephritis mechanism refers to a group of infectious and allergic diseases.The term "infectious-allergic 'reflects the formation of infectious allergy in conjunction with various non-immune organ damage.There are also forms of autoimmune diseases, which are caused by damage to renal tissue autoantibodies, i.e.antibodies to its own authority.
Glomerulonephritis an independent disease, but can occur and many systemic diseases, such as systemic lupus erythematosus, hemorrhagic vasculitis, infectious endocarditis, etc.
prevalence of glomerulonephritis
Glomerulonephritis -. It is one of the most common kidney diseases inchildren, leading to the development of chronic renal failure and early disability.As the prevalence of it is second only to urinary tract infection in acquired renal diseases in childhood.
Acute glomerulonephritis can develop at any age, but most patients are persons up to 40 years.
Symptoms of glomerulonephritis
acute diffuse glomerulonephritis develops within 6-12 days after infection, typically streptococcal (sore throat, tonsillitis, pyoderma);most nefritogenen b-hemolytic streptococcus group A, especially strains 12 and 49. characterized by the following symptoms:
- hematuria (gross hematuria often);
- blood pressure.
Children acute glomerulonephritis usually has cycled throughout, with rapid onset, in most cases ends in recovery.In adults, the most common variant worn with urine changes without common symptoms gradually takes a chronic course.
first signs of acute glomerulonephritis appear 1-3 weeks after exposure to an infectious disease, or other factors.Disease begins general weakness, headache, nausea, back pain, chilling, decreased appetite.There may be body temperature rises to very high numbers.Pallor face, swelling of the eyelids, a dramatic decrease in the amount of urine.
Reducing the amount of urine may last 3-5 days and then increased diuresis, but the relative density of the urine, according to tests, reduced.
Another characteristic feature is the presence of blood in the urine - haematuria.Urine gets the color "meat slops", or becomes dark brown or black.In cases microhematuria urine color can not be changed.At the beginning of the disease is dominated by fresh red blood cells, further distinguished mainly vyschelochnye.
Edema - one of the most characteristic symptoms of glomerulonephritis .They are usually located on the face, there in the morning, in the evening decreasing.Prior to the development of visible swelling around 2-3 liters.liquid can be trapped in the muscles, the subcutaneous tissue.In total children in the preschool set edema more difficult, sometimes they are defined only on some seal subcutaneous tissue.
Hypertension (high blood pressure) occurs in about 60% of cases.In severe glomerulonephritis high blood pressure can last for several weeks.The defeat of the cardiovascular system in the acute course of glomerulonephritis seen in 80-85% of children.
may be enlargement of the liver, changes in the central nervous system function.
With a favorable course of the disease and timely diagnosis and treatment of 2-3 weeks disappear edema, normalizes blood pressure.Typically, the recovery in acute glomerulonephritis occurs in 2-2.5 months.
are two most typical forms of acute glomerulonephritis :
- cyclic form (starts violently)
- latent form (characterized by gradual onset) occurs infrequently, and the diagnosis it is important, because often in this form of the disease becomes chronic.
Every acute glomerulonephritis , not ended completely in the course of the year, should be considered in chronic crosser.
Distinguish following clinical forms of chronic glomerulonephritis :
- nephrotic form (see nephritic syndrome.) - The most common form of primary nephrotic syndrome.
- Hypertensive form.For a long time among the predominant symptoms of hypertension, whereas urinary syndrome little pronounced.
- mixed form.In this form has both hypertensive and nephrotic syndromes.
- latent form.It is often a form;usually occurs only weakly pronounced urinary syndrome without hypertension and edema.
Allocate and hematuric form, as in a number of cases of chronic glomerulonephritis hematuria may occur without significant proteinuria and general symptoms.
All forms of chronic glomerulonephritis may periodically give relapses, rather resembling or repeats the pattern of the first attack of acute diffuse glomerulorefrita.Very often worsening observed in autumn and spring, and appear 1-2 days after exposure to the stimulus, usually a streptococcal infection.
Causes of glomerulonephritis
Development glomerulonephritis associated with acute and chronic diseases of various organs, mainly streptococcal nature.
most common causes of glomerulonephritis are:
- scarlet fever;
- purulent skin lesions (streptococcal);
reason for the development of glomerulonephritis can serve and SARS, measles, chicken pox.
Among etiological factors include cooling the body and in a moist environment ( "trench" nephritis).Cooling causes the blood supply to the kidney reflex disorders and affects the course of immunological reactions.
There are reports of a causal role of microorganisms such as Staphylococcus aureus, Streptococcus pneumoniae, Neisseria meningitidis, Plasmodium malaria, Toxoplasma gondii and some viruses.
usually top the disease for 1-3 week preceding streptococcal infection as pharyngitis, tonsillitis, scarlet fever, skin lesions - impetigo, pyoderma.It was found that the cause acute glomerulonephritis, as a rule, only "nefritogennye" strains of b-hemolytic streptococcus group A.
believed that if an outbreak of streptococcal A infection in the children's collective nefritogennymi caused by strains that jade become ill 3-15% of those infectedchildren, although others among sick child adults and children about 50% of the changes detected in the urine, i.e.they are likely to suffer torpid (oligosymptomatic, asymptomatic) nephritis.
Among children who recover from scarlet fever, 1% develop acute glomerulonephritis the treatment in the hospital and in 3-5% of children treated at home.Respiratory virus infection in a child with chronic tonsillitis or carriage skin nefritogennogo Strep A can lead to the activation of the infection and to determine the occurrence of acute glomerulonephritis.
Complications of glomerulonephritis
In acute diffuse glomerulonephritis may experience the following complications:
- Acute heart failure (less than 3% of cases);
- Acute renal failure (1% of patients);
- Acute renal hypertensive encephalopathy (preeclampsia, eclampsia);
- Bleeding in the brain;
- Acute visual impairment (blindness passing);
- becomes chronic diffuse glomerulonephritis .
One of the factors of chronic inflammation in the kidney is the so-called hypoplastic kidney dysplasia, iebacklog of renal tissue from the chronological age of the child.
When progressiruyuscheem flow, unresponsive to the active immunosuppressive therapy, chronic diffuse glomerulonephritis enters its final stage - secondary contracted kidney.
Glomerulonephritis - this is one of the most common kidney diseases in children, leading to the development of chronic renal failure and early disability.
diagnosis of glomerulonephritis
diagnosis of acute glomerulonephritis based on the occurrence in young adults recovering from angina or acute respiratory viral infections - edema, headache, hypertension and following the results of laboratory tests.
characteristic features of glomerulonephritis are:
- hematuria - blood in the urine.Urine gets the color "meat slops", or becomes dark brown or black.In cases microhematuria urine color can not be changed.At the beginning of the disease is dominated by fresh red blood cells, further distinguished mainly vyschelochnye.
- proteinuria (albuminuria) is usually moderate (3-6%), kept 2-3 weeks.
- When microscopy urinary sediment revealed hyaline and granular casts, with makrogemeturii - erythrocyte.
- endogenous creatinine clearance study reveals decline in kidney filtration capacity.
- sample Zimnitsky detects decreased urine output, nocturia.High relative density of urine svdetelstvuet stored concentrating ability of the kidneys.
- residual nitrogen content increases in the blood (acute azotemia) urea, the title SLA-O and the LRA.Creatinine, cholesterol increased.
- When equilibrium study of acids and bases in the blood - acidosis;decrease in albumin is detected, increasing the alpha and beta globulins.
- in blood marked leukocytosis, accelerated ESR.
- In doubtful cases, renal biopsy is performed, followed by morphological study of bi-optic material.
Treatment of glomerulonephritis
Treatment of acute glomerulonephritis :
- mode (all Bolin with acute glomerulonephritis should be hospitalized in nephrology and therapeutic department is appointed to bed..);
- Clinical nutrition (diet №7);
- etiological (protivostreptokokkovoe) treatment (penicillin or erythromycin Ampioks);
- hormonal treatment (prednisolone) and nonhormonal immunosuppressants (Azathioprine, cyclophosphamide), anti-inflammatory drugs (Voltaren), heparin;
- Symptomatic treatment (hypertension, edema, etc.);
- treatment of complications;
- Spa treatment (in spas Satarai Mahi-Hasa, Yangantau et al.);
- Clinical examination (observation for 2 years).
the treatment of chronic glomerulonephritis carried out the same activities as in acute glomerulonephritis , especially in those periods of exacerbation.