The term "glomerulonephritis" refers to several diseases of the kidneys, which have an immuno-inflammatory nature, but differ in consequences, clinic and nature of the course. Diseases affect people up to the age of forty and often lead to disability and death. It is especially important to see the first signs of an illness and to seek medical help in time to stop the development of the disease. This article will discuss pathogenesis, etiology, clinical features and the principles of treatment for glomerulonephritis.
Disease classification
Depending on the clinical course, glomerulonephritis is:
- Acute - occurs at least two weeks after an infectious disease, most often of a bacterial nature. The disease can last for twelve months.
- Chronic - lasts longer than a year.
- Rapidly progressive or subacute is the most severe form, rapidly leading to renal failure.
Glomerulonephritis, which arose after a disease is called secondary, and idiopathic or primary - occurs on its own.
Causes and pathogenesis of the disease
The mechanism of the onset of pathology depends on the type of glomerulonephritis, the clinic of which is different. Factors provoking the disease:
- Acute - develops as a result of a previous infection, but it happens that the disease is non-infectious in nature. The main causes leading to the disease are: bacteria - meningococci, salmonella, pneumococci, streptococci; viruses - Coxsackie, Epstein-Barra, paramyxovirus; parasites - malarial plasmodium, toxoplasma; poisoning with toxic substances and certain types of drugs - serum or vaccine. In addition to the above, acute lupus erythematosus may be preceded by lupus erythematosus, systemic vasculitis, and Goodpasture syndrome.
- Chronic - often a continuation of the acute form, but other diseases can also be the cause - ankylosing spondylitis, Crohn's disease, malignant tumors, diabetes mellitus, pathological conditions associated with connective tissue; taking medications - non-steroidal anti-inflammatory, antibiotics, in rare cases, medical immunological drugs. Often, the disease occurs as primary for no specific reason.
- Subacute - develops with immune disorders. Antibodies are produced against an infection that has entered the body of an individual. So-called circulating immune complexes (CECs) are created. They are deposited in the kidneys on the membranes of capillaries or between them. Biochemical reactions occur that increase the permeability of the membrane of glomerular capillaries. As a result of this, microcirculation is disturbed, microscopic thrombi and necrotic areas are formed. In the area of the glomeruli of the kidneys, an inflammatory process develops.
Symptoms of the disease
The course and symptoms depend on the form of the disease. For the clinic of glomerulonephritis, 3 syndromes are characteristic:
- Nephrotic - includes all the signs that are characteristic of various kidney diseases: impaired urination, decreased daily urine volume, swelling, laboratory tests show a high protein content in urine.
- Hypertensive - high blood pressure is noted for all kidney damage. It is associated with a violation of blood circulation in them. With glomerulonephritis, sharp pressure drops are noted.
- Hematuric - an admixture of blood appears in urine due to a violation of the functioning of the arteries of the kidneys. In addition, there are pain in the lumbar.
Symptoms sometimes manifest separately, and most often are mixed. As already mentioned, a disease can have three forms of course. The clinic, etiology and pathogenesis of acute and subacute glomerulonephritis are pronounced, have recognizable symptoms. They clearly indicate the onset of the disease. The chronic form for a long time does not declare itself by any signs, so the disease is detected already at a late stage, when there are signs of renal failure.
Acute glomerulonephritis
The disease is noted by the following main symptoms: swelling, hypertension and changes in urine. There are two forms of the clinical course: cyclic and latent. The first begins abruptly. After infectious diseases, the patient suddenly rises in temperature, general weakness, palpitations, and headache are observed. The second begins gradually, is poorly diagnosed and often leads to the chronic development of the disease. The following symptoms are characteristic of the acute glomerulonephritis clinic:
- swelling of the face after sleep;
- aching pain in the lumbar;
- an admixture of blood in the urine, it becomes dark in color;
- reduction in urine volume;
- coughing and feeling short of breath;
- high blood pressure.
In the analysis of urine contains protein, red blood cells, cylinders. ESR is increased, the concentration of cholesterol and lipids is increased.
Rapidly progressing illness
The clinic of glomerulonephritis of this form of the disease is manifested by vivid symptoms and rapid progression. The disease begins suddenly with nephrotic syndrome. The patient's condition is characterized by the following symptoms:
- sharp deterioration;
- severe swelling of the whole body;
- high pressure;
- impaired kidney function;
- temperature rise;
- joint pain.
In the analysis of urine, a high content of red blood cells is detected, the daily amount of urine excreted is sharply reduced. After some time, the blood increases the content of urea and creatinine, a deficiency of iron is detected. The disease progresses and with inadequate treatment, death occurs. It is very important to identify the disease in time and take appropriate measures.
Chronic glomerulonephritis
The clinic of chronic glomerulonephritis has several forms of the course:
- Nephrotic - there is an inflammatory lesion of the kidneys with the occurrence of hematuria, proteinuria and edema. After some time, blood pressure rises and symptoms of renal failure appear.
- Hypertensive - at the beginning of the disease there is an increased blood pressure, which reaches significant figures. During the day, pressure indicators may vary. Urinary syndrome is negligible.
- Mixed - a combination of the first two forms.
- Latent - all symptoms are mild. Edema and high blood pressure are often absent, has a long course.
- Hematuric - an admixture of blood appears in the urine. In a laboratory study, protein is found in small quantities.
So, based on the etiology and pathogenesis, the clinic of chronic glomerulonephritis can develop for a long period without any signs of the disease. Often, the patient learns about an ailment accidentally when taking tests for a completely different reason or until kidney failure begins and the following symptoms appear:
- frequent urination at night;
- swelling of the face and ankles;
- urine foams heavily;
- high blood pressure
- the content of blood and protein in urine;
- the appearance of nausea and vomiting;
- lack of appetite;
- insomnia;
- fast fatiguability;
- the dermis becomes dry, itching appears;
- cramps at night.
Edema is very stable, they do not pass even from taking diuretics. With the development of renal failure, they decrease and the patient believes that the disease recedes. In fact, the disease is progressing and heart failure and anemia are added to the kidney. All these signs lead to the death of the patient after 5-30 years.
Diagnosis of the disease
To diagnose the disease, the doctor performs the following procedures:
- a conversation with the patient, during which complaints of the patient are identified, and a complete picture is collected on the history of the disease;
- examination of the patient - puffiness is determined, blood pressure is measured, skin integuments are checked;
- a general analysis of urine and blood is prescribed;
- a study is being conducted on biochemistry and an immune analysis of blood serum;
- An ultrasound of the kidneys is done, in which the size of the organ is revealed;
- sometimes nephroscintigraphy is used;
- a kidney biopsy is taken.
Specialist consultations are appointed if necessary. Given the etiology, pathogenesis and clinic of glomerulonephritis, diagnosis and treatment are carried out according to a predetermined plan.
Therapy of acute glomerulonephritis
The disease caused by streptococcal infection in most cases goes away on its own without the use of medications. The patient is prescribed compliance with bed rest and exclusion of sodium chloride from the diet. Acute glomerulonephritis, when the urinary syndrome is moderate and urine contains a small amount of protein, treatment begins no earlier than seven weeks later. During this time, remission may occur. If significant changes are detected in the urine, having studied the etiology, pathogenesis and clinic, the treatment of acute glomerulonephritis, in the diagnosis of which various examination methods were used, it is required to start immediately. For therapy, it is prescribed:
- a salt-free diet with a fluid intake of not more than one liter;
- antibacterial or antiviral drugs;
- medicines to relieve pressure;
- diuretic drugs;
- glucocorticosteroids, for example, Prednisone, are used only in difficult situations and with repeated acute glomerulonephritis with concomitant connective tissue disease;
- cytostatics - used for contraindications or inefficiency of hormones.
With a positive course of the clinic of acute glomerulonephritis, after about three months, recovery occurs. After the disease, the patient is under clinical supervision.
Therapy of a rapidly progressive form of the disease
With this form, treatment is started immediately. For therapy, apply:
- Immunosuppressants with corticosteroid hormones. This combination of drugs has an effective effect and prevents unwanted reactions of these agents.
- Antihypertensive. When taking them, you must ensure that the pressure does not drop sharply, otherwise the filtering functions of the kidneys worsen.
- In the diet, it is necessary to reduce the intake of protein foods.
- A large amount of concentrated glucose is administered intravenously.
- A solution of "sodium bicarbonate" is prescribed for drip administration.
- For heart failure, digitalis medications and diuretics are used.
Having studied the pathogenesis, etiology and clinic of glomerulonephritis in a rapidly progressive form, we can conclude that the disease involves a rapid course. A decrease in renal function is increasing, urinary sediment is changing, nephrotic syndrome and persistent blood pressure develop. Treatment methods are aimed at suppressing inflammatory processes. Glucocorticoids and immunosuppressants are used in high dosage. The use of dialysis in this form of the disease is not effective, and a kidney transplant is not used. The prognosis, even with timely initiation of treatment, is disappointing. Patients live no more than two years. The cause of death is renal failure and uremia.
Tactics for the treatment of a chronic form of the disease
The goal of the treatment of chronic glomerulonephritis, etiology, pathogenesis, diagnosis, and the clinic, which were established earlier, is to achieve maximum remission, slow down the development of the disease and preserve the patient's working capacity as long as possible. For this, the patient needs the following:
- Defined mode. It is forbidden to work in production with harmful conditions and hard physical labor, as well as night shifts. Quitting smoking and drinking alcohol is necessary. In case of exacerbation of the disease, mandatory hospitalization is required in a specialized department until the condition improves.
- Compliance with the diet. The clinic of glomerulonephritis affects the choice of treatment tactics, however, the principle of proper nutrition, regardless of clinical manifestations, is to limit the use of table salt to its complete exclusion from the diet. In addition, it is recommended to significantly reduce the amount of daily fluid intake and hot spices. Food should contain vitamins and minerals. Animal proteins should not be ruled out, but they should not be abused.
- Pharmacotherapy.
Use: Prednisone, Methotrexate, Azathioprine, Delagil, Unitiol, Heparin, Aspirin, Dipyridamole, Lovastatin; “Moexipril”, “Lisinopril”, “Torasemide”, “Indapamide”.
- Physiotherapy. In the clinic of chronic glomerulonephritis, these procedures are used to reduce the inflammatory process and blood coagulation, improve blood supply to tissues and renal glomeruli, remove excess fluid from the body, and improve the immune system. Contraindications for physiotherapy are: severe swelling, severe chronic renal failure, high levels of red blood cells and blood pressure.
Features of the structure of the kidneys in the children's body. The development of glomerulonephritis
The structure and functioning of the kidneys in the children's body has its own characteristics. In shape they are more rounded, only with age they take the usual form of a bean, and the relative mass is greater than in adults. They are mobile and are slightly below normal. Their fastest growth is observed in the first year of a baby’s life and in adolescence during puberty. The composition of the kidneys includes millions of tiny structural units called glomeruli, which filter and purify the blood from metabolic products and toxins. It is known that glomeruli can be affected due to an inadequate response of the immune system when it produces antibodies that destroy its own tissues. As a result, the capillaries of the renal glomeruli are damaged, the violation of their circulation contributes to the development of the inflammatory process, leading to pathogenic changes in the kidneys. Glomerulonephritis in children most often develops after previous infectious diseases, prolonged use of certain drugs, vaccinations and poisoning.
Manifestation of the disease
Glomerulonephritis occurs at any age, but children from three to twelve years old are more often ill. The clinic of glomerulonephritis in children is such that the ailment can occur for a long time without any symptoms or, conversely, begin abruptly from a serious condition. The disease has an acute, subacute or chronic form and proceeds with the following symptoms:
- Urine discoloration. She gets the color of meat slops. This is due to the high content of red blood cells in it. In addition, urine becomes foamy due to an increase in protein excretion. The daily amount of urine is reduced.
- Swelling. The first swelling begins to appear on the face after a night's sleep. With the development of the disease, edema occurs on the legs, abdomen and further, spreads throughout the body.
- Arterial hypertension. Due to fluid retention in the body, an increase in blood pressure occurs.
In acute glomerulonephritis in children, the clinic of the disease is accompanied by fever, poor appetite, lethargy, pain in the lower back. The subacute form of the disease develops rapidly, is difficult to treat and is often accompanied by various complications, including chronic renal failure. The chronic course of the disease can be asymptomatic for a long time. But even a mild form of glomerulonephritis leads to negative consequences. Parents need to be attentive to the state of health of their child and even with a slight deterioration in his condition, consult a doctor.
Complications and prognosis
Risk factors for complications in the clinic of glomerulonephritis are the rate of development of the disease and the age of the patient. With the rapidly progressive form, complications occur within two to five years, in other cases, this period increases to 10 years. The consequences of the disease can be: acute renal failure, eclampsia, manifested by high intracranial pressure and possible cerebral edema, retinal vasospasm, stroke, pulmonary edema. The prolonged course of the disease ends with a chronic form of glomerulonephritis, which subsequently always leads to renal failure and death. With streptococcal infection, the prognosis of the disease is favorable. With proper diagnosis and treatment, the clinic of glomerulonephritis can be called favorable, since in half of the cases it ends with a successful recovery, and in the rest, constant maintenance therapy is necessary.
Disease prevention
The primary prevention of glomerulonephritis is the prevention of infection by infectious diseases: tonsillitis, pharyngitis, sinusitis, otitis media, skin inflammation.In addition, you should not use drugs uncontrollably without a doctor's prescription. Urine tests should be taken periodically, especially after infectious diseases, so as not to miss the asymptomatic form of glomerulonephritis.
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Conclusion
Immuno-inflammatory glomerulonephritis is a serious kidney disease. Most often, they develop as a complication after another disease, but can also occur as an independent disease. The acute form passes without treatment, subject to bed rest and proper nutrition, but more often it requires pharmacotherapy. Chronic, which occurs a year after the onset of the first symptoms, ends with irreversible processes in the kidneys. Therefore, timely diagnosis of the clinic of glomerulonephritis is of particular importance, and treatment initiated on time helps to slow down the development of the disease.