Glomerulonephritis is an autoimmune disease of an inflammatory nature, in which there is damage to the renal glomeruli, and the renal tubules are also affected. The action is accompanied by non-elimination of fluid and salts from the body as a result of the formation of a secondary circulatory disturbance in the body, which in the final result often leads to the appearance of sharp pressure surges and fluid overload.
In simple terms, glomerulonephritis is an inflammation of the renal glomeruli, or, as they are also called, glomerulitis. Another name for the disease is glomerular nephritis. The disease can be represented in different forms: acute renal failure, nephrotic syndrome, or in the form of isolated proteinuria and / or hematuria. The listed conditions are divided into proliferative or non-proliferative groups. They also have a variety of subgroups. It is worthwhile to consider in more detail the classification of chronic glomerulonephritis, whose ICD code is N03.
Acute form of the disease
Acute diffuse glomerulonephritis has three main signs: edematous, hypertonic, and urinary.
Mostly acute. Patients note fever, impotence, swelling of the face, headache, decreased diuresis.
Edema is considered an early indicator of the disease. They appear in 80-90% of patients, are located more on the face and, together with pallor of the skin, form a characteristic face for nephritis. Often, fluid accumulates in the cavities (pleural, abdominal and pericardial cavities). The increase in mass due to edema in a short time reaches 15-20 kilograms or more. As a rule, after 2-3 weeks they disappear.
Arterial hypertension is considered one of the main signs of acute diffuse glomerulonephritis, which can be observed in 70-90% of patients and is associated with pathology of the blood supply to the kidneys. In most situations, hypertension does not reach significant figures and extremely rarely systolic pressure exceeds 180 millimeters of mercury. Art., and diastolic - 120 millimeters of mercury. Art. This development of arterial hypertension complicates the work of the heart and can be expressed in acute heart failure, especially left ventricular, more often in the form of shortness of breath, cough and seizures of cardiac asthma. Hypertrophy of the left ventricle of the heart is formed.
One of the very first signs of acute nephritis is considered to be a decrease in urine output, in certain cases anuria can be traced. A decrease in urine output is associated with changes in the glomeruli, which leads to a decrease in their filtration. In this case, as a rule, there is no decrease in the relative density of the weight of urine.
According to medical characteristics, it is divided into 2 forms:
- The first type - the cyclic form - is coming rapidly. There are swelling, shortness of breath, headache, back pain, decreased urine. Significant albuminuria and hematuria are detected. Blood pressure rises. Edema does not go away for half a month, and then in the process of the disease, a fracture begins, polyuria forms and blood pressure decreases. The cure period can be accompanied by hypostenuria. But often, with excellent well-being of the patients and almost full resumption of working capacity, proteinuria in small amounts, 0.03-0.1% o and residual hematuria, can occur for months, for a long time.
- The second type of acute jade is latent. It is often found and is of great importance, as it often goes into a more complex form. This model is characterized by a gradual onset without any individual signs and is expressed only by minor dyspnea or swelling on the legs. This kind of nephritis can only be diagnosed with regular urinalysis. The duration, regarding the active stage, in this process of acute glomerulonephritis can be significant - from 2 to 6 months.
Chronic glomerulonephritis
Chronic glomerulonephritis (ICD N03) develops incredibly slowly. Many patients cannot even clearly tell when the disease arose. In chronic glomerulonephritis, urine output decreases. It reveals protein and blood. This is accompanied by edema, while they can be both small, almost inconspicuous, and very noticeable. Edema can only occur in the face or subcutaneous tissue and internal organs. In chronic glomerulonephritis syndrome, the patient always wants to sleep, regularly feels tired, his body temperature rises, blood pressure rises, shortness of breath forms, and his vision decreases. Often suffering from this disease is thirsty, and on exhalation it is possible to smell urine.
WHO in the classification of chronic glomerulonephritis divides the disease into:
- Nephritic - characterized by the fact that the main syndrome is nephritic with symptoms of kidney inflammation.
- Hypertensive - characterized by the dominance of all syndromes with just this.
- Mixed or nephritic-hypertonic. There are several forms in this situation.
- Latent. Almost does not have an obvious medical picture, with the exception of underdeveloped urinary syndrome. This form of acute nephritis very often becomes chronic.
- Hematuric, which is expressed only by the presence of hematuria.
Any form of the disease can be complicated. At this time, the symptoms of the disease are similar to those of acute glomerulonephritis. According to the morphological classification of chronic glomerulonephritis, a subacute malignant form is also distinguished. It is characterized by hypertension, Lyhoman, regular edema, cardiac pathologies. In some cases, it can become very aggravated and go into a more complex one.
Sooner or later, the disease leads to the formation of a secondary shriveled kidney and chronic renal failure.
Rapidly Progressive Glomerulonephritis
According to the etiology and pathogenesis, in the morphological classification of chronic glomerulonephritis, two forms are distinguished:
- Primary - formed as a result of direct morphological destruction of the organ.
- Secondary, which is considered the result of a primary disease. This includes infectious invasion by bacteria, microbes and other pathogens, harmful substances, malignant formations or systemic diseases, for example, systemic lupus erythematosus, vasculitis and so on.
Focal Segmental Glomerular Jade
The diagnosis of chronic glomerulonephritis is characterized by the disclosure of certain sclerosis in the capillary loops. Most of this type of glomerulonephritis is formed as a result of prolonged and / or intensive parenteral use of harmful substances, or the presence of HIV, AIDS. The disease is expressed as nephrotic syndrome or in the form of persistent proteinuria. They are usually combined with arterial hypertension and red blood cell count. The course of the disease is quite growing, and monitoring is very negative. It should be noted that this is the most negative of all morphological variants of the disease. In addition, it rarely responds to the implementation of intense immunosuppressive cure.
Membranous Glomerulonephritis
This type of glomerular nephritis is characterized by the presence of diffuse thickening in the walls of the glomerular capillaries with their splitting and further doubling. And also huge formations appear on the basal membrane of the glomeruli on the epithelial side of the immune complexes. It should be noted that in thirty percent of patients it turns out to determine the relationship between membranous nephropathy and hepatitis B virus, certain medications, as well as malignant tumors. It is very important to thoroughly examine patients with membranous glomerulonephritis for the presence of hepatitis B or a tumor. This type of glomerulonephritis is expressed by the formation of nephrotic syndrome, and only 15-30% of patients have arterial hypertension and hematuria. Representatives of the stronger sex are more susceptible to the disease, but women are less, it is curious that the prognosis of cure is more positive in women. In general, only fifty percent of patients have renal failure.
Mesangioproliferative Glomerular Jade
This is the most common type of glomerulonephritis. Unlike the ones listed above, this species meets absolutely all the criteria for glomerulonephritis of an immuno-inflammatory nature. It manifests itself in the form of expansion of mesangy, proliferation of its cells and deposition of immune complexes under the endothelium and in it. The main medical signs are hematuria and / or proteinuria. Hypertension is much less common.
With the presence of immunoglobulin A in the glomeruli
It is possible to meet under the name Berger's disease or IgA-nephritis. The disease affects the younger generation of men. The main symptom is hematuria. Fifty percent of patients have recurrent macrohematuria. If burdens such as nephrotic syndrome or hypertension have not joined the process, then the prognosis of cure is absolutely positive.
Mesangiocapillary glomerulonephritis
This is one of the most negative according to the prognosis of cure glomerular nephritis, characterized by intensive proliferation of mesangial cells with invasion of the renal glomeruli. As a result, a distinctive lobation of the glomeruli and an increase in the basal membranes are formed. Quite often, the relationship of the disease with cryoglobulinemia or, more often, with hepatitis C is revealed. For this reason, a painstaking study to detect hepatitis C or cryoglobulinemia is very important. This type of glomerular nephritis is usually expressed in hematuria and proteinuria. In addition, nephrotic syndrome, hypertension, which is not treated, is often formed.
Treatment
It is worth considering the clinical recommendations of chronic glomerulonephritis. Therapy is determined by the form of the disease, the factors causing its formation and the severity of the symptoms. In the acute form with a colorful medical picture, the therapy of glomerulonephritis in an integral order includes a severe regimen in a hospital setting. Antibiotic therapy is carried out for such patients for 7-10 days, salt and fluid are limited, and diuretics are prescribed for edema. An increase in blood pressure will require the use of antihypertensive drugs. The main goal of cure for chronic glomerulonephritis is the protection of kidney tissue from subsequent damage. For this reason, with a mild course and high risk of the formation of chronic renal failure, immunosuppressive substances are prescribed. Glomerulonephritis therapy includes more than just immunosuppressive treatment. In order to stabilize the course with absolutely all forms of glomerulonephritis, non-immune nephroprotective therapy is used. Based on the classification of chronic glomerulonephritis, clinical recommendations indicate that different substances are prescribed to patients for this purpose. A very significant nuance of curing glomerulonephritis is considered to be a diet with reduced salt intake, which makes it possible to reduce blood pressure and reduce water retention in the body. Treatment of glomerulonephritis will require the use of replacement therapy. For certain patients with end-stage disease, a kidney transplant is performed.
Complications
The progression of chronic glomerulonephritis, which is associated with hemodynamic disorders, manifested proteinuria and metabolic disorders, over time leads to a decrease in the number of functioning nephrons and can lead to an absolute loss of filtering function of the kidneys. For this reason, two types of renal failure are more dangerous burdens of glomerulonephritis. In addition, an increase in blood pressure increases the risk of forming a pathology of cerebral circulation and myocardial infarction in patients with glomerulonephritis. There is also a danger of the formation of diseases of thrombotic origin. A severe complication of glomerulonephritis is considered to be a nephrotic crisis, which is characterized by: a sharp rise in temperature, the occurrence of intense cutting pain in the abdomen and redness of the skin.
It can be concluded that this disease carries a lot of danger. At the first symptoms, you should immediately visit a doctor to confirm or exclude the diagnosis. He will appoint all the necessary tests that need to be taken. And after the shape is determined, an effective course of treatment will be prescribed. Of course, along with a strict diet at number 5.