Human health is very fragile, and quite often some ailments become the causes of other more serious and complex diseases. One of these diseases is glomerulonephritis - a kidney lesion that is caused by simple infectious pathologies, often leading to kidney failure, and later disability.
Pathogenesis
Pathogenetic changes leading to the formation of glomerular nephritis, in 70% of cases, belong to pathological modifications of the organs of the immune system, which are hormonal in nature.
The disease develops as a result of damage by the immune complexes of the blood to the glomeruli of the kidneys, as well as due to the physiological processes of elimination by the kidneys of toxic substances and decay products. Similar components pass through the basement membrane in the renal glomeruli, on which immunocomplexes accumulate. Then a special complementary system begins to activate, in which vasoactive substances (polymorphonuclear, nephritic and blood coagulation components) are released, which are just responsible for the onset of acute inflammation.
Classification
The pathogenesis and etiology of glomerulonephritis is quite complex, therefore, their main criteria are signs of impaired structure and shape of the renal glomeruli, thereby characterizing the course of the disease. Rarely enough, but still the problem has an innate form, the acquisition of pathology is much more common.
The main manifestations of the disease are the following manifestations:
- The acute form - passes latently, hidden or sluggish character, there is also a cyclic manifestation.
- A rapidly progressive species, also called subacute, is the most dangerous form of kidney damage.
- The etiology and pathogenesis of diffuse glomerulonephritis is severe. The pathological process captures not only the capillaries in the glomeruli of the kidneys, but also the vessels of other tissues and organs, that is, as a result, there is a general vascular lesion. Most often occurs after acute infectious diseases (pneumonia, tonsillitis, otitis media, scarlet fever). It also happens that an illness is formed due to pharyngitis, laryngitis, septic endocarditis and typhus.
- Post-streptococcal - develops as a complication after streptococcal infection.
- Mesangiocapillary - a pathology is formed due to an increase in the number of endothelial and mesangial cells.
- Mesangioproliferative - development begins after an excessive increase in the number of proliferating renal cells - glomeruli.
- Idiopathic glomerulonephritis - the pathogenesis of this disease has not yet been identified and most often appears at the age of 8-30 years.
- Chronic - if the disease is not treated for more than a year, it passes into this form and is difficult to treat.
All chronic forms can relapse from time to time, and then it partially or completely proceeds with an acute course. Exacerbations are seasonal in autumn and spring.
Symptoms
The etiology and pathogenesis of glomerulonephritis are designed so that the treatment of the disease begins when there are already clear signs of the presence of the disease. Most often occurs against the background of an infectious disease, after 1-3 weeks and is caused by streptococci.
The main symptoms of malaise include:
- increased swelling, especially on the eyelids, feet and legs;
- the presence in the urine of blood and a change in its color to dark brown;
- a sharp decrease in urine volume;
- increase in pressure;
- headache;
- weakness;
- nausea and vomiting;
- decreased appetite;
- constant thirst;
- increase in body temperature;
- dyspnea;
- weight gain.
Swelling
This problem develops in both chronic and acute course of the disease.
The pathogenesis of edema with glomerulonephritis is quite complex and includes such mechanisms.
1. Inflammation of the glomeruli occurs as follows:
- stagnation of blood in the vessels of the kidneys;
- hypoxia in the juxtaglomerular apparatus;
- nucleation of the renin-angiotensin system;
- aldosterone secretion;
- a delay in the body of sodium and an increase in blood osmotic pressure;
- swelling.
2. The next cause of inflammation is:
- a change in renal circulation;
- decrease in glomerular filtration rate ;
- sodium retention;
- swelling.
3. The last reason is:
- an increase in permeability in the renal filter;
- proteinuria;
- hypoproteinemia;
- swelling.
Causes
The pathogenesis of glomerulonephritis is most often formed due to the presence of streptococcal infection in the body. Often, an ailment develops due to previous health problems:
- pneumonia;
- sore throats;
- scarlet fever;
- tonsillitis;
- measles
- streptoderma;
- ARVI (acute respiratory viral disease);
- chicken pox.
Quite often, the pathogenesis of acute glomerulonephritis and chronic is associated with transferred viruses:
- meningitis
- toxoplasma;
- streptococcus and staphylococcus.
To increase the likelihood of developing a problem, a considerable stay in the cold and in high humidity can. These factors change the course of immune responses, and lower the blood supply to the kidneys.
Complications
The pathogenesis of acute glomerulonephritis very often leads to the appearance of more serious and even life-threatening ailments, including:
- heart and kidney failure;
- cerebral hemorrhage;
- hypertensive renal encephalopathy;
- renal colic;
- vision problems;
- hemorrhagic stroke;
- the transition of malaise into a chronic form with constantly recurring relapses.
Diagnostics
To identify the presence of the disease, doctors prescribe a series of tests. Glomerulonephritis is characterized by certain transformations in the body.
- Macro and microhematuria - a change in urine to black or dark brown is observed. In the analysis of urine, performed in the early days of the disease, there may be fresh red blood cells, then they turn into a leached form.
- Albuminuria - in the first 2–3 days, a moderate amount of up to 6% is observed in protein. After microscopic examination of the urine sediment, granular and hyaline or erythrocyte cylinders are present.
- Nocturia - in the case of the Zimnitsky test, there is a sharp decrease in diuresis. By examining creatinine clearance, a decrease in the filtering function of the kidneys can be observed.
- A general blood test is also performed, in which an increase in ESR (erythrocyte sedimentation rate) and leukocytes is detected.
- Biochemical analysis reveals an increase in the volume of creatinine, urea and cholesterol.
Acute glomerulonephritis
Therapy of acute glomerulonephritis, etiology and pathogenesis depend on the form of its course. Allocate:
- Cyclic - characterized by a pronounced clinic and a stormy onset of all the main symptoms.
- Acyclic (latent) - has an erased form of the course with a mild onset and mild symptoms.
The therapy of the latent form is very complicated by the late diagnosis due to the worn-out symptoms. Because of this, the ailment often becomes chronic. In the case of a favorable course and timely treatment of the acute form, all the symptoms of the disease disappear after 2-3 weeks of active therapy.
The duration of pharmacological actions depends on timely diagnosis. On average, a full recovery of a patent can be said after 2-3 months.
Chronic form
The etiology and pathogenesis of chronic glomerulonephritis most often develop as a result of an acute disease, although it may appear as a separate disease. Such a diagnosis is established when the acute course has not been eliminated throughout the year.
Therapy of a chronic illness depends on the form of the course:
- Nephritic - all inflammatory processes in the kidneys are combined with nephritic syndrome and are considered primary. Symptoms of hypertension and renal failure appear later.
- Hypertensive - the main sign of the disease is high blood pressure. Deviations in the urine are weak. This form often appears after latent.
- Mixed - hypertonic and nephritic symptoms are combined equally during an illness.
- Hematuric glomerulonephritis - the pathogenesis of this disease is the presence of blood impurities in the urine, while the protein is present in small quantities or is absent altogether.
- Latent - the symptoms of the disease are mild, there are no violations of blood pressure and edema. The course of the disease in a similar form can be quite long, up to 20 years. The result is always renal failure.
Regardless of the form of the pathogenesis of chronic glomerulonephritis, constant deepening of the disease with clinical signs characteristic of the acute phase is possible. Because of this, therapy for a chronic condition is very similar to an acute form. Over time, such exacerbations lead to renal failure and to the wrinkled kidney syndrome.
Treatment clinic
The etiology and pathogenesis of glomerulonephritis may be different, but the treatment of the disease is carried out according to the same scheme:
- Compliance with bed rest, especially when there is general weakness, fever and unbearable headaches.
- A diet in which the basis is to be given to limited intake of salt, liquid, and protein-containing foods. This nutrition will significantly reduce the load on the affected kidneys.
- Mandatory intake of anticoagulant drugs; they help reduce blood coagulation, as well as antiplatelet agents that improve blood flow.
- Nonsteroidal drugs are prescribed against the inflammatory process, only under the strict supervision of a doctor.
- Immunosuppressive therapy is prescribed without fail . Drugs in this group are sent to suppress immunity to prevent the production of antibodies. Glucocorticosteroids and cytostatics are most commonly used.
- Antihypertensive therapy is performed, drugs are used for it to lower the pressure in the presence of signs of arterial hypertension.
- To eliminate edema and increase fluid secretion, diuretics are prescribed.
- Antibacterial drugs are prescribed if it is necessary to eliminate infectious processes, as well as when using immunosuppressive drugs. This is to prevent bacterial infection from entering the body.
- General strengthening therapy is mandatory.
All drugs to eliminate the pathogenesis of glomerulonephritis are prescribed by the urologist individually, depending on the clinical course of the disease, as well as the severity of certain symptoms. Therapeutic procedures are carried out in a hospital until a complete laboratory remission occurs. Then, outpatient monitoring of the patient's condition is mandatory, and, if necessary, symptomatic treatment is added.
Food
Important for patients with glomerulonephritis, regardless of the form of its course, is strict adherence to dietary recommendations prescribed by a doctor. Following a diet, you need to significantly reduce the use of water and salt, as well as protein foods.
Nutritionists strongly recommend consuming no more than 2 grams of salt per day. Easily digestible animal proteins should be present in the patient’s diet; for this, eating egg white and cottage cheese will be ideal. Soups on meat broth are extremely undesirable during the period of the disease. The maximum fluid intake per day should be 600-1000 ml and up to 50 grams of fat.
It is very important for successful therapy to seek timely medical attention. Although, after full recovery, the patient must be under the supervision of a doctor for a long time and adhere to a diet for a year after recovery. The only thing you can do is increase your fluid intake.
Recommendations
For effective treatment of the pathogenesis of glomerulonephritis, the recommendation scheme should be carried out to the maximum, because the patient’s full recovery will depend on this. Just for this reason, all patients are immediately hospitalized and provide them with complete bed rest. At the time of clarifying the stage of the disease, it may take 2-6 weeks to recover, which must be carried out in bed without fail. Bed rest will provide an even distribution of heat, which will beneficially affect blood vessels that can expand, which will increase blood flow in all organs, especially in the kidneys. Due to this, it is possible to eliminate puffiness, increase filtration and increase the work of all systems of the genitourinary structures.
If you follow all the recommendations prescribed by the urologist, and also follow a diet in full force, you can achieve a high-quality result and complete recovery.