Today, people often turn to specialists for help complaining of pain in the lower back. This often indicates kidney disease. Jade is usually called a large group of inflammatory processes of this organ. In the article, we will consider such a type of pathology as acute glomerulonephritis, its causes, diagnosis, treatment and recommendations of doctors.
Etiology of the disease
Glomerulonephritis is a type of kidney disease in which the inflammatory process affects the renal glomeruli. The main etiological factor that leads to the onset of the disease is infection. More often - streptococcal (especially hemolytic streptococcus), staphylococci and pneumococci are less important. The causes of acute glomerulonephritis can also be:
- tonsillitis, flu, or other serious infectious diseases that are accompanied by a bacterial infection;
- scarlet fever;
- less commonly, kidney inflammation occurs after pneumonia, rheumatism, malaria, typhoid fever and typhus.
A characteristic feature of the disease is hematuria - the presence of blood in urine tests in excess of values significantly exceeding the norm.
However, attaching a certain importance to bacterial damage to the body, it should be noted that a number of concomitant factors play a role in the occurrence of acute nephritis:
- Cold - cooling the body. For example, during the period of world wars, the role of cooling was especially clearly demonstrated. During a stay in cold trenches and lying on the ground, the so-called trench or military jade developed.
- Inadequate nutrition. If a person does not consume enough fluid, vitamins and minerals and does not monitor nutrition, then the body is unable to cope even with a minor infection, which leads to complications.
Pathogenesis and diagnosis
To date, the pathogenesis of acute glomerulonephritis is not well understood. Most studies and observations have established two ways of developing the disease:
- Immunocomplex - nephritis appears as a result of sedimentation of the antigen - antibody complexes in the glomeruli of the kidneys. These complexes are formed when the body is infected. If the antibody settles on the walls of the capillaries, it has a destructive effect on the kidneys from the inside. Deposits consisting of immunoglobulins G, M are also formed here.
- The primary autoimmune method is also called the immunoallergic process. It is formed as a result of the influence of the human environment and hereditary predispositions.
In severe cases of the disease, the diagnosis of acute glomerulonephritis is not difficult, especially its edematous-hypertonic form. However, in most cases, it is necessary to differentiate the disease with acute nephritis with diseases similar in various symptoms.
- First of all, it is necessary to exclude heart diseases, accompanied by circulatory failure with the presence of edema, as well as hypertension. Therefore, a thorough examination of the heart with particular attention to the possibility of right ventricular and left ventricular circulatory failure should be carried out first.
- The so-called stagnant kidney should be excluded. A detailed clinical examination will distinguish acute nephritis from hypertension, which in some cases can be difficult. In particular, in the presence of hypertensive crises.
- It is necessary to distinguish acute nephritis from exacerbation of a chronic disease. Here, anamnesis data, clinical course and a number of biochemical parameters can help.
- It is necessary to conduct a differential diagnosis of acute nephritis with focal nephritis based on the anamnesis and the presence or absence of general symptoms (increased blood pressure, edema, etc.), as well as a number of urological diseases (cystitis, pyelitis, kidney stone disease, etc.).
Only a thorough clinical and laboratory examination will allow in the vast majority of cases to make the correct diagnosis.
Forms and syndromes of pathology
Inflammatory disease honor can be classified by the duration of the disease:
- fast progressing;
- acute;
- chronic glomerulonephritis.
The last two manifestations of the disease can occur with urinary or nephrotic syndrome.
Two forms of glomerulonephritis should be distinguished:
- Intracapillary, when all phenomena are localized mainly in the glomerular vasculature.
- Extracapillary, in which pathological changes are concentrated mainly outside the vasculature, in the lumen of the Shumlyansky-Bowman capsule, the proliferation of cells of which leads to the formation of the so-called half moon compressing the glomeruli.
The extracapillary form of nephritis gives a more severe prognosis compared to intracapillary nephritis, since it often develops renal failure. Typically, accumulations of leukocytes, thrombi, necrosis and inflammatory effusion of a serous or fibrinous nature in the cavity of the Shumlyansky-Bowman capsule are noted inside the capillary loops; often in the lumen of the capsule fibrinous mass falls along with red blood cells.
Acute glomerulonephritis syndromes:
- Urinary: proteinuria, hematuria, cylindruria.
- Nephrotic is characterized by massive proteinuria, hypoalbuminemia, hypercholesterolemia, edema.
- Hypertensive.
Symptoms of the disease
The Association of General Practitioners of the Russian Federation has created clinical recommendations. Acute glomerulonephritis: a description of the disease, diagnosis, treatment and preventive measures are the main sections discussed in them.
Symptoms of the disease appear already on the 7-14th day of infection. First, the physical activity of a person decreases, weakness appears and there is no appetite.
The most typical complaints of patients with acute course of the disease are:
- Swelling, lower back pain, blanching of the skin. The most frequent and earliest symptom, attracting the attention of the patients themselves, is swelling. Initially, they usually appear on the face and, together with pallor, create a look characteristic of a patient with jade. Pain in the lower back is observed in 30-40% of patients and, of course, is directly associated with kidney damage - in particular, with a stretching of the renal capsule due to hyperemia of the organ.
- Weakness, shortness of breath, fever. Following edema, shortness of breath very quickly appears, the occurrence of which is associated with an acute increase in blood pressure, weakening of the left ventricle, swelling of tissues (including the heart muscle) and intoxication of the body - in particular, the central nervous system. In some patients, shortness of breath is very severe, up to asphyxiation as cardiac asthma.
- Headaches, nausea. In addition to complaints of shortness of breath, sometimes patients complain of a heartbeat and, in particular, headaches, which is associated with both general intoxication and the presence of hypertension, which is found in 70-80% of all patients.
- Pressure increase. From the cardiovascular system, there are pronounced changes. Most important is the increase in blood pressure, which is the earliest sign of the disease, sometimes even before the appearance of edema, and urine in acute glomerulonephritis shows pathological changes. Hypertension (up to 180 / 100-220 / 120) is caused not only by an increase in the maximum blood pressure, but also in the minimum, the latter being more stable than systolic. Increased blood pressure is associated with impaired renal circulation and the formation in the kidneys of an increased amount of pressor substances acting on the vasomotor centers of the brain.
- The allocation of a scarce amount of urine or its complete absence. Its shade varies depending on the type of pathology.
Clinical picture
When diagnosing acute glomerulonephritis, the doctor conducts not only an external examination, but also listens to the heart, palpates the abdomen, prescribes tests and examinations.
The disease is characterized by features:
- Percussion is determined by the expansion of the borders of the heart across, mainly to the left, the cardiac impulse is usually not resistant.
- During auscultation, tones are usually muffled, a slight systolic murmur is often heard at the apex. At the beginning of the disease, bradycardia is often observed up to 40 strokes per 1 minute - apparently of a reflex origin, due to irritation of the aortic receptors and the carotid sinus. With a decrease in blood pressure, bradycardia disappears, often giving way to moderate tachycardia.
- On the electrocardiogram, changes in the T wave in all leads - it is made low or biphasic. In addition, a decrease in voltage is observed, which is apparently associated with ischemic changes in the myocardium.
- In addition to arterial pressure, often there is an increase in venous pressure up to 250-300 mm of water column, there is a moderate slowdown in blood flow velocity and an increase in the mass of circulating blood, on average, up to 7-8 liters. Shock and minute heart volumes are also increased in about 50% of patients.
- Changes in the respiratory system are usually absent at first, and subsequently due to circulatory disorders or the attachment of a secondary infection - in particular, the presence of congestion or focal pneumonia, bronchitis, and in severe, relatively rare cases, even pulmonary edema. The liver is often enlarged due to circulatory failure or edema.
- From the gastrointestinal tract, at first usually without any deviations from the norm, dyspeptic disorders can occur in the future. The spleen is usually not enlarged, with the exception of nephritis of malarial etiology. The temperature is normal or subfebrile.
- A study of urine in acute diffuse glomerulonephritis reveals the presence of protein, red blood cells, cylinders and white blood cells in it. The amount of protein in the urine ranges from 1 to 10%, especially at the beginning of the disease, during the first 7-10 days.
- The most important and characteristic sign for nephritis is the presence of red blood cells in the urine, with 15–16% of patients exhibiting macrohematuria, in other cases microhematuria. The number of bodies varies on average from 4-5 to 20-30 in the field of view, a significant part of them is leached. In 10-12% of patients, urine is the color of "meat slops", due to hemolysis of red blood cells and the conversion of hemoglobin to hematin.
- A less characteristic symptom compared to protein and red blood cells are hyaline and granular cylinders in the urine, less often epithelial; their presence indicates a simultaneous defeat of the tubules.
- Most patients have hypochromic anemia.
The manifestation of the disease in children
Acute glomerulonephritis in children is manifested in the same way as in adults. Since children in younger and preschool ages are more susceptible to viral diseases, tonsillitis, tonsillitis and similar pathologies, doctors note in them frequent cases of complications of bacterial streptococcal infection.
In some cases, a prolonged course of the disease and its transition to a chronic form are noted.
Doctors say that jade becomes a frequent complication after school-age children have a respiratory illness. Less commonly, inflammation of the kidneys occurs after pneumonia, measles, mumps, intestinal infection, rheumatism, tuberculosis and other diseases.
A significant factor of a non-bacterial nature is hypothermia. This is confirmed by statistical data: children are more often sick in winter and spring, less often in summer and autumn. As a rule, it is during the cold season that chronic diseases can worsen.
Cases of kidney inflammation after injury, vaccination, or as a reaction to an intolerant drug are also known. Acute glomerulonephritis in children is the same as in adults: the duration of the disease varies from a few weeks to two to five months. Edema usually lasts for 10-15 days, blood pressure drops significantly during the first 2-3 weeks, and the maximum pressure even earlier, shortness of breath and palpitations decrease, the amount of urine increases, the general well-being of patients improves. Headaches soon disappear, but lower back pains persist for quite some time. Changes in urine are eliminated more slowly - in particular, albuminuria and hematuria.
Disease treatment
Treatment of acute glomerulonephritis should be carried out strictly under the supervision of a specialist. It is long and complex.
An important role in therapy is given to nutrition. Having a diet is an important point for recovery. Doctors recommend a vegetable-milk diet. It is also necessary to exclude spicy, salt and extractive substances.
Treatment of acute glomerulonephritis involves:
- Etiotropic therapy. It is used to remove the focus of infection with antibiotics: macrolides, penicillins of the latest generation.
- Pathogenetic treatment. Hormones and antitumor drugs are used to prevent the proliferation of connective tissue and the formation of scars. Such medications are prescribed based on the clinical picture and, as a rule, have serious side effects.
- Symptomatic Therapy If severe hypertension is noted, then drugs are used to lower the pressure, and diuretics are prescribed for edema. To facilitate the work of the heart muscle, blood-thinning drugs are prescribed.
Consequences of the disease
Acute glomerulonephritis is a dangerous disease. Among its complications can be identified:
- With prolonged illness, renal failure develops into a chronic form.
- There is heart and respiratory failure.
- Persistent arterial hypertension may appear, which is a negative sign in the prognosis.
- In the absence or untimely treatment, a rapid development of symptoms occurs: an increase in edema, hematuria and proteinuria.
- Also, the disease is dangerous with a complication in the form of a hemorrhage in the brain.
- There is a constant decrease in visual acuity.
Disease prognosis
With timely treatment, acute glomerulonephritis can be treated. The prognosis is often favorable. Fatalities are extremely rare.
It is necessary to conduct thorough treatment until complete recovery, so that in the future the disease does not take the form of a chronic course.
It is unacceptable when a patient who has had acute nephritis leaves medical supervision with an improvement in his condition, even significant.
The patient should continue to be treated (including outpatient) until complete recovery - in particular, until the disappearance of protein and, in particular, red blood cells in the urine and restoration of normal functional activity of the kidneys.
In the future, during the year, the patient should avoid chills, colds, especially those associated with lying on the ground and bathing. Compliance with the correct mode of work and life always favorably affects the performance of patients.
Acute glomerulonephritis: recommendations for prevention
To prevent the disease from becoming acute or chronic, you need to follow some rules:
- Elimination of all chronic infectious foci and oral sanitation.
- Timely thorough treatment of acute and chronic tonsillitis.
- Tracking the body's reactions to food, changing the environment in order to prevent allergic reactions.
- Exclude smoking and drinking alcohol.
- Give preference to an active lifestyle, proper nutrition.
- The fight against colds, frequent cooling of the body and, in particular, hardening are preventive measures in relation to acute jade.
If a person has suffered acute glomerulonephritis once, then he should be systematically observed by a doctor and seek help with the first symptoms of an exacerbation of the disease.