Today, people often seek help from specialists with complaints of back pain. This often indicates kidney disease. It is customary to call nephritis 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 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. Also, the causes of acute glomerulonephritis can be:
- angina, influenza or other severe infectious diseases that are accompanied by a bacterial infection;
- scarlet fever;
- less often inflammation of the kidneys occurs after pneumonia, rheumatism, malaria, abdominaland typhus.
A characteristic feature of the disease is hematuria - the presence of blood in urine tests in excess of values that are significantly higher than the norm.
However, giving a certain importance to the 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 colds - cooling the body. For example, during the world wars, the role of cooling was especially clearly demonstrated. During the stay in the cold trenches and lying on the ground, the so-called trench or military nephrites developed.
- Malnutrition. If a person consumes an insufficient amount of liquid, vitamins and microelements and does not monitor nutrition, then the body is not able to cope with even 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 in the glomeruli of the kidneys of antigen-antibody complexes. These complexes are formed when the body is affected by an infection. If the antibody settles on the walls of the capillaries, it has a destructive effect on the kidneys from the inside. Deposits are also formed here, consisting of immunoglobulins G, M.
- Primary autoimmune way - also called immunoallergic process. Formed as a result of the influence of the environmenthuman habitation 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 of acute nephritis from diseases similar in various symptoms.
- First of all, heart disease, accompanied by circulatory failure with edema, and hypertension should be excluded. 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 also be excluded. A detailed clinical examination will distinguish acute nephritis from hypertension, which in some cases is not an easy task. In particular, in the presence of hypertensive crises.
- It is necessary to distinguish acute nephritis from an exacerbation of a chronic disease. History, clinical course and a number of biochemical parameters can help here.
- It is necessary to conduct a differential diagnosis of acute nephritis with focal nephritis based on the history and the presence or absence of general symptoms (increased blood pressure, edema, etc.), as well as a number of urological diseases (cystitis, pyelitis, nephrolithiasis, etc..).
Only a thorough clinical and laboratory examination will allow a correct diagnosis in the vast majority of cases.
Forms and syndromes of pathology
Inflammatory disease honor can be classified according to the time course of the disease:
- rapidly progressing;
- spicy;
- 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 vascular network, in the lumen of the Shumlyansky-Bowman capsule, the proliferation of cells of which leads to the formation of the so-called crescents that compress the glomeruli.
Extracapillary form of nephritis gives a more severe prognosis compared to intracapillary, as it often develops renal failure. Usually, accumulations of leukocytes, blood clots, necrosis and an inflammatory effusion of a serous or fibrinous nature in the cavity of the Shumlyansky-Bowman capsule are noted inside the capillary loops; often, a fibrinous mass falls into the lumen of the capsule along with erythrocytes.
Acute glomerulonephritis syndromes:
- Urinary: proteinuria, hematuria, cylindruria.
- Neprotic is caused by massive proteinuria, hypoalbuminemia, hypercholesteremia, edema.
- Hypertensive.
Symptoms of disease
Association of Physiciansgeneral practice of the Russian Federation created clinical guidelines. Acute glomerulonephritis: description of the disease, diagnosis, treatment and prevention measures - the main sections discussed in them.
Symptoms of the disease appear as early as 7-14 days of infection. First, the physical activity of a person decreases, weakness appears and there is no appetite.
The most typical complaints of patients in the acute course of the disease are:
- Swelling, back pain, skin blanching. The most frequent and early symptom that attracts the attention of the patients themselves is edema. At first, they usually appear on the face and, together with pallor, create a characteristic appearance for a patient with nephritis. Lower back pain is observed in 30-40% of patients and is, of course, directly related to kidney damage - in particular, with stretching of the renal capsule due to hyperemia of the organ.
- Weakness, shortness of breath, fever. Following edema, shortness of breath appears very quickly, 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 suffocation, similar to cardiac asthma.
- Headaches, nausea. In addition to complaints of shortness of breath, sometimes patients complain of palpitations and, in particular, headaches, which is associated both with general intoxication and with the presence of hypertension, which is found in 70-80% of all patients.
- Increase in pressure. On the part of the cardiovascular system, there are pronounced changes. Of greatest importance 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 due to an increase not only in the maximum arterial pressure, but equally in the minimum one, the latter being more stable than the systolic one. An increase in blood pressure is associated with impaired renal circulation and the formation in the kidneys of an increased amount of pressor substances that act on the vasomotor centers of the brain.
- Producing scanty or no urine. 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, feels the abdomen, prescribes tests and examinations.
The disease is characterized by features:
- Percussion is determined by the expansion of the borders of the heart in diameter, mainly to the left, the cardiac impulse is usually not resistant.
- On auscultation, tones are usually muffled, and a slight systolic murmur is often heard at the apex. At the onset of the disease, bradycardia of up to 40 beats per minute is often noted - apparently, of reflex origin, due to irritation of the receptors of the aorta and carotid sinus. With a decrease in blood pressure, bradycardia disappears, often replaced by moderate tachycardia.
- On the electrocardiogramchanges in the T wave in all leads - it becomes low or biphasic. In addition, there is a decrease in voltage, which is apparently associated with ischemic changes in the myocardium.
- In addition to arterial, there is often an increase in venous pressure up to 250-300 mm of water column, there is a slowdown in blood flow to a moderate degree and an increase in the mass of circulating blood, on average up to 7-8 liters. Stroke and minute volumes of the heart are also elevated in about 50% of patients.
- Changes in the respiratory organs are usually absent at first, and later they are caused by a circulatory disorder or the addition 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 special deviations from the norm, later dyspeptic disorders may occur. The spleen is usually not enlarged, with the exception of nephritis of malarial etiology. The temperature is normal or subfebrile.
- Urine examination in acute diffuse glomerulonephritis reveals the presence of protein, erythrocytes, cylinders and leukocytes in it. The amount of protein in the urine ranges from 1 to 10%, especially at the onset of the disease, during the first 7-10 days.
- The most important and characteristic sign for nephritis is the presence of erythrocytes in the urine, and in 15-16% of patients macrohematuria is observed, in other cases - microhematuria. The number of bodies varies on average from 4-5 to 20-30 per field of view, a significant part of them is leached. In 10-12% of patients, urine of the color of "meat slop" is observed, due to hemolysis of red blood cells and the conversion of hemoglobin to hematin.
- A less characteristic symptom compared to protein and erythrocytes are hyaline and granular casts in the urine, less often - epithelial; their presence indicates the simultaneous defeat of the tubules.
- Most patients have hypochromic anemia.
Manifestation of disease in children
Acute glomerulonephritis in children manifests itself in the same way as in adults. Since children at a younger and preschool age are more susceptible to viral diseases, tonsillitis, tonsillitis and similar pathologies, doctors note that they often have complications from bacterial streptococcal infection.
In some cases, there is a protracted course of the disease and its transition to a chronic form.
Doctors note that nephritis is becoming a frequent complication after suffering a respiratory disease in school-age children. Less commonly, inflammation of the kidneys manifests itself after pneumonia, measles, mumps, intestinal infection, rheumatism, tuberculosis and other diseases.
Hypocooling of the body is considered a significant factor of non-bacterial nature. This is confirmed by statistical data: children are more likely to get sick in winter and spring, less often in summer and autumn. As a rule, it is during the cold period that chronic diseases can worsen.
There are also known cases of inflammation of the kidneys after injury, vaccination or as a reaction to an intolerable drug. Acute glomerulonephritis in children proceeds in the same way as in adults: the duration of the disease is different - from several 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 is even earlier, shortness of breath and palpitations decrease, the amount of urine increases, and the general well-being of patients improves. The headaches soon disappear, but the pain in the lower back still persists for quite some time. Changes in the urine are more slowly eliminated - in particular, albuminuria and hematuria.
Treatment of disease
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. The presence of a diet is an important point for recovery. Doctors recommend a plant-milk diet. It is also necessary to exclude spicy, s alt 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 anticancer drugs are used to prevent the growth of connective tissue and the formation of scars. These drugs are prescribed based on the clinical picture and usually have serious side effects.
- Symptomatic therapy. If notedsevere hypertension, then drugs are used to lower 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 are:
- With a long illness, kidney failure develops into a chronic form.
- Heart and respiratory failure appears.
- Persistent arterial hypertension may appear, which is a negative sign in the prognosis.
- In the absence or untimely treatment, symptoms develop rapidly: an increase in edema, hematuria and proteinuria.
- Also, the disease is a dangerous complication in the form of cerebral hemorrhage.
- There is a constant decrease in visual acuity.
Disease prognosis
When promptly seeking help, acute glomerulonephritis is treatable. The prognosis is often favorable. Fatalities are extremely rare.
It is necessary to carry out 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 when his condition improves, even significantly.
The patient should continue to be treated (including on an outpatient basis) until complete recovery - in particular, until the disappearanceprotein and, in particular, erythrocytes in the urine and the restoration of normal functional activity of the kidneys.
Further, 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
So that the disease does not turn into an acute or chronic form, you must follow some rules:
- Elimination of all chronic infectious foci and sanitation of the oral cavity.
- Timely and thorough treatment of acute and chronic tonsillitis.
- Tracking the body's reactions to food, changing the environment in order to prevent allergic reactions.
- No 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 nephritis.
If a person has had acute glomerulonephritis once, then he should be systematically observed by a doctor and seek help at the first symptoms of an exacerbation of the disease.
