Human he alth is very fragile, and quite often some ailments become the causes of other more serious and complex diseases. One of these diseases is glomerulonephritis - kidney damage, which is caused by simple infectious pathologies, often causing 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 immune system, which are of a hormonal 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 excretion of toxic substances and decay products by the kidneys. Such components pass through the basement membrane in the renal glomeruli, on which immunocomplexes accumulate. Next, a speciala complementary system in which vasoactive substances (polymorphonuclear, nephritic and blood coagulation components) are released, which are precisely responsible for the onset of acute inflammation.
Classification
The pathogenesis and etiology of glomerulonephritis are quite complex, so their main criteria are signs of a violation of the structure and shape of the renal glomeruli, thereby characterizing the course of the disease. Rarely enough, but still the problem has a congenital form, the acquisition of pathology is much more common.
The main types of the disease are the following manifestations:
- Acute form - passes latently, hidden or sluggish in nature, there is also a cyclic manifestation.
- The rapidly progressive form, 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 the disease is formed due to pharyngitis, laryngitis, septic endocarditis and typhus.
- Post-streptococcal - develops as a complication after a streptococcal infection.
- Mesangiocapillary - pathology is formed due to an increase in the number of endothelial and mesangial cells.
- Mesangioproliferative - developmentbegins after an excessive increase in the number of proliferating kidney cells - glomerulus.
- 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 turns 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 nature - in autumn and spring.
Symptoms
The etiology and pathogenesis of glomerulonephritis are built in such a way that the treatment of the disease begins when there are already clear signs of the disease. Most often occurs against the background of an infectious disease, after 1-3 weeks and is caused by streptococci.
The main signs of illness include:
- increased puffiness, especially on the eyelids, feet and lower legs;
- the presence of blood in the urine and its color change to dark brown;
- dramatic decrease in urine volume;
- pressure increase;
- headaches;
- weakness;
- nausea and vomiting;
- loss of appetite;
- constant thirst;
- increased body temperature;
- shortness of breath;
- weight gain.
Edema
This problem develops in both chronic and acute course of the disease.
The pathogenesis of edema in glomerulonephritis is quite complex andincludes such mechanisms.
1. Inflammation of the glomeruli occurs according to the following pattern:
- stagnation of blood in the vessels of the kidneys;
- hypoxia in the juxtaglomerular apparatus;
- the origin of the renin-angiotensin system;
- aldosterone secretion;
- delay in the body of sodium and an increase in blood osmotic pressure;
- edema.
2. The next cause of inflammation is:
- change in renal circulation;
- decrease in glomerular filtration rate;
- sodium retention;
- edema.
3. The last reason is:
- increase in renal permeability filter;
- proteinuria;
- hypoproteinemia;
- edema.
Reasons
The pathogenesis of glomerulonephritis is most often formed due to the presence of a streptococcal infection in the body. Often the disease develops due to previous he alth problems:
- pneumonia;
- angina;
- scarlet fever;
- tonsillitis;
- measles;
- streptoderma;
- ARVI (acute respiratory viral disease);
- chickenpox.
Quite often the pathogenesis of acute and chronic glomerulonephritis is associated with transferred viruses:
- meningitis;
- toxoplasma;
- Streptococcus and Staphylococcus aureus.
Increase the likelihood of developing a problem, can be a considerable stay in the cold and in high humidity. These factors alter the course of immune responses and reduce blood supply to the kidneys.
Complications
The pathogenesis of acute glomerulonephritis very often leads to more severe and even life-threatening ailments, including:
- heart and kidney failure;
- brain hemorrhage;
- renal encephalopathy in hypertensive form;
- renal colic;
- vision problems;
- hemorrhagic stroke;
- transition of malaise into a chronic form with constantly recurring relapses.
Diagnosis
To detect the presence of a disease, doctors prescribe a series of tests. Glomerulonephritis is characterized by certain transformations in the body.
- Macro- and microhematuria - there is a change in urine to black or dark brown. Urinalysis performed in the first days of the disease may contain fresh red blood cells, then they turn into a leached form.
- Albuminuria - in the first 2-3 days, protein is observed in a moderate amount up to 6%. Microscopic examination of the urine sediment shows granular and hyaline or erythrocyte casts.
- Nycturia - in the case of the Zimnitsky test, there is a sharp decrease in diuresis. By examining creatinine clearance, one can observe a decrease in the filtering function of the kidneys.
- A complete blood count is also performed, which reveals an increase in ESR (erythrocyte sedimentation rate) and leukocytes.
- Biochemical analysis reveals an increase involume of creatinine, urea and cholesterol.
Acute glomerulonephritis
Therapy of acute glomerulonephritis, etiology and pathogenesis depend on the form of its course. Highlight:
- Cyclic - characterized by a pronounced clinic and rapid onset of all major symptoms.
- Acyclic (latent) - has an erased form of the course with a mild onset and mild symptoms.
Therapy of the latent form is very complicated by late diagnosis due to the blurring of symptoms. Because of this, the disease often becomes chronic. In the case of a favorable course and timely treatment of the acute form, all symptoms of the disease disappear after 2-3 weeks of active therapy.
The duration of pharmacological action 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 the disease in an acute form, 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 disease depends on the form of leakage:
- Nefritic - all inflammatory processes in the kidneys are combined with nephritic syndrome and are considered primary. Symptoms of hypertension and kidney failure appear later.
- Hypertensive - the main symptom of the disease is high blood pressure. Abnormalities in the urine are expressedweakly. This form often appears after the latent one.
- Mixed - hypertensive and nephritic symptoms are combined equally during 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 not at all.
- Latent - the symptoms of the disease are mild, there are no violations of blood pressure and swelling. The course of the disease in this form can be quite long, up to 20 years. This always results in kidney failure.
Regardless of the form of the pathogenesis of chronic glomerulonephritis, permanent deepening of the disease with clinical signs characteristic of the acute phase is possible. Because of this, the treatment of the chronic condition is very similar to the acute form. Over time, these exacerbations lead to kidney failure and to the “shrunken 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 based on limited s alt, fluids and protein foods. This diet will significantly reduce the burden on the affected kidneys.
- Mandatory intake of drugs of the anticoagulant group, they help reduce blood clotting, as well as antiplatelet agents,improve blood flow.
- Non-steroid drugs are prescribed against the inflammatory process, only under the strict supervision of a doctor.
- Immunosuppressive therapy is mandatory. The drugs in this group are aimed at suppressing the immune system to prevent the production of antibodies. The most commonly used are glucocorticosteroids and cytostatics.
- Antihypertensive therapy is being performed, for which drugs are used to lower blood pressure in the presence of signs of arterial hypertension.
- Diuretic drugs are prescribed to eliminate edema and increase fluid secretion.
- Antibacterial drugs are prescribed if it is necessary to eliminate infectious processes, and also when using immunosuppressive drugs. This is done to prevent bacterial infection from entering the body.
- Fortifying therapy is mandatory.
All drugs to eliminate the pathogenesis of glomerulonephritis are prescribed by a 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 a strictadherence to dietary recommendations prescribed by the doctor. Adhering to a diet requires significantly reducing the intake of water and s alt, as well as protein foods.
Nutritionists strongly recommend consuming no more than 2 grams of s alt 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 in meat broth are highly undesirable during the period of illness. The maximum fluid intake per day should be 600-1000 ml and up to 50 grams of fat.
Very important for successful therapy is timely seeking medical help. Although after complete 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 therapy of the pathogenesis of glomerulonephritis, the scheme of recommendations should be carried out to the maximum, because the complete recovery of the patient will depend on this. Just for this reason, all sick people are immediately hospitalized and provided with complete bed rest. At the time of determining the stage of the disease, it may take from 2-6 weeks to correct, which must be spent in bed. Bed rest will ensure an even distribution of heat, which will have a beneficial effect on the vessels, which can expand, which will increase blood flow in all organs, especially in the kidneys. Due to this, it is possible to achieve the elimination of puffiness, increase filtration andincrease in the work of all systems of the genitourinary structures.
If you follow all the recommendations prescribed by the urologist, as well as follow the diet in full force, you can achieve a high-quality result and a complete recovery.
