Glomerulonephritis is an autoimmune disease of an inflammatory nature, in which there is a lesion of the renal glomeruli, and the renal tubules are also affected. The action is accompanied by the non-excretion of fluid and s alts from the body as a result of the formation of a secondary circulatory disorder in the organ, which in the final result often leads to sudden pressure surges and fluid overload.
To put it simply, glomerulonephritis is an inflammation of the renal glomeruli or, as they are also called, a glomerulus. Another name for the disease is glomerular nephritis. The disease can be presented 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 different subgroups. It is worth considering in more detail the classification of chronic glomerulonephritis, the ICD code of which is N03.
Acute disease
Spicydiffuse glomerulonephritis has three main features: edematous, hypertensive and urinary.
Mostly acute. Patients report 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 to a greater extent on the face and form, together with the pallor of the skin, a characteristic face for a nephritic. Often, fluid accumulates in cavities (pleural, abdominal, and pericardial cavities). The increase in mass due to edema reaches 15-20 kilograms or more in a short time. As a rule, they disappear after 2-3 weeks.
One of the main signs of acute diffuse glomerulonephritis is arterial hypertension, which is 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 numbers and very 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 failure, more often in the form of shortness of breath, cough and attacks of cardiac asthma. Hypertrophy of the left ventricle of the heart is formed.
One of the very first signs of acute nephritis is a decrease in urine output, in certain cases anuria can be traced. The decrease in urine output is associated with changes in the glomeruli, which leads to a decrease in filtration in them. In this case, as a rule, there is no decrease in the relativeurine weight density.
By medical characteristics, it is divided into 2 forms:
- The first kind - the cyclic form - comes swiftly. Edema, shortness of breath, headache, back pain occur, the amount of urine decreases. There is significant albuminuria and hematuria. Increases blood pressure. Edema does not go away for half a month, and then a fracture begins in the process of the disease, polyuria is formed and blood pressure decreases. The healing period can be accompanied by hypostenuria. But often, with excellent he alth of patients and an almost complete resumption of working capacity, proteinuria can occur for a long time, for months, in small amounts - 0.03-0.1%o and residual hematuria.
- The second type of acute nephritis is latent. It occurs frequently and is of great importance, as it often turns into a more complex form. This model is characterized by a gradual onset without any individual signs and is expressed only by slight shortness of breath or swelling in the legs. This kind of nephritis can only be diagnosed with regular urine tests. 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 can not even clearly say when the disease began. In chronic glomerulonephritis, urine output is reduced. It contains protein and blood. This is accompanied by swelling, while they can be both small, almost inconspicuous, and very noticeable. Swelling can either only face, or subcutaneous tissue and internal organs. With the syndrome of chronic glomerulonephritis, the patient always wants to sleep, regularly feels tired, his body temperature rises, blood pressure rises, shortness of breath forms, and vision decreases. Often, those suffering from this disease are thirsty, and on exhalation it is possible to smell urine.
WHO in the classification of chronic glomerulonephritis divides the disease into:
- Nepritic - characterized by the fact that the main syndrome is considered to be nephritic with symptoms of inflammation of the kidneys.
- Hypertensive - is characterized by dominance among all syndromes precisely by this.
- Mixed or nephritic-hypertensive. There are several forms in this situation.
- Latent. Almost does not have an obvious medical picture, with the exception of an insufficiently manifested urinary syndrome. This form of acute nephritis often becomes chronic.
- Hematuric, which is expressed only by the presence of hematuria.
Any form of illness can get worse. At this time, the signs 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, fever, regular edema, and cardiac pathologies. In some cases, it can become very aggravated and turn into a more complex one.
Illness earlyeither late leads to the formation of a secondary shrunken kidney and chronic renal failure.
Rapidly progressive glomerulonephritis
According to the etiology and pathogenesis, in the morphological classification of chronic glomerulonephritis, there are two forms:
- Primary - formed as a result of direct morphological destruction of the organ.
- Secondary, which is considered the result of the underlying disease. This includes infectious invasion by bacteria, microbes and other pathogens, harmful substances, malignant tumors or systemic diseases, for example, systemic lupus erythematosus, vasculitis, etc.
Focal segmental glomerular nephritis
The diagnosis of chronic glomerulonephritis is characterized by the opening of certain sclerotic formations in the capillary loops. Most of all, this type of glomerulonephritis is formed as a result of prolonged or / and intensive parenteral use of harmful substances, or the presence of HIV, AIDS. The disease is expressed in the form of a nephrotic syndrome or in the form of persistent proteinuria. They are usually combined with arterial hypertension and erythrocyturia. The course of the disease is quite increasing, and monitoring is very negative. It should be noted that this is the most negative of absolutely all morphological variants of the disease. In addition, it rarely responds to intensive immunosuppressive treatment.
Membranous glomerulonephritis
This type of glomerular nephritis is characterized by the presence of diffuse thickening in the walls of glomerular capillaries with their splitting and further doubling. And also there are huge formations on the basement membrane of the glomeruli on the epithelial side of the immune complexes. It should be noted that in thirty percent of patients it is possible to determine the relationship between membranous nephropathy and the hepatitis B virus, certain medications, and malignant tumors. Patients with membranous glomerulonephritis are very important to thoroughly examine 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 for a cure is more positive in women. In general, only fifty percent of patients develop kidney failure.
Mesangioproliferative glomerular nephritis
This is the most common type of glomerulonephritis. Unlike those listed above, this species meets absolutely all the criteria for immunoinflammatory glomerulonephritis. It manifests itself in the form of expansion of the mesangium, proliferation of its cells and deposition of immune complexes under the endothelium and in it. The main medical signs are hematuria and/or proteinuria. Significantly less often, hypertension is formed.
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. And fifty percent of patients have recurrent gross hematuria. In the event that such burdens as nephrotic syndrome or hypertension have not joined the process, then the prognosis of the cure is absolutely positive.
Mesangiocapillary glomerulonephritis
This is one of the most negative glomerular nephritis in terms of prognosis, characterized by intense proliferation of mesangial cells with invasion of the renal glomeruli. As a result, the lobulation of the glomeruli, which is distinctive for this species, 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 usually presents with hematuria and proteinuria. In addition, often formed nephrotic syndrome, hypertension, which is not treated.
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, glomerulonephritis therapy inevitably includes a harsh regimen in a hospital setting. Such patients are given antibiotic therapy for 7-10 days,limit s alt and liquid, with edema manifested, diuretics are prescribed. An increase in blood pressure will require the appointment of antihypertensive drugs. The main goal of treatment in chronic glomerulonephritis is to protect kidney tissue from subsequent damage. For this reason, with a difficult course and a high risk of developing chronic renal failure, immunosuppressive substances are prescribed. Therapy for glomerulonephritis includes not only immunosuppressive treatment. In order to stabilize the course in absolutely all forms of glomerulonephritis, non-immune nephroprotective therapy is used. Based on the classification of chronic glomerulonephritis, clinical guidelines indicate that patients are prescribed different substances for this purpose. A very significant nuance of curing glomerulonephritis is a diet with reduced s alt 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. Selected end-stage patients undergo kidney transplantation.
Complications
The progression of chronic glomerulonephritis, associated with hemodynamic disorders, proteinuria and metabolic disorders, eventually leads to a decrease in the number of functioning nephrons and can cause an absolute loss of the filtering function of the kidneys. For this reason, two types of renal failure are more dangerous burdens of glomerulonephritis. In addition, an increase in arterialpressure increases the risk of developing pathology of cerebral circulation and myocardial infarction in patients with glomerulonephritis. There is also a risk of developing 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 pains 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 prescribe all the necessary tests that need to be taken. And after the form is determined, he will prescribe an effective course of treatment. Of course, along with a strict diet number 5.
