Glomerulonephritis is a disease in which damage occurs renal tissue. This disease primarily affects the renal glomeruli, where primary filtration of blood occurs. Chronic course of this disease gradually leads to the loss of the kidneys’ ability to perform their function - to cleanse the blood of toxic substances with development renal failure.
What is the glomerulus and how do the kidneys work?
Blood entering the kidneys through renal artery distributed within the kidney to the smallest vessels, which flow into the so-called renal glomerulus.What is a renal glomerulus?
In the renal glomerulus, the blood flow slows down, as through a semi-permeable membrane, the liquid part of the blood with electrolytes and dissolved in the blood organic substances seeps into Bowman's capsule (which, like a wrapper, envelops the renal glomerulus on all sides). From the glomerulus, the cellular elements of the blood with the remaining amount of blood plasma are removed through the renal vein. In the lumen of Bowman's capsule, the filtered part of the blood (without cellular elements) is called primary urine.
What is Bowman's capsule and renal tubules (loop of Henle)?
But in addition to toxic substances, many useful and vital substances are dissolved in this urine - electrolytes, vitamins, proteins, etc. In order for everything useful for the body to return to the blood, and everything harmful to be excreted in the final urine, primary urine passes through a system of tubes (loop of Henle, renal tubule). It happens permanent processes the passage of substances dissolved in primary urine through the wall of the renal tubule. Having passed through the renal tubule, primary urine retains toxic substances in its composition (which need to be eliminated from the body) and loses those substances that cannot be eliminated.
What happens to urine after it is filtered?
After filtration, the final urine is excreted through the renal tubule into the renal pelvis. Accumulating in it, urine gradually flows into the bladder in the lumen of the ureters.
What happens with glomerulonephritis in the kidneys?
Mainly with glomerulonephritis, the glomeruli of the kidneys are affected.
- Because of inflammatory reaction The following changes occur in the wall of the glomerular vessels:
- The wall of the vessels of the renal glomerulus becomes permeable to cellular elements
- Microthrombi form, which clog the lumen of the glomerular vessels.
- The blood flow in the vessels of the affected glomeruli slows down or stops altogether.
- Cellular elements of the blood enter the lumen of Bowman's capsule.
- Blood cells in the lumen of Bowman's capsule clog its lumen.
- Blood cells clog the lumen of the kidney tubules.
- The entire process of filtration of blood and primary urine in the affected nephron is disrupted (nephron is a complex: renal glomerulus + Bowman's capsule + renal tubules).
- Due to impaired blood flow in the renal glomerulus, the lumen of its vessels becomes empty and they are replaced connective tissue.
- As a result of blockage of the renal tubules by blood cells, their lumen becomes empty and the walls stick together, with the entire nephron being replaced by connective tissue.
- The gradual “death” of nephrons leads to a decrease in the volume of filtered blood, which is the cause of renal failure.
- Kidney failure causes toxic substances to accumulate in the blood, and necessary for the body the substances do not have time to return the remaining nephrons of the kidneys to the blood.
From the above, it becomes clear that the cause of kidney dysfunction is the inflammatory process developing in the renal glomeruli. Now briefly about the causes of inflammation of the renal glomeruli.
- Common infectious diseases
- sore throat, tonsillitis
- scarlet fever
- infective endocarditis
- septic conditions
- pneumococcal pneumonia
- typhoid fever
- meningococcal infection
- mumps(piggy)
- chicken pox(chickenpox)
- infections caused by Coxsackie viruses
- Rheumatic and autoimmune diseases:
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Henoch-Schönlein disease
- hereditary pulmonary-renal syndrome
- Vaccination and blood transfusions
- Substance intoxication:
- Organic solvent poisoning
- alcoholic drinks
- mercury poisoning
- Radiation therapy, radiation sickness
Types and symptoms of chronic glomerulonephritis
With the flow and clinical manifestations allocate the following types:1. Latent– the most common (accounts for about 45% of all cases of chronic glomerulonephritis). Appears not expressed external symptoms: moderate swelling and increase blood pressure. It is more evident by laboratory examination data: general urine test reveals increased level protein, red blood cells and leukocytes.
2. Hematuric– a rare form (accounts for no more than 5% of total number sick). Manifests as follows external signs: Pink or red urine. In general urine analysis an increased number of altered red blood cells is detected.
3. Hypertensive– a common form (accounts for about 20% of the total incidence). Manifests as follows external symptoms: constant increase in blood pressure, increase in the volume of daily urine excreted, night urge to urinate. In general urine analysis are revealed increased content protein and altered red blood cells, urine density is slightly below normal or within the lower limit of normal.
4. Nephrotic- a common form (about 25%). The disease manifests itself as follows: external signs: increased blood pressure, severe swelling, reduced amount of daily urine excreted. Laboratory signs V general urine test: increased density urine, increased protein content in urine; biochemical analysis blood reveals: a decrease in total protein (mainly due to albumin), an increase in blood cholesterol.
5. Mixed (nephrotic-hypertensive)– characterized by symptoms of the two forms described above: nephrotic and hypertensive.
Methods for diagnosing chronic glomerulonephritis
To diagnose all types of chronic glomerulonephritis, the following types of examinations are used:
| Type of diagnosis | Why is it appointed? |
| General urine test | This analysis reveals changes in the following indicators: urine density, the presence of protein and casts, the presence of leukocytes and red blood cells, the color of urine. |
| Biochemical blood test | This analysis examines the following indicators: general level blood protein, blood albumin level, creatinine level, urea level, cholesterol level and all fat fractions (lipidogram). |
| Kidney biopsy and biopsy microscopy | This research method allows you to examine tissue changes in the structure of the glomeruli of the kidneys and identifies various morphological forms of glomerulonephritis. In many ways, the histological form of glomerulonephritis is a criterion for prescribing adequate treatment. |
Stages of chronic glomerulonephritis
Compensation stage Initial stage(compensation stage) the functional activity of the kidneys is not changed.Stage of decompensation- associated with the progression of the disease with impaired renal function (decompensation stage). Stage with impaired renal function and the development of chronic renal failure.
| External signs | Laboratory signs |
| General urine test
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Uremia- severe renal failure. At this stage of the disease, the kidneys finally lose their ability to maintain normal composition blood.
Diagnosis of chronic glomerulonephritis
| Laboratory signs acute glomerulonephritis: | |
| General urine analysis: |  |
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| Zimnitsky test: | |
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| Biochemical blood test: | |
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| Immunological study blood: | |
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Treatment of chronic glomerulonephritis
| Type of treatment | Target | Practical information |
| Eliminate the source of chronic inflammation, which is a trigger for autoimmune kidney damage |
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| Reduce the load on the kidneys. Physical activity accelerates metabolic processes, which lead to the acceleration of the formation of nitrogenous compounds toxic to the body. | The patient is advised to stay with recumbent positions, unless absolutely necessary, do not get out of bed. |
| Impaired kidney function leads to changes in the electrolyte balance of the blood, loss needed by the body nutrients and the accumulation of harmful toxic substances. An adequate diet can reduce the adverse effects of the above factors. | Table number 7 Nutrition Features:
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| Improving blood flow. With inflammation in the renal glomeruli, conditions are created for the formation of blood clots in their vessels and blockage of their lumen. Drugs in this group prevent this process. |
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| Nonsteroidal anti-inflammatory drugs | There is evidence that indomethacin and ibuprofen affect the activity of the immune response. Suppressing immune damage to the kidneys leads to improved kidney health. | Indomethacin
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| Drugs that suppress the activity of the immune system have a beneficial effect in glomerulonephritis. By reducing the activity of the immune reaction, these drugs suppress destructive processes in the renal glomeruli. | Steroid drugs:
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| With the development of renal failure, fluid retention in the body may occur, as well as changes in the concentration of hormones produced by the kidneys. These changes often lead to a persistent increase in blood pressure, which can only be reduced with medication. |
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| Obstructed blood flow in the inflamed glomeruli of the kidneys, accumulation of cellular blood elements in the renal tubules requires activation of fluid flow in the nephron. Therefore, diuretics can have a positive effect in glomerulonephritis. |
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| In the event that a patient with glomerulonephritis has a chronic focus of infection ( chronic sinusitis, sinusitis, endometritis, urethritis, tonsillitis), its sanitation with antibacterial drugs is necessary. | In each specific case, the type of antibiotic is selected individually by the attending physician depending on the following factors:
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Health prognosis for chronic glomerulonephritis
In the absence of treatment, the disease steadily leads to the loss of functionally active nephrons by the kidneys with the gradual onset of renal failure.At active treatment with suppression of the activity of the immune system, the course of the disease improves significantly, renal failure does not develop or the timing of its onset is significantly delayed.
There is evidence of complete remission (successful cure of the disease) during treatment with suppression of immune activity.
What are the features of chronic glomerulonephritis in children?
General Features glomerulonephritis in childhood:- The clinical picture of the disease can vary greatly.
- Chronic glomerulonephritis– the most common cause of chronic renal failure in children (except newborns).
- Up to 40% of all cases of hemodialysis and kidney transplantation in children are performed for chronic glomerulonephritis.
The main causes of chronic glomerulonephritis in children:
- In most cases, the causes are unknown. The disease develops as primary chronic, that is, the child did not have acute glomerulonephritis before.
- The role of irrational treatment of chronic foci of infection (sore teeth, inflamed tonsils), severe hypovitaminosis, hypothermia and malnutrition during acute glomerulonephritis cannot be excluded.
- Slow currents play a role infectious processes: cytomegalovirus infection, hepatitis B, parainfluenza, etc.
- Congenital disorders renal tissue structures.
- Hereditary immunodeficiencies(decreased immune system function due to genetic disorders).
- nephrotic (edema-proteinuric);
- hematuric;
- mixed.
- The disease develops acutely after hypothermia, sore throat, acute respiratory infection, vaccinations, or without visible reasons.
- The main symptoms are swelling and the presence of protein in the urine.
- The disease lasts a long time, periods of improvement are followed by new exacerbations. Chronic renal failure gradually develops.
- Usually there are no complaints - the child feels normal.
- A small amount of red blood cells and protein are found in the urine. Sometimes such changes persist for 10-15 years without any symptoms.
- Many children are found chronic tonsillitis(inflammation of the tonsils) and other chronic foci of infection.
- Occasionally, swelling, lower back pain, headache, increased fatigue, stomach ache .
- In some children, the disease is accompanied by anemia, pallor, and increased blood pressure.
- If symptoms persist for a long time, there is a risk of chronic renal failure.
- A combination of blood and protein in the urine, edema, and increased blood pressure is typical.
- Manifestations of high blood pressure: headaches and dizziness, lower back pain, lethargy, irritability, blurred vision, and sometimes convulsions.
- Anemia and pallor are often noted.
- The disease is severe, and chronic renal failure develops very early.
How is it carried out? dispensary observation children suffering from chronic glomerulonephritis?
Dispensary observation is carried out until the child is transferred to an adult clinic:
- Chronic pyelonephritis. A disease in which inflammation predominantly develops in the renal pelvis, calyces, and tubular system of the kidneys.
- Amyloidosis. A disease in which the metabolism of proteins and carbohydrates is disrupted in kidney cancer
Is it possible to drink alcohol if you have glomerulonephritis?
Alcohol consumption negatively affects the condition of all organs and systems, and the kidneys are no exception. Alcohol can aggravate the course of chronic glomerulonephritis, so it is recommended to avoid it completely. The taboo also applies to carbonated drinks. Is it possible to eat watermelons if you have glomerulonephritis?
People suffering from chronic glomerulonephritis can eat watermelons. But since they contain a lot of liquid, the recommended maximum quantity The consumption of watermelons is determined depending on the form and stage of the disease. Consult your doctor. Sometimes, with chronic glomerulonephritis, it is even recommended to arrange fasting “watermelon” days.
latent form– the prognosis is favorable; - hematuric and hypertensive form– the prognosis is serious;
- mixed and proteinuric form- the prognosis is unfavorable.
Glomerulonephritis
Glomerulonephritis are immunoinflammatory diseases, predominantly affecting the glomeruli of the kidneys, as well as involving the tubules and interstitial tissue.
Glomerulonephritis According to the mechanism of development, it belongs to the group of infectious-allergic diseases. The term “infectious-allergic” reflects the formation of an infectious allergy in combination with various non-immune organ damage. There are also autoimmune forms of the disease, which are caused by damage to the kidney tissue by autoantibodies, i.e. antibodies to one's own organ.
Glomerulonephritis is an independent disease, but can also occur in many systemic diseases, such as systemic lupus erythematosus, hemorrhagic vasculitis, infective endocarditis, etc.
Prevalence of glomerulonephritis
Glomerulonephritis is one of the most common kidney diseases in children, leading to the development of chronic renal failure and early disability. In terms of prevalence, it is second only to urinary tract infection among acquired kidney diseases in childhood.
Spicy glomerulonephritis can develop at any age, but most patients are under 40 years of age.
Causes of glomerulonephritis
Development glomerulonephritis associated with acute and chronic diseases of various organs, mainly streptococcal in nature.
The most common causes of glomerulonephritis are:
scarlet fever;
purulent skin lesions (streptoderma);
pneumonia;
The reason for the development glomerulonephritis ARVI, measles, and chickenpox can also serve.
To the number etiological factors This also applies to cooling the body in a humid environment (“trench” nephritis). Cooling causes reflex disorders of the blood supply to the kidneys and affects the course of immunological reactions.
There are reports of the causative role of microorganisms such as Staphylococcus aureus, Streptococcus pneumoniae, Neisseria meningitidis, Plasmodium malaria, Toxoplasma gondii and some viruses.
Typically, the onset of the disease is preceded 1-3 weeks by a streptococcal infection in the form of pharyngitis, tonsillitis, scarlet fever, and skin lesions - impetigo-pyoderma. It has been established that acute glomerulonephritis is caused, as a rule, only by “nephritogenic” strains of group A b-hemolytic streptococcus.
It is believed that if an outbreak of streptococcal A infection in a children's group is caused by nephritogenic strains, then 3-15% of infected children will develop nephritis, although among adults and children around the sick child, approximately 50% show changes in the urine, i.e. they probably suffer from torpid (limited, asymptomatic) nephritis.
Among children who have had scarlet fever, 1% develop acute glomerulonephritis during treatment in a hospital and in 3-5% of children treated at home. A respiratory viral infection in a child with chronic tonsillitis or carriage of cutaneous nephritogenic streptococcus A can lead to activation of the infection and cause the occurrence of acute glomerulonephritis.
Pathogenesis
The development of glomerulonephritis is always associated with chronic or acute infection localized in various organs and usually having a streptococcal nature. Most often, glomerulonephritis develops against the background of Staphylococcus aureus, Neisseria meningitidis, Streptococcus pneumoniae, Toxoplasma gondii, Plasmodium malaria infection, as well as invasion of certain viruses. In some cases, glomerulonephritis develops as a result of vaccinations, chemical poisoning, or consumption of foods containing preservatives.
The leading immunopathological process in glomerulonephritis is considered to be the formation of so-called immune complexes in the blood or kidneys. Moreover, the main antigen is usually endostreptolysin A of nephritogenic streptococci. At the very beginning of the disease, a typical picture forms in the blood: an increase in immune complexes and a decrease in C3 complement, while C1, C2 and C4 remain normal. Plus, an increase in antibodies to O-antistreptolysin (streptolysin-0), anti-NADase B (deoxyribonuclease B) or anti-NADase (nicotinamide adenine nucleotidase) of streptococci is detected in the blood serum. When performing a kidney biopsy at the first stage of the disease, from approximately the 28th day to the 42nd day, the test material reveals damage to the glomeruli from 80 to 100%. Lumpy granular deposits of immunoglobulin G and C3 complement are formed along the basement membranes of the glomerular capillaries and mesangium. A third of patients have a tubulointerstitial component. It should be noted that in the acute form of the disease a characteristic picture of proliferative endocapillary glomerulonephritis is formed. However, after a maximum of two and a half months, these deposits are no longer detected. However, the thickness of the mesangial matrix and the number of mesangial cells may remain high for several years. Almost anyone can get glomerulonephritis, but men under the age of forty and children are most susceptible to it. At the same time, in children, glomerulonephritis is the most common of all kidney diseases, which leads to the development of renal failure and/or early disability and is in second place in terms of prevalence, second only to urinary tract infections.
Symptoms of glomerulonephritis
Acute diffuse glomerulonephritis develops 6-12 days after infection, usually streptococcal ( angina, tonsillitis, pyoderma); The most nephritogenic is b-hemolytic streptococcus of group A, especially strains 12 and 49. The following symptoms are characteristic:
oliguria;
increased blood pressure.
hematuria (often gross hematuria);
Acute in children glomerulonephritis usually has a cyclical course, with a violent beginning, in most cases ending with recovery. In adults, the erased version with changes in urine without general symptoms is more common, gradually taking a chronic course.
The first signs of acute glomerulonephritis appear 1-3 weeks after an infectious disease or exposure to other factors. The disease begins with general weakness, headache, nausea, lower back pain, chills, loss of appetite. There may be rises in body temperature to very high numbers. There is pallor of the face, swelling of the eyelids, and a sharp decrease in the amount of urine produced.
The decrease in urine volume can last 3-5 days, after which diuresis increases, but the relative density of urine, according to tests, decreases.
Another characteristic sign is the presence of blood in the urine - hematuria. Urine takes on the color of “meat slop” or becomes dark brown or black. In cases of microhematuria, the color of urine may not change. At the beginning of the disease, fresh erythrocytes predominate; later, predominantly leached erythrocytes are released.
Edema is one of the most characteristic symptoms glomerulonephritis. They are usually located on the face, appear in the morning, and decrease in the evening. It takes about 2-3 liters before visible edema develops. fluid may be retained in the muscles and subcutaneous tissue. In obese children of preschool age, edema is more difficult to determine; sometimes they are determined only by some compaction of the subcutaneous tissue.
Hypertension (high blood pressure) is observed in approximately 60% of cases. In severe cases of glomerulonephritis, the increase in blood pressure may last for several weeks. Damage to the cardiovascular system due to acute course glomerulonephritis is observed in 80-85% of children.
There may be an enlargement of the liver, changes in the function of the central nervous system.
With a favorable course of the disease and timely diagnosis and treatment, swelling disappears after 2-3 weeks and blood pressure normalizes. Typically, recovery from acute glomerulonephritis occurs after 2-2.5 months.
There are two most characteristic forms of acute glomerulonephritis:
Cyclic form (starts violently)
The latent form (characterized by a gradual onset) is common, and its diagnosis has great value, since often with this form the disease becomes chronic.
Any spicy glomerulonephritis, which did not end without a trace within a year, should be considered to have become chronic.
The following clinical forms of chronic disease are distinguished: glomerulonephritis:
Nephrotic form is the most common form primary nephrotic syndrome.
Hypertensive form. For a long time, arterial hypertension predominates among the symptoms, while urinary syndrome is less pronounced.
Mixed form. In this form, there are simultaneously nephrotic and hypertensive syndromes.
Latent form. This is a fairly common form; It usually manifests itself only as a mild urinary syndrome without arterial hypertension and edema.
The hematuric form is also distinguished, since in some cases chronic glomerulonephritis may present with hematuria without significant proteinuria or general symptoms.
All forms of chronic glomerulonephritis may periodically give relapses, very reminiscent or completely repeating the picture of the first acute attack of diffuse glomerulorephritis. Exacerbations are especially common in autumn and spring and occur 1-2 days after exposure to an irritant, most often a streptococcal infection.
Complications of glomerulonephritis
In acute diffuse glomerulonephritis The following complications may occur:
Acute heart failure (in less than 3% of cases);
Acute renal failure (in 1% of patients);
Acute renal hypertensive encephalopathy (preeclampsia, eclampsia);
Bleeding in the brain;
Acute visual impairment (transient blindness);
Transition to chronic diffuse glomerulonephritis.
One of the factors in the chronicization of the inflammatory process in the kidneys may be the so-called hypoplastic dysplasia of the kidney, i.e. lag in the development of renal tissue from the chronological age of the child.
With a progressive course, unresponsive to active immunosuppressive therapy, chronic diffuse glomerulonephritis passes into its final stage - a secondary wrinkled bud.
Glomerulonephritis is one of the most common kidney diseases in children, leading to the development of chronic renal failure and early disability.
Diagnosis of glomerulonephritis
Diagnosis of acute glomerulonephritis is based on the appearance in young people after a sore throat or acute respiratory viral infection - edema, headache, arterial hypertension and the results of the following laboratory tests.
Characteristic signs of glomerulonephritis are:
Hematuria is the presence of blood in the urine. Urine takes on the color of “meat slop” or becomes dark brown or black. In cases of microhematuria, the color of urine may not change. At the beginning of the disease, fresh erythrocytes predominate; later, predominantly leached erythrocytes are released.
Proteinuria (albuminuria) is usually moderate (up to 3-6%), lasting 2-3 weeks.
Microscopy of urinary sediment reveals hyaline and granular casts, and with macrohemeturia - erythrocyte casts.
A study of endogenous creatinine clearance reveals a decrease in the filtration capacity of the kidneys.
The Zimnitsky test detects decreased diuresis and nocturia. High relative density of urine indicates preserved concentrating ability of the kidneys.
The content of residual nitrogen (acute azotemia), urea, ASL-O titer and ASG increases in the blood. The content of creatinine and cholesterol is increased.
When studying the balance of acids and bases in the blood - acidosis; a decrease is detected albumin, increase in alpha and beta globulins.
Leukocytosis and accelerated ESR are observed in the blood.
In doubtful cases, a kidney biopsy is performed, followed by a morphological examination of the bioptic material.
Treatment of glomerulonephritis
Hospitalization in the nephrology department
Bed rest
Diet No. 7a: protein restriction, salt is limited for edema, arterial hypertension
Antibiotics (for acute post-streptococcal glomerulonephritis or the presence of foci of infection)
Immunosuppressants and glucocorticoids are ineffective for post-infectious, post-streptococcal acute glomerulonephritis. Immunosuppressive therapy - glucocorticoids and cytostatics - for exacerbation of chronic glomerulonephritis. Glucocorticoids are indicated for mesangioproliferative chronic glomerulonephritis and chronic glomerulonephritis with minimal changes in the glomeruli. In membranous chronic glomerlonephritis, the effect is unclear. In membranoproliferative chronic glomerulonephritis and focal segmental glomerulosclerosis, glucocorticoids are ineffective. Prednisolone is prescribed 1 mg/kg/day orally for 6-8 weeks, followed by rapid decline up to 30 mg/day (5 mg/week), and then slowly (2.5-1.25 mg/week) until complete withdrawal. Pulse therapy with prednisolone is carried out with high CGN activity in the first days of treatment - 1000 mg IV drip 1 time per day for 3 days in a row. After the activity of chronic glomerulonephritis decreases, monthly pulse therapy is possible until remission is achieved.
Cytostatics (cyclophosphamide 2-3 mg/kg/day orally or intramuscularly or intravenously, chlorambucil 0.1-0.2 mg/kg/day orally, as alternative drugs: cyclosporine - 2.5- 3.5 mg/kg/day orally, azathioprine 1.5-3 mg/kg/day orally) are indicated for active forms of chronic glomerulonephritis with high risk progression of renal failure, as well as in the presence of contraindications for the use of glucocorticoids, ineffectiveness or the occurrence of complications when using the latter (in the latter case, combined use is preferred, which allows reducing the dose of glucocorticoids). Pulse therapy with cyclophosphamide is indicated for high activity of chronic glomerulonephritis, either in combination with pulse therapy with prednisolone (or against the background of daily intake of prednisolone), or in isolation without additional prescription of prednisolone; in the latter case, the dose of cyclophosphamide should be 15 mg/kg (or 0.6-0.75 g/m2 body surface) IV monthly:
The simultaneous use of glucocorticoids and cytostatics is considered more effective than glucocorticoid monotherapy. It is generally accepted to prescribe immunosuppressive drugs in combination with antiplatelet agents, anticoagulants - the so-called multicomponent regimens: 3-component circuit(without cytostatics): prednisolone 1 - 1.5 mg/kg/day orally for 4-6 weeks, then 1 mg/kg/day every other day, then reduced by 1.25-2.5 mg/week until discontinuation + heparin according 5000 IU 4 times a day for 1-2 months with a transition to phenindione or acetylsalicylic acid at a dose of 0.25-0.125 g/day, or sulodexide at a dose of 250 IU 2 times/day orally + Dipyridamole 400 mg/day orally or intravenously. 4-component Kinkaid-Smith circuit: prednisolone 25-30 mg/day orally for 1-2 months, then dose reduction by 1.25-2.5 mg/week until discontinuation + Cyclophosphamide 100-200 mg for 1-2 months, then half dose until remission is achieved (cyclophosphamide can be replaced with chlorambucil or azathioprine) + Heparin 5000 units 4 times a day for 1-2 months with a transition to phenindione or acetylsalicylic acid, or sulodexide + Dipyridamole 400 mg/day orally or intravenously. Ponticelli regimen: initiation of therapy with prednisolone - 3 days in a row at 1000 mg/day, the next 27 days prednisolone 30 mg/day orally, 2nd month - chlorambucil 0.2 mg/kg (alternating prednisolone and chlorbutine). Steinberg's regimen - pulse therapy with cyclophosphamide: 1000 mg IV monthly for a year. In the next 2 years - 1 time every 3 months. In the next 2 years - once every 6 months.
Antihypertensive therapy: captopril 50-100 mg/day, enalapril 10-20 mg/day, ramipril 2.5-10 mg/day
Diuretics - hydrochlorothiazide, furosemide, spironolactone
Antioxidant therapy (vitamin E), but there is no convincing evidence of its effectiveness.
Lipid-lowering drugs (nephrotic syndrome): simvastatin, lovastatin, fluvastatin, atorvastatin at a dose of 10-60 mg/day for 4-6 weeks, followed by a dose reduction.
Antiplatelet agents (in combination with glucocorticoids, cytostatics, anticoagulants; see above). Dipyridamole 400-600 mg/day. Pentoxifylline 0.2-0.3 g/day. Ticlopidine 0.25 g 2 times a day
Plasmapheresis in combination with pulse therapy with prednisone and/or cyclophosphamide is indicated for highly active chronic glomerulonephritis and there is no effect from treatment with these drugs.
Surgical treatment. Kidney transplantation is complicated in 50% by graft relapse, and in 10% by graft rejection.
Treatment of individual morphological forms
Mesangioproliferative chronic glomerulonephritis
With slowly progressing forms, incl. with IgA nephritis, there is no need for immunosuppressive therapy. With a high risk of progression - glucocorticoids and/or cytostatics - 3- and 4-component regimens. The effect of immunosuppressive therapy on long-term prognosis remains unclear.
Membranous chronic glomerulonephritis
Combined use of glucocorticoids and cytostatics. Pulse therapy with cyclophosphamide 1000 mg IV monthly. In patients without nephrotic syndrome and normal renal function - ACE inhibitors.
Membranoproliferative (mesangiocapillary) chronic glomerulonephritis
Treatment of the underlying disease. ACE inhibitors. In the presence of nephrotic syndrome and decreased renal function, therapy with glucocorticoids and cyclophosphamide with the addition of antiplatelet agents and anticoagulants is justified.
Chronic glomerulonephritis with minimal changes
Prednisolone 1 - 1.5 mg/kg for 4 weeks, then 1 mg/kg every other day for another 4 weeks. Cyclophosphamide or chlorambucil if prednisolone is ineffective or cannot be discontinued due to relapses. For ongoing relapses of nephrotic syndrome - cyclosporine 3-5 mg/kg/day (children 6 mg/m2) for 6-12 months after achieving remission.
Focal segmental glomerulosclerosis
Immunosuppressive therapy is not effective enough. Glucocorticoids are prescribed for a long time - up to 16-24 weeks. Patients with nephrotic syndrome are prescribed prednisolone 1 - 1.2 mg/kg daily for 3-4 months, then every other day for another 2 months, then the dose is reduced until discontinuation. Cytostatics (cyclophosphamide, cyclosporine) in combination with glucocorticoids.
Fibroplastic chronic glomerulonephritis
In case of a focal process, treatment is carried out according to the morphological form that led to its development. The diffuse form is a contraindication to active immunosuppressive therapy.
Treatment according to clinical forms is carried out if it is impossible to perform a kidney biopsy.
Latent form of glomerulonephritis. Active immunosuppressive therapy is not indicated. For proteinuria >1.5 g/day, ACE inhibitors are prescribed.
Hematuric form of glomerulonephritis. Inconsistent effect of prednisolone and cytostatics. For patients with isolated hematuria and/or slight proteinuria, ACE inhibitors and dipyridamole.
Hypertensive form of glomerulonephritis. ACE inhibitors; target blood pressure level is 120-125/80 mm Hg. During exacerbations, cytostatics are used as part of a 3-component regimen. Glucocorticoids (prednisolone 0.5 mg/kg/day) can be prescribed as monotherapy or as part of combination regimens.
Nephrotic form of glomerulonephritis - indication for a 3- or 4-component regimen
Mixed form - 3- or 4-component treatment regimen.
The kidneys are an important organ of the urinary system, responsible for regulating the process of homeostasis. Thanks to the smooth functioning of the organs, the balance of electrolytes is maintained, toxins and other substances are removed from the body. harmful substances. Any disturbances in the functioning of the kidneys lead to the development of the most various diseases, providing negative impact for the functioning of the whole organism. Chronic glomerulonephritis without proper treatment provokes the development of renal failure. Disease long time may be in a latent state, often occurring without severe symptoms. Treatment of chronic glomerulonephritis is a set of measures aimed at preserving kidney function, which is always carried out under the supervision of a nephrologist.
Chronic glomerulonephritis (CGN) is a progressive diffuse disease in which the glomerular apparatus of the kidneys is damaged. In the absence proper treatment or latent course, the disease leads to the development of nephrosclerosis and renal failure, which are dangerous to human life and health. The incidence of chronic glomerulonephritis among the population is 1–2%. The chronic form of the disease is spoken of when after primary therapy recovery does not occur, and periods of remission and exacerbation alternate throughout the year. The chronic form of glomerulonephritis can develop as a complication after the acute form of the disease.
The disease is classified as an autoimmune condition that causes in the tissues of the urinary system and kidneys pathological changes. In chronic glomerulonephritis, against the background of an inflammatory reaction, microthrombi form in the walls of the glomerular vessels, blood flow slows down, and necrosis develops. If chronic glomerulonephritis is not treated, complications are inevitable: nephrons die, which can be fatal.
Causes of development and risk factors
The disease can be provoked by pathologies of infectious origin, as well as unfavorable factors.
- acute glomerulonephritis;
- infectious diseases of internal organs;
- blood diseases of infectious origin;
- systemic pathologies;
- poisoning by poisonous or toxic substances;
- chronic alcoholism, drug use.
In case of chronic glomerulonephritis, the prognosis for recovery will be favorable if the disease was recognized in time and the necessary treatment was carried out.
Classification and forms
There are several forms of the disease, each of which has its own clinical signs.
Latent form
A common form of the disease, occurring in 45% of cases. It is characterized by mild urinary syndrome without edema and high blood pressure. This form of the disease can last more than 10 years and manifest itself minor violations in the functioning of the urinary system. If left untreated, uremia develops, in which the blood is poisoned by parts of urine. The disease is determined by the results of a blood test, which shows increased levels of protein, red blood cells and white blood cells.
Hypertensive form
The frequency of occurrence is 20% of all cases. The disease has pronounced symptoms: increased blood pressure, increased daily urine volume. Most often it is a continuation of the acute or latent form of the disease. Blood pressure levels may fluctuate during the day, hypertrophy of the left ventricle of the heart develops, which is significantly reflected in general health sick. In this form, chronic glomerulonephritis with isolated urinary syndrome often occurs, which can manifest itself against the background of an acute form of the disease or with constant surges in blood pressure.
Hematuric form
Enough rare form, occurring in 5% of patients. A characteristic feature is the presence of blood in the urine (hematuria). With the right and timely treatment, careful differential diagnosis has a favorable prognosis. The hematuric form causes only 6% of patients.
Nephrotic glomerulonephritis
It is diagnosed in 25% of patients with chronic glomerulonephritis and has severe symptoms. Blood biochemistry results show decreased protein levels and increased cholesterol levels. The patient often complains of lack of appetite, ammonia odor from the mouth, increased weakness. Chronic glomerulonephritis of the nephrotic form can completely disrupt kidney function.
Beginning of development of glomerulonephritis
Nephrotic-hematuric (mixed) form
Severe form, with rapid development and poor prognosis. Patients have complaints of severe swelling, severe impairment heart rate, increased “renal” pressure. Frequent exacerbations are the result improper treatment and a warning that the kidneys will soon stop performing their functions. With rapid development, death is possible.
Any form of chronic glomerulonephritis is characterized by periods of remission and exacerbation. With relapses, symptoms resemble acute attack which can last for several days or weeks. During the period of remission, the clinical picture of chronic glomerulonephritis is less pronounced or completely absent. Exacerbation most often occurs in spring or autumn. A relapse can be caused by eating disorders and refusal to take previously prescribed medications.
Clinical manifestations of the disease
Chronic diffuse glomerulonephritis, depending on the pathomorphological changes in the renal tissue and form, manifests itself in different ways:
- increased fatigue;
- decreased appetite;
- frequent nausea, urge to vomit in the morning;
- perversion of taste;
- swelling of various localizations;
- smell of ammonia from the mouth;
- anemia;
- skin itching;
- tremor;
- decreased sensitivity;
- cloudy urine, mixed with blood;
- increased blood pressure;
- heart rhythm disturbance.
IN acute period illness, body temperature rises, pain in the lumbar region of varying intensity is felt. All symptoms are expressed to a lesser or greater extent, but their appearance requires prescription full examination followed by treatment.
How to recognize the disease
Diagnosis of chronic glomerulonephritis is not difficult if the patient’s medical history has previously been noted acute form diseases. With a latent course, it can be difficult to recognize chronic diffuse glomerulonephritis. If suspected, this examination includes:
- urine test;
- blood biochemistry;
- Ultrasound of the kidneys;
- glomerular biopsy.
The results obtained make it possible to accurately diagnose the disease, determine the form of the disease, and assess the condition of the kidneys. For chronic glomerulonephritis, diagnosis may include additional research, consultations with other specialists. Based on the examination results, the doctor selects the optimal treatment regimen, which, although it cannot completely cure the disease, will help slow down necrotic changes in the kidney tissues.
Treatment methods
Treatment chronic form glomerulonephritis directly depends on the degree, morphology, form of the disease, and the intensity of symptoms. In the acute period, the patient is prescribed inpatient treatment, bed rest, strict diet, taking medications.
In chronic glomerulonephritis, symptoms and treatment always require attention from a nephrologist. The therapy carried out will not be able to completely rid the patient of the pathology, but it can make periods of remission longer. Treatment is aimed at reducing the intensity of symptoms, restoring the functions of affected kidney tissue, improving blood circulation and metabolic processes.
Drug therapy includes:
- Non-steroidal anti-inflammatory drugs (Nimid, Ortofen, Ibuprofen and others).
- Glucocorticosteroids (Prednisolone).
- Cytostatics (Cyclosporine).
- Anticoagulants (Heparin).
- Antiplatelet agents (Curantil).
- Antihypertensives (Enalapril, Enap, Kaptopres).
- Diuretics (Furosemide, Indapamide, Lasix).
- Antibiotics wide range actions (Emsef, Augmentin, Sumamed).
Any drug used for treatment must be prescribed by a doctor. Drugs are administered during the acute period of illness in a hospital setting, often intravenously or intramuscularly, which allows for more quick effect from treatment.
In more severe cases, with running forms Plasmapheresis may be prescribed, which is a procedure for cleansing the body of toxic substances that impair kidney function.
When chronic diffuse glomerulonephritis progresses, the only way saving a person's life is considered permanent hemodialysis or a kidney transplant.
Reinforced drug therapy carried out only during exacerbation. As practice shows, if you follow the prescribed treatment regimen, use modern drugs You can achieve long-term remission - from a year or more.
For chronic glomerulonephritis, medication treatment is carried out in acute stage. During the period of remission, the patient is prescribed a strict diet, factors that can provoke an exacerbation are excluded. In some cases, therapy is carried out folk remedies which consists of taking decoctions and infusions of medicinal herbs.
Treatment with folk remedies cannot be the basis of therapy, and the use of any prescription should be discussed with your doctor. In the absence of treatment or advanced forms of the disease, CGN syndromes completely or partially disrupt kidney function, cause tissue necrosis with the subsequent development of renal failure.
Diet
Chronic diffuse glomerulonephritis is a disease that requires constant medical supervision, as well as adherence to a strict diet and lifestyle changes. Patients with a history of this disease are prescribed a strict diet No. 7, which limits the consumption of salt, fried, and spicy foods. It is recommended to reduce the amount of protein foods and increase the amount of fluid consumed. If the diet is not followed, chronic glomerulonephritis and its clinical signs will lead to the development of renal failure.
Preventive measures
Prevention of chronic glomerulonephritis is aimed at reducing the frequency of exacerbations and their intensity.
Measures to prevent the development of the disease:
- Gentle work regime.
- Avoiding hypothermia.
- No contact with poisonous and toxic substances.
- Strengthening the immune system.
- Proper and healthy nutrition.
- Quitting smoking and drinking alcohol.
- Compliance with all doctor’s prescriptions and recommendations.
- Preventive examinations once a year.
Compliance simple rules will help not only prevent the development of chronic glomerolonephritis, but also reduce the risk of exacerbations, which will help the kidneys perform their functions. For patients with a history of kidney pathologies, it is important to understand that treatment with folk remedies alone will not help cope with the problem. Only complex therapy under the supervision of a physician will increase the patient’s chances of a positive prognosis.
– it’s a complicated matter. This disease is considered very common, since among all therapeutic pathologies its frequency reaches 2%. The disease can affect people at any age, but is more common between 20 and 40 years of age. It develops most often when acute glomerulonephritis is not cured in time, although there are also cases when the disease immediately becomes chronic.
Pathological changes in the kidneys can be caused by bacteria and viruses, which are often carried into this organ by blood from other parts of the body affected by infectious processes.
Determination of symptoms and treatment for chronic glomerulonephritis should be carried out exclusively), since self-medication with this disease can be fraught with extremely unpleasant consequences.
Symptoms of chronic glomerulonephritis
The main symptom of this disease is disruption of normal kidney function lasting more than 1 year (both organs are affected). Usually the symptoms of the disease begin to appear so gradually and slowly that the person for a long time does not even suspect that he has dangerous disease and therefore remains for a long time without appropriate treatment, which aggravates the situation.
The most characteristic general symptoms for this disease:
- swelling (especially in the legs);
- dyspnea;
- persistent increase in blood pressure;
- pallor and swelling of the face, which is characterized by a special term - “nephritic face”.
The remaining manifestations of the disease in chronic form are usually hidden from the patient himself. They are associated with changes in the composition of blood and urine, water-salt balance, structural disorders blood vessels in the organ and filtration processes in the urinary system.
When the disease becomes chronic, there are two stages:
- Stage of renal compensation. During this period, the function of nitrogen excretion in the kidneys is sufficient. Symptoms such as small amounts of protein and blood in the urine appear, and severe urinary syndrome is possible.
- Stage of renal decompensation - urinary syndrome is less significant, the nitrogen-excreting function of the urinary organs is insufficient.
During the chronic form there may be various options Therefore, doctors distinguish several types of the disease, each of which has its own characteristics of symptoms, the most pronounced signs and a set of pathological changes that occur in the body of a sick person.
Chronic minimal glomerulonephritis is characterized by disruption of the small processes of podocytes. In individual loops of nephrons, loosening and swelling of the tissue and thickening of the basement membranes occur.
By external symptoms it is impossible to distinguish this variety, correct diagnosis only possible using electron microscopy.
Membranous - the walls of the renal tubules thicken diffusely. The reason is the deposition of immune system complexes on the surface of blood vessels. At the same time, the kidney increases in size and has a smooth surface. Often this type of illness is associated with allergic reactions in the body to medications or with processes that occur in the presence of tumors.
Mesangial – accompanied by changes in mesangium cells during the deposition of immune complexes on the surface of blood vessels. The buds have a dense consistency.
Focal - pathological changes and deposition of hyaline substance do not occur throughout the entire volume of renal tissue, but only in individual foci or segments.
In addition, doctors distinguish between types of the disease according to the speed of development of its symptoms:
- rapidly progressing – develops over 2–5 years;
- slowly progressive – develops over more than 10 years.
Symptoms of various forms of the disease
Depending on which symptoms appear during the development of the disease, the following forms of chronic glomerulonephritis are distinguished:
- Latent – manifested by urinary syndrome, occurring in almost half of patients. It does not cause swelling or increased blood pressure. Symptoms include hematuria, leukocyturia, proteinuria (that is, urine tests reveal blood, leukocytes and protein). As a rule, this type of disease develops over a long period of time (up to 20 years).
- Hypertensive – accompanied by an increase in blood pressure. It is observed in approximately every fifth patient. The pressure can increase quite intensively, up to 200/120 mm Hg. Art., and its fluctuations are possible during the day. Accompanied this form illness and other symptoms: changes in the structure of the fundus of the eye (neuroretinitis), cardiac asthma, which is provoked by failure of the left ventricle of the heart. The disease manifests itself over a long period of time and is fraught with onset.
- Hematuric - severe macrohematuria manifests itself, that is, blood enters the urine in such quantities that it can be noticed by a change in color, without special clinical trials. This symptom can lead to the development of anemia due to constant blood loss. This symptomatology occurs in approximately one in twenty patients.
- Nephrotic – occurs in every fourth patient and is accompanied by nephrotic syndrome. Manifested by the following symptoms: the release of protein in the urine, a violation of water metabolism, as a result of which not only external, but also internal edema develops (accumulation large quantity fluid in the pleura, pericardium). Blood is found in the urine, and blood pressure may increase. With this type of disease, renal failure occurs quite quickly, which negatively affects the patient’s condition.
- Mixed - accompanied by the manifestation of nephrotic-hypertensive syndrome, in which symptoms of both of the above-described forms of the disease are observed.
Thus, this pathology chronic kidney disease may manifest itself different symptoms, which determine the characteristics of the disease, its course, treatment and possible complications in the future.
Diagnostics
Diagnosis of chronic glomerulonephritis always includes comprehensive examination. In order to correctly diagnose this disease, it is necessary to collect a very large amount of information about the patient, about his current condition, about all infectious and non-communicable diseases that were in the past. During the examination, the patient is prescribed:
- Clinical and biochemical urine analysis. The presence of chronic glomerulonephritis is indicated by the results of tests in which protein is observed in the urine, shaped elements blood (in particular, leukocytes, erythrocytes), protein, cylinders. Along with pathological changes in biochemical composition urine and its specific gravity changes.
- Blood tests. With this disease, the amount of protein in the blood and the ratios in the amounts of different fractions of protein compounds change. Studies show an increase in the number of antibodies to streptococcus (in test results referred to as ASL-O) and a decrease in the content of complement system components C3 and C4. With this disease, the levels of several types of immunoglobulins in the blood (IgA, IgM, IgG) increase.
- Zimnitsky test - laboratory test urine, in which urine is collected over one day in 8 containers (each container contains urine excreted over three hours). By this survey it is possible to determine the change in urine production during the day (the ratio of nighttime and daytime urination), its total quantity, density. In addition, you can compare the volume of fluid consumed and excreted.
- Rehberg's test is a test of kidney function that determines their filtering ability. For the examination, 24-hour urine and blood serum taken from a vein are simultaneously required. The amount of creatinine in the blood and urine is determined.
- Excretory urography is an x-ray that covers the area from top edge kidneys to the border urethra. In this image, you can determine the position, shape and size of organs, the structure of their tissues, and the presence of stones.
- Renography is a study that uses a special radioactive substance(technetium-99). It is injected into the kidneys and the excretion process is recorded using a gamma camera, which is installed next to the organ. By the nature of this process, you can determine the rate of urine excretion from the patient’s body.
- with this disease, pathological changes in the structure of the kidney tissue: its sclerotization and decrease in volume.
- A kidney tissue biopsy is performed to determine changes in the histological structure of the kidney. A tissue sample is taken using a special needle that is inserted through the back muscles. The procedure is very complicated, so it is performed exclusively in inpatient conditions and use local anesthesia. To avoid complications and ensure proper manipulation, the biopsy is monitored using ultrasound.
In addition to these basic studies, the attending physician may prescribe other examinations, based on what associated symptoms develop in the patient. This could be an ultrasound of other organs, an ECG. If vision deteriorates at the same time, consultation with an ophthalmologist and examination of the fundus are necessary.
Based on the examination results, the doctor makes a differential diagnosis of glomerulonephritis and other diseases that may manifest the same symptoms.
Among these diseases:
- kidney stone disease;
- kidney amyloidosis;
- kidney tuberculosis;
- polycystic kidney disease;
- nephrotic syndrome;
- chronic pyelonephritis;
- arterial hypertension.
As a rule, diagnosing the chronic form of glomerulonephritis does not represent difficult task, but difficulties may arise with latent, hematuric and hypertensive types of the disease.
In the case when these studies show a typical picture of renal tissue disorders and associated changes in the internal environment of the body, a diagnosis of “chronic glomerulonephritis”, or CGN, is established. After completing the diagnosis, they begin to choose treatment tactics for the patient.
Treatment
Is it possible? If you consult a doctor in a timely manner and follow all prescriptions, you can ensure that the disease stops reoccurring. Many factors are very important in this matter: individual characteristics organism, neglect of the disease, degree of damage to the urinary system, approaches to treatment.
Treatment of the disease depends on what factors led to these pathological changes.
Chronic kidney disease can be triggered by its acute form (if it is not treated promptly and correctly), hereditary predisposition, immune changes in the body (for example, allergies, consequences of vaccination, autoimmune diseases).
The influence of hypothermia and general weakening of the body due to the effects of unfavorable environmental factors, poor nutrition. All this must be taken into account when developing treatment tactics, otherwise the root cause of the disease will constantly interfere effective elimination problems.
Without appropriate therapy, the disease can lead to very serious consequences, including renal failure, kidney dystrophy, hemorrhages from its blood vessels and others dangerous conditions. For chronic glomerulonephritis, treatment is very complex and includes several components, each of which is extremely important for maintaining the human body and eliminating the problem.
Corticosteroid therapy
This is the basis of pathogenetic therapy for this disease. Data medicines are prescribed in a dose determined by the doctor based on the patient’s condition. Typically, the dosage of corticosteroids is gradually increased gradually. Treatment is carried out in courses, which, if necessary (during exacerbations), should be repeated periodically. The dosage regimen is developed individually in each case. With progressive azotemia, sclerosis of the renal glomeruli, their atrophy and high blood pressure, corticosteroids hormonal drugs contraindicated.
In some cases, when treated with corticosteroids, the patient worsens inflammatory processes in foci of infection in other organs. Then there is a need for simultaneous administration antibacterial drugs(if the infection is bacterial) or appropriate therapy for other infectious agents.
Immunosuppressive therapy
When glomerulonephritis becomes chronic, changes in the immune system patient. Specific substances are formed in his body (antibodies that are produced in response to antigens, fractions of the complement system C3 and C4). These compounds are deposited on the delicate tissues of the renal glomeruli and lead to their destruction. As a result, the blood circulation of organs and the processes of urine formation are disrupted. Therefore, treatment of chronic glomerulonephritis must necessarily include an impact on immune processes in the body.
Immunosuppressants in some cases can replace corticosteroid hormonal drugs or be used simultaneously with them. There are conditions in which this therapy needs to be stopped, so constant monitoring of the patient’s well-being is necessary.
Drugs that suppress the immune system have different adverse reactions, among which there is an effect on the condition of the optic nerve.
Therefore, while taking these medications, constant monitoring by an ophthalmologist is necessary.
Anti-inflammatory therapy
Aimed at eliminating inflammatory processes in the organs of the urinary system. Anti-inflammatory drugs relieve pain and reduce fever, and reduce the release of protein from the blood into the urine. If corticosteroids and anti-inflammatory drugs are used concomitantly, the dosage of the hormones may be reduced in some cases.
Anticoagulant therapy
When changes occur that increase the risk of blood clotting. In particular, this is the deposition of fibrin on the walls of the glomeruli and arterioles. To normalize blood clotting and prevent complications, anticoagulants are taken. In addition, they can have other effects: reduce inflammation and allergic reactions.
As a result of this therapy, the filtering function of the kidneys improves, the excretion of protein in the urine decreases, and the ratio of different fractions of protein substances in the blood serum is normalized.
Antihypertensive therapy
Since glomerulonephritis, in particular in its hypertensive form, increases blood pressure, it is necessary to normalize it. For this purpose, the doctor prescribes medications that reduce blood pressure. Moreover, such therapy must be selected with great caution: the patient is negatively affected not only high blood pressure, but also him sharp decline, and also sudden changes. Therefore, it should be reduced gradually.
Medicines that have a diuretic effect not only reduce blood pressure, but also increase the outflow of fluid from the body, which prevents the development of severe swelling. For example, with a mixed form of the disease, natriuretics are prescribed, which are characterized by the following double action. But medicines with a diuretic effect, which are based on purine derivatives, are ineffective in eliminating edema caused by impaired renal function.
Diet
Nutritional correction is also an integral part of the treatment of this disease. A diet for chronic glomerulonephritis is necessary to normalize the composition of blood serum so that the urinary system can cope with the processes of urine formation and excretion.
Very close attention You need to pay attention to the amount of salt you consume. In mixed and nephrotic forms of the disease, salt consumption should be minimal. The patient needs only the amount of sodium chloride that is initially present in food products, so dishes are not salted at all during preparation.
If a patient has developed a hypertensive chronic type of the disease, the amount of salt in his food should be about 3-4 g per day, and the content of proteins and carbohydrates should be normal.
If there is no edema provoked by a violation of the renal filtering ability, the amount of protein in the food should be sufficient so that enough protein substances enter the body, because they are intensively lost in the urine.
With glomerulonephritis, as with any other disease, it is very important that the patient’s diet is balanced and correct.
Food must contain everything necessary substances, because if they are deficient, the person’s condition will worsen and the likelihood of complications will increase.
Among the vitamins, A, C and group B are especially valuable in this case.
If at any stage of treatment of the disease there is a need to limit the consumption of salt or protein compounds, such a diet should not last long. Long-term shortage of these vital important substances also negatively affects human health, so nutrition during the entire period of therapy should be adjusted from time to time depending on changes in functional state kidney
Other treatment features
It has been noted that the climate in the patient’s place of residence has a special effect on the course of the disease. Doctors advise during treatment to be in a dry and warm climate, where there is no likelihood of exposure to cool, moist air and further hypothermia.
If the patient’s health is not critical (no heart failure, excessive edema, uremia), he can be sent to spa treatment. The optimal holiday destinations are Central Asia or Crimea (South Coast).
Thus, if chronic glomerulonephritis is suspected, diagnosis should begin as soon as possible, without waiting for the onset of dangerous consequences for the patient's body.
Once the diagnosis is made, appropriate treatment must be carried out. It is very important that the patient follows all the doctor’s instructions and adheres to a gentle regimen, including nutrition. Neglecting such appointments may worsen the condition.
is a progressive diffuse immunoinflammatory lesion of the glomerular apparatus of the kidneys, resulting in sclerosis and renal failure. May be asymptomatic, include increased blood pressure, edema, disorders general condition. Diagnostics uses clinical and biochemical research urine, ultrasound of the kidneys, morphological examination of renal tissue (biopsy), excretory urography, renography. Treatment includes nutritional regulation, corticosteroid, immunosuppressive, anticoagulant, diuretic, and antihypertensive therapy.
In some patients, chronic glomerulonephritis is caused by hereditary predisposition (defects in the cellular immune system or complement) or congenital renal dysplasia. Also to non-infectious factors include allergic reactions to vaccination, alcohol and drug intoxication. Other immunoinflammatory diseases can cause diffuse damage to nephrons - hemorrhagic vasculitis, rheumatism, systemic lupus erythematosus, septic endocarditis, etc. The occurrence of pathology is facilitated by cooling and weakening of the body’s general resistance.
Pathogenesis
In the pathogenesis of chronic glomerulonephritis, the leading role belongs to immune disorders. Exogenous and endogenous factors cause the formation of specific CECs, consisting of antigens, antibodies, complement and its fractions (C3, C4), which are deposited on the glomerular basement membrane and cause its damage. In chronic glomerulonephritis, glomerular damage is intracapillary in nature, disrupting microcirculation processes with the subsequent development of reactive inflammation and dystrophic changes.
The disease is accompanied by a progressive decrease in the weight and size of the kidneys and thickening of the kidney tissue. Microscopically, the fine-grained surface of the kidneys, hemorrhages in the tubules and glomeruli, and loss of clarity of the medulla and cortex are determined.
Classification
In etiopathogenetic terms, infectious-immune and non-infectious-immune variants of chronic glomerulonephritis are distinguished. According to the pathomorphological picture of the detected changes, minimal, proliferative, membranous, proliferative-membranous, mesangial-proliferative, sclerosing types of the disease and focal glomerulosclerosis are distinguished. During the pathology, a phase of remission and exacerbation is distinguished. According to the speed of development, the disease can be rapidly progressive (within 2-5 years) and slowly progressive (more than 10 years).
In accordance with the leading syndrome, several forms of chronic glomerulonephritis are distinguished: latent (with urinary syndrome), hypertensive (with hypertensive syndrome), hematuric (with a predominance of gross hematuria), nephrotic (with nephrotic syndrome), mixed (with nephrotic-hypertensive syndrome). Each of the forms occurs with periods of compensation and decompensation of the nitrogen excretory function of the kidneys.
Symptoms of chronic glomerulonephritis
Symptoms are due to clinical form diseases. The latent form occurs in 45% of patients and occurs with isolated urinary syndrome, without edema and arterial hypertension. Characterized by moderate hematuria, proteinuria, leiocyturia. The course is slowly progressive (up to 10-20 years), the development of uremia occurs late. In the hematuric variant (5%), persistent hematuria, episodes of gross hematuria, and anemia are noted. The course of this form is relatively favorable, uremia occurs rarely.
The hypertensive form of chronic glomerulonephritis develops in 20% of cases and occurs with arterial hypertension with mild urinary syndrome. Blood pressure rises to 180-200/100-120 mm Hg. Art., often subject to significant daily fluctuations. Changes in the fundus of the eye (neuroretinitis), left ventricular hypertrophy, and cardiac asthma are observed as a manifestation of left ventricular heart failure. The course of this form is long and steadily progressing, resulting in renal failure.
The nephrotic variant, occurring in 25% of cases, occurs with massive proteinuria(over 3 g/day), persistent diffuse edema, hypo- and dysproteinemia, hyperlipidemia, edema of the serous cavities (ascites, hydropericardium, pleurisy) and associated shortness of breath, tachycardia, thirst. Nephrotic and hypertensive syndromes constitute the essence of the most severe, mixed form of chronic glomerulonephritis (7% of cases), which occurs with hematuria, severe proteinuria, edema, arterial hypertension. An unfavorable outcome is determined rapid development renal failure.
Diagnostics
The leading diagnostic criteria are clinical and laboratory data. When collecting anamnesis, the fact of the presence of chronic infections, acute glomerulonephritis, systemic diseases. Typical changes general analysis urine is the appearance of red blood cells, leukocytes, cylinders, protein, and a change in the specific gravity of urine. To assess kidney function, Zimnitsky and Rehberg tests are performed. Hypoproteinemia and dysproteinemia, hypercholesterolemia are detected in the blood, the titer of antibodies to streptococcus (ASL-O, antihyaluronidase, antistreptokinase) increases, the content of complement components (C3 and C4) decreases, and the level of IgM, IgG, IgA increases.
Ultrasound of the kidneys during the progressive course of chronic glomerulonephritis reveals a decrease in the size of organs due to sclerosis of the renal tissue. Excretory urography, pyelography, nephroscintigraphy help to assess the condition of the parenchyma and the degree of renal dysfunction. To identify changes in other systems, ECG and EchoCG, ultrasound of the pleural cavities, and fundus examination are performed.
Depending on the clinical variant of the disease, a differential diagnosis With chronic pyelonephritis, nephrotic syndrome, polycystic kidney disease, kidney stones, renal tuberculosis, renal amyloidosis, arterial hypertension. To establish the histological form of chronic glomerulonephritis and its activity, as well as to exclude pathologies with similar manifestations, a kidney biopsy is performed with a morphological examination of the resulting renal tissue sample.
Treatment of chronic glomerulonephritis
Features of therapy are dictated by the clinical form of the disease, the rate of progression of disorders and the presence of complications. It is recommended to follow a gentle regimen with the exception of overwork, hypothermia, and occupational hazards. During periods of remission, treatment of chronic infections that support the course of the process is required. The diet prescribed for chronic glomerulonephritis requires restrictions table salt, alcohol, spices, accounting for liquids drunk, increasing daily norm squirrel.
Drug treatment consists of immunosuppressive therapy with glucocorticosteroids, cytostatics, NSAIDs; prescribing anticoagulants (heparin, phenindione) and antiplatelet agents (dipyridamole). Symptomatic therapy may include diuretics for edema, antihypertensive drugs for hypertension. In addition to full inpatient courses of therapy during periods of exacerbation, supportive outpatient therapy during remission and treatment at climatic resorts are indicated.
Prognosis and prevention
Effective treatment of chronic glomerulonephritis can eliminate the leading symptoms (hypertension, edema), delay the development of renal failure and prolong the patient’s life. All patients are monitored by a nephrologist. The latent form has the most favorable prognosis; more serious – hypertensive and hematuric; unfavorable - nephrotic and mixed forms. Complications that worsen the prognosis include pleuropnemnonia, pyelonephritis, thromboembolism, and renal eclampsia.
Since the development or progression of irreversible changes in the kidneys is most often initiated by streptococcal and viral infections, wet hypothermia, their prevention is of paramount importance. In case of pathology accompanying chronic glomerulonephritis, observation of related specialists is necessary - otolaryngologist, dentist, gastroenterologist, cardiologist, gynecologist, rheumatologist, etc.
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