Glomerulonephritis

Description:

Glomerulonephritis — the inflammation of renal balls, to a lesser extent tubules, followed by secondary disturbances of blood circulation in kidneys with a delay in an organism of water and salt, is frequent development of a heavy overload by liquid and arterial hypertension.

Glomerulonephritis symptoms:

On a current the glomerulonephritis happens acute and chronic.
The acute glomerulonephritis develops at persons of young age in 10 — 12 days after an infectious disease more often, is characterized by hypostases, arterial гипертензиёй and pathological changes of urine. At patients the headache, short wind sometimes passing into suffocation attacks (cardiac asthma), sharp reduction of a mocheotdeleniye, sometimes to a full anury and bystry development of hypostases are noted (it is preferential on a face). Hypostases in combination with pallor of skin create characteristic outward of the patient ("the person of a nefritik"). Then hypostases extend on all body, and sometimes liquid accumulates in pleural, belly cavities and a pericardium. Arterial hypertension precedes other symptoms of a disease more often. Usually it moderate, however also substantial increase of the ABP is possible (to 200/120 mm of mercury.). Hypertensia serves as the reason of development of the expressed circulatory unefficiency (an asthma, a pneumorrhagia, attacks of cardiac asthma). At inspection of the patient expansion of borders of heart, emphasis of the second tone on an aorta, systolic noise at a top, bradycardia are defined, in lungs wet rattles are listened. At the high ABP, wet brain the nephritic eclampsia which is shown by the sharpest headaches, vomiting, epileptiform convulsive attacks can develop; there is no uraemia at the same time. Hypertensia and hypostasis of a retina of an eye cause a vision disorder with the advent of "fog" before eyes, an illegibility of vision of objects. Sometimes owing to amotio of a retina there occurs total loss of sight. The hamaturia and a proteinuria are observed. The microhematuria is noted from the 1st day of a disease, sometimes passes into a gross hematuria (urine of color of meat slops). In an urocheras lixivious erythrocytes — 100 — 200 under review and more, and also leukocytes, cylinders and a renal epithelium are found.

Glomerulonephritis reasons:

In most cases the glomerulonephritis develops owing to an excessive immune response on infectious antigens. Most often the streptococcal infection (quinsy, tonsillitis, pneumonia, infectious damages of skin) is a cause of illness, tuberculosis, malaria, syphilis is more rare. The disease can be provoked by vaccination, poison of bees or other insects, an allergy to pollen of plants, medicines. Emergence of a glomerulonephritis and its transition to a chronic form are promoted by cooling, salt overconsumption, persistent infection (tonsillitis, caries of teeth, an adnexitis, hepatitis, tuberculosis), a drunkenness.

Treatment of the Glomerulonephritis:

In an active phase the high bed rest during 4-6 weeks is necessary, fruit and sugar or fruit and vegetable days are shown. Administration of proteins is limited only in the first days of treatment then the patient has to be transferred to the full-fledged proteinaceous mode. Introduction to a diet of vegetable oil is reasonable. In the presence of symptoms of the developing chronic renal failure purpose of a rigid diet of Giordano-Giovanetti (a potato vegetable-fruit diet) is shown. The thirst mode, "water blow"  are used at adults, however are unacceptable for children's clinic. Restriction of liquid is unreasonable even at an edematous syndrome. The amount of sodium chloride, including contents it in foodstuff should not exceed 1 g/days. Content of sodium in a diet gradually increase to physiological norm by the end of the first month from an onset of the illness (aggravation) if clinical laboratory data indicate remission. All patient during the acute period (or at an aggravation) appoint antibiotics. Use of the drugs directed against a streptococcal infection - penicillin, semi-synthetic penicillin is reasonable. Antibiotics appoint in an age dosage with drug change each 8-10 days. At a nephrotic form in connection with increase in clearance of antibiotics their dosage increases by 20-50%. Applying corticosteroids, appoint drugs of penicillin of the prolonged action. Sanitation of the chronic centers of an infection (caries of teeth, adenoid disease) is obligatory. Corticosteroids are effective at treatment of the majority of manifestations of a glomerulonephritis, however it is not necessary to hurry with their appointment at an acute glomerulonephritis, and at the mixed disease form their efficiency is doubtful. Prednisolonum is appointed at the rate of 1,5-2 mg/kg or 40-50 mg to 1 sq.m of a body surface; at inefficiency of such treatment during 2-3 weeks it is possible to increase a dose or to appoint in addition drugs of an immunodepressive effect. Duration of use of the maximum doses of Prednisolonum of 2-3 weeks then the dose is gradually reduced the general course of treatment proceeded 2-3 months. At a dose decline drug is given mainly in the first half of day. The supporting steroid therapy is carried out by discontinuous courses (a half of the maximum dose 3 days with 3-or a 4-day interval or every second day enter, at intercurrent diseases - daily). Drugs of a 4-aminoquinolinic row (Resochinum, chloroquine) can be appointed at long disease. At gormonorezistentny forms of a glomerulonephritis use of tsitostatik is shown. In recent years more and more broad application in nephrological clinic is found by heparin, anticoagulants of indirect action, antiagregant, indometacin approximately according to the same scheme, as well as treatment by leukeranum. For fight against a gipertenzionny syndrome use Reserpinum, hypothiazid, dopegit, clonidine. Hypertensia should not be considered as a contraindication to a klecheniye by corticosteroids, but demands longer restriction of sodium, administration of drugs of potassium (potassium chloride of 3-5 g/days, fruit - prunes, bananas), uses of hypotensive drugs (Reserpinum, Dibazolum, apressine, hypothiazid). Small hypostases do not demand special treatment. At considerable hypostases appoint a dichlothiazide, furosemide, Acidum etacrynicum, Triamterenum, antagonists of Aldosteronum apply.
At an edematous and albuminuretic form it is shown in/in administration of plasma, Haemodesum (5 ml/kg). Widely appoint vitamins A, groups B, C, R. Odnim from the most effective methods of treatment of a chronic renal failure is a hemodialysis. In recent years considerably efficiency of renal transplantation with selection of the donor for antigens of histocompatibility of HLA increased. Expediency of rehabilitation of sick children in the conditions of local nephrological sanatoria is proved.