Acute glomerulonephritis

Description:

Diffusion glomerulonephritis - an immunoallergic disease with preferential defeat of vessels of balls: proceeds in the form of acute or chronic process with repeated aggravations and remissions. In more exceptional cases the subacute glomerulonephritis of which the rapid progressing current quickly leading to a renal failure is characteristic is observed. A diffusion glomerulonephritis - one of the most frequent diseases of kidneys.

Acute glomerulonephritis - a disease of the infectious and allergic nature with preferential defeat of capillaries of both kidneys. It is widespread everywhere. Are ill at the age of 12-40 years more often, men are slightly more often. There is in the countries with a frigid and humid climate, a seasonal disease.

Symptoms of the Acute glomerulonephritis:

The acute glomerulonephritis is characterized by three main symptoms - edematous, hypertensive and uric. Find in urine mainly protein and erythrocytes. The amount of protein in urine usually fluctuates from 1 to 10 g/l, but quite often reaches 20 g/l and more. However high content a beam in urine is noted only in the first 7-10 days therefore at a late research of urine the proteinuria more often is low (less than 1 g/l). The small proteinuria in some cases can be from the very beginning of a disease, and during some periods it can be even absent. Small amounts of protein in urine at the patients who had acute nephrite are observed long and disappear only through 3-6, and in some cases even 9-12 months from the beginning of a disease.

Hamaturia - an obligatory and constant sign of an acute gpomerulonefrit; in 13-15% of cases there is a gross hematuria, in other cases - a microhematuria, the quantity of erythrocytes can sometimes not exceed 10-15 under review. A cylindruria - not an obligatory symptom of an acute gpomerulonefrit. In 75% of cases find single hyaline and granular cylinders, epithelial cylinders sometimes meet. The leukocyturia, as a rule, happens insignificant, however sometimes find 20-30 leukocytes and more under review. At the same time always nevertheless quantitative dominance of erythrocytes over leukocytes is noted that comes to light at calculation of branded elements of an urocheras by means of Kakovsky's techniques better - Addis, De Almeyda - Nechiporenko.

Oliguria (400-700 ml of urine a day) - one of the first symptoms of acute nephrite. In certain cases within several days the anury (an acute renal failure) is observed. At many patients in turning of the first several days of a disease the insignificant or moderate azotemia is noted. Often at an acute glomerulonephritis the hemoglobin content and number of erythrocytes in peripheral blood decrease. It is connected with a hydremia (the increased content of water in blood), and also can be caused by true anemia as a result of influence of the infection which led to development of a glomeruponefrit (for example, at a septic endocarditis.

Often the raised SOE is defined. Quantity of leukocytes in blood, as well as temperature reaction, are defined by the initial or accompanying infection (temperature normal is more often and there is no leukocytosis).

In a clinical picture of an acute glomerulonephritis hypostases which are a precursory symptom of a disease at 80-90% of patients are of great importance; they are located preferential on a face and together with pallor of skin create the characteristic "person of a nefritik". Often liquid collects in cavities (pleural, belly, pericardium cavities). The body weight increase for a short time can reach 15 - 20 kg and more, but in 2-3 weeks hypostases usually disappear. One of cardinal symptoms of an acute diffusion gpomerulonefrit is the arterial hypertension observed at 70-90% of patients. In most cases the ABP does not reach high levels (180/120 mm of mercury.). At children and teenagers increase in the ABP happens less than at adults. Sharply arisen arterial hypertension can lead to development of an acute heart failure, especially left ventricular. Later development of a hypertrophy of a left ventricle of heart is possible. At inspection expansion of limits of cordial dullness is defined that can be caused by accumulation of transudate in a cavity of a pericardium and a myocardium hypertrophy. Functional systolic noise on a top, the emphasis of the II tone on an aorta, sometimes a cantering rhythm are quite often listened: in lungs - dry and wet rattles. On an ECG changes of teeth of R and T in standard leads, quite often deep tooth of Q and a little reduced voltage of the ORS complex can be observed.

Arterial hypertension at an acute glomerulonephritis can be followed by development of an eclampsia, but there is no uraemia at the same time. It is more correct to consider an eclampsia .ostry encephalopathy as it is caused by arterial hypertension and hypostases (hypervolemic wet brain). Despite a heavy clinical picture of eclamptic attacks, they seldom come to an end in death and pass mostly completely.

Distinguish two most characteristic forms of an acute glomerulonephritis. The cyclic form begins violently. There are hypostases, short wind, a headache, pain in lumbar area, the amount of urine decreases. In analyses of urine - high figures of a proteinuria and hamaturia. The ABP raises. Hypostases stick to 2-3 weeks. Then during a disease there comes the change: the polyuria develops and the ABP decreases. The period of recovery can be followed by a hyposthenuria. However it is frequent at good health of patients and almost complete recovery of working capacity can it is long, for months to be observed the small proteinuria (0,03 - 0,1 g/l) and a residual hamaturia. The latent form meets quite often, and diagnosis is of it great importance as it becomes frequent at this form a disease of chronic. This form of a glomerulonephritis is characterized by the gradual beginning without any expressed subjective symptoms and shown only by a small asthma or hypostases standing. In such cases the glomerulonephritis manages to be diagnosed only at a systematic research of urine. Duration of rather active period at a latent form of a disease can be considerable (2-6 months and more).

The acute glomerulonephritis can be followed by a nephrotic syndrome. Any acute glomerulonephritis which did not end completely within a year needs to be considered passed into chronic. It is necessary to remember that in some cases sharply begun diffusion glomerulonephritis can accept character of a subacute malignant ekstrakapillyarny glomerulonephritis with violently progressing current.

Reasons of the Acute glomerulonephritis:

There is a disease most often after quinsies, tonsillitis, upper respiratory tract infections, scarlet fever, etc. An important role in emergence of a gpomerulonefrit is played by a streptococcus, especially type 12 of a beta and hemolitic streptococcus of group A. In the countries with hot climate is more often than others to an acute glomerulonephritis streptococcal skin diseases precede. It can also develop after pneumonia (including staphylococcal), diphtherias, ypny and a typhoid, a brucellosis, malaria and some other infections. Emergence of a glomerulonephritis under the influence of a viral infection, after introduction of vaccines and serums (serumal, vaccinal nephrite) is possible. Also cooling of an organism in the wet environment ("trench" nephrite) is among ethnological factors.

Cooling causes reflex disorders of blood supply of kidneys and influences the course of immunological reactions. Now idea of an acute gpomerulonefrit as about immunocomplex pathology is standard, emergence of symptoms of a glomerulonephritis after the postponed infection is preceded by long stage of latency during which reactivity of an organism changes, antibodies to microbes or viruses are formed. Complexes antigen - an antibody, interacting with a complement, are postponed for surfaces of a basal membrane of capillaries preferential of balls. The generalized vasculitis with damage mainly of kidneys develops.

Treatment of the Acute glomerulonephritis:

The bed rest and diet are appointed. Sharp restriction of table salt in food (no more than 1,5 - 2 g/days) already in itself can lead to the strengthened release of water and elimination of edematous and hypertensive syndromes. At first appoint sugar days (for 400 - 500 sugar in days from 500-600 ml of tea or fruit juice). Further give water-melons, pumpkin, oranges, potatoes which provide almost completely beznatriyevy food.

Long restriction of consumption of proteins at an acute glomerulonephritis is insufficiently proved as the delay of nitrogenous slags, as a rule, is not observed, and the increase in the ABP assumed sometimes under the influence of proteinaceous food is not proved. From proteinaceous products it is better to use cottage cheese, and also ovalbumin. Fats are resolved in number of 50-80 g/days. For ensuring daily caloric content add carbohydrates. Liquid can consume up to 600 - 1000 ml/days. Antibacterial therapy is shown at explicit communication of a glomerunefrit with the available infection, for example at a long septic endocarditis, an adenoid disease. At an adenoid disease the tonzildektomiya in 2-3 months after subsiding of the acute phenomena of a glomerulonephritis is shown.

Use of steroid hormones - Prednisolonum is reasonable (Prednisonum), Triamcinolonum (dexamethasone). Treatment Prednisolonum is appointed not earlier than in 3-4 weeks from the beginning of a disease when the general symptoms (in particular, arterial hypertension) are less expressed. Corticosteroid hormones at a nephrotic form or a prolonged current of an acute glomerulonephritis are especially shown, and also at a so-called residual uric syndrome including a hamaturia. Prednisolonum is applied, since a dose of 10-20 mg/days, quickly (within 7-10 days) bring a daily dose to 60 mg. This dose continues to be given during 2-3 weeks, then it is gradually reduced. The course of treatment lasts 5-6 weeks. Total quantity of Prednisolonum on a course of 1500-2000 mg. If the sufficient medical effect during this time is not reached, it is possible to continue treatment supporting to doses and Prednisolonum (on 10-15 mg/days) is long under medical control. Corticosteroid therapy influences both on edematous, and an uric syndrome. It can promote recovery and the prevention of transition of an acute glomerulonephritis to chronic. Moderate arterial hypertension is not a contraindication to use of corticosteroid drugs. At a tendency to increase in the ABP and increase of hypostases treatment by corticosteroid hormones should be combined with hypotensive and diuretic means. If in an organism there are infection centers, then along with corticosteroid hormones it is necessary to appoint antibiotics.

In the presence of arterial hypertension and especially at emergence of an eclampsia complex hypotensive therapy by peripheral vazodilatator (verapamil, гидралазин, Sodium nitroprussidum, diazoxide) or sympatholytics (Reserpinum, clonidine) in combination with saluretics (furosemide, Acidum etacrynicum) and tranquilizers is shown (diazepam, etc.). Ganglioblokator can be applied and (3 adrenoblockers. For reduction of wet brain use osmotic diuretics (40% glucose solution, Mannitolum). At spasms (at 1 stage) give a radio and oxygen anesthesia. At ongoing spasms carry out bloodletting.