Chronic glomerulonephritis

Description:

This infectious and allergic disease renal гломерул which develops after postponed acute or without the previous acute beginning as a result of latentno the proceeding oligosymptomatic process. Preferential defeat of renal balls is characteristic of a chronic glomerulonephritis.

Symptoms of the Chronic glomerulonephritis:

Allocate 5 main clinical forms of a chronic glomerulonephritis — latent, gematurichesky, nephrotic, hypertensive and the mixed type. The latent glomerulonephritis is shown only by urine changes — a moderate proteinuria, a hamaturia, a leukocyturia, moderate increase in the ABP is sometimes noted, there are no considerable hypostases usually. The Gematurichesky glomerulonephritis is shown by a constant hamaturia sometimes with gross hematuria episodes without considerable proteinuria and the general symptoms (raising of the ABP, hypostases). The chronic glomerulonephritis with a nephrotic syndrome is shown by the expressed hypostases, a considerable proteinuria and a cylindruria. In blood decrease in amount of crude protein (to 40 — 50 g/l), increase in level of cholesterol of blood up to 15,5 mmol/l is noted (600 mg / 100 ml and above). The chronic glomerulonephritis with secondary hypertensia is shown by changes from cardiovascular system: substantial increase of the ABP, repeated nasal bleedings, deterioration in sight, development of cardiac asthma is possible. Changes in urine are insignificant — a moderate microhematuria and a proteinuria.
The chronic glomerulonephritis of the mixed type is characterized by persistent hypostases, the high ABP. Development of a chronic renal failure is characteristic of all forms of a chronic glomerulonephritis.

Reasons of the Chronic glomerulonephritis:

Development of this disease disturbance of activity of immune system under the influence of the postponed bacterial infections (quinsy, scarlet fever) is the cornerstone, of viral infections (flu, a SARS, a viral hepatitis) and some other diseases. As a result sensitivity of an organism to so-called antigens — the substances of the proteinaceous nature which are, for example, a part of disease-producing microbes or products of their life activity (toxins) increases. In response to the antigens which got to an organism in blood antibodies appear. They block antigens, connect them, forming cell-bound immune complexes "antigen — an antibody". At the healthy person these complexes are absorbed by blood cells, including leukocytes, or brought out of an organism with urine. In an organism of the patient with a chronic glomerulonephritis the formed cell-bound immune complexes not completely are removed through kidneys, and settle in walls of capillaries of renal balls where there is the first stage of formation of urine — filtering of a blood plasma. But, happens, antibodies contact not only antigens, but also a membrane of balls — the basic structural element of a wall of capillaries of renal balls. In response to it inflammatory process both in a wall of capillaries develops, and on its internal surface where settle fibrin, thrombocytes and other blood cells. Gradually the gleam of capillaries is narrowed, the blood flow on them is slowed down, and over time becomes impossible at all. Capillaries zapustevat. As soon as the ball ceases to function, also tubules are switched off from work, that is all nephron — structural unit of a kidney perishes, and on its place connecting fabric expands, the hem is formed. However reserve opportunities of kidneys are very big as total quantity of nephrons in them reaches the few less than two million. Switching off from work even does not lead a half of nephrons to disturbance of life activity of an organism yet. And only in that case when less than 40 — 30% of all nephrons function, process of formation of urine is broken. Removal with urine of end products of protein metabolism is at a loss. Concentration of nitrogenous substances, in particular urea, raises, develops in blood a chronic renal failure.

Treatment of the Chronic glomerulonephritis:

Treatment of a chronic glomerulonephritis consists in the corresponding mode, a diet, use of medicamentous means and has to be strictly individualized depending on a form, a stage, a phase, the frequency of aggravations, existence of associated diseases. The mode in a phase of remission and a stage of preservation of functions of kidneys has to be sparing. Patients should avoid overfatigue and overcooling. Hard physical work, work during a night shift, in the open air in cold season, in hot workshops, in stuffy rooms is contraindicated to them. On, an opportunity should recommend to the patient day rest lying during 1-1,5 h. When developing an intercurrent disease obligatory observance of a bed rest, the corresponding therapy, if necessary purpose of antibacterial agents (the antibiotics which are not possessing nephrotoxic action) is recommended. Sanitation of the centers of persistent infection is necessary for the prevention of aggravations and stabilization of a condition of the patient. For the women who are ill a chronic glomerulonephritis, pregnancy is always serious testing and can threaten with a process aggravation in kidneys, emergence (or increase) to a hypertension. At a nephrotic form and, especially, existence of a hypertension pregnancy is contraindicated. Especially it is dangerous at disturbance of functions of kidneys. Observance of a diet is important. The general requirements imposed to a diet irrespective of a nephrite form: restriction (up to a complete elimination) table salt, extractive substances, spices, alcohol; purpose of the full-fledged vitaminized food. It is useful for patient to eat water-melons, melons, pumpkin, grapes. Treatment by antibiotics is applied only at an aggravation of a chronic glomerulonephritis, developing of intercurrent diseases, an aggravation of inflammatory process in the centers of an infection and during hormonal therapy. The latent form of a chronic glomerulonephritis (especially without aggravations) does not demand special restrictions in the mode and food, except the above-stated, concerning all nephrite forms. Food has to correspond to physiological requirements at insignificant restriction of table salt (to 6-8 g a day). The use of liquid is not limited. In a stage of remission there is no need for medicamentous therapy.
In case of an aggravation it is possible to recommend treatment by aminoquinolinic drugs. Patients with a latent form of a glomerulonephritis are subject to dispensary inspection 1-2 times a year: measurement of arterial pressure, the general blood test and urine, Kakovsky's test - Addis, definition of a daily proteinuria, assessment of a functional condition of kidneys on clearance of endogenous creatinine. In a phase of an aggravation of a chronic glomerulonephritis of patients treat in a hospital, apply antibiotics, appoint diets No. 7a, 7; exclude table salt or limit up to 2-4 g a day, watch a water balance. Pathogenetic and symptomatic therapy is appointed. At gematurichesky option of a latent form of a chronic glomerulonephritis prohibit patients long walking, mobile sports, bathing in open reservoirs. The temporary effect can give purpose of aminocapronic acid (if the hamaturia is caused by increase in fibrinolitic activity of a blood plasma). In some cases the hamaturia can decrease at long (3-4 weeks) reception of infusion or extract of a nettle. Patients with a nephrotic form of a chronic glomerulonephritis have to adhere to the sparing mode. In a diet limit reception of table salt to 2-4 g a day, and periodically (for 1-1,5 months) completely exclude it. Strictly watch a water balance: the amount of the liquid used in days has to equal to the volume of the urine emitted for the last days plus 300-500 ml (no more). The amount of protein in a daily diet at the kept function of kidneys has to correspond to physiological need plus that quantity which the patient loses per day with urine. In the presence of hypostases fasting days 1-2 times a week with observance of an apple or potato and apple diet are effective. As symptomatic therapy appoint actions, diuretic with various mechanism. Widely use hypothiazid, furosemide. For the prevention of development of a hypopotassemia along with diuretic drugs appoint potassium drugs.
At an aggravation of a nephrotic form of chronic nephrite the good effect renders prolonged use of Chingaminum (on condition of absence of sharp hypertensia and an azotemia). At a hypertensive and nephrotic form of a chronic glomerulonephritis symptomatic therapy hypotensive (Reserpinum, etc.) and diuretics is appointed. In a stage of compensation of these forms of a disease the good effect gives sanatorium treatment. Pathogenetic therapy of a chronic diffusion glomerulonephritis can include the steroid hormones (Prednisolonum, etc.) possessing an antiinflammatory and immunodepressive effect. They promote increase in a diuresis by influence on secretion of antidiuretic hormone and Aldosteronum. It should be noted that hormonal therapy is contraindicated at a persistent hypertension and the phenomena of disturbance of azotovydelitelny function of kidneys. At uraemia special value is given to fight against an azotemia. Reception of protein with food is limited to 18-30 g a day, generally at the expense of meat. Appoint courses antibiotics of a broad spectrum of activity and fermented milk products (for suppression of rotting in intestines). In the absence of hypostases plentiful drink is recommended. To remove intoxication phenomena, appoint group B vitamins, glucose, ascorbic acid, a gastric lavage, enemas with hydrosodium carbonate, and also carry out a hemodialysis by means of the device "artificial kidney". Now successful developments of operations on renal transplantation are conducted.