Sharp glomerulonefrit – the disease of immunoinflammatory character which is characterized by involvement of structural units of kidneys – nefron and primary defeat of the glomerular device. Sharp glomerulonefrit proceeds with development of ekstrarenalny syndromes (edematous and hypertensive) and renalny manifestations (an uric syndrome). In diagnostics of a sharp glomerulonefrit the urine research (the general analysis, Reberg, Zimnitsky, Nechiporenko's test), ultrasonography of kidneys, biochemical and immunological blood test, a biopsy of renal fabric is applied. Treatment of a sharp glomerulonefrit demands observance of a bed rest and a diet, purpose of steroid hormones, hypotensive, diuretichesky means.
Sharp glomerulonefrit develops mainly at children at the age of 2-12 years and adults up to 40 years. Men get sick by 15,2 times more often than women. The peak of incidence of a sharp glomerulonefrit falls on damp and cold season. At a sharp glomerulonefrit there is a primary defeat of balls (kidney little bodies), besides in pathological process are involved a tubule and interweft tissue of both kidneys. Damage of kidneys at a sharp glomerulonefrit is connected with the specific immune reaction caused by infectious or allergic process.
Reasons of a sharp glomerulonefrit
In most cases development of a sharp glomerulonefrit is accompanied by the postponed streptococcal infection – pharyngitis, quinsy, an exacerbation of tonsillitis, scarlet fever, an erysipelatous inflammation of skin. As the Etiologichesky agent in these cases the b-hemolytic streptococcus of group A, as a rule, acts. Definition of the raised caption of antibodies to a streptococcal gialuronidaza and - Oh, increase in the CEC containing anti-genes to a streptococcus testifies to a streptococcal etiology of a sharp glomerulonefrit.
Sometimes development of a sharp glomerulonefrit is preceded by a viral infection – flu, epidemic parotitis, chicken pox, a rubella, infectious , herpes, hepatitis. More rare sharp glomerulonefrit develops after diphtheria, staphylococcal and pnevmokokkovy pneumonia, malaria, a brucellosis, an infectious endocarditis, belly and a typhus and other infections.
Except infectious and immune sharp glomerulonefrit the noninfectious and immune forms of a disease caused by introduction of serums and vaccines, individual intolerance of pollen of plants, reception of nefrotoksichny medicines, a sting of insects or snakes, alcoholic intoxication, etc. the reasons meet. Overcooling, anatomo-physiological incompleteness of a structure of nefron at children serve contributing to development of a sharp glomerulonefrit by factors.
Now the urology holds the opinion that sharp glomerulonefrit - it is immunocomplex pathology. After infectious or allergic influence there is a change of reactivity of an organism that is shown by formation of antibodies to alien anti-genes. Interacting with a complement, immune complexes are postponed on surfaces of basal membranes of capillaries of balls. The structure of capillary walls changes, permeability of vessels increases, conditions for a tromboobrazovaniye are created.
Frustration conducts traffic of renal fabric to the fact that in an ischemic kidney function system renin-angiotensin-aldosteronovoy becomes more active that HELL leads to a spasm of peripheral vessels and, as a result, increase. On this background processes of a filtration and reabsorption are broken, there is a delay of Na and water, in urine pathological elements appear.
Classification of a glomerulonefrit
For the reasons causing damage distinguish primary, idiopathic and secondary glomerulonefrit. Primary glomerulonefrit it is connected with infectious, allergic or toxic impact on renal fabric; secondary – serves as display of system pathology (a hemorrhagic vaskulit, hard currency, etc.); idiopathic glomerulonefrit develops for the uncertain reasons.
On character of a current allocate sharp (prescription several weeks), subsharp (prescription several months) and chronic (prescription over a year) glomerulonefrit. Also depending on etiofaktor sharp glomerulonefrita can be infectious and immune and noninfectious and immune.
Depending on the volume of defeat of the glomerular device distinguish sharp glomerulonefrit focal (it is struck
Sharp glomerulonefrit can develop on various morphological types - proliferative endocapillary, proliferative ekstarakapilyarny, mezangioproliferativny, membranozno-proliferative, skleroziruyushchy.
On a clinical current sharp glomerulonefrit can develop in the classical developed form (with gipertenzivny, edematous and uric syndromes), in a bisindromny form (a combination of an uric syndrome with edematous or gipertenzivny) or a monosyndromic form (only with an uric syndrome).
In MKB-10 for designation of a sharp diffusion glomerulonefrit the concept "sharp nefritichesky syndrome" is used.
Symptoms of a sharp glomerulonefrit
The classical picture of a sharp glomerulonefrit includes a triad of simptomokompleks: kidney (renalny) – an uric syndrome and extra kidney (ekstrarenalny) – edematous and gipertenzivny syndromes. Sharp glomerulonefrit usually demonstrates 1-2 weeks later after the etiologichesky influence taking place (infections, allergic reaction etc.)
Emergence of hypostases – the earliest and frequent sign of a sharp glomerulonefrit, occurs at 70-90% of patients, at a half of them hypostases happen considerable. Hypostases settle down mainly in a face: are most expressed in the mornings and fall down in the afternoon, being replaced by puffiness of anklebones and shins. Further the edematous syndrome can progress to an anasarka, a hydropericardium, a gidrotoraks, ascites. In certain cases at a sharp glomerulonefrit visible hypostases can be absent, however daily increase in body weight of the patient testifies to a liquid delay in fabrics.
Arterial hypertension at a sharp glomerulonefrit is usually expressed moderately: at 60-70% of patients HELL does not exceed 160/100 mm of mercury. However persistent long hypertensia has the adverse forecast. The combination of arterial hypertension to bradycardia less than 60 is characteristic of a sharp glomerulonefrit. in min. which can keep for 1-2 weeks. At sharply developing gipovolemiya the phenomena of insufficiency of the left ventricle, the expressed cardiac asthma and hypostasis of lungs are possible.
Development of the cerebral violations caused brain hypostasisby - headache, nausea and vomitings, decrease in sight, "veil" before eyes, a hearing impairment, psychomotor excitability is quite often noted. Development of angiospastichesky encephalopathy – an eklampsiya (toniko-clonic spasms, loss of consciousness, swelling of cervical veins, cyanosis of a neck and the person, a pulse urezheniye etc.) can become extreme manifestation of a cerebral syndrome.
The current of a sharp glomerulonefrit can accompany a pain syndrome of various degree of expressiveness: waist pains to a thicket are symmetric and caused by stretching of kidney capsules and violation of an urodinamika.
The uric syndrome at a sharp glomerulonefrit is characterized by early development of an oliguriya and even anury in combination with strong thirst. At the same time increase in relative density of urine, emergence in urine of hyaline and granular cylinders, erythrocytes, a large amount of protein is noted.
Eritrotsituriya can proceed in the form of a mikrogematuriya (Er-5 - 50 – 100 under review) or makrogematuriya at which urine becomes colors of "meat slops". The proteinuria and a gematuriya at a sharp glomerulonefrit are more expressed in the first days of a disease.
More rare sharp glomerulonefrit develops as a monosyndromic (uric) form without hypostases and at normal HELL. Against the background of a sharp glomerulonefrit the nephrotic syndrome can develop.
Diagnostics of a sharp glomerulonefrit
At diagnostics of a sharp glomerulonefrit it is considered the existence of typical clinical syndromes, changes in urine, biochemical and immunological blood test given to ultrasonography and a biopsy of a kidney.
The general analysis of urine is characterized by a proteinuria, gematuriy, tsilindruriy. Reduction of amount of daily urine and increase in its relative density is typical for Zimnitsky's test. Reberg's test at a sharp glomerulonefrit reflects decrease in filtrational ability of kidneys.
Changes of biochemical indicators of blood can include a gipoproteinemiya, a disproteinemiya (reduction of albumine and increase in concentration of globulins), emergence of SRB, and sialovy acids, a moderate hypercholesterolemia and a giperlipidemiya, a giperazotemiya. At a research of a koagulogramma shifts in the curtailing system – a hyper coagulative syndrome are defined.
Immunological analyses allow to reveal increase of a caption of ASL-O, of anti-streptokinase, an antigialuronidaza, anti-deoxyribonuclease In; increase in maintenance of IgG, IgM, is more rare than IGA; gipokomplementemiya of SZ and S4. Ultrasonography of kidneys at a sharp glomerulonefrit usually shows not changed sizes of bodies, reduction of an ekhogennost, reduction of speed of a glomerular filtration.
As indications to carrying out a biopsy of a kidney serve need of differentiation of a sharp and chronic glomerulonefrit, the fast-progressing course of a disease. At a sharp glomerulonefrit in a nefrobioptata signs of cellular proliferation, infiltration of balls, existence of dense deposits of immune complexes, etc. are defined by monocytes and neutrophils. At a gipertenzivny syndrome carrying out a research of an eye bottom and the ECG is necessary.
Treatment of a sharp glomerulonefrit
Therapy of a sharp glomerulonefrit is carried out in an urological hospital and demands purpose of a high bed rest, saltless dietary food with restriction of consumption of animal protein, liquids, purpose of "sugar" and fasting days. The strict accounting of amount of the consumed liquid and volume of a diuresis is made.
The main therapy at a sharp glomerulonefrit consists in use of steroid hormones - Prednisolonum, dexamethasone a course up to 5-6 weeks. At the expressed hypostases and arterial hypertension diuretichesky and hypotensive means are at the same time appointed. Antibiotic treatment is carried out at the available symptoms of an infection (tonsillitis, pneumonia, an endocarditis, etc.).
At a sharp renal failure purpose of anticoagulants, carrying out a hemodialysis can be required. The course of hospitalization of a sharp glomerulonefrit makes 1-1,5 months then the patient is written out under observation of the nephrologist.
Forecast and prevention of a sharp glomerulonefrit
In most cases sharp glomerulonefrit well gives in to therapy by kortikosteroidny hormones and comes to an end with recovery. In 1/3 cases transition to a chronic form of a glomerulonefrit is possible; deaths are extremely rare. At a stage of dispensary observation the patient needs a dynamic research of urine.
Prevention of development of primary sharp glomerulonefrit and its recurrence consists in treatment of sharp infections, sanitation of the chronic centers in a nasopharynx and an oral cavity, increase in resilience of an organism, prevention of cooling and long stay in the damp environment. Preventive vaccination are contraindicated to persons with the raised allergic background (urticaria, bronchial asthma, hay fever).