Chronic glomerulonefrit – the progressing diffusion immunoinflammatory defeat of the glomerular device of kidneys from the outcome in a sclerosis and a renal failure. Manifestations of a chronic glomerulonefrit depend on the developed disease form: hypertensive, nephrotic, gematurichesky, latent. In diagnostics of a chronic glomerulonefrit apply a clinical and biochemical trial of urine, ultrasonography of kidneys, a morphological research of renal fabric (biopsy), excretory urography, a renografiya. Treatment of a chronic glomerulonefrit includes regulation of food, kortikosteroidny, immunosupressivny, antikoagulyantny, diuretichesky, hypotensive therapy.
In urology understand as a chronic glomerulonefrit various on an etiology and a patomorfologiya primary glomerulopatiya which are followed by inflammatory and destructive changes and leading to nephrosclerosis and a chronic renal failure. Among all therapeutic pathology chronic glomerulonefrit makes about 1-2% that allows to speak about its rather high prevalence. Chronic glomerulonefrit it can be diagnosed at any age, however more often the first symptoms of nephrite develop in 20-40 years. The progressing current of a glomerulonefrit long (over a year) and bilateral diffusion damage of kidneys are signs of chronic process.
Reasons of a chronic glomerulonefrit
Synchronization and progressing of a disease can be a consequence of not cured sharp glomerulonefrit. At the same time often cases of development of a primary and chronic glomerulonefrit without the previous episode of the sharp attack meet.
The reason of a chronic glomerulonefrit manages to be found out not in all cases. The leading significance is attached to nefritogenny strains of a streptococcus and existence in an organism of the centers of a chronic infection (pharyngitis, tonsillitis, antritis, cholecystitis, caries, a periodontal disease, an adneksit and so forth), to persistiruyushchy viruses (flu, hepatitis B, herpes, chicken pox, an infectious mononukleoz, a rubella, a Cytomegaloviral infection).
At a part of patients chronic glomerulonefrit is caused by hereditary predisposition (defects in system of cellular immunity or a complement) or congenital kidney displaziya. Also refer allergic reactions to vaccination, alcoholic and medicinal intoxication to noninfectious factors of a chronic glomerulonefrit. Other immunoinflammatory diseases can cause diffusion damage to nefron – hemorrhagic vaskulit, rheumatism, system red a wolf cub, a septic endocarditis etc. Emergence of a chronic glomerulonefrit is promoted by cooling and weakening of the general resilience of an organism.
In pathogenesis of a chronic glomerulonefrit the leading role belongs to immune violations. Exogenous and endogenous factors cause formation of the specific CEC consisting of anti-genes, antibodies, a complement and its fractions (C3, C4) which are besieged on a basal membrane of balls and cause its damage. At a chronic glomerulonefrit defeat of klubochyok has the intrakapillyarny character breaking processes of microcirculation with the subsequent development of a jet inflammation and dystrophic changes.
Chronic glomerulonefrit is followed by the progressing reduction of weight and the sizes of kidneys, consolidation of renal fabric. Microscopically the fine-grained surface of kidneys, hemorrhages in tubules and balls, loss of clearness of a brain and cortical layer is defined.
Classification of a chronic glomerulonefrit
In the etiopatogenetichesky relation allocate infectious and immune and noninfectious and immune options of a chronic glomerulonefrit. On a patomorfologichesky picture of the found changes distinguish minimum, proliferative, membranozny, proliferative , mezangialno-proliferative, skleroziruyushchy types of a chronic glomerulonefrit and focal .
During a chronic glomerulonefrit allocate a phase of remission and an aggravation. On development speed the disease can be in an expedited manner progressing (within 2-5 years) and slowly progressing (more than 10 years).
According to the leading syndrome distinguish several forms of a chronic glomerulonefrit – latent (with an uric syndrome), gipertenzionny (with a hypertensive syndrome), gematurichesky (with prevalence of a makrogematuriya), nephrotic (with a nephrotic syndrome), mixed (with a nephrotic and hypertensive syndrome). Each of forms proceeds with the periods of compensation and a decompensation of azotovydelitelny function of kidneys.
Symptoms of a chronic glomerulonefrit
The symptomatology of a chronic glomerulonefrit is caused by a clinical form of a disease. The latent form of a chronic glomerulonefrit occurs at 45% of patients, proceeds with the isolated uric syndrome, without hypostases and arterial hypertension. It is characterized by a moderate gematuriya, a proteinuria, a leyotsituriya. The current which is slowly progressing (up to 10-20 years), development of uraemia comes late. At gematurichesky option of a chronic glomerulonefrit (5%) the resistant gematuriya, makrogematuriya episodes, anemia is noted. The current of this form rather favorable, uraemia arises seldom.
The Gipertenzionny form of a chronic glomerulonefrit develops in 20% of observations and proceeds with an arterial hypertension at poorly expressed uric syndrome. HELL raises to 180-200/100-120 mm of mercury., quite often is exposed to considerable daily fluctuations. Changes of an eye bottom are observed (neyroretinit), a hypertrophy of the left ventricle, cardiac asthma as display of left ventricular heart failure. A current of a gipertenzionny form of nephrite long and steadily progressing from the outcome in a renal failure.
The nephrotic option of a chronic glomerulonefrit which is found in 25% of cases proceeds with a massive proteinuria (over 3 g/days), persistent diffusion hypostases, hypo - and a disproteinemiya, a giperlipidemiya, dropsy of serous cavities (ascites, a hydropericardium, pleurisy) and related short wind, tachycardia, thirst. Nephrotic and gipertenzivny syndromes make an essence of the heaviest, mixed form of a chronic glomerulonefrit (7% of observations). Proceeds with the gematuriya expressed by a proteinuria, hypostases, arterial hypertension. The failure is defined by bystry development of a renal failure.
Diagnostics of a chronic glomerulonefrit
As the leading criteria of diagnostics of a chronic glomerulonefrit serve clinical laboratory data. When collecting the anamnesis the fact of existence of chronic infections, the postponed sharp glomerulonefrit, system diseases is considered. As typical changes of the general analysis of urine serves emergence of erythrocytes, leukocytes, cylinders, protein, change of specific weight of urine. For assessment of function of kidneys Zimnitsky and Reberg's tests are carried out.
In blood at a chronic glomerulonefrit the gipoproteinemiya and a disproteinemiya, a hypercholesterolemia is found, the caption of antibodies to a streptococcus increases (ASL-O, of an antigialuronidaz, anti-streptokinase), the maintenance of components of a complement (SZ and S4) decreases, the level IgM, IgG, IGA increases.
Ultrasonography of kidneys at the progressing current of a chronic glomerulonefrit finds reduction of the sizes of bodies at the expense of a sklerozirovaniye of renal fabric. The excretory urography, a piyelografiya, a nefrostsintigrafiya help to estimate a parenchyma condition, extent of dysfunction of kidneys. For identification of changes from other systems the ECG and EhoKG, ultrasonography of pleural cavities, survey of an eye bottom is carried out.
Depending on clinical option of a chronic glomerulonefrit performing differential diagnostics with chronic pyelonephritis, a nephrotic syndrome, polikistozy kidneys, a pochechnokamenny disease, tuberculosis of kidneys, amiloidozy kidneys, arterial hypertension is required. For establishment of a histologic form of a chronic glomerulonefrit and its activity, and also a pathology exception with similar manifestations the kidney biopsy with a morphological research of the received sample of renal fabric is carried out.
Treatment of a chronic glomerulonefrit
Features of leaving and therapy at a chronic glomerulonefrit are dictated by a clinical form of a disease, speed of progressing of violations and existence of complications. Observance of the sparing mode with an exception of reexhaustions, overcoolings, professional vrednost is recommended. During the periods of remission of a chronic glomerulonefrit treatment of the chronic infections supporting the course of process is required. The diet appointed at a chronic glomerulonefrit demands restriction of table salt, alcohol, spices, the accounting of the drunk liquid, increase in standard daily rate of protein.
Drug treatment of a chronic glomerulonefrit consists of immunosupressivny therapy by glucocorticosteroids, cytostatics, NPVS; purposes of anticoagulants (heparin, fenindion) and antiagregant (dipiridamol). Symptomatic therapy can include reception of diuretics at hypostases, hypotensive cure for hypertensia. Except full stationary courses of therapy during the periods of an aggravation of a chronic glomerulonefrit, carry out the supporting out-patient therapy during remission, treatment in climatic resorts.
Forecast and prevention of a chronic glomerulonefrit
Effective treatment of a chronic glomerulonefrit allows to eliminate the leading symptoms (a hypertension, hypostases), to delay development of a renal failure and to prolong life to the patient. All patients with a chronic glomerulonefrit are on the dispensary account at the urologist.
The latent form of a chronic glomerulonefrit has the optimum forecast; more serious – gipertenzivny and gematurichesky; adverse - nephrotic mixed forms. The plevropnemnoniya, pyelonephritis, a thrombembolia, a kidney eklampsiya belong to the complications worsening the forecast.
As development or progressing of irreversible changes in kidneys is most often initiated by streptococcal and viral infections, damp overcooling, paramount value is gained by their prevention. At the pathology accompanying a chronic glomerulonefrit observation of adjacent experts – the otolaryngologist, the stomatologist, the gastroenterologist, the cardiologist, the gynecologist, the rheumatologist, etc. is necessary.