Glomerulonefrit – a disease of kidneys of immunnovospalitelny character. Strikes mainly kidney balls. To a lesser extent interstitsialny fabric and tubules of kidneys are involved in process. Glomerulonefrit proceeds as the independent disease or develops at some system diseases (the infectious endocarditis, hemorrhagic vaskulit, system red a wolf cub). The clinical picture of a glomerulonefrit consists of uric, edematous and hypertensive syndromes. At a glomerulonefrita data of analyses of urine, Zimnitsky and Reberg's tests, ultrasonography of kidneys and UZDG of kidney vessels have diagnostic value.
Glomerulonefrit – a disease of kidneys of immunnovospalitelny character. Strikes mainly kidney balls. To a lesser extent interstitsialny fabric and tubules of kidneys are involved in process. Glomerulonefrit proceeds as the independent disease or develops at some system diseases (the infectious endocarditis, hemorrhagic vaskulit, system red a wolf cub). In most cases development of a glomerulonefrit is caused by excessive immune reaction of an organism to anti-genes of the infectious nature. There is also autoimmune form of a glomeruloronefrit at which damage of kidneys results from destructive influence autoantitet (antibodies to cages of own organism).
At a glomerulonefrita complexes an anti-gene antibody are postponed in capillaries of kidney balls, worsening blood circulation owing to what process of production of primary urine is broken, there is a delay in an organism of water, salt and products of exchange, the level of protivogipertenzivny factors decreases. All this leads to arterial hypertension and development of a renal failure.
Prevalence of a glomerulonefrit
Glomerulonefrit takes the second place among acquired diseases of kidneys at children after infections of urinary tract. According to statistical data of domestic urology glomerulonefrit is the most frequent reason of an early invalidization of patients owing to development of a chronic renal failure.
Development of a sharp glomerulonefrit is possible at any age, but, as a rule, the disease arises at patients aged up to 40 years.
Reasons of a glomerulonefrit
Usually the sharp or chronic streptococcal infection (quinsy, pneumonia, tonsillitis, scarlet fever, a streptodermiya) is the reason of development of a glomerulonefrit. The disease can develop, as a result of measles, chicken pox or a SARS. The probability of emergence of a glomerulonefrit increases at long stay on cold in the conditions of the increased humidity ("trench" nephrite) as the combination of these external factors changes the course of immunological reactions and causes violation of blood supply of kidneys.
There are data confirming communication of a glomerulonefrit with the diseases caused by some viruses, Toxoplasma gondii, Neisseria meningitidis, Streptococcus pneumoniae and Staphylococcus aureus. In most cases glomerulonefrit develops in 1-3 weeks after a streptococcal infection, and, results of researches most often confirm what glomerulonefrit was caused by "nefritogenny" strains of a b-hemolytic streptococcus of group A.
At emergence in children's collective of the infection caused by nefritogenny strains of a streptococcus, symptoms of a sharp glomerulonefrit are noted at 3-15% of the infected children. When carrying out laboratory researches of change in urine come to light at 50% of the children and adults surrounding the patient that testifies about torpedo (asymptomatic or malosimptomny) a current of a glomerulonefrit.
After scarlet fever sharp glomerulonefrit develops at 3-5% of the children receiving treatment in house conditions and at 1% of the patients treated in the conditions of a hospital. Can lead a SARS at the child who has chronic tonsillitis or is the carrier of a skin nefritogenny streptococcus to development of a glomerulonefrit.
Symptoms of a glomerulonefrit
Symptoms of a sharp diffusion glomerulonefrit appear one-three weeks later after the infectious disease which is usually caused by streptococci (quinsy, a piodermiya, tonsillitis). Three main groups of symptoms are characteristic of a sharp glomerulonefrit:
- uric (oliguriya, micro or makrogematuriya);
Sharp glomerulonefrit at children, as a rule, develops violently, flows cyclically and usually comes to an end with recovery. At emergence of a sharp glomerulonefrit at adults the erased form of which urine changes, lack of the general symptoms and a tendency to transition to a chronic form are characteristic is more often observed.
Begins glomerulonefrit from temperature increase (the considerable hyperthermia is possible), poznablivaniye, the general weakness, nausea, a loss of appetite, a headache and pain in lumbar area. The patient becomes pale, his eyelids swell. At a sharp glomerulonefrit reduction of a diuresis in the first 3-5 days from the beginning of a disease is observed. Then the amount of the emitted urine increases, but its relative density decreases. One more constant and obligatory sign of a glomerulonefrit – a gematuriya (availability of blood in urine). The mikrogematuriya develops in 83-85% of cases. In 13-15% development of a makrogematuriya of which urine of color of "meat slops" is characteristic, sometimes – black or dark brown is possible.
One of the most specific symptoms of a glomerulonefrit are the face edemas expressed in the mornings and decreasing during the day. It should be noted that the delay of 2-3 liters of liquid in muscles and hypodermic fatty cellulose is possible also without development of visible hypostases. Full children of preschool age sometimes have the only symptom of hypostases some consolidation of hypodermic cellulose.
At 60% of patients with a sharp glomerulonefrit the hypertension which at a severe form of a disease can last up to several weeks develops. In 80-85% of cases sharp glomerulonefrit causes damage to cardiovascular system at children. Dysfunction of the central nervous system and increase in a liver are possible.
Allocate two main options of a current of a sharp glomerulonefrit:
- typical (cyclic). The rough beginning and considerable expressiveness of clinical symptoms is characteristic;
- latent (acyclic). The erased form of a glomerulonefrit which is characterized by the gradual beginning and weak expressiveness of symptoms. Constitutes considerable danger owing to late diagnosing and a tendency to transition to chronic glomerulonefrit.
At a favorable current of a sharp glomerulonefrit, timely diagnosing and an initiation of treatment the main symptoms (hypostases, arterial hypertension) disappear within 2-3 weeks. The absolute recovery is noted in 2-2,5 months.
It is allocated the following options of a current of a chronic glomerulonefrit:
- nephrotic (uric symptoms prevail);
- hypertensive (increase in arterial pressure is noted, the uric syndrome is expressed poorly);
- mixed (a combination of hypertensive and nephrotic syndromes);
- latent (quite common form which is characterized by absence of hypostases and arterial hypertension at poorly expressed nephrotic syndrome);
- gematuricheskiya (existence of erythrocytes in urine is noted, other symptoms are absent or are poorly expressed).
The recidivous current is characteristic of all forms of a glomerulonefrit. Clinical symptoms of an aggravation remind or completely repeat the first episode of a sharp glomerulonefrit. The probability of a recurrence increases during the spring-autumn period and comes 1-2 days later after influence of an irritant as which the streptococcal infection usually acts.
Complications of a glomerulonefrit
Sharp diffusion glomerulonefrit can lead to development of the following complications:
- sharp renal failure (about 1% of cases);
- acute heart failure (less than 3% of cases);
- preeklampsiya or eklampsiya (sharp renal gipertenzivny encephalopathy);
- intracerebral hemorrhage;
- passing violation of sight;
- chronic diffusion glomerulonefrit.
The factor increasing probability of transition of a sharp glomerulonefrit to chronic is the hypoplastic dysplasia of a kidney at which renal fabric develops with lag from chronological age of the child. For the chronic diffusion glomerulonefrit which is characterized by the progressing current and resistance to active immunosuppressive therapy, the secondary wrinkled kidney becomes an outcome. Glomerulonefrit occupies one of the leading places among diseases of the kidneys leading to development of a renal failure in children and an early invalidization of patients.
Diagnostics of a glomerulonefrit
Diagnosis "glomerulonefrit sharp" is made on the basis of the anamnesis (recently postponed infectious disease), clinical manifestations (hypostases, arterial hypertension) and these laboratory researches. By results of analyses the following changes are characteristic:
- micro or makrogematuriya. At a makrogematuriya urine becomes black, dark brown, or gains color of "meat slops". At a mikrogematuriya of change of color of urine it is not observed. In the first days of a disease urine contains mainly fresh erythrocytes, then – vyshchelochny.
- moderated (usually within 3-6%) an albuminuriya within 2-3 weeks;
- granular and hyaline cylinders at a mikrogematuriya, eritrotsitarny – at a makrogematuriya by results of microscopy of an uric deposit;
- nikturiya, decrease in a diuresis when conducting test of Zimnitsky. Safety of concentration ability of kidneys is confirmed by the high relative density of urine;
- decrease in filtrational ability of kidneys by results of a research of clearance of endogenous creatinine;
By results of the general blood test at a sharp glomerulonefrit also increase in SOE comes to light . Biochemical blood test confirms increase in content of urea, cholesterol and creatinine, increase in a caption of nuclear heating plant and ASL-O. The sharp azotemiya (increase in content of residual nitrogen) is characteristic.
Ultrasonography of kidneys and UZDG of vessels of kidneys is carried out. If given laboratory researches and ultrasonography are doubtful, the biopsy of a kidney and the subsequent morphological research of the received material is made for confirmation of the diagnosis of a glomerulonefrit.
Treatment of a glomerulonefrit
Treatment of a sharp glomerulonefrit will be moved in the conditions of a hospital. The diet No. 7, a bed rest is appointed. The patient appoints antibacterial therapy (ampicillin + , penicillin, erythromycin), immunity correction non-hormonal (, ) and hormonal (Prednisolonum) medicines is carried out. The complex of medical actions includes anti-inflammatory treatment (diclofenac) and the symptomatic therapy directed to reduction of hypostases and normalization of arterial pressure.
In the subsequent sanatorium treatment is recommended. After the postponed sharp glomerulonefrit patients within two years are under observation of the nephrologist. At treatment of a chronic glomerulonefrit in the period of an aggravation the complex of the events similar to therapy of a sharp glomerulonefrit is held. The scheme of treatment during remission is defined, proceeding from existence and expressiveness of symptoms.