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Glomerulonephritis – the infectious and allergic disease relating to group of acquired diseases of kidneys. Various forms of a glomerulonephritis differ on an etiology, manifestations, disease and its outcome. It is most often characterized by an immune inflammation of renal balls, and also a further, secondary inflammation of tubules of kidneys and an interstition.
Distinguish an acute glomerulonephritis, a swift-flowing form of an illness, and a chronic glomerulonephritis. The acute form of a disease can be most often caused by the postponed earlier streptococcal infection – a post-streptococcal glomerulonephritis. On an etiology distinguish primary glomerulonephritis and secondary which arise at general diseases – a system lupus erythematosus, rheumatism, a nodular periarteritis and others.
The infections postponed earlier – streptococcal, staphylococcal and other bacterial infections are causes of illness. In certain cases as an etiological factor in development of a disease hepatitises B and C, and perhaps tsitomegalovirusny infection can act. The glomerulonephritis can develop against diseases of the parasitic nature, under toxic influence of some drugs, at alcohol intake and drugs, these habits have especially strong influence at teenage age. Disturbance in scheduling of planned preventive inoculations can also promote developing of an illness. Therefore prevention of a glomerulonephritis has to contain exact observance of planned inoculations and medical examinations.
Development of a glomerulonephritis happens against reactions of cellular and humoral immunity. As a rule, the postponed earlier infectious disease, causes an immune response in an organism, cell-bound immune complexes are formed. Developed for this antibody are carried by a blood flow on all systems, striking bodies, sensitive to them. It can be a cardiac muscle, there is a rheumatic heart trouble, joints – rheumatism or as in this case balls of kidneys — an acute glomerulonephritis.
At children the disease leads to a renal failure and as a result of disability. The post-streptococcal glomerulonephritis unlike other forms of a disease meets at children at the age of 5-12 more often, the course of a disease at teenagers and young people is also observed. The acute form of an illness can develop at any age, less often the disease meets after 40 flyings.
The disease develops not later than in three weeks after the postponed streptococcal infection, for example, of quinsy, tonsillitis, a pyoderma, affecting both kidneys. To start disease the general symptoms are characteristic it is weakness, a headache, a fever, nausea, a back pain, high temperature. The acute glomerulonephritis causes puffiness a century, pallor, reduction of the emitted urine.
The clinical picture of a disease is ambiguous. Disease can take place in a cyclic form with rapid development and many symptoms, and maybe in the latent, that is erased latent form. Often diagnosis of a glomerulonephritis at a latent form of disease happens out of time that gives the chance of an illness to pass into chronic.
Characteristic clinical symptoms of a glomerulonephritis this availability of blood at an urination and hypostases on a face. The hamaturia can be insignificant and it is possible to find this symptom only by means of the analysis of urine. But urine is more often has red-brown color. Puffiness is also not always noticeable it or baggies lower eyelids and noticeable narrowing of eyes, or sharp increase of body weight on 3-4 kilograms.
Decrease in amount of urine, so-called oliguria can continue till 5 days, then release of urine is normalized, but the reduced density of urine is observed. Also increase of arterial pressure which can continue within several weeks is characteristic of an acute glomerulonephritis.
At the positive forecast the main symptoms of a glomerulonephritis disappear within the first month, and recovery happens for 2-2,5. In cases of late diagnosis or if the illness does not respond to treatment within a year, the disease passes into a severe chronic form.
The glomerulonephritis at children often develops in an acute form. Children of the advanced preschool and younger school age are more subject to a disease. Babies are practically not ill a glomerulonephritis. Disease extremely rough with critical fervescences.
The chronic glomerulonephritis is distinguished on four clinical forms. At any current the remission periods which are replaced by aggravations similar to an acute form of an illness are characteristic. Aggravations can be seasonal, and also arising at repeated infection with infectious diseases of the streptococcal nature.
The necrotic form of a glomerulonephritis is characterized by generalized hypostases, perhaps, their development to ascites and an anasarca. At laboratory researches increase of protein in urine and its decrease in blood is found. At the same time the level of lipids and globulins increases, the level of albumine decreases.
The hypertensive form of an illness does not include such pronounced symptoms of a glomerulonephritis as necrotic, hypertensia is characteristic of this form. Also the mixed form of a current of a chronic glomerulonephritis is possible. In this case symptoms of both forms are present at the same time.
Also as well as the acute glomerulonephritis chronic can proceed almost asymptomatically. The latent form is characterized only by weak disturbance of release of urine.
Diagnosis of a glomerulonephritis
The suspicion on an acute glomerulonephritis is caused by a triad of symptoms: hypostases, hamaturia, arterial hypertension. At a latent form of disease indications to further diagnosis is data of the anamnesis of the previous disease and definition of anti-streptococcal antibodies and their concentration in blood serum.
X-ray contrast research and a number of laboratory analyses is appointed to exclude existence of other renal diseases. So differential diagnosis of a glomerulonephritis has to exclude exacerbations of nephrites, including a hereditary form, tuberculosis of kidneys, a nephrolithiasis. Diagnosis of a glomerulonephritis includes also this earlier postponed diseases, long supervision over a condition of the patient, consultation of the oculist. At a glomerulonephritis there are changes of an eyeground. At extremely rapid current of an illness conduct research of fabrics – a biotapt of a kidney.
At laboratory researches of urine existence of a hamaturia or cylindruria is confirmation of the diagnosis. In the first days of disease in the analysis of urine lymphocytes are found. They are reflection of immune process in balls of kidneys.
Blood test reveals a neurophilic leukocytosis, anemia, increase in SOE. Data show reduced glomerular filtering, increase in nitrogenous slags in blood. Disturbances of system of coagulability of blood are found. It is most often provided by fibrin degradation products, and also fibrinogen in blood serum and urine.
Treatment of a glomerulonephritis
At confirmation of the diagnosis of the patient it is necessary to hospitalize. Treatment of a glomerulonephritis in a hospital demands a bed rest, the patient needs rest and heat that contributes to normalization of blood circulation in kidneys and to lowering of arterial pressure. The diet with the dosed reception of liquid for stopping of hypostases is appointed. In the first days the diet is strictly controlled, excluded availability of salt in food, its use gradually is resumed after disappearance of hypostases. Also exclude dishes with the rich content of potassium, extractive substances, allergens.
Drug treatment of a glomerulonephritis includes antibacterial therapy, antibiotics of a penicillinic row a course are most often appointed 1.5-2 months. Purpose of heparin subcutaneously a course is recommended 2-4 weeks. Drug prevents an intravascular blood coagulation. If symptoms of a glomerulonephritis include arterial hypertension APF inhibitors, intravenous injections of Aminophyllinum in solution of glucose and the subsequent infusion of furosemide are appointed. Use of clonidine, Methyldopum is admissible.
Forecast of treatment of a glomerulonephritis most often favorable. 85-90% of patients recover completely, at other patients urine changes remain that does not give the chance to speak about an absolute recovery. At prolonged treatment of a disease transition to a chronic form with signs of a necrotic syndrome is possible. The lethal outcome is registered seldom, most often at untimely detection of a latent form of disease.
Complications of a glomerulonephritis
At the first stage of a course of a disease emergence of heavy complications, life-threatening the patient is possible. Heavy disease can cause a renal eclampsia, acute renal and heart failure.
Renal eclampsia one of the most frequent complications of an acute glomerulonephritis. The eclampsia or angiopastichesky encephalopathy is a brain vasospasm, wet brains. Signs of complication are toniko-clonic spasms, before them the headache, nausea, vomiting, a vision disorder follow. The attack of an eclampsia reminds epileptic, is followed by jump of arterial pressure and several minutes can last. Also a series of attacks is observed. Without timely stopping of an attack there is a hematencephalon.
At a giperergichesky current of an acute form of an illness the acute renal failure develops. Complications of a glomerulonephritis are caused by a rapid current of an illness. The acute renal failure is followed by the sharp termination of urination. As a result of a water delay in an organism slags and potassium collect, thereby causing hyper hydration and acidosis. At further development of a renal failure there are intoxication symptoms – anoreya, nausea, repeated vomitings, diarrhea. The hemorrhagic syndrome, defeat of cardiovascular system and TsNS join. The patient can fell into an uremic coma, most often to whom causes the complicated glomerulonephritis in children.
More rare, especially children, have complications of a glomerulonephritis from cardiac performance. Acute cardiovascular insufficiency is characterized by such signs as increase in a liver, increase of peripheral puffiness and a fluid lungs. The fluid lungs most often also becomes the reason of a lethal outcome without the timely help.
Prevention of a glomerulonephritis
The correct treatment of streptococcal diseases, observance of a calendar of preventive inoculations and sanitation of the centers of an infection in an organism make the main measures of prevention. The children who transferred a post-streptococcal glomerulonephritis have to be under dispensary observation for 5 flyings after treatment.
Routine medical examinations and laboratory researches allow to find early an illness and to avoid complications. Self-treatment, neglect the general symptoms most often leads to severe forms of a disease.