Alice asks:
I have chronic tonsillitis - how to exclude chronic glomerulonephritis, because it complicates tonsil diseases?
Responsible Medical laboratory consultant "Synevo Ukraine":
Good afternoon, Alice! Start with a urinalysis. In chronic glomerulonephritis, as a result of the analysis, the following changes should be observed: the appearance of erythrocytes, cylinders, protein, an increase in the level of leukocytes. In this case, the specific gravity of urine is normal or increased. In doubtful cases, a general urinalysis is supplemented by his urinalysis according to Nechiporenko. In addition, it would not be superfluous to conduct blood biochemistry (protein, proteinogram, urea, creatinine), to determine the presence of antistreptolysin O, antistreptokinase, antihyaluronidase. And finally, do an ultrasound of the kidneys. With the results of all studies, go to a face-to-face appointment with a urologist / nephrologist. It would be enough. Be healthy!
Elena asks:
Hello! I am 30 years old. I have hr. glomerulonephritis, FSGS, latent form, morphological type. This diagnosis was first made to me in October 2008. Pressure 120/80, 130/80. I take teveten 600 and dipyridamole. Please tell me, with such a diagnosis and such indicators, can I give birth? And is it possible anywhere at all (for example, abroad)?
Responsible Palamarchuk Alina Nikolaevna:
Elena, before planning a pregnancy, be sure to visit a good therapist, and preferably a nephrologist (a specialist in kidney diseases), do an additional examination, after that only he will give you recommendations and permission to become pregnant. Pregnancy and childbirth are also possible in our country, but your pregnancy will need to be carried out only together with these specialists.
Valery asks:
Thank you for not leaving my question unanswered. Can you please tell me what tests or what kind of instrumental examination should be done in order to more accurately diagnose "glomerulonephritis"? Let's try to be examined in Simferopol, at the local level. Thanks in advance.
Responsible Velichko Marina Borisovna:
You need to do 2 general urine tests, a general blood test, and if changes are found in them, contact a nephrologist. There are such specialists in the republican hospital. If the level of protein in the urine is more than 3.5 g / day. it is advisable to perform a kidney biopsy. This can be done in Kyiv centers, in particular at the Institute of Nephrology.
Anton asks:
Is it possible to eat watermelons with glomerulonephritis?
Responsible Chernikov Alexey Vitalievich:
Can. In chronic glomerulonephritis, watermelon fasting days are even used. The amount depends on the stage and form of the disease and should be clearly determined by your doctor. There are clear tables for calculating fluid intake depending on the disease and the patient's body weight. So, it is better without amateur performance.
Irina asks:
Hello. I am 32 years old. I have been suffering from chronic glomerulonephritis since the age of 14. gave birth to a child. the largest protein in the urine was 3 grams. biochemical analysis of blood is always normal. swelling never happened. but after taking prednisolone (I no longer take it), my blood pressure became 140/100, but I feel fine. could it be kidney pressure. and whether chronic glomerulonephritis always leads to CRF.
Responsible Velichko Marina Borisovna:
Unfortunately, chronic glomerulonephritis is always a progressive disease in terms of the development of arterial hypertension and renal failure. An increase in blood pressure must be compensated. In your case, it would be advisable to start with ramipril 5-10 mg/day. Target blood pressure should be 130/80 mmHg. Art. At least once every six months, it is necessary to monitor urine, blood and biochemistry (urea, creatinine) tests in order not to miss the onset of active progression and take measures in time. Get registered under the supervision of a nephrologist at your place of residence, there will be someone to consult with.
Veronica asks:
What is chronic glomerulonephritis? Thank you.
Responsible Medical consultant of the portal "site":
Hello Veronica! Chronic glomerulonephritis is a kidney disease that predominantly affects the renal glomeruli (glomeruli). It is characterized by a relapsing course. The main symptoms are proteinuria (protein in the urine), edema, and increased blood pressure. The most common cause is an infectious-allergic process after diseases caused by streptococcal infections. In the absence of adequate treatment and a severe progressive course, chronic glomerulonephritis leads to the development of renal failure. Chronic glomerulonephritis is treated by a nephrologist. Take care of your health!
George asks:
Hello, I am 22 years old, at the age of 9 I had a sore throat, which in turn gave a complication to the kidneys, there was pressure under 200 (which they could not bring down within 3 days), later the pressure was brought down, the condition was normalized. As a result, a diagnosis of chronic glomerulonephritis in the stage of stable remission was made. For all the time after that, my kidneys never bothered me, the tests that I did both for the military registration and enlistment office and for myself periodically showed a normal result. I would like to know: - Is it possible now, with good analyzes of both urine and blood, how else to confirm my diagnosis? What is the daily protein intake? I read on the Internet that it is somewhere around 40 g (can I increase it to at least 80-100) - drinking alcohol (occasionally wine)? Is there a limit on how much water you can drink per day? - physical activity was also prohibited - can I do it (push-ups, pull-ups, sprinting (on cardio)) now I do it all with caution and in a small amount, I'm not going to go to the gym, only with my own weight. Thank you very much in advance for such online consultations.
Responsible Mazaeva Yulia Alexandrovna:
Hello, chronic glomerulonephritis remains for life. Acute glomerulonephritis can give a complete recovery. I don't know how correctly you were diagnosed in the past. Urinalysis monitoring and renal tissue biopsy can give an accurate answer, but this is done only with persistent changes in urine tests for certain indications. Restrictions on protein and fluid intake are needed only if there is kidney failure as a complication of an underlying kidney disease. Physical activity is limited in acute glomerulonephritis until complete recovery and constantly in chronic glomerulonephritis.
Oleg asks:
Hello. I have been suffering from chronic glomeluronephritis, urinary syndrome since the age of 2. Now I am 35 years old. The last exacerbation with significant edema and protein release was at the age of 7 years. Then up to 25 years - a complete remission. From the age of 25 to the present, my health has worsened: my blood pressure has gradually increased to almost constant values of 160-170 / 100-110 mm Hg, general weakness, constant fatigue, fatigue, headaches, constant heartbeat, pain in the area hearts. There were swelling of the whole body with an increase in weight by 10-15 kg, and then a decrease in weight, chronic pyelonephritis, ICD developed.
Constant daily diuresis - 3 liters or more, although I consume fluids less than 3 liters per day. Oud. urine weight according to Zimnitsky - 1003 - 1010. Blood sugar, urine - no. Cardiogram - a violation of the processes of repolarization in the left ventricle. Hypertensive angiopathy of the retina in both eyes. But CRF 0 st. (protein - n / o, creatinine cr. - 89 mmol / l, urea cr. - 5.4 mmol / l, Reberg's test - 269.99 ml / min).
Will I get CKD with this condition and at about what age will I get CKD?
How to delay the onset of CRF?
Responsible Ivanov Dmitry Dmitrievich:
Dear Oleg,
Judging by the amount of urine excreted, the relative density of urine and the Rehberg test, you have hyperfiltration against the background of increased blood pressure - i.e. preclinical renal dysfunction. The first thing to do is to normalize blood pressure, for which ACE inhibitors or ARBs or PIR (aliskiren) are used. You are indicated for combination therapy with a diuretic, for example, Enap 10 mg twice in combination with xipamide 10 mg / day, or olmesartan + 20/12.5 or noliprel-forte or rasilez150 + losartan 50 mg. Target blood pressure is less than 140/90-130/80. With normalization of blood pressure, the amount of urine will decrease. And then we will make predictions.
Olga asks:
Hello! Please tell me about the diagnosis and treatment of my son. He is 32 years old, as a result of the kidney biopsy, a diagnosis was made (mesangiocapillary glomerulonephritis with a moderate tubulo -stust component, subendothelial deposits of IgG, to a lesser extent C3, IGA, IGM, focal deposits Iga, IgG in mesangshium, focal deposits of immunoglobulins, C3 in the epithelial epithelis in the epithelial of the dances , IN THE STROMA BETWEEN TUBULES, IgG, IgM IN ZONES OF CELLULAR INFILTRATES Treatment was prescribed: sandimun 100 mg daily, medrol 12 mg daily under the cover of lanzapa, diuver 10 mg daily. The last general clinical analysis of urine: color - yellow transparency - slightly turbid specific gravity - 1018 reaction (pH) - 6 protein - 6.85 g / l glucose - no ketone bodies detected - bilirubin not detected - negative urobilinogen - negative squamous epithelium - single in Transitional epithelium - 0-1 in the field of view; renal epithelium - no leukocytes were found - 2-4 in the field of view, macrophages: 0-1 in the field of view; erythrocytes - unchanged: 0-0-1 in the field of view; changed 1-3 in field of view cylinders - hyaline: single mucus in the preparation - a small amount of salt - oxalate crystals in a small amount of bacteria - a moderate amount. Biochemical blood test total protein - 50 serum creatinine - 78. Tell me why there is no improvement from the prescribed treatment, from which there are massive edema all over the body and face, the state of health worsens, please advise us how to proceed. Do we have a chance.
Responsible Velichko Marina Borisovna:
Mesangio-capillary glomerulonephritis is one of the prognostically unfavorable and difficult-to-treat forms of nephritis. Your son is on immunotropic treatment to reduce urinary protein loss, but the dose of sandimmun should be 3.5 mg/kg body weight, i.e. in your case is clearly inadequate.
Maybe that's why there is no positive dynamics.
Massive edema with such a protein in the blood should not be - it means there is a violation of the diet regarding salt intake or non-compliance with the water balance. Discuss these points with your doctor or come for a consultation with us at the Institute of Nephrology
Larisa asks:
The diagnosis of glomerulonephritis was established after a biopsy. The disease did not manifest itself, but in 2004, at a 20-week pregnancy, severe eclampsia developed, after which I developed hypertension, BP-200 \ 130-230 \ 140, but responds well to treatment, on ultrasound - increased echogenicity of the parenchyma and linear calcifications up to 1 cm in both kidneys, and hypertrophy of the renal pedicle. All biochemical parameters are normal, urine protein is 2.0. The attending physician says that, according to the results of the ultrasound, my kidney tissue begins to die, is this true?
Responsible Kostynenko Tatyana Vladimirovna:
According to your data: exacerbation of glomerulonephritis = progression of the process. This often happens during pregnancy. It needs to be treated. Progression of glomerulonephritis with outcome in CRF.
Responsible Velichko Marina Borisovna:
I understand that after eclampsia in 2004 was diagnosed with glomerulonephritis. According to ultrasound data, it is possible to draw a conclusion only about changes in the size of the kidneys in dynamics. If they have significantly decreased during the year, then sclerosis develops. Your task is to monitor and correct blood pressure in time, monitor kidney function and urine tests once every 3 months, and not take nephrotoxic drugs.
Tatyana asks:
My mother was prescribed ketosteril, she had elevated urea and kerotene. At the moment, kerotene is normal, and urea is also elevated. The doctor canceled her intake of ketosteril, whether the decision was correct.
Responsible Velichko Marina Borisovna:
The expediency of prescribing ketosteril and monitoring the effectiveness (based on periodic examination data) of its use are determined by the doctor who observes the patient. Ketosteril is prescribed to inhibit the progression of renal failure in CKD 4 tbsp. subject to a low-protein diet (proteins and vegetable and animal origin 0.6 g / kg / day). You do not indicate the indicators of your mother. The second important indication for the appointment of ketosteril is protein-energy deficiency (for example, with long-term persistent nephrotic syndrome).
Antonina asks:
Good afternoon. A diagnosis of chronic glomerulonephritis was made. Increased pressure is present. Urinalysis (Combi-scan-500):
Transparency: full
Relative density: 1020
Reaction: sour
Protein - traces
Glucose: abs
Ketone bodies: negative
squamous epithelium: significantly
Transitional epithelium: no
Renal epithelium: no
Leukocides: 0-1-2 per field of view
Erythrocytes: 30-40 per field of view, unchanged and altered
Slime: moderate
Blood, normal, no changes
This diagnosis was made by a urologist, sent for a consultation with a nephrologist. The nephrologist prescribed an endoscopic examination of the bladder, and the drug Enap, 2.5 mg, removal of the tonsils + 2 urine tests: general and Necheporenko. So far, the nephrologist confirms the diagnosis by 90%.
My question is: with such indicators in the urine, can such a serious diagnosis be immediately made? if so, what are the most effective treatments available, including methods used in European countries? Is a complete cure possible?
Glomerulonephritis is a disease in which the kidney tissue is damaged. In this disease, the renal glomeruli are primarily affected, in which the primary filtration of blood occurs. The chronic course of this disease gradually leads to the loss of the ability of the kidneys to perform their function - to cleanse the blood of toxic substances with the development of renal failure.
What is a renal glomerulus and how do the kidneys work?
Blood entering the kidneys through the renal artery is distributed inside the kidney through the smallest vessels that flow into the so-called renal glomerulus.What is a renal glomerulus?
In the renal glomerulus, the blood flow slows down, as the liquid part of the blood with electrolytes and organic substances dissolved in the blood seeps through the semipermeable membrane into the Bowman's capsule (which, like a wrapper, envelops the renal glomerulus from all sides). From the glomerulus, the cellular elements of the blood with the remaining amount of blood plasma are excreted through the renal vein. In the lumen of the Bowman's capsule, the filtered part of the blood (without cellular elements) is called primary urine.
What is Bowman's capsule and renal tubules (loop of Henle)?
But in addition to toxic substances, many useful and vital substances are dissolved in this urine - electrolytes, vitamins, proteins, etc. In order for everything useful for the body to return to the blood again, and all harmful to be excreted as part of the final urine, the primary urine passes through the tube system (the loop of Henle, the renal tubule). In it, constant processes of transition of substances dissolved in the primary urine through the wall of the renal tubule occur. After passing through the renal tubule, primary urine retains in its composition toxic substances (which must be removed from the body) and loses those substances that cannot be removed.
What happens to urine after it has been filtered?
After filtration, the final urine is excreted through the renal tubule into the renal pelvis. Accumulating in it, urine gradually flows into the lumen of the ureters into the bladder.
What happens with glomerulonephritis in the kidneys?
Glomerulus of the kidneys is mainly affected in glomerulonephritis.
- Due to the inflammatory reaction in the wall of the vessels of the glomeruli, the following changes occur:
- The wall of the vessels of the renal glomerulus becomes permeable to cellular elements
- Microthrombi are formed, which clog the lumen of the vessels of the glomeruli.
- The blood flow in the vessels of the affected glomeruli slows down or even stops.
- Blood cells enter the lumen of the Bowman's capsule.
- Blood cells in the lumen of Bowman's capsule clog its lumen.
- Blood cells clog the lumen of the renal tubules.
- The entire process of filtering blood and primary urine in the affected nephron is disrupted (nephron is a complex: renal glomerulus + Bowman's capsule + renal tubules).
- Due to impaired blood flow in the renal glomerulus, the lumen of its vessels becomes empty and is replaced by connective tissue.
- As a result of blockage of the renal tubules by blood cells, their lumen becomes empty and the walls stick together with the replacement of the entire nephron with connective tissue.
- The gradual "death" of nephrons leads to a decrease in the volume of filtered blood, which is the cause of renal failure.
- Kidney failure leads to the fact that toxic substances accumulate in the blood, and the substances necessary for the body do not have time to return the remaining kidney nephrons to the blood.
From the above, it becomes clear that the cause of the disruption of the kidneys is the inflammatory process that develops in the renal glomeruli. Now briefly about the causes of inflammation of the renal glomeruli.
- Common infectious diseases
- angina, tonsillitis
- scarlet fever
- infective endocarditis
- septic conditions
- pneumococcal pneumonia
- typhoid fever
- meningococcal infection
- mumps (mumps)
- chickenpox (chickenpox)
- infections caused by coxsackieviruses
- Rheumatic and autoimmune diseases:
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Schönlein-Henoch disease
- hereditary pulmonary-renal syndrome
- Vaccination and transfusion of blood components
- Substance intoxication:
- Poisoning by organic solvents
- alcoholic drinks
- mercury poisoning
- radiotherapy, radiation sickness
Types and symptoms of chronic glomerulonephritis
According to the course and clinical manifestations, the following types are distinguished:1. Latent- the most common (accounts for about 45% of all cases of chronic glomerulonephritis). Appears unexpressed external symptoms: moderate swelling and increased blood pressure. More manifested by laboratory examination data: general urine analysis reveals an increased level of protein, erythrocytes and leukocytes.
2. Hematuric- a rare form (no more than 5% of the total number of patients). Manifested by the following outward signs: pink or red urine. In the general analysis of urine an increased number of altered erythrocytes is detected.
3. Hypertensive- a common form (about 20% of the total incidence). Manifested by the following external symptoms: a constant increase in blood pressure, an increase in the volume of daily urine excreted, nocturnal urge to urinate. In the general analysis of urine an increased content of protein and altered erythrocytes is detected, the density of urine is slightly below normal or within the lower limit of normal.
4. Nephrotic- a common form (about 25%). The disease manifests itself as follows outward signs: high blood pressure, severe swelling, reduced amount of daily urine excreted. Laboratory signs in general urinalysis: increased density of urine, increased protein content in the urine; blood chemistry reveals: a decrease in total protein (mainly due to albumin), an increase in blood cholesterol.
5. Mixed (nephrotic-hypertonic)- characterized by symptoms of the two forms described above: nephrotic and hypertensive.
Methods for diagnosing chronic glomerulonephritis
For the diagnosis of all types of chronic glomerulonephritis, the following types of examinations are used:
| Type of diagnostics | Why is it appointed? |
| General urine analysis | This analysis reveals changes in the following indicators: urine density, the presence of protein and cylinders, the presence of leukocytes and erythrocytes, urine color. |
| Blood chemistry | This analysis examines the following indicators: total blood protein, blood albumin, creatinine, urea, cholesterol and all fat fractions (lipidogram). |
| Kidney biopsy and microscopy of the biopsy | This research method allows you to explore tissue changes in the structure of the glomeruli of the kidneys and reveals various morphological forms of glomerulonephritis. In many ways, the histological form of glomerulonephritis is a criterion for the appointment of adequate treatment. |
Stages of chronic glomerulonephritis
Stage of compensation The initial stage (stage of compensation) functional activity of the kidneys is not changed.Stage of decompensation- associated with the progression of the disease with impaired renal function (stage of decompensation). Stage with impaired renal function and the development of chronic renal failure.
| External signs | Laboratory signs |
| General urine analysis
|
Uremia- severe degree of renal failure. At this stage of the disease, the kidneys finally lose their ability to maintain normal blood composition.
Diagnosis of chronic glomerulonephritis
| Laboratory signs of acute glomerulonephritis: | |
| General urine analysis : |  |
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| Zimnitsky's test: | |
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| Blood chemistry : | |
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| Immunological blood test: | |
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Treatment of chronic glomerulonephritis
| Type of treatment | Target | Practical Information |
| Eliminate the source of chronic inflammation, which is a trigger factor for autoimmune kidney damage |
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| Reduce the burden on the kidneys. Physical activity accelerates metabolic processes, which lead to an acceleration of the formation of nitrogenous compounds that are toxic to the body. | The patient is advised to stay in a supine position, without getting out of bed unless absolutely necessary. |
| Violation of the kidneys leads to a change in the electrolyte balance of the blood, the loss of nutrients needed by the body and the accumulation of harmful toxic ones. An adequate diet can reduce the adverse effects of the above factors. | Table number 7 Power features:
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| Improved blood flow. With inflammation in the renal glomeruli, conditions are created for the formation of blood clots in their vessels and blockage of their lumen. The drugs of this group prevent this process. |
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| Non-steroidal anti-inflammatory drugs | There is evidence that indomethacin and ibuprofen affect the activity of the immune response. Suppression of immune damage to the kidneys leads to an improvement in the condition of the kidneys. | Indomethacin
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| Means that suppress the activity of the immune system have a beneficial effect in glomerulonephritis. By reducing the activity of the immune response, these drugs suppress the destructive processes in the renal glomeruli. | Steroid drugs:
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| With the development of kidney failure, there may be fluid retention in the body, as well as a change in the concentration of hormones produced by the kidneys. These changes often lead to a persistent increase in blood pressure, which can only be reduced with medication. |
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| The obstructed blood flow in the inflamed glomeruli of the kidneys, the accumulation of blood cells in the renal tubules requires activation of the fluid flow in the nephron. Therefore, diuretics can have a positive effect in glomerulonephritis. |
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| In the event that a patient with glomerulonephritis has a chronic focus of infection (chronic sinusitis, sinusitis, endometritis, urethritis, tonsillitis), it is necessary to sanitize it with antibacterial drugs. | In each case, the type of antibiotic is selected by the attending physician individually, depending on the following factors:
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Health prognosis for chronic glomerulonephritis
In the absence of treatment, the disease steadily leads to the loss of functionally active nephrons by the kidneys with the gradual onset of renal failure.With active treatment with suppression of the activity of the immune system, the course of the disease improves significantly, renal failure does not develop or the timing of its onset is significantly delayed.
There is evidence of complete remission (successful cure of the disease) during treatment with suppression of immune activity.
What are the features of chronic glomerulonephritis in children?
General features of glomerulonephritis in childhood:- The clinical picture of the disease can vary greatly.
- Chronic glomerulonephritis is the most common cause of chronic renal failure in children (except newborns).
- Up to 40% of all cases of hemodialysis and kidney transplantation in children are performed for chronic glomerulonephritis.
The main causes of chronic glomerulonephritis in children:
- In most cases, the causes are unknown. The disease develops as primary chronic, that is, before that the child had no acute glomerulonephritis.
- The role of irrational therapy of chronic foci of infection (sick teeth, inflamed tonsils), severe hypovitaminosis, hypothermia and malnutrition during acute glomerulonephritis is not excluded.
- A certain role is played by slowly ongoing infectious processes: cytomegalovirus infection, hepatitis B, parainfluenza, etc.
- Congenital disorders of the structure of the renal tissue.
- Hereditary immunodeficiencies(decreased function of the immune system due to genetic disorders).
- nephrotic (edematous-proteinuric);
- hematuric;
- mixed.
- The disease develops acutely after hypothermia, tonsillitis, acute respiratory infection, vaccinations, or for no apparent reason.
- The main symptoms are swelling and the presence of protein in the urine.
- The disease proceeds for a long time, periods of improvement are replaced by new exacerbations. Gradually, chronic renal failure develops.
- Usually there are no complaints - the child feels fine.
- A small amount of erythrocytes and protein is found in the urine. Sometimes such changes persist for 10-15 years without any symptoms.
- Many children are found chronic tonsillitis(inflammation of the tonsils) and other chronic foci of infection.
- Edema, back pain, headache, fatigue, abdominal pain may occur periodically.
- In some children, the disease is accompanied by anemia, pallor, and increased blood pressure.
- If symptoms persist for a long time, there is a risk of chronic renal failure.
- Characterized by a combination of impurities of blood and protein in the urine, edema, increased blood pressure.
- Manifestations of high blood pressure: headaches and dizziness, lower back pain, lethargy, irritability, blurred vision, sometimes convulsions.
- Often there is anemia, pallor.
- The disease is severe, chronic renal failure develops very early.
How is dispensary observation of children suffering from chronic glomerulonephritis carried out?
Dispensary observation is carried out until the child is transferred to an adult clinic:
- Chronic pyelonephritis. A disease in which inflammation mainly develops in the pelvis, calyx, tubular system of the kidneys.
- Amyloidosis. A disease in which the metabolism of proteins and carbohydrates is disturbed in kidney cancer
Is it possible to drink alcohol with glomerulonephritis?
Alcohol consumption negatively affects the state of all organs and systems, and the kidneys are no exception. Alcohol can aggravate the course of chronic glomerulonephritis, so it is recommended to completely abandon it. The taboo also applies to carbonated drinks. Is it possible to eat watermelons with glomerulonephritis?
People suffering from chronic glomerulonephritis can eat watermelons. But since they contain a lot of liquid, the recommended maximum amount of watermelons consumed is determined depending on the form and stage of the disease. Consult with your doctor. Sometimes with chronic glomerulonephritis it is even recommended to arrange unloading "watermelon" days.
latent form- the prognosis is favorable; - hematuric and hypertonic form- the prognosis is serious;
- mixed and proteinuric form- the prognosis is unfavorable.
- it's a complicated matter. This disease is considered very common, since among all therapeutic pathologies its frequency reaches 2%. The disease can affect people at any age, but is more common between 20 and 40 years of age. It develops most often when acute glomerulonephritis is not cured in time, although there are cases when the disease immediately becomes chronic.
Bacteria and viruses can provoke pathological changes in the kidneys, which are often brought into this organ by blood from other parts of the body affected by infectious processes.
Determination of symptoms and treatment in chronic glomerulonephritis should be carried out exclusively), since self-medication for this ailment can be fraught with extremely unpleasant consequences.
Symptoms of chronic glomerulonephritis
The main symptom of this disease is a violation of the normal activity of the kidneys lasting more than 1 year (both organs are affected). Usually, the symptoms of the disease begin to appear so gradually and slowly that a person does not even suspect that he has a dangerous disease for a long time and therefore remains without appropriate treatment for a long time, which aggravates the situation.
The most characteristic general symptoms for this disease are:
- swelling (especially in the legs);
- dyspnea;
- persistent increase in blood pressure;
- pallor and swelling of the face, which is characterized by a special term - "nephritic face".
The remaining manifestations of the disease in a chronic form, as a rule, are hidden from the patient himself. They are associated with changes in the composition of blood and urine, water-salt balance, disturbances in the structure of blood vessels in the organ and filtration processes in the urinary system.
With the chronicity of the disease, two stages are distinguished:
- Stage of renal compensation. During this period, the function of nitrogen excretion in the kidneys is sufficient. Symptoms such as a slight ingress of protein and blood into the urine appear, a pronounced urinary syndrome is possible.
- The stage of renal decompensation - the urinary syndrome is less significant, the nitrogen excretion function of the urinary organs is insufficient.
During the chronic form, there can be various options, so doctors distinguish several varieties of the disease, each of which has its own characteristics of symptoms, the most pronounced signs and a set of pathological changes that occur in the body of a sick person.
Chronic minimal glomerulonephritis is characterized by a violation of the small processes of podocytes. Loosening and swelling of the tissue, thickening of the basement membranes occur in separate loops of nephrons.
It is impossible to distinguish this variety by external symptoms; correct diagnosis is possible only with the help of electron microscopy.
Membranous - the walls of the renal tubules diffusely thicken. The reason is the deposition of complexes of the immune system on the surface of the vessels. In this case, the kidney increases in size and has a smooth surface. Often this type of disease is associated with allergic reactions in the body to drugs or with processes that occur in the presence of tumors.
Mesangial - accompanied by changes in the cells of the mesangium during the deposition of immune complexes on the surface of the vessels. The kidneys at the same time have a dense texture.
Focal - pathological changes and the deposition of hyaline substance does not occur in the entire volume of the renal tissue, but only in individual foci or segments.
In addition, doctors distinguish varieties of the disease according to the speed of development of its symptoms:
- rapidly progressive - develops within 2-5 years;
- slowly progressive - develops over more than 10 years.
Symptoms of various forms of the disease
Depending on which of the symptoms appear during the development of the disease, the following forms of chronic glomerulonephritis are distinguished:
- Latent - manifested by urinary syndrome, occurs in almost half of patients. It does not cause swelling or increased blood pressure. As symptoms appear hematuria, leukocyturia, proteinuria (that is, blood, leukocytes and protein are detected in urine tests). As a rule, this kind of disease develops for a long time (up to 20 years).
- Hypertension - accompanied by an increase in blood pressure. It occurs in approximately one in five patients. The pressure can rise very intensively, up to 200/120 mm Hg. Art., and during the day its fluctuations are possible. This form of the disease is accompanied by other symptoms: changes in the structure of the fundus of the eye (neuroretinitis), cardiac asthma, which is provoked by insufficiency of the left ventricle of the heart. The disease manifests itself for a long time and is fraught with an onset.
- Hematuric - pronounced macrohematuria is manifested, that is, blood enters the urine in such quantities that it can be seen by a change in color, without special clinical studies. Such a symptom can lead to the development of anemia due to constant blood loss. This symptomatology occurs in about one in twenty patients.
- Nephrotic - occurs in every fourth patient and is accompanied by nephrotic syndrome. It manifests itself with such symptoms: protein excretion in the urine, a violation of water metabolism, as a result of which edema develops not only external, but also internal (accumulation of a large amount of fluid in the pleura, pericardium). Blood is found in the urine, blood pressure may increase. With this type of disease, renal failure occurs quickly enough, which negatively affects the patient's condition.
- Mixed - accompanied by the manifestation of nephrotic-hypertensive syndrome, in which symptoms of both of the above forms of the disease are observed.
Thus, this pathology of the kidneys in a chronic form can manifest itself with various symptoms that determine the characteristics of the disease, its course, treatment and possible complications in the future.
Diagnostics
Diagnosis of chronic glomerulonephritis always includes a comprehensive examination. In order to correctly diagnose this ailment, it is necessary to collect a very large amount of information about the patient, about his current condition, about all infectious and non-infectious diseases that were in the past. During the examination, the patient is assigned:
- Clinical and biochemical analysis of urine. The presence of chronic glomerulonephritis is indicated by the results of tests in which protein, blood cells (in particular, leukocytes, erythrocytes), protein, cylinders are observed in the urine. Along with pathological changes in the biochemical composition of urine, its specific gravity also changes.
- Blood tests. With such an ailment in the blood, the amount of protein changes, the ratios in the number of different fractions of protein compounds. Studies show an increase in the amount of antibodies to streptococcus (referred to as ASL-O in the test results) and a decrease in the content of the components of the complement system C3 and C4. With this disease, the indicators of several types of immunoglobulins in the blood (IgA, IgM, IgG) increase.
- Zimnitsky's test is a laboratory study of urine, in which urine is collected within one day in 8 containers (each container contains urine excreted in three hours). According to this examination, it is possible to determine the change in urine production during the day (the ratio of night and daytime urination), its total amount, density. In addition, you can compare the amount of fluid consumed and excreted.
- Rehberg's test is a study of kidney function, in which their filtering ability is revealed. For examination, daily urine and blood serum taken from a vein are required at the same time. Determine the amount of creatinine in the blood and excreted urine.
- Excretory urography is an X-ray image that covers the area from the upper edge of the kidneys to the border of the urethra. On this image, you can determine the position, shape and size of organs, the structure of their tissues, the presence of stones.
- Renography is a study that uses a special radioactive substance (technetium-99). It is injected into the kidneys and with the help of a gamma camera, which is installed next to the organ, the excretion process is recorded. By the nature of this process, it is possible to determine the rate of urine excretion from the patient's body.
- with this disease, pathological changes in the structure of the renal tissue: its sclerotization and decrease in volume.
- A biopsy of the renal tissue is performed to determine changes in the histological structure of the kidney. A tissue sample is taken with a special needle that is inserted through the back muscles. The procedure is very complicated, therefore, it is performed exclusively in stationary conditions and local anesthesia is used. To exclude complications and the correct implementation of the manipulation, the biopsy is monitored using ultrasound.
In addition to these basic studies, the attending physician may prescribe other examinations, based on what concomitant symptoms develop in the patient. It can be ultrasound of other organs, ECG. With simultaneous deterioration of vision, consultation with an ophthalmologist and examination of the fundus are necessary.
Based on the results of the examinations, the doctor conducts a differential diagnosis of glomerulonephritis and other diseases that may manifest with the same symptoms.
Among these diseases:
- nephrolithiasis;
- amyloidosis of the kidneys;
- kidney tuberculosis;
- polycystic kidney disease;
- nephrotic syndrome;
- chronic pyelonephritis;
- arterial hypertension.
As a rule, the diagnosis of the chronic form of glomerulonephritis is not a difficult task, but difficulties may arise with latent, hematuric and hypertensive varieties of the disease.
In the case when these studies show a typical picture of a violation of the renal tissue and related changes in the internal environment of the body, a diagnosis of "chronic glomerulonephritis", or CGN, is established. After completing the diagnosis, they begin to choose the tactics of treating the patient.
Treatment
Is it possible? With a timely visit to the doctor and the fulfillment of all prescriptions, it is possible to ensure that the disease stops recurring. Many factors are very important in this matter: the individual characteristics of the organism, the neglect of the disease, the degree of damage to the organs of the urinary system, approaches to treatment.
Treatment of the disease depends on what factors led to these pathological changes.
Chronic kidney disease can be provoked by its acute form (if it is not treated on time and correctly), hereditary predisposition, immune changes in the body (for example, allergies, the effects of vaccination, autoimmune diseases).
Perhaps the influence of hypothermia, a general weakening of the body due to the action of adverse environmental factors, and malnutrition. All this must be taken into account when developing treatment tactics, otherwise the root cause of the disease will constantly prevent the effective elimination of the problem.
Without appropriate therapy, the disease can lead to very serious consequences, including kidney failure, kidney dystrophy, hemorrhages from its blood vessels, and other dangerous conditions. In chronic glomerulonephritis, the treatment is very complex, includes several components, each of which is extremely important for maintaining the human body and eliminating the problem.
Corticosteroid therapy
This is the basis of pathogenetic therapy for this disease. These drugs are prescribed in a dose that is determined by the doctor based on the patient's condition. As a rule, gradually the dosage of corticosteroids is gradually increased. Treatment is carried out in courses, which, if necessary (during exacerbations), should be repeated periodically. The scheme of reception is developed in each separate case individually. With progressive azotemia, sclerosis of the renal glomeruli, their atrophy and high blood pressure, corticosteroid hormonal preparations are contraindicated.
In some cases, during treatment with corticosteroids, the patient exacerbates inflammation in the foci of infection in other organs. Then there is a need for the simultaneous administration of antibacterial drugs (if the infection is bacterial) or appropriate therapy for other infectious agents.
Immunosuppressive Therapy
With chronic glomerulonephritis, changes in the patient's immune system play a very serious role. Specific substances are formed in his body (antibodies that are produced in response to antigens, fractions of the complement system C3 and C4). These compounds are deposited on the delicate tissues of the renal glomeruli and lead to their destruction. As a result, the blood circulation of organs and the processes of urination are disturbed. Therefore, the treatment of chronic glomerulonephritis must necessarily include an impact on the immune processes in the body.
Immunosuppressants in some cases can replace corticosteroid hormonal drugs or be used simultaneously with them. There are conditions in which this therapy must be stopped, so constant monitoring of the patient's well-being is necessary.
Drugs that suppress the immune system have various side effects, among which there is an effect on the condition of the optic nerve.
Therefore, while taking these funds, constant monitoring by an ophthalmologist is necessary.
Anti-inflammatory therapy
It is aimed at eliminating inflammatory processes in the organs of the urinary system. Anti-inflammatory drugs anesthetize and lower the temperature, reduce the release of protein from the blood into the urine. If corticosteroids and anti-inflammatory drugs are used at the same time, in some cases it is possible to reduce the dosage of hormones.
Anticoagulant therapy
When there are such changes in which the risk of blood clotting increases. In particular, this is the deposition of fibrin on the walls of the glomeruli and arterioles. Anticoagulants are taken to normalize blood clotting and prevent complications. In addition, they are able to have other effects: reduce inflammation and allergic reactions.
As a result of such therapy, the filtering function of the kidneys improves, protein excretion into the urine decreases, and the ratio of different fractions of protein substances in the blood serum normalizes.
Antihypertensive therapy
Since with glomerulonephritis, in particular, with its hypertensive form, blood pressure rises, it is necessary to normalize it. To this end, the doctor prescribes drugs that reduce pressure indicators. Moreover, such therapy must be selected with great care: the patient is negatively affected not only by high blood pressure, but also by its sharp decrease, as well as sudden changes. Therefore, it should be reduced gradually.
Drugs that have a diuretic effect not only lower blood pressure, but also increase the outflow of fluid from the body, which prevents the development of severe edema. For example, with a mixed form of the disease, natriuretics are prescribed, which are characterized by such a double action. But drugs with a diuretic effect, which are based on purine derivatives, are ineffective in eliminating edema caused by impaired renal function.
Diet
Nutrition correction is also an integral part of the treatment of this disease. A diet for chronic glomerulonephritis is necessary to normalize the composition of blood serum so that the urinary system can cope with the processes of urination and urination.
Very close attention should be paid to the amount of salt consumed. With mixed and nephrotic forms of the disease, salt intake should be minimal. The patient is satisfied with the amount of sodium chloride that is initially present in food, so the dishes are not salted at all during cooking.
If a patient has developed a chronic hypertensive type of the disease, the amount of salt in his food should be about 3-4 g per day, and the content of proteins and carbohydrates should be normal.
If there are no edemas provoked by a violation of the renal filtering ability, the amount of protein in the food should be sufficient so that enough protein substances enter the body, because they are intensively lost in the urine.
With glomerulonephritis, as with any other disease, it is very important that the patient's nutrition is balanced, correct.
Food should contain all the necessary substances, because if they are lacking, a person’s condition will worsen, and the likelihood of complications will increase.
Among the vitamins, especially valuable in this case are A, C and group B.
If at any stage of the treatment of the disease it became necessary to limit the intake of salt or protein compounds, such a diet should not last long. A long-term lack of these vital substances also adversely affects human health, so nutrition during the entire period of therapy should be adjusted from time to time depending on changes in the functional state of the kidneys.
Other features of treatment
It is noticed that the climate in the patient's place of residence has a special effect on the course of the disease. Doctors advise during treatment to be in a dry and warm climate, where there is no chance of exposure to cool, moist air and further hypothermia.
If the patient's health is not critical (there is no heart failure, excessive edema, uremia), he can go to a spa treatment. The best places for recreation are Central Asia or the Crimea (South Coast).
Thus, if chronic glomerulonephritis is suspected, diagnosis should be started as soon as possible, without waiting for the onset of dangerous consequences for the patient's body.
Once the diagnosis is established, appropriate treatment must be carried out. It is very important that the patient follow all the doctor's instructions and adhere to a sparing regimen, including nutrition. Neglect of such appointments can aggravate the condition.
To treat this problem, you need to adhere to a strict diet and observe bed rest. It is also necessary to reduce the consumption of table salt and drink no more than one liter of water per day. This will help relieve swelling and bring blood pressure back to normal. It is necessary to include egg white and cottage cheese in your diet. Foods containing protein help to remove excess fluid from the body.
What is acute glomerulonephritis?
This is an inflammatory disease of the kidneys with damage to the renal glomeruli. Most often, this disease affects men aged 12-40 years. To avoid pathologies, do not allow frequent hypothermia of the body.
Mostly sick people living in countries with a cold and humid climate.
Acute glomerulonephritis - treatment and symptoms
You can determine if you have this disease by the following symptoms:
- The most common symptom of the disease is swelling. In the morning, it appears on the face, and closer to the second half of the day it appears on the legs in the ankles and shins. A large amount of fluid begins to accumulate in the human body, which leads to an increase in body weight.
- Increased blood pressure. This can lead to heart failure.
- The amount and color of the secreted liquid changes (dirty red). But it happens that the color of urine does not change, so it is necessary to take tests to check for the presence of red blood cells in it.
- Vision may be impaired.
- Headaches and dizziness.
If you find the above symptoms, you should consult a neurologist or therapist.
Triad of symptoms in acute glomerulonephritis
Acute diffuse glomerulonephritis develops only after serious infectious diseases such as tonsillitis, otitis media, pneumonia, etc. During this period, there is an unhealthy pallor of the skin and swelling of the whole body. In some cases, patients are concerned about acute pain in the kidney area.
Treatment of acute glomerulonephritis
There is a four-component treatment regimen.
- For two months, you should take prednisolone 30 mg once a day. Gradually, the amount of the drug is reduced until it disappears completely.
- Cytostatic until target remission.
- Within a month, take heparin five thousand units four times a day, gradually making the transition to aspirin.
- Dipyramole 400 mg per day.
Before using this scheme, be sure to consult with your doctor.
Prevention in acute glomerulonephritis
In order not to get sick, you must constantly keep your body warm and prevent hypothermia. At the first symptoms of serious infectious diseases, it is necessary to immediately begin intensive treatment, as well as eliminate the foci of infections. Particular attention should be paid to the tonsils (tonsils).
Complications of acute glomerulonephritis
The most severe consequence of the disease can be eclampsia of the kidneys. At this stage, cramps, severe headaches and high blood pressure may appear. The patient may also lose consciousness. After such attacks, irreversible consequences begin to develop, which lead to death.
Priority patient concerns in acute glomerulonephritis
Most often, the patient during the illness feels weakness, malaise. Over time, performance and appetite decrease. Fatigue increases. Fever may develop, accompanied by bouts of heat.
Do they take in the army with acute glomerulonephritis?
If you are diagnosed with this disease, then you can avoid being drafted into the army. If, after your recovery, the tests show that pathological changes persist in the urine, then you will be unfit for military service. The conclusion on the category of fitness is made after a second examination. In the absence of impaired renal function, it will not be possible to avoid being drafted into the army.
Urinary syndrome in acute glomerulonephritis
During the period of illness, the patient's urine volume decreases significantly. The daily amount of excreted fluid is usually no more than 700 ml. This process occurs due to inflammatory changes in the glomeruli. With uroscopy, you can notice that the urine is cloudy and has a sediment due to the large number of red blood cells in it.
To prevent this disease, all preventive measures must be observed. If you find any of the above symptoms, be sure to make an appointment with a therapist.