Glomerulonephritis - what it is, causes, signs, symptoms and treatment of acute form. Treatment of individual morphological forms

The diagnosis of glomerulonephritis in adult patients is a very health-threatening condition. Glomerulonephritis is a complex of immunological diseases that affect the kidneys. The pathology affects the glomerular filter, further involving the interstitial tissue of the kidney in the pathological process, with further progression of the process, resulting in the development of sclerotic changes in the renal tissue and further renal failure.

Case history of glomerulonephritis (ICD 10)

This pathology was first identified and described by a doctor in 1827 named Bright R.. This disease acquired the name of its “creator”, after which a more detailed description and classification appeared in the twentieth century. As a result, the disease was divided into stages and type of course. And only after medical practice biopsy entered, only then it became possible to study the disease from the point of view of pathogenesis.

Currently, according to the modern classification of kidney disease glomerulonephritis (ICD code N00 - N08), there are many clinical forms.

Glomerulonephritis clinical forms, classification

The classification provides for the division of pathology into forms, phases of the disease, according to the morphology of the process.

According to the classification of clinical forms, the following are distinguished:

• Nephrotic form;
• Latent form;
• Hypertensive;
• Hematuric;
• Mixed;

Like most chronic diseases, glomerulonephritis is divided according to its phases into an exacerbation phase, when kidney function sharply decreases, acute symptoms appear, and changes in the structure of the kidney parenchyma increase. And also – the stage of remission. During this period, the disease subsides, kidney function can be restored, and the symptoms subside.

Based on their morphology, that is, the specific process occurring in the kidney tissue, multiple forms of glomerulonephritis are distinguished, for example, rapidly progressive renal glomerulonephritis. This principle of dividing the disease as a whole determines the further treatment of the patient.

Glomerulonephritis, pathogenesis

There are several theories regarding the development of the disease glomerulonephritis. One of them, more than others, has the right to life and it is immune. Some sources of literature consider the mechanism of development of such a pathology as a genetic anomaly of one of the links in the formation of the immune system. As a result, the recovery processes in some parts of the nephron (the functional unit of the kidney) are disrupted. That is, simply put, a person’s own immune system begins to consider kidney tissue as foreign (antigen) and, as a result, attacks it, just as it destroys, for example, a virus that has entered the body.

Glomerulonephritis, clinic

The manifestations of this disease are several main symptoms:

• As a rule, the patient experiences swelling in the face, upper and lower extremities;
• The symptom of hypertension manifests itself in the form of an uncontrolled increase in blood pressure. Such hypertension cannot be classically corrected through drug therapy;
• The appearance of formed blood elements (erythrocytes) in the urine, which can be visible to the naked eye in the form of blood impurities in the urine, while the urine has the color of “meat slop”, for example, in the pathology of hematuric glomerulonephritis (reviews). A significant amount of protein also appears in the urine. This condition is explained by a violation of the filtration process in the glomeruli of the kidney, as a result of a violation of their structure.

And also the most severe symptom manifestations of glomerulonephritis are cerebral. This condition is manifested by attacks of seizures, similar to epilepsy, but called eclampsia.

If the disease progresses quickly, then the symptoms increase rapidly. At the same time, patients with glomerulonephritis must undergo constant medical examination and inpatient treatment.

Diagnostics

Diagnosis requires numerous laboratory tests and the presence of competent specialists. First, the patient's complaints are collected, then an objective examination is carried out. After this, a clinical and laboratory examination is carried out. Signs of hematuria are detected in the urine: Microhematuria - at the beginning of the process, or macrohematuria - in the acute form of the disease.

The release of protein in the urine is also a diagnostic sign of the development of glomerulonephritis. Next, a clinical blood test and biochemical parameters of kidney samples are examined. An increase in ESR, leukocytes in the blood, a decrease in total protein, an increase in lipoproteins, nitrogen, creatinine and urea indicate the presence of kidney pathology. A test for streptococcal antibodies will more accurately tilt the diagnosis towards glomerulonephritis.

After which a series of instrumental studies are carried out using ultrasound, radiography of the kidneys (excretory urography), computed tomography. If it is necessary to clarify the immediate cause of the development of the process, biopsy material is taken. To do this, under ultrasound control, a section of kidney tissue is taken and sent for histological examination.

Once the diagnosis is made, treatment begins.

Glomerulonephritis (ICD code 10), treatment

A patient with such a diagnosis should be hospitalized in a specialized department and placed on bed rest. Diet table according to Pevzner No. 7a is prescribed, with restriction of salt and proteins.

But the main direction of treatment is the use of drugs that suppress the immune system. Hormonal drugs (prednisolone) and cytostatics (azathioprine) are used. Anticoagulants and anti-inflammatory drugs are also used for auxiliary therapy.

But before starting treatment and making a diagnosis, you should understand in detail the causes of the disease. We will discuss the possible causes of glomerulonephritis in more detail in the next article.

Causes

In most cases, streptococcal diseases lead to the development of glomerulonephritis. But other infections and their complications also occur. Numerous factors that can provoke the onset of such a severe pathology as glomerulonephritis, the causes of its occurrence, namely the pathogenesis of the development of the disease have several theories.

Theories of the development of glomerulonephritis (pathogenesis)

There are several theories about the occurrence of this disease, but the main cause of glomerulonephritis and the main theory is immunological. So, pathogenetically, according to this theory, the disease develops against the background of a focus of acute or chronic infection, which can be located in various organs, not only in the kidneys. Usually the source of infection is streptococcus. But it is also possible the presence of streptococcus pneumoniae, the causative agent of meningitis, and toxoplasma, malarial plasmodium, and the appearance of some infections of viral etiology.

The essence of the immunological theory of the development of the process in the kidneys is the formation of immunological complexes in the bloodstream. These complexes appear as a result of exposure to various bacteria and infectious processes on the body, to which the immune system responds by producing antibodies to the emerging antigen. Moreover, the antigen can be either endogenous (inside the body) or exogenous (outside). Both a microorganism and a drug administered for the first time, toxins, and salts of heavy metals can be perceived as an antigen of the body. Also, your own body, for some reason, may perceive own fabric kidneys as an antigen.

Further, the resulting immune complex circulates in the systemic bloodstream, passing through the glomerular filters, where they are retained and deposited, which leads to subsequent damage to the tissue of the glomerular filter and other parts of the kidney.

Or, when antibodies appear directly to the kidney tissue, they attack and destroy the identified antigen (filtration glomeruli), causing inflammation and further damage and destruction. This inflammation leads to the activation of hypercoagulation processes (increased coagulation) in the bloodstream of microvessels. Then the processes of reactive inflammation are added. After which the glomerular tissue is replaced by connective tissue and actually dies. All this leads to loss of kidney filtration function and further development of renal failure.

The second theory for the appearance of glomerulonephritis is hereditary, that is, there is a predisposition to this disease along the genetic line. It is also called Alport syndrome. This syndrome is characterized by a dominant type of inheritance, most often in the male line with manifestations of hematuric glomerulonephritis, a combination of this pathology with hereditary deafness.

Glomerulonephritis: causes of the disease

Modern medicine identifies the following possible causes and predisposing factors for the occurrence of glomerulonephritis:

• The presence in the body of a focus of acute or chronic infection, more often streptococcal, but the presence of the pathogen and staphylococci, gonococci, malarial plasmodium, toxoplasma, and others is possible. But only microorganisms can lead to such a disease. A wide variety of viruses and even fungal infections can provoke the onset of glomerulonephritis;
• Exposure to the body of various highly toxic chemicals leads to sclerotic changes in the renal tissue, and even possibly to the development of acute renal failure with complex exposure and systemic damage;
• Allergization of the body due to the use of new medicines, which have not previously been introduced into this organism. This manifestation is also typical in patients with a history of allergies;
• Administration of vaccines – causes of glomerulonephritis in children;
• The presence of systemic diseases, such as systemic lupus erythematosus, rheumatoid arthritis and others, in which generalized damage occurs;
• Errors in nutrition in the form of consumption of large quantities of low-quality preservatives.

Glomerulonephritis: causes, symptoms, predisposing factors

Predisposing factors that can lead to the development of glomerulonephritis indirectly are:

• Prolonged exposure to low temperatures is a serious factor leading to the further development of such pathology. This occurs due to the fact that as a result of hypothermia, vascular spasm occurs throughout the body reflexively, in order to conserve energy;
• The presence of diabetes mellitus of the second and first types in the patient, due to systemic metabolic disorders, also contributes to the appearance of the disease glomerulonephritis;
• For women, the predisposing factor is childbirth and/or curettage of the uterine cavity (as an open entrance gate for the infectious process and hematogenous infection).

The cause of the development of acute and chronic glomerulonephritis

Of course, in modern clinical practice, the main cause of acute glomerulonephritis is streptococcal infection. Along with this, glomerulonephritis in children (symptoms, causes, treatment) appears as a result of vaccinations, since it is this contingent that is subject to routine vaccination.

But often, many believe that the reasons for the development of acute and chronic processes should be radically different. But that's not true. The dependence of the process is purely individual. Moreover, the reasons chronic glomerulonephritis, as a rule, is a long-term, sluggish process in the body.

In any case, in the presence of predisposing factors, exposure of the body to streptococcal or any other infection, as well as in the presence of a predisposition to allergic processes, the risk of glomerulonephritis increases. But no one is immune from the occurrence of an autoimmune process. Therefore, it is worth considering the etiology of the disease glomerulonephritis (causes, treatment) in the next article.

Etiology

In fact, the main etiological factor in the occurrence of glomerulonephritis is hemolytic streptococcus. Thus, the etiology, pathogenesis, and clinical picture of glomerulonephritis depend on when and how severely the streptococcal infection was suffered.

A few weeks before the first signs of glomerulonephritis appear, the patient develops a sore throat, streptococcal tonsillitis, pharyngitis, and various types of skin lesions. Moreover, the development of the process in the kidneys may not be observed for some time. Infection with streptococcus can also begin, for example, in the cardiovascular system, and will then lead to glomerulonephritis.

In this case, glomerulonephritis, etiology, pathogenesis has a starting point in the form of the appearance of endostreptolysin A nephritogenic streptococci, which is the main antigen to which the immune system reacts, starting an irreversible process. As a result, immune complexes (antigen - antibody) appear, which settle on the renal tubules of the filtration system, which causes disruption of the structure of the renal tissue and leads to the replacement of connective tissue with normal renal tissue.

This etiology, or rather the stages of development of the process, determines the clinical picture, which, depending on the degree of damage, differs in symptoms. Next, we will consider all possible manifestations of glomerulonephritis, both typical and atypical.

Symptoms

We can suspect each disease if it has any symptoms or clinical picture. Glomerulonephritis is no exception. As a rule, the manifestations of this disease do not take long to appear and appear one to three weeks after the appearance of a sore throat, for example, or tonsillitis involving a streptococcal infection. In general, the symptoms are similar to each other, but depending on the form of the course and the nature of the process, they may differ. As a result, the patient’s further treatment will depend.

The main symptoms of glomerulonephritis in women and men

The disease begins abruptly, immediately after suffering from pharyngitis or tonsillitis. The patient develops symptoms of intoxication of the whole body in the form of constant feeling nausea, periodic vomiting, general significant weakness, decreased or lack of appetite, increased body temperature.

General intoxication is accompanied by more specific manifestations of glomerulonephritis:

• Dull or aching pain in the lumbar region, characteristic of kidney damage;
• Swelling of the upper half of the body (face) and the lower extremities also swell;
• An increase in blood pressure that does not decrease is not controlled by classical therapy for hypertension;
• Pallor skin;
• Reduced daily diuresis due to reduced filtration in the glomeruli of the kidneys;
• Urine acquires a characteristic red color, described in the literature as the color of “meat slop,” due to damage to the microvessels of the filtration apparatus of the kidney.

Of the above symptoms, there are the most characteristic manifestations of glomerulonephritis, such as the classic triad. This is the mandatory presence of hypertensive manifestations, urinary and edematous syndrome in the patient. Each of them has a number of distinctive features from other diseases with similar symptoms. Urinary syndrome manifests itself in the form of virtually absent urination. The patient complains of a significantly reduced amount of urine, which can reach about fifty milliliters per day (oliguria or anuria). Urine has a characteristic red color. In this case, pain occurs in the lumbar region.

Glomerulonephritis is characterized by the presence of hypertensive syndrome, which manifests itself in the form of a persistent increase in blood pressure that is not amenable to drug correction. The numbers can range from 130/90 to 170/120 mm. rt. Art. Diastolic pressure rises equally as systolic. The highest blood pressure numbers are observed at the very beginning of the disease, after which they may decrease, but still remain elevated compared to normal indicators. Along with the rise in pressure, a rapid heartbeat appears; during an objective examination, the doctor listens for the accent of the second tone over the aorta. Pressure surges occur due to fluid and sodium retention in the body. Hypertension is followed by sleep disturbances, headaches, decreased vision, and a feeling of nausea. Swelling develops.

Symptoms of acute and chronic glomerulonephritis

According to the clinical course, glomerulonephritis is divided into acute and chronic. At least in general outline their clinic is similar, but there are some features and differences.

Acute glomerulonephritis has its own symptoms and treatment in adults, which differ from chronic glomerulonephritis. This clinical variant of the course manifests itself as urinary, hypertensive, edematous and cerebral syndrome. Acute glomerulonephritis is also divided into latent glomerulonephritis (symptoms and treatment in children and adults are generally similar). This form of acute course is common and often develops into a chronic course of the disease. Latent glomerulonephritis is characterized by a gradual onset and does not have pronounced clinical signs, only slight shortness of breath and swelling of the lower extremities. It lasts for two to six months.

There is also a cyclic form of acute glomerulonephritis, which is characterized by headache, pain in the lumbar region, swelling, shortness of breath and, of course, hematuria. An increase in pressure is observed. This condition lasts up to three weeks, after which the volume of daily diuresis increases, as a result of which the pressure decreases and the swelling goes away. At the same time, the density of urine decreases sharply.

Every acute glomerulonephritis that is not cured within one year is automatically considered chronic.

Chronic glomerulonephritis symptoms in adults are as follows, depending on the stage of the disease. There are two of them in the chronic course:

• The stage of compensation, during which there is a relatively preserved ability of the kidneys to filter and excretory function. It can only manifest itself by the presence of protein in the urine and red blood cells.
• And also the stage of renal decompensation, when the last capabilities of the urinary system are disrupted, resulting in hypertension and edema.
• Also, depending on which signs of chronic glomerulonephritis predominate, several forms are distinguished: nephrotic, hypertensive, latent, hematuric and mixed.

Glomerulonephritis in children: symptoms

In childhood, the onset of the disease is always violent and spontaneous, several weeks after a sore throat or vaccination. Clinical manifestations in children are striking, and glomerulonephritis very often develops acute.

Characteristic signs of glomerulonephritis in children are as follows: pronounced swelling of the face and legs, increased blood pressure, which is not typical for children, tearfulness, lethargy, sleep disturbance and appetite, nausea, vomiting, increased body temperature, chills. With adequate therapy, complete recovery occurs after one and a half to two months.

Chronic glomerulonephritis in children often occurs in the form of hematuria.

You can read about the future diagnosis of glomerulonephritis, symptoms and treatment with folk remedies in our next article.

Diagnostics

As a rule, the presence of a pronounced clinical picture and the correct collection of anamnesis (data about a recent infection) make it possible to suggest a diagnosis of glomerulonephritis. But everything is not always so simple in reality and not according to the “books”. Often even acute glomerulonephritis, diagnosis and treatment are even more difficult due to the blurred clinical picture. Therefore, we will analyze all possible methods for making the correct diagnosis for this disease.

Complaints and history taking

Regardless of whether the clinical manifestations are erased or not, the path to diagnosis is first paved by collecting complaints. Typical symptoms in this case are a sharp increase in blood pressure, swelling of the eyelids, face, and lower extremities. The patient may complain of pain in the lumbar region, shortness of breath, chills, and increased body temperature. A clear sign indicating a pathological process in the kidneys is hematuria and urinary disorders. Often, the patient independently notices an unusual color of urine, as well as a decrease in the amount of urine excreted per day.

Tests for glomerulonephritis, indicators

Indicative studies in the diagnosis of glomerulonephritis are laboratory tests. When the pathology of glomerulonephritis is suspected, the patient’s blood parameters are approximately as follows: there is an increase in ESR in a clinical blood test, leukocytosis with an increase in the number of eosinophils, and a decrease in hemoglobin.

A biochemical blood test gives the following indicators: with glomerulonephritis, total protein in the blood serum will be reduced, a-globulins will be increased, residual nitrogen, creatinine, urea, and cholesterol will be increased. An increase in the titer of antibodies to streptococcus (antistreptolysin O, antistreptokinase) is also detected.

A urine test for glomerulonephritis is necessary and very informative, the indicators of which will be more than normal. There will be a significant amount of protein present, a large number of red blood cells, due to which the urine acquires a dark red color. The presence of cylinders is also characteristic. The specific gravity of urine will be increased, but may be within the acceptable range.

You also still need to find out what urine is like with glomerulonephritis through special urine tests according to Nechiporenko and Zimnitsky.

Instrumental diagnostic methods

One of the most common methods today is the method ultrasound diagnostics. Ultrasound can detect an increase in the size of the kidneys and structural changes kidney tissue.

Radioisotope angiography allows you to evaluate vasculature renal tissue, kidney function and viability. To do this, special substances are introduced into the patient’s body that are capable of emitting radioactive rays and are a kind of markers by which the condition of the kidneys is determined.

If glomerulonephritis is suspected, electrocardiography and fundus examination are required. To exclude manifestations of hypertension based on the symptoms of hypertension.

For a more accurate diagnosis and determination of the specific form of the disease, a biopsy is used. Using a biopsy endoscope, a piece of kidney tissue is taken and sent for histological examination, where the final diagnosis is made. This procedure is a kind of differential diagnosis of glomerulonephritis according to their course and forms, in order to determine the tactics of further treatment.

Differential diagnosis of chronic glomerulonephritis

The most difficult is the correct diagnosis, especially if the clinic does not fully correspond to the pathology. Differential diagnosis of pyelonephritis and glomerulonephritis is aimed at identifying one or another disease. Also, differential diagnosis of glomerulonephritis is carried out between hypertension and renal amyloidosis, a tuberculous process of renal tissue.

Pyelonephritis is easier to distinguish from glomerulonephritis by the presence of significant hematuria and its characteristics. With glomerulonephritis, altered red blood cells are present in the urine and more. Also, pyelonephritis will not have characteristic streptococcal antibodies in the blood serum, and bacteria will be present in the urine culture.

Hypertension is more complicated. But fundus examination will help here. With hypertension there is a change in the vessels of the fundus, which will not happen with glomerulonephritis. There will also be less pronounced hypertrophy of the heart muscle, and a lower tendency to hypertensive crises with glomerulonephritis. Characteristic changes in urine with glomerulonephritis (hematuria) appear much earlier than the increase in pressure.

Glomerulonephritis differs from renal amyloidosis by the absence of a history of previous or currently existing tuberculosis, arthritis, chronic sepsis, purulent pathology of the lungs, and amyloidosis of other organs. The final confirmation of the diagnosis is the results of a biopsy of renal tissue with a histological conclusion.

It should be remembered that edema with glomerulonephritis differs from that with other pathologies. But clinical manifestations are not reliable, and laboratory and instrumental diagnostics should be considered the most reliable diagnostic signs. Also, differentiation of the diagnosis must be carried out not only with other pathologies, but also between a chronic process and an acute one. The management of such patients will differ. And depending on the clinical forms, treatment will be selected. In order to find out the existing options for the clinical course, we will consider in the next article the classification of glomerulonephritis.

Classification

In order to carry out adequate treatment, you should understand what forms and degrees of glomerulonephritis there are. For this purpose, many classifications of this pathology have been created.

Glomerulonephritis is divided according to its course, stages, and clinical forms. Also according to the causes of occurrence (bacterial infection, viral, the presence of protozoa in the body and unknown), according to the nosological form, according to pathogenesis (immunologically determined and not determined). Let us consider in more detail all of the above classifications.

Clinical classification of glomerulonephritis

Clinical classification is most popular in medical practice, since it is by the manifestations of the patient’s symptoms and their totality that the course of the pathology and further management tactics are determined. This division of glomerulonephritis is an accessible method for determining the clinical course, due to the absence of the need for extensive and expensive diagnostics. And so, the following variants of glomerulonephritis are distinguished:

• Latent variant, when the disease does not have pronounced clinical manifestations, except for the presence of hematuria and minor jumps in blood pressure. Often this option is characteristic of the chronic course of glomerulonephritis.
• The hematuric variant of glomerulonephritis is characterized by the presence of almost isolated hematuria (the presence of red blood cells in the urine, to a greater or lesser extent) without signs of proteinuria and other symptoms.
• There is also hypertensive glomerulonephritis, namely its variant of the course, when glomerulonephritis manifests itself to a greater extent by an increase in blood pressure. At the same time, urinary syndrome is mildly expressed. The pressure can reach the limits of 180/100 and 200/120 mm Hg, and can also fluctuate significantly during the day. As a rule, the hypertensive variant of the course is already a consequence of the development of a latent form of acute glomerulonephritis. As a result, hypertrophic changes in the left ventricle develop, the doctor listens for the accent of the second tone over the aorta. Such hypertension often does not become malignant.
• Glomerulonephritis with a nephrotic course is the most common. The characteristic features for this variant of the course are the combination of this syndrome (increased excretion of protein in the urine) with signs of inflammation of the kidney tissue.

The mixed variant of the course is characterized by a combination of nephrotic syndrome and hypertensive syndrome. Accordingly, clinical manifestations will be characteristic of these two syndromes.

Classification according to the phases of the disease is also important clinically. As in most pathologies with a chronic course, there is a phase of exacerbation and remission.

Morphological variants of glomerulonephritis

The morphological classification provides for the division of glomerulonephritis according to the histological conclusion of histologists. The morphological forms of glomerulonephritis in children are similar to those in adults. The following forms of glomerulonephritis are classified according to morphology:

• The most common morphological form of chronic glomerulonephritis is mesangioproliferative glomerulonephritis, the clinical symptoms of which manifest themselves as follows. In this case, there will be persistent hematuria, and kidney damage of this kind occurs to a greater extent in males. Another form that can be called is the hematuric form of glomerulonephritis. An increase in blood pressure is quite rare. According to its morphological structure, this form is characterized by the deposition of immune complexes in the mesangium and endothelial structures of the glomerulus of the kidneys. Clinically, this form is comparable to the nephrotic form and, less commonly, the hypertensive form, as well as nephropathy, which occurs under the name Berger’s disease.
• Membranous glomerulonephritis also exists. This type of glomerulonephritis is not widespread among the population, about five percent. In this case, an immunological study is carried out, through which fibrin threads and deposits of IgM and IgG are detected in the small vessels of the glomeruli. By clinical manifestations This option proceeds rather slowly, and has characteristic proteinuria, or a possible manifestation of nephrotic syndrome. This form, although it progresses slowly, is predicted to be less optimistic than the previous form.
• Mesangiocapillary or membranoproliferative glomerulonephritis is observed in approximately twenty percent of cases, with damage to the basement membrane, namely the mesangium. Immunologically, deposits of immunoglobulins A and G are detected in the capillaries of the glomeruli, as a result of which the epithelization of the glomerular tubules changes. This form is more characteristic of the female sex. According to the symptoms, the manifestations are characteristic of nephrotic syndrome; there is also significant hematuria and loss of protein in the urine. This form tends to progress.
• Due to the fact that this process begins after various types of infectious processes, it can be designated as post-streptococcal glomerulonephritis in adults.
• Morphological glomerulonephritis is also distinguished in the classification in the form of lipoid nephrosis. This pathology is typical for children. Lipids are detected in the glomerular tubules. This form has a good prognosis when treated with glucocorticoids.

And there is fibroplastic glomerulonephritis according to morphological classification. This form manifests itself as diffuse processes of sclerosis and fibrosis in all glomerular structures of the kidneys. As a result, dystrophy processes predominate. Chronic renal failure develops quite quickly.

Morphological forms characterize chronic glomerulonephritis, the classification of which is described above. You can learn about other nuances of the course of chronic glomerulonephritis in the following article.

Chronic glomerulonephritis

Chronic glomerulonephritis (ICD code N03) is a pathology that affects the glomerular apparatus of the kidneys through immune complex damage, leading to hematuria and hypertension.

Chronic glomerulonephritis (ICD 10): causes of development, pathogenesis

This variant of the course of glomerulonephritis can develop either as a consequence of acute or independently immediately in a chronic form. Chronic glomerulonephritis is more common than acute glomerulonephritis, and mainly affects men aged about forty to forty-five years.

Due to the reasons for its occurrence, the chronic form of the course differs little from the acute one, but in the chronic case, viral infections such as the hepatitis B virus, herpetic infection and cytomegalovirus become important. Also, one of the causes of chronic glomerulonephritis (ICB 10 N03) is the ingestion of drugs and heavy metal salts into the body. And, of course, predisposing factors are of great importance - hypothermia, injury, systematic consumption of alcoholic beverages, excessively harmful working conditions.

In the pathogenesis, the leading role is played by immune disorders, which, with prolonged exposure, lead to inflammation in the glomerular apparatus of the renal tissue. Or, regardless of external factors, an autoimmune process of kidney damage may develop; this occurs as a result of the body’s immune system perceiving the glomerular membranes as a foreign body, that is, an antigen. A number of processes that are formed as a result of neglected immune mechanisms also have an impact on the formation of glomerulonephritis. Thus, emerging proteinuria damages the tubules of the renal tissue, and an increase in intraglomerular pressure in the vessels leads to an increase in their permeability and destruction.

The histological picture of the disease chronic glomerulonephritis (ICD code 10 N03) is characterized by total edema, the presence of fibrosis of the renal tissue, complete atrophy of the filtration unit, which causes shrinkage of the kidney. As a result, they become denser and decrease in size. If there are glomeruli that have retained their function, then they are significantly enlarged.

Chronic glomerulonephritis, syndromes

There are a number of syndromes, according to the classification, characteristic of the clinical course of chronic glomerulonephritis:

• Hematuria syndrome manifests itself in the form of blood in the urine, or completely blood-stained urine.
• Hypertension syndrome affects the patient's condition through a sharp, persistent increase in blood pressure, which is difficult to correct with medication, and its independent reduction. Pressure surges can be repeated up to several times a day.
• Nephrotic syndrome is characteristic of this disease and manifests itself as a large loss of protein in the urine.
• Latent chronic renal glomerulonephritis, one of its most insidious manifestations, is also isolated. This type occurs without typical clinical signs and often, unnoticed by the patient, can lead to the development of chronic renal failure due to the absence of complaints and, as a result, lack of treatment.
• The mixed syndrome combines the presence of hypertensive and nephrotic syndromes in combination with severe edema.

How separate species distinguish subacute glomerulonephritis according to its course. It has a malignant course. Prognostically, this pathology is unfavorable. Patients die from renal failure within six to one and a half months.

Diagnostics

The diagnosis of chronic glomerulonephritis is made on the basis of a thorough examination. In addition to the routine collection of complaints and anamnesis data, examination through laboratory tests and instrumental methods is key in making a diagnosis.

It is necessary to carry out, in addition to many usual studies, the following basic diagnostic measures:

• General urine analysis, Nechiporenko and Zimnitsky tests, determination of daily proteinuria (protein excretion in urine per day).
• Biochemical blood test with determination of kidney samples (urea, creatinine, residual nitrogen, uric acid), as well as accounting for total serum protein and its fractions.
• An immunogram is determined.
• An ophthalmologist performs a fundus examination.
• Through X-ray methods excretory urography is performed to determine the integrity of renal function.
• A radionuclide examination of the urinary system is also carried out by introducing a special substance into the body, which seems to mark pathological areas.
• Of course, an ultrasound examination of the urinary system to examine the structure and size of the kidneys.
• Computed tomography or MRI may be used.

In conclusion, and in order to determine the morphological type of chronic glomerulonephritis, a kidney biopsy is performed under ultrasound control for histological examination.

Depending on which syndrome predominates, as well as on the degree of progression of the process and the morphological variant of the course, appropriate therapy is selected. As a rule, therapy is symptomatic and is carried out to maintain the functional capacity of the kidneys.

But with a malignant and rapidly progressive course, aggressive four-component therapy is prescribed, consisting of glucocorticoids, cytostatics, plasmapheresis and anticoagulants. This treatment is carried out in the case of an absolutely proven immune process in the kidneys.

Also, in case of chronic glomerulonephritis, recommendations are given on diet (table No. 7 a), daily routine (during an exacerbation of the disease, it is bedtime), and further lifestyle.

Prognosis of chronic glomerulonephritis

The appearance of such a disease in a patient very often and quickly leads to disability at a relatively young age, the appearance of chronic renal failure, which worsens the quality of life, and even death.

Depending on the forms and stage of the disease, a more accurate prognosis for life can be made. In the next article we will describe the possible existing stages and forms of glomerulonephritis.

Forms and stages

Any of existing species glomerulonephritis has its own division into forms and stages depending on the clinical course. Chronic glomerulonephritis has a greater division due to the duration of the disease and the type of its course.

Forms of acute glomerulonephritis

Acute glomerulonephritis also has forms of the pathological process; there are two of them:

• The first includes the acute cyclic form. It is characterized acute manifestations and rapid onset of the disease. The patient's symptoms and complaints are expressed to a significant extent. There is a sharp increase in temperature, pain in the lumbar region, difficulty urinating, urine becomes red, and vomiting appears. In especially severe cases, urinary disorders progress until it is absent for several days, followed by the development of acute renal failure. Although, usually, this variant of the clinical course is a favorable prognosis for recovery.
• The second form is latent or, in other words, protracted. It manifests itself as a long, gradual onset of symptoms and a protracted course of the entire pathological period from six months to one year. The clinical manifestations are the same as those of the acute cyclic form, they only increase gradually, and for some time they may manifest themselves only as a couple of symptoms.
• Any acute glomerulonephritis in the absence of positive dynamics and recovery over the course of a year is automatically considered to become chronic.

Chronic glomerulonephritis, stages

This disease in its chronic form has a greater clinical division than its acute form. Depending on the “height” of the process, chronic glomerulonephritis is divided into the following stages, or phases:

• The active stage of the process, which is characterized by rapid progression of the pathological process in the kidneys and vivid symptoms. This stage is further divided into three:
• The peak period of the disease;
• Period of attenuation of symptoms;
• And the stage of clinical remission;
• The inactive stage of chronic glomerulonephritis manifests itself in the form of clinical and laboratory symptoms subsiding.

Also distinguished terminal stage diseases. This option is considered when signs of chronic renal failure appear.

There is a conditional division of chronic glomerulonephritis into two more stages according to the body’s ability to resume kidney function:

• The stage of compensation, when the body is still coping with the emerging pathology and the kidney continues to function, albeit with significant disturbances in its structure.
• And the stage of decompensation of the process. It is characterized by the undermining of all compensatory mechanisms and manifests itself in the form of renal failure.

Clinical forms of chronic glomerulonephritis

Chronic glomerulonephritis can occur in several clinical directions, when, to varying degrees, certain symptoms predominate. The following clinical variants of chronic glomerulonephritis are distinguished:

• Latent glomerulonephritis;
• Nephrotic;
• Hematuric;
• Mixed;
• Hypertensive;
• Let us consider each of the flow options in more detail.

Chronic glomerulonephritis, the nephrotic form, is the most common variant of the course of this pathology. The nephrotic form manifests itself with significant levels of proteinuria (more than 3.5 grams per daily quantity urine). This symptom is often almost the only manifestation and occurs as a result of damage to glomerular tissue. In the blood serum, a decrease in total protein and an increase in globulins, lipids, as well as hypercholesterolemia can be detected.

Nephrotic syndrome can be assessed clinically by appearance patient. The face is swollen, pale, dry skin predominates. Patients are not active; inhibition processes appear in speech and actions. In the case of severe forms, there may be accumulation of fluid in the pleural or abdominal cavity, and oliguria (little urine) develops. Such phenomena are a provocative factor for the emergence and development of various infectious diseases.

Chronic glomerulonephritis, the hematuric form, is characterized only by the presence of blood in the urine. It can manifest itself as macro- and microhematuria. Protein excretion in urine is insignificant. There are usually no other symptoms. Hematuric chronic glomerulonephritis progresses slowly.

Chronic glomerulonephritis, a hypertensive variant of the course, manifests itself in the form of surges in blood pressure that appear periodically. In addition, the patient does not complain about anything; a small amount of protein is detected in the urine in the laboratory. The disease progresses unnoticed and is detected by chance, already when there is hypertrophy of the left ventricle of the heart and altered vessels of the fundus. This course of the disease slowly leads the patient to chronic renal failure. Chronic glomerulonephritis, a hypertensive form, the medical history of such patients is replete with examinations from cardiology and ophthalmology, as heart failure and retinal detachment may develop.

In the case when chronic glomerulonephritis develops, a latent form of the disease forms. This pathology is asymptomatic for many years and can be diagnosed only after the development of chronic renal failure. The most minor manifestations may be loss of protein in the urine, rarely hematuria, low levels of arterial hypertension and edema, to which the patient does not attach importance.

The mixed form of the disease includes, as the name suggests, all possible manifestations. Progresses quickly.

Chronic diffuse glomerulonephritis is also one of the forms of this disease, but belongs to a different classification, and more often occurs secondary, that is, as a complication of another pathology (septic endocarditis).

All of the above forms exist for the purpose of selecting the optimal treatment, the methods of which will be discussed further.

Treatment

Complex treatment of chronic glomerulonephritis requires not only drug treatment, but also the use of diet therapy and sanatorium-resort treatment. In the acute stage of the disease, hospitalization in a hospital is necessary. Let's take a closer look possible treatment and prognosis of the disease chronic glomerulonephritis: can it be cured or not.

Treatment of chronic glomerulonephritis, symptomatic therapy drugs

To select the correct treatment, it is necessary to accurately determine the clinical course of the disease. Different forms require an individual approach to therapy.

If the patient has chronic glomerulonephritis with a latent course, that is, if there is less than one gram of protein in the daily amount of urine and mild manifestations of hematuria (up to eight red blood cells in the field of view), with preserved renal function, chimes, delagil and trental are used. The course of such drugs is up to three months.

For hematuric form, which slowly progresses, use membrane stabilizers for up to one month (dimephosphamide solution), the same delagil and vitamin E. It is also possible to add indomethacin or voltaren to therapy for up to four months. The drugs trental and/or chimes are an indispensable use.

With the hypertensive form of glomerulonephritis, treatment is more complex. Since this form is steadily progressing, and constantly elevated blood pressure is caused by impaired renal blood flow (“vicious circle”), it is necessary to use drugs that normalize hemodynamic processes in the kidneys (chimes, trental, long-term use for many years). Also used in therapy nicotinic acid, β-blockers, diuretics, calcium agonists.

If chronic glomerulonephritis with a nephrotic form is detected, even without the presence of hypertension and renal failure, active therapy must be used. This type of therapy includes the use of glucocorticoids and cytostatics. The four-component treatment has a significant therapeutic effect. This form is also characterized by hypercoagulability, which is why anticoagulants are prescribed.

Pathogenetic methods of treatment of chronic glomerulonephritis

In order to prescribe treatment, which is aimed at eliminating the mechanisms of development of the disease, the pathogenesis of chronic glomerulonephritis should be taken into account.

Thus, the leading drugs for the treatment of glomerulonephritis are glucocorticoids, cytostatic drugs, anticoagulants and plasmapheresis. This therapy is used in cases where the process of disease progression is active and there is a high risk of complications and a threat to the patient’s life.

There are some indications for this therapy, or a four-component treatment regimen: significant activity of the pathological process in the renal tissue, the presence of nephrotic syndrome even in the absence of hypertension, minor morphological changes in the glomerular apparatus of the kidneys. There are several treatment regimens. For active nephritis in adults, prednisolone is used in a dosage of 0.5 to 1 milligram per kilogram of body weight for eight weeks, then the dosage is gradually reduced and therapy is continued for up to six months. A similar treatment for chronic glomerulonephritis in children, but the scheme has its own nuances. In this case, prednisolone is prescribed for up to four days, and then a four-day break is taken.

Also, in the presence of the most active process in the kidneys with rapid progression of pathology, “pulse therapy” is used.

But, like every therapy, this treatment has a number of side effects: the development of Itsenko-Cushing syndrome, the development of osteoporosis, gastric ulcer with the possible development of bleeding.

Chronic glomerulonephritis must be treated along with glucocorticoids, drugs that suppress the immune system. These include cyclophosphamide, chlorambucil and others.

You should also take into account the entire pathogenetic process in order to treat glomerulonephritis and use anticoagulants. The drug of choice is heparin in a daily dosage of up to fifteen thousand units, which are separated by more than four administrations. The effectiveness of therapy is assessed by increasing the clotting time after several doses.

Chimes indirectly influence the process of antiplatelet production in the vascular wall of the glomerular filter. Its clinical effects include improved renal blood flow.

Acetylsalicylic acid is also prescribed for the same purpose.

Treatment of acute and chronic glomerulonephritis using NSAIDs

In order to reduce the inflammatory process and analgesic effect, I use non-steroidal anti-inflammatory drugs (NSAIDs) - ibuprofen, indomethacin, voltaren - in the treatment of glomerulonephritis.

When the activity of the process is weak, NSAIDs can be prescribed as an alternative to glucocorticoids. For example, indomethacin is indicated for patients with urinary protein excretion and preserved renal function. But there are also contraindications here. Also, in case of activation of the pathological process, they switch to corticosteroids.

Plasmapheresis is used as one of the components of therapy for glomerulonephritis. It is indicated for the treatment of a rapidly progressive disease, as well as in the case of secondary glomerulonephritis against the background of another systemic pathology.

General principles of treatment of chronic glomerulonephritis

Along with drug treatment, you should adhere to a diet. For this, table No. 7a is prescribed, and recommendations are given to reduce the amount of salt in food, and also reduce the protein load on the kidneys.

Sanatorium-resort treatment is recommended for patients with a latent course of the process or in remission of the disease with mild nephrotic syndrome. It is possible to use folk remedies in combination to treat chronic glomerulonephritis. But such treatment must be coordinated with a doctor in accordance with the drug therapy being carried out, so as not to aggravate the condition.

Is it possible to cure chronic glomerulonephritis forever?

The prognosis of the disease chronic glomerulonephritis is generally unfavorable and treatment of the pathological process is carried out only with the aim of slowing down the decline of kidney function, postponing disability and improving the patient’s quality of life.

It all depends on the form of the disease and the therapy performed. But often glomerulonephritis leads to disability or even death.

Therefore, the answer to the question whether chronic glomerulonephritis can be cured is unambiguous.

Acute glomerulonephritis

This pathology in most cases affects young people and is characterized by inflammation of the glomerular apparatus of the kidneys of immune origin with further involvement of all kidney structures in the process.

Etiology and pathogenesis of acute glomerulonephritis

As a rule, glomerulonephritis develops after acute streptococcal infections, such as tonsillitis, tonsillitis and others. It is also possible to establish that the patient recently suffered from pneumonia, diphtheria, or viral infections. It is possible to develop glomerulonephritis as a result of exposure to malarial plasmodium and after the administration of vaccines. But to a greater extent, the occurrence of such a pathology depends on beta-hemolytic streptococcus, namely group A. There are also a number of provocative conditions, such as hypothermia, a humid climate, and prolonged exposure to harmful working conditions.

Other etiological factors may be various drugs that were introduced into the body for the first time, various chemical compounds and other allergens, in the case of individual intolerance and activation of the immunological process.

The pathogenetic mechanism for the development of glomerulonephritis is an immune reaction in the formation of an antigen-antibody complex and their deposition on the vascular wall of the glomeruli of the kidneys. As a result, inflammatory processes occur in the capillary wall - vasculitis.

All manifestations of glomerulonephritis occur several weeks after the illness.

Acute glomerulonephritis, clinic

Acute glomerulonephritis develops sharply, with vivid clinical manifestations. Patients complain of pain in the lumbar region, which spreads on both sides. Symptoms of general intoxication of the body appear: increased body temperature to high levels, general weakness, nausea, vomiting. Patients notice a sharp decrease in the amount of urine per day, and oliguria develops. The color of the urine also changes, it becomes red (“the color of meat slop”). As the disease progresses, anuria (complete absence of urine) may develop. Typically, this symptom indicates the development of acute renal failure.

A typical manifestation is swelling. Patients develop swelling not only of the lower extremities, but also of the face. The eyelids swell, the skin becomes noticeably pale. During development severe conditions accumulation of fluid can occur in the natural cavities of the body: chest cavity, abdominal cavity, in the heart area. This type edema is characterized by its appearance in the morning, and by the evening the swelling decreases. A few weeks after the onset of the disease, the swelling disappears.

Another important manifestation of acute glomerulonephritis is an increase in blood pressure. It occurs abruptly at the onset of the disease and reaches numbers up to 180 systolic and up to 120 diastolic mm Hg. A symptom such as hypertension can lead to the development of serious complications: pulmonary edema, left ventricular hypertrophy, the occurrence of seizures of the epileptic type, but of a different nature (eclampsia). This concept, eclampsia, occurs due to swelling of the brain tissue, namely the motor centers. It manifests itself as loss of consciousness, acrocyanosis (blueness of the limbs and face), seizures or increased tone of all muscles.

Acute glomerulonephritis, syndromes and forms

Acute glomerulonephritis can be divided into two forms according to the course of the disease:

• The first includes an acute form of cyclic flow. It is characterized by a spontaneous, rapid onset of the disease and vivid clinical manifestations. The prognosis for this course is favorable, as it ends with the patient’s complete recovery.
• The second is a protracted form, which is accompanied by slow progression of the pathological process and the gradual appearance of symptoms. This form has a long course, from six months to one year.
• Acute glomerulonephritis is characterized by the presence of nephrotic syndrome. It manifests itself in the form of excretion of a large amount of protein in the urine, a corresponding decrease in protein in the blood serum, an increase in lipids, and swelling.
• There is a transition from acute glomerulonephritis to subacute glomerulonephritis, which tends to rapidly worsen the condition. And also, if the process is delayed, it can turn into a chronic process.
• Acute diffuse glomerulonephritis is also one of the acute forms, but it can also be chronic.

Complications of acute glomerulonephritis

The most common and severe complications of this disease are: acute renal failure, heart failure, cerebral edema with the development of eclampsia, hemorrhagic stroke, varying degrees of retinopathy up to retinal detachment.

How is acute glomerulonephritis diagnosed (recommendations)

Diagnosis of glomerulonephritis is based on collecting patient complaints, determining the presence of infectious diseases several weeks before the onset of symptoms, an objective examination by a doctor and clinical and laboratory diagnostics. As well as instrumental studies.

In a general urine test, an increase in leukocytes, urine density, high protein excretion (from 1 to 20 grams per liter), and hematuria are observed. A urine test according to Zimnitsky is also performed.

In a clinical blood test, a decrease in hemoglobin, leukocytosis, and an increase in ESR are observed. A biochemical blood test reflects the presence of renal damage: an increase in the level of urea, creatinine, uric acid. The proteinogram indicates the loss of protein by the body: a decrease in total protein in the blood serum and albumin.

When performing an immunogram, it is possible to detect an increased amount of immunoglobulins, an increased titer of antibodies to streptococcus in the event of a disease - acute post-streptococcal glomerulonephritis in children and adults.

Diagnostics using instrumental methods begins with ultrasound examination. X-rays with a contrast agent can also be performed. The vessels of the fundus are examined and an ECG is performed. In conclusion, for accurate diagnosis perform a puncture biopsy of the kidneys.

All recommendations for this disease are based on inpatient treatment and timely diagnosis. With the development of the pathology of acute glomerulonephritis in children, clinical recommendations are aimed at promptly seeking medical help from parents in order to avoid progression of the disease and the onset of disability of the child, or chronicity of the process. Therefore, the disease requires urgent treatment, the methods of which will be discussed in the next article.

Treatment

The main therapy for acute glomerulonephritis is, of course, medication, but it is also necessary to adhere to proper nutrition.

Diet for acute glomerulonephritis

There are specially developed diets according to Pevzner. For acute glomerulonephritis, diet tables No. 7, 7a and 7b are used. The essence of these diets is to sharply limit table salt in foods, limit protein foods, and limit the intake of water and liquids.

At the onset of the disease, foods with a high glucose content are recommended. Namely, five hundred grams of sugar per day, with five hundred milliliters of tea or fruit juice per day. Next, watermelons, oranges, pumpkins, and potatoes are prescribed in the diet, which together represent an almost complete absence of sodium in the diet. Patients are also advised to count their daily urine output. With this diet, the amount of fluid consumed should be approximately equal to the amount of urine excreted.

The sequence of prescribing tables: at the beginning of the disease, table No. 7a is prescribed, it is followed for one week, then they move on to table No. 7b for a month, after which they eat according to table No. 7 for a year. But, taking into account all of the above, nutrition for acute glomerulonephritis should be balanced.

Not only the diet, but you should also adhere to strict bed rest, and also avoid hypothermia and drafts.

Acute glomerulonephritis, treatment, drugs

The main therapy for acute glomerulonephritis is medication. If a precise connection between glomerulonephritis and a previous illness with streptococcal infection has been established. As antibacterial therapy, oxacillin is used in half a gram up to four times a day intramuscularly, or erythromycin in a quarter of a gram with the same frequency of application.

An important point in the treatment of acute glomerulonephritis is the use immunosuppressive therapy. Such treatment is indicated in the absence of hypertensive syndrome, in the presence of a long course of pathology and signs of acute renal failure. Glucocorticoids such as prednisolone or methylprednisolone are prescribed in case of excessive activity and progression of the process. The course of administration is one and a half to two months at a dosage of one milligram per kilogram of the patient’s body weight. After a period of administration, the dosage is gradually reduced and after which the drug is discontinued.

There is another group of drugs that are more effective than glucocorticoids, but their use should be justified by the low therapeutic effect of prednisolone. Such drugs are cytostatics. These include cyclophosphamide and azathioprine. The first is taken at one and a half to two milligrams per kilogram of body weight, azathioprine is administered at two to three milligrams per kilogram of the patient’s body weight. The duration of the course is up to eight weeks, after which the effectiveness of treatment is assessed, and then the dosage is gradually reduced to the minimum maintenance level. The above therapy is etiotropic treatment for acute glomerulonephritis.

Each patient is treated individually. In rare cases, combination therapy with glucocorticoids and cytostatics may be necessary. Acute glomerulonephritis in children, treatment is pathogenetic and symptomatic therapy is almost the same as in adults, with the exception of dosages depending on the age of the child.

Acute glomerulonephritis, auxiliary therapy

But auxiliary therapy is also necessary. In order to improve blood circulation and nutrition of the kidney parenchyma, namely the glomeruli, anticoagulants and antiplatelet agents are used. Such drugs are heparin, chimes and trental.

Additionally, if the patient has high blood pressure, calcium agonists, such as verapamil, or ACE inhibitors, capoten, are prescribed.

Each syndrome is treated almost separately. If edema is present, fluids are naturally limited and diuretics (saluretics) are prescribed:

• The most common is furosemide, forty to eighty milligrams per day;
• Veroshpiron retains blood potassium and does not remove it. Take up to two hundred milligrams per day.
• Hypothiazide is prescribed up to one hundred mg per day.
• Also, symptomatic treatment is aimed at eliminating the phenomena of hematuria, the manifestations of which do not go away after exposure to the main pathogenetic treatment. For this purpose, aminocaproic acid is prescribed in tablet form or intravenously in a course of seven days. Further, it is possible to use dicinone intramuscularly. Faculty therapy describes the principles of treatment of the disease acute glomerulonephritis in more detail, indicating the dosages of drugs and their variety.

Complications such as acute heart failure and eclampsia due to cerebral edema require urgent resuscitation measures and must be treated under conditions intensive care unit with the availability of appropriate equipment.

Prevention of acute glomerulonephritis

Measures to prevent this condition are always aimed primarily at eliminating all predisposing factors, treating a chronic source of infection, and avoiding hypothermia. In case of aggravated allergic anamnesis, this condition is especially typical for children, refuse vaccinations, administration of serums and introduction of drugs into the body for the first time, without a sensitivity test, in order to avoid acute drug-induced glomerulonephritis.

Acute glomerulonephritis is always more difficult to treat than to prevent. Especially if we're talking about about nephrotic glomerulonephritis, which will be described in the next article.

Therefore, any pathology that can provoke the appearance of glomerulonephritis should be promptly diagnosed and treated so that it does not develop into such a complex disease.

Nephrotic glomerulonephritis

Glomerulonephritis is a disease that has many forms, stages, and course phases. There are two main types of disease - acute and chronic. And it is chronic, due to its duration of the disease and the variety of clinical forms, that has several classifications and divisions.

Forms of chronic glomerulonephritis

Chronic glomerulonephritis is divided into several forms of its clinical manifestations, which predominate in this particular case. Highlight:

• hematuric form, which manifests itself in the form of blood in the urine;
• hypertensive, characterized by a predominant increase in blood pressure;
• latent form, clinically manifested by isolated urinary syndrome;
• mixed, can combine several forms of clinical manifestations;
• and nephrotic form of glomerulonephritis.
• Let us examine in detail the nephrotic form, its clinical manifestations, diagnosis and treatment.

Nephrotic syndrome with glomerulonephritis, pathogenesis

The incidence of this syndrome is about twenty percent. This form is a series of immunological reactions in the renal tissue, in which a factor appears in the urine that gives a positive reaction to the lupus test, and manifests itself symptomatically in a polysyndromic manner.

The main clinical manifestation in this case is proteinuria. Protein loss in urine can occur to a significant extent, greater than 3.5

grams in the daily amount of urine, this is typical for the onset of the disease, and in moderation, with a tendency to reduce proteinuria to more late stages glomerulonephritis taking into account decreased renal function.

A symptom such as proteinuria directly reflects the nephrotic variant of glomerulonephritis. Its presence means hidden damage to the glomerular apparatus of the kidneys. Nephrotic glomerulonephritis, or the syndrome of this disease, develops as a result of prolonged exposure to the main pathological factor, as a result of which the permeability of the basement membrane of the glomerular filter increases. Then blood protein and plasma begin to pass through the damaged membrane. This, in turn, causes even greater structural disturbances in the epithelium of the renal tubules, which aggravates the pathological process even further.

Nephrotic glomerulonephritis in children and adults, symptoms

The main symptom of the disease is the excretion of protein in the urine. As a result of changes in the interstitium of the glomerular tubules and capillaries. A general urine test reveals a significant amount of protein, an increase in leukocytes may be present, as a sign of a local inflammatory process, and casts may be detected. A biochemical blood test proves the loss of protein, hypoproteinemia appears, a decrease in the amount of albumin and an increase in globulins. Hyperlipidemia, hypercholesterolemia, and an increase in triglycerides are also observed. The coagulogram shows evidence of fibrinogen growth, which can lead to complications in the form of thrombosis. The disease has both rapid and slow progression, but as a result still leads to the development of chronic renal failure.

A patient with chronic glomerulonephritis with a nephrotic form complains of swelling of the face, eyelids, lower extremities in the area of ​​the legs and feet. Upon examination, you may notice pale skin and dryness. The speech of such patients is inhibited, they are not active. Urinary function is impaired, which manifests itself in the form of oliguria (a significantly reduced amount of urine per day). If a severe course of the syndrome develops, fluid accumulation may occur in the pleural cavity, abdominal cavity with the development of ascites, and even in the pericardium.

The combination of all symptoms and pathogenetic factors lead to a significant decrease in general immune responses, which provokes increased sensitivity to various types of infections that can complicate the course of the underlying disease.

Nephrotic and nephritic forms of glomerulonephritis in children

Children are characterized by the manifestation of chronic glomerulonephritis in the form of nephrotic syndrome, which is similar to that in adults, and nephritic.

Glomerulonephritis with nephrotic syndrome in children has some similarities with nephrotic syndrome. But the main difference is the pathogenesis of the syndrome. It appears as a result of an inflammatory process in the kidney tissue, which can be caused not only by glomerulonephritis, but also by other pathological conditions. It manifests itself not only as proteinuria, but also as hematuria, hypertension, and, among other things, peripheral edema.

The combination of these syndromes is typical for both children and adults, especially in the chronic course of the disease. But most often glomerulonephritis in children, the nephrotic form, is the main diagnosis.

Glomerulonephritis, nephrotic syndrome, treatment

Treatment of this form of the disease is aimed at reducing membrane permeability and protein loss. In this case, the general principles of managing patients with glomerulonephritis remain the same.

The diet for glomerulonephritis with nephrotic syndrome is shown as the seventh according to Pevzner, depending on the stage of the disease with various variations (7a, 7b or 7).

The same diet is prescribed for diffuse glomerulonephritis, which we will discuss later in the article.

Diffuse glomerulonephritis

Kidney disease diffuse glomerulonephritis is a collective and general name and concerns only the extent of damage to the tissue of both kidneys.

There are acute and chronic diffuse glomerulonephritis.

Acute diffuse glomerulonephritis in children and adults

This pathology develops as a result of infectious diseases (tonsillitis, pneumonia, etc.), caused, most often, by group A streptococcal infection. Diffuse glomerulonephritis is possible as a result of severe hypothermia, especially in conditions of high air humidity, as well as after injection vaccines or serums.

The etiology of occurrence confirms the pathogenesis of the disease. That is, glomerulonephritis does not occur at the beginning of the infectious process, but after a couple of weeks, which is confirmed by the presence of the production of blood antibodies to hemolytic streptococcus just at the beginning of the disease of acute glomerulonephritis.

Chronic diffuse glomerulonephritis, pathophysiology, forms

This type of glomerulonephritis is a common pathology and develops as a result of prolonged acute glomerulonephritis. It is also possible for the disease to start on its own, which is most often detected by chance during preventive examinations, as it often occurs latently, with minor changes in the general condition of the patient, or in the laboratory. A chronic course may occur as a result of untreated nephropathy in pregnant women. One of the most significant causes of the development of chronic glomerulonephritis today is the autoimmune mechanism. As a result, antibodies are produced to the proteins of the kidney tissue and destroy it, causing local inflammation and destructive changes.

This glomerulonephritis is a form of Bright's disease.

Also, chronic glomerulonephritis, according to its morphological forms, is divided into:

• Membranous glomerulonephritis;
• Chronic diffuse mesangioproliferative glomerulonephritis;
• Membranoproliferative;
• Fibroplastic;
• A form of focal glomerular sclerosis;
• Lipoid nephrosis.

The most common form is diffuse mesangial proliferative glomerulonephritis. Pathology is detected at a young age, more often in the male population. This form is characterized by hematuria and occurs as a result of the accumulation of immune complexes under the endothelium of small vessels of the glomerular filter of the kidneys, namely in the mesangium. This form is prognostically favorable and has a benign course.

Diffuse glomerulonephritis, treatment

The most interesting question for people faced with this form of pathology is treatment. There are certain subtleties in the treatment of acute and chronic diffuse glomerulonephritis, but the general principles of managing such patients remain.

There is pathogenetic treatment, aimed directly at the impact and elimination of the causes of the disease, symptomatic treatment, carried out when the patient has one or another manifestation of the disease, prevention of complications and relapses of the disease, and a therapeutic and protective regime using diet and hospital stay.

The main drugs used for diffuse glomerulonephritis of any course (acute and chronic) are corticosteroids, non-steroidal anti-inflammatory drugs, cytostatics, antibacterial drugs, and symptomatic therapy. Diffuse proliferative glomerulonephritis and any other form of chronic course will require the same therapy.

It is also necessary to remember to exclude the influence of predisposing factors, such as hypothermia and harmful working conditions. Carry out timely sanitation of foci of chronic infection and timely treatment acute processes in the body, including acute glomerulonephritis, in order to avoid its transition to a chronic course. It has important carrying out preventive examinations for the timely detection of the latent form, which we will discuss in the next article.

Latent glomerulonephritis

Latent glomerulonephritis is one of the forms of the clinical course of chronic glomerulonephritis. This option is very insidious, since long time can be practically asymptomatic for the patient, as a result of which timely diagnosis is difficult and, accordingly, treatment is delayed.

This clinical form is the most common among others. Clinically for the patient no visible reasons for anxiety, no swelling, hypertensive syndrome, the patient is able to work. Only minor phenomena of microhematuria or loss of protein in the urine suggest renal pathology. Rarely, patients may complain of short-term episodes of increased blood pressure, minor swelling that may not bother them, as well as general weakness and pain in the lumbar region.

Latent glomerulonephritis has a relatively favorable prognosis due to the fact that the disease has a chronic course and almost always leads to chronic renal failure, but with adequate treatment it progresses poorly. Therefore, with the pathology of latent glomerulonephritis, the patient forum cites as an example many of its own stories of the disease with fairly favorable prognosis for life. It is only necessary to adhere to the treatment regimen, in which, among other things, traditional medicine can be used. We will discuss how traditional medicine helps with glomerulonephritis later in the article.

Glomerulonephritis is a disease that requires constant monitoring and treatment. In the arsenal of specialists for the treatment of this pathology there are numerous drugs with powerful effects. But in addition to the main therapy, there is also auxiliary therapy, which includes preparations for glomerulonephritis according to traditional medicine recipes, diet, spa treatment, daily routine, etc.

Traditional treatment of glomerulonephritis

This type of therapy is only an auxiliary part of the main treatment and can be prescribed or recommended by the attending physician after a detailed examination. Herbs for glomerulonephritis alone will not cope with the disease, but can only worsen its prognosis.

But it should be noted that infusions and decoctions have a positive effect on the course of the disease, reduce inflammatory processes in the kidneys and in the body in general, and also promote recovery processes and the removal of fluid from the body and reduce the toxic effect of some drugs of basic drug therapy.

There are many recipes for herbs and individual herbs that can help in the fight against glomerulonephritis. Let's look at some of them.

Quite common in urological practice is a kidney collection, which includes plantain, horsetail, rose hips, calendula, yarrow, string. It is recommended to take this infusion three times a day, half a glass.

Traditional medicine also offers a recipe for a decoction of flax seeds, steelweed, and birch leaves. The effect of the decoction will be observed when drinking one glass per day for a long course.

Celery has proven itself well in the fight against kidney pathology. The juice of this plant must be used fresh daily, fifteen milliliters. But you can take more than just celery juice. We recommend pumpkin juice and birch juice in an amount equal to the drinking regime. This drink is a good alternative to drinks such as tea for glomerulonephritis.

Corn silk is always a good helper for kidney diseases. To do this, make an infusion in the proportion of a teaspoon of raw materials to half a liter of boiling water, you can also add cherry tails. After which the broth is infused for several hours and taken one dessert spoon up to four times a day. This product has a diuretic effect and reduces the severity of edema.

Delicious recipes are also used. To do this, you need to take one glass of honey, one hundred grams of figs, several lemons and walnuts, for glomerulonephritis, this remedy will improve kidney function. It should be taken in the form of mixed ground raw materials, two tablespoons on an empty stomach once a day.

A decoction of sea buckthorn branches is used as tea. Its restorative properties are used in many branches of medicine.

Elderberry flower is widely used in the treatment of glomerulonephritis with folk remedies. To do this, prepare a decoction from one heaped spoon of raw materials and a quarter liter of boiled hot water. The prepared decoction must be divided into four doses.

In addition to folk remedies, you should remember about your daily routine and special nutrition.

Diet table for glomerulonephritis

For glomerulonephritis, a doctor prescribes a specialized diet, once developed by nutritionist Pevzner. The main idea of ​​all subtypes of this diet (7a, 7b) is to limit protein, salt, and spices. Of course, excluding alcohol. Table No. 7a is prescribed for acute glomerulonephritis or exacerbation of a chronic process. Table No. 7b is a continuation of the previous one, when remission of the disease is achieved.

The method of preparing dishes is mainly boiled and stewed; you can take lightly fried products without breading. Meat and fish should be boiled first, and broth should not be consumed due to the accumulation of extractive substances in it.

• lean poultry, fish, preferably sea, beef;
• fresh baked goods, eggs, limited;
• low fat fermented milk and dairy products;
• most vegetables, berries and fruits in any form;
• sugar, honey, cereals, pasta;
• up to twenty grams of butter per day when added to prepared dishes;
• refined vegetable oil for cooking;
• juices of vegetables and fruits diluted with water in equal proportions.

Prohibited for consumption following products and dishes:

• smoked and pickles, even homemade;
• semi-finished products and sausages factory production;
• broths, margarine, spices and spicy foods;
• mushrooms, sorrel, peas, beans, radishes, onions and garlic;
• fatty meats (pork), fatty fish;
• carbonated drinks, strong black tea, coffee, hot chocolate;
• alcoholic drinks regardless of strength.

It should be noted that the diet is designed in such a way as to take into account all the body’s needs for nutrients, vitamins, and proteins, but at the same time reduce the load on the kidneys as much as possible.

Do not forget about the daily routine and such medical and health institutions as a sanatorium (glomerulonephritis), folk remedies are also auxiliary in the fight against the disease. But, before going to the resort, you should achieve stable remission of glomerulonephritis, and also consult with a specialist.

The daily regimen should be gentle for this pathology. Sports with glomerulonephritis, especially acute and exacerbation of chronic, are contraindicated. Otherwise, during the period of attenuation of symptoms, in each specific case, depending on the type of sport, you should consult your doctor.

If this disease develops, the patient must be provided with proper care, especially if there are complications and the process is rapidly progressing.

In order to find out what kind of care is needed for patients with glomerulonephritis, you should read the material in the following article.

Care for glomerulonephritis

With glomerulonephritis, constant care for the patient is necessary, especially in situations of exacerbation of chronic and acute conditions of glomerulonephritis, as well as in the event of complications of this disease. Typically, such care is provided by medical personnel as patients are hospitalized.

Nursing care for glomerulonephritis

The duties of a nurse include not only carrying out doctor’s orders and performing manipulations, but also creating the proper conditions for patients for their speedy recovery. Comfort, treatment, nutrition and the effectiveness of treatment depend on the proper actions of the nurse. Work average medical personnel includes several points - this is assistance in recovery, improvement of the general condition of the patient, preventive measures and relief of the condition in the event of complications that bring suffering to the patient.

In addition to the fact that the nurse carries out all the necessary doctor’s orders for collecting media for laboratory tests, preparing the patient for a particular diagnostic test, as well as directly administering drugs, her responsibilities include monitoring the frequency of doses of tablet medications and monitoring the general condition of the patient. At the same time, the nursing process for glomerulonephritis in adults and children is a series of measures to provide assistance and dynamic monitoring. The nurse is on duty next to the patients, and the responsibility falls on her shoulders to monitor the condition of the patients. At different times of the day, the patient may present certain complaints directly to the nurse, who, in turn, reports these data to the doctor. Its functions also include constant measurement of blood pressure, temperature and calculation of daily diuresis of patients suffering from glomerulonephritis.

It is also necessary to take into account the fact that nursing care for glomerulonephritis also involves assessing the quality of nutrition and meals. The nurse monitors the implementation of the attending physician’s diet recommendations. And if errors in nutrition or non-compliance are identified, she carries out explanatory work with the patient or his relatives about compliance with the regime.

Nursing interventions for glomerulonephritis

It is the nurse who performs all the items listed on the appointment sheet. The main interventions are intramuscular and intravenous injections drugs. Also, if necessary, during diagnosis, especially through radiography and other methods, the nurse prepares the patient as follows:

• Explain the principle of preparation for the study to the patient;
• Monitor compliance with the fourth diet on the eve of the study;
• Monitor your laxative intake before the procedure or perform an intestinal enema;

Since with glomerulonephritis the patient’s condition is constantly monitored through urine tests, nurse explains:

• how to collect liquid;
• in what container and at what time of day;
• how to label a container with collected urine;
• teach how the patient can independently collect data on daily diuresis.

One of the main tasks of medical personnel is urgent Care with glomerulonephritis. This disease is accompanied by severe edema, hypertension and other complications that can cause the appearance of emergency. But taking into account the fact that it is the nurse who is constantly with the patients, the further prognosis of the patient’s condition will depend on her initial actions. And so, for the disease glomerulonephritis, the standard of care for the spontaneous occurrence of severe complications is:

• If eclampsia develops, they try to prevent tongue biting (put a handkerchief or rubberized object between the teeth). Magnesium sulfate 25 percent solution and 20-30 milliliters of 40 percent glucose are also administered intravenously or intramuscularly;
• Convulsive syndrome is relieved with sibazon;
• If excessively high blood pressure occurs, it is reduced with sodium nitroprusside 10 mcg per kilogram of body weight per minute or labetalol. It is possible to use furosemide; nifedipine has a good effect under the tongue or intravenously;
• But the nurse is always the first to inform the doctor about the occurrence of acute conditions.

In cases where the patient is at home due to the pathology of glomerulonephritis, the clinic can provide nursing care by agreement as state aid, or privately in collaboration with commercial entities.

Of course, the disease glomerulonephritis requires constant care for patients, and not only during treatment, but also during prevention, the measures of which will be discussed in the next article.

Prevention

Any pathological condition in medicine can and should be prevented, this also applies to glomerulonephritis. Basics preventive methods in acute and chronic glomerulonephritis are the same.

Glomerulonephritis prevention primary and secondary

Prevention measures can be divided into primary and secondary.

Primary prevention of glomerulonephritis is a set of measures aimed at preventing the occurrence of this disease in people predisposed to it due to the presence of certain factors. That is, if there are harmful working conditions, it is necessary to change them, avoid hypothermia and prolonged exposure to a damp, cold climate. Also, do not inject drugs for the first time, without conducting an appropriate test for them in people with high allergenicity of the body. The same applies to vaccinations and the administration of various serums. If a focus of streptococcal infection appears, immediately begin treatment and dynamic monitoring of the condition of all organs and systems, including the kidneys. Carry out regularly preventive examinations and conduct an ultrasound examination of the urinary system.

Secondary prevention of glomerulonephritis includes preventing relapse of the disease when it occurs, even once (this applies to acute glomerulonephritis), or its progression (in the case of a chronic course). To do this, the patient must adhere to a special diet, reduce physical activity, and exclude active sports. It is necessary to change working conditions to more favorable ones, you also need to regularly undergo prescribed treatment and observation by a nephrologist, and if indicated, be hospitalized in a hospital.

In the prevention of glomerulonephritis, the role of sanatorium-resort treatment and timely rehabilitation after glomerulonephritis are important. This program is designed for the period after acute glomerulonephritis, as well as rehabilitation for chronic glomerulonephritis, with attenuation of symptoms and achievement of clinical and laboratory remission. It is a complex therapeutic exercises and exercises in order to stabilize the condition, reduce congestion, improve renal blood flow, activity of the cardiovascular system, and normalize the emotional status of the patient. As well as following a diet and taking certain herbal remedies or traditional medicine under the supervision of a specialist and only with his prescription and recommendations. Each set of exercises is prescribed individually according to a specific program.

But any rehabilitation and prevention must be carried out competently and under the supervision and consent of a specialist, since failure to comply with certain rules can lead to a deterioration in the patient’s condition and the development of complications. We will describe what complications may arise in the next article.

Complications of glomerulonephritis

Both acute and chronic glomerulonephritis can provoke the development of severe complications and also lead to undesirable consequences.

The main complications of glomerulonephritis in adults

As a rule, complications can develop with acute glomerulonephritis and the progressive course of chronic glomerulonephritis. For example, in the case of the development of uncontrolled hypertension, or anuria and other symptoms and syndromes accompanying this disease. Why is glomerulonephritis dangerous?

• Acute renal failure may develop;
• The appearance of acute heart failure;
• Cerebral edema provokes the development of an eclamptic state;
• Due to blood clotting disorders, thrombus formation develops and the risk of pulmonary embolism develops;
• Hemorrhagic stroke of the brain is also observed as a complication of glomerulonephritis;
• Due to prolonged high blood pressure, retinopathy appears, turning into retinal detachment;

Consequences of glomerulonephritis

The adverse consequences of this disease include the development of disability in the patient as a result of complete loss of kidney function and forced constant hemodialysis. The constant need for observation and inpatient treatment should be taken into account due to the emergence of aggravated course of the disease and restrictions in the patient’s life activities. Also, with the development of certain complications, in the absence of an adequate response of the body to emergency measures and therapy, the patient’s death may occur. Also, death is observed not only after the development of an attack of eclampsia, for example, or a cerebral hemorrhage, but as a result of failures of all compensatory mechanisms and the onset of the decompensation stage. For example, prolonged high blood pressure has a detrimental effect on the body as a whole and aggravates the course of the disease. We will talk about this and much more in the next article.

Pressure with glomerulonephritis

Arterial hypertension in glomerulonephritis is an integral symptom in its acute and chronic course.

Pressure in acute glomerulonephritis

Acute glomerulonephritis, in addition to the variety of symptoms, is manifested by increased blood pressure. As a rule, the pressure does not reach high numbers, while systolic can be about 180, and diastolic about 120 mmHg. At the same time, hypertension does not last long and responds quite well to drug correction. But, also in the presence of high blood pressure, acute left ventricular failure can develop with further pulmonary edema, and as a result lead to hypertrophic processes of the myocardium. It is also possible that it affects the brain due to swelling of its tissue, which provokes an attack of eclampsia.

The mechanism of increased blood pressure in chronic glomerulonephritis

In chronic glomerulonephritis, there is also a symptom of increased blood pressure, and in the presence of this symptom as the main one, even one of the clinical forms of glomerulonephritis is distinguished - hypertensive. At the beginning of the development of the disease, blood pressure with glomerulonephritis increases slightly, episodes of increased blood pressure are rare and patients rarely seek help with them. As the pathology progresses, hypertension becomes stable, diastolic pressure especially often increases, and reaches high numbers. Although the course of the disease is slow, it has a tendency to progress. As a result, pathology causes glomerulonephritis and renal failure.

This symptom entails many disorders and complications. Chronic renal failure is accompanied by retinopathy, swelling of the optic nerve, and retinal detachment may occur. Headaches, pain in the heart area, and rhythm disturbances also appear.

The mechanism of increasing blood pressure itself is based on excess accumulation of fluid in the body, including in the bloodstream, as a result of which the volume of circulating blood increases, which forces the heart muscle to contract more actively in order to “drive” the resulting volume throughout the bloodstream. Following this, peripheral vascular resistance is formed, which further aggravates the situation. As a result, the heart is forced to push an already significant volume of blood, but in addition to this, it also has to overcome the increased resistance of the vascular wall. Also, at the same time, activation of coagulation and fibrin deposition in the renal tubules occurs, as a result of which the capillary resistance in the kidneys increases, the blood thickens, which becomes more difficult to push through small vessels, and the circle closes.

These phenomena in the case of chronic glomerulonephritis take a long time to form, but steadily lead to persistent hypertension. It should be noted that for any pathology, glomerulonephritis, the pulse is not an indicative symptom unless heart failure has developed.

Prognosis of arterial hypertension

In the case of increased blood pressure during acute glomerulonephritis, the prognosis is quite favorable due to the high rate of cure of this disease. As a result, the symptom of hypertension goes away along with the pathology.

The chronic course of the pathology is more complicated. It is necessary to select symptomatic therapy that corrects pressure and strictly adhere to it. Including many restrictions for such patients. Read on to find out which ones exactly.

Restrictions

Glomerulonephritis is a serious disease that requires an integrated approach to treatment. Taking into account the pathogenesis, glomerulonephritis requires patients to comply with all rules regarding lifestyle, nutrition, and daily routine, in which there are many restrictions. Let's look at the main ones in question-answer mode.

Is it possible to play sports with glomerulonephritis?

The disease in the stage of attenuation of symptoms involves rehabilitation in the form of physical therapy in order to increase the tone of the whole body, improve renal blood flow and urine outflow. But, if the patient was involved in sports professionally before illness, then increased physical activity is contraindicated in chronic cases, and is limited until recovery in acute glomerulonephritis. You cannot participate in sports competitions and championships a year after suffering an acute illness, and throughout your life if it is chronic.

Of course, each case is unique and needs to be approached individually, and before physical activity, consult a specialist.

Is it possible to eat seeds if you have glomerulonephritis?

According to the diet tables developed for this disease, namely No. 7, No. 7a, No. 7b, eating sunflower seeds is contraindicated. Since the product is fatty and also fried, which does not correspond to the basic concept of the entire diet for glomerulonephritis.

Can glomerulonephritis be cured on its own?

Glomerulonephritis is a disease that requires mandatory hospitalization in a hospital, since it can result in various life-threatening conditions for the patient. If self-medication is attempted, the patient’s condition may sharply worsen, which will lead to irreparable consequences, numerous serious complications, or even fatal outcome. And in the case of an acute process, it becomes chronic. Therefore, it is best to entrust the treatment of glomerulonephritis to specialists.

When glomerulonephritis has developed, can you drink alcohol?

Alcohol is a terrible enemy for any kidney disease, as it puts a heavy burden on the body’s excretory function. In the case of glomerulonephritis, there is serious damage to the glomerular filter, as a result of which the process of filtering the body's waste products is difficult. Therefore, if the kidneys are also loaded with alcohol breakdown products, many serious conditions can be provoked, including the development of acute renal or heart failure.

One of the common questions is the possibility of carrying a pregnancy to term with glomerulonephritis, which we will discuss in the next article.

Glomerulonephritis during pregnancy

In pregnant women, acute glomerulonephritis is quite rare, perhaps due to increased production of glucocorticoids. There are also rare cases of exacerbation of chronic glomerulonephritis, but pathology does occur during pregnancy and significantly aggravates the course of pregnancy.

How does glomerulonephritis occur during pregnancy?

A number of scientists have conducted studies of patients who suffered late pregnancy gestosis. As a result of a puncture biopsy of the kidneys, signs of glomerulonephritis were morphologically identified in all examined women. Therefore, it can be assumed that glomerulonephritis can be hidden under the guise of gestosis, and perhaps even provoke its onset during pregnancy.

As a rule, glomerulonephritis in pregnant women occurs with signs of hypertensive, nephrotic and mixed syndromes.

The hypertensive form of glomerulonephritis during pregnancy is a risk for many complications of both pregnancy and the woman’s health. Against the background of constant hypertension, termination of pregnancy may occur at short stages; at later stages of gestation, such interruptions cause massive uterine bleeding. The risk of intrauterine growth retardation also increases due to constantly impaired blood flow due to spasm of peripheral vessels. It should be noted high risk the occurrence of preeclampsia and eclampsia during pregnancy, in comparison with the usual condition of women with this disease. The development of eclampsia is a risk for the fetus and also threatens the health and even life of the mother.

Against the background of the disease, glomerulonephritis during pregnancy with nephrotic syndrome also has an unfavorable prognosis. This clinical form is accompanied by massive proteinuria, hypercholesterolemia, and the presence of edema, which can develop up to anasarca. With such a critical condition of the body, premature placental abruption may develop with the development of bleeding, and cases of antenatal fetal death are possible.

Also, women with membranous nephropathy may experience severe complications. This pathology is accompanied and complicated by thrombosis of small renal vessels, and subsequently the renal veins, which can provoke acute renal failure, as well as lead to the detachment of a blood clot and pulmonary embolism.

Glomerulonephritis: can you give birth or not?

The issue of carrying a pregnancy to term if a woman has glomerulonephritis is decided in each individual case purely individually on the basis of all diagnostic data and only in a hospital setting. But, in general, we can say with confidence that the presence of glomerulonephritis is a high risk of obstetric complications, which a woman should be fully aware of before pregnancy.

Also, women suffering from glomerulonephritis are concerned about the method of delivery: whether it is possible to give birth with glomerulonephritis on their own or not. As in the case of pregnancy, such a decision is a combination of nephrological, obstetric and general somatic factors. The woman must be hospitalized in advance in an obstetric hospital of the third level of accreditation, where the issue of management of childbirth is decided by the council. Generally speaking, it is always recommended to conduct childbirth conservatively, that is, naturally, and proceed to surgical delivery only according to strict indications.

You can also find out a lot of interesting information on the forums. The women's forum will tell you first-hand about pregnancy with glomerulonephritis. But you should not completely trust everything that is said, since each case is unique and needs an individual clinical analysis.

Forecast

The prognosis for the disease glomerulonephritis largely depends on the course of the disease (acute or chronic), on the clinical form, progression, etc.

Prognosis of acute glomerulonephritis

The prognosis for the development of acute glomerulonephritis also largely depends on its clinical course, however, in terms of health and life it is more favorable in comparison with its chronic course. But often, if acute glomerulonephritis has been neglected, or does not respond well to drug treatment, and continues for more than a year, then it can become chronic, and as a result, the prognosis for recovery changes. The acute process itself is quite productively cured, resulting in recovery. But even after this, the patient needs to continue observation and adherence to the regimen for another year to prevent transition to a chronic course.

Prognosis for chronic pathology

In the case of the development of chronic glomerulonephritis, depending on the clinical and morphological form, the prognosis changes. Thus, hematuric glomerulonephritis has a relatively favorable life prognosis, but in any case, chronic renal failure develops within ten to fifteen years if all recommendations and regular treatment are followed.

In the case of autoimmune glomerulonephritis, the prognosis depends on the degree of damage to the renal tissue and the degree of progression of the process. The chronic course of the pathology is most often caused by an autoimmune process in the body. To prolong kidney function and improve quality of life, the patient must undergo ongoing treatment. There is no recovery in such a situation.

Priority problem in glomerulonephritis

To understand the possible chances of recovery or a long-term favorable course of the disease, the pathogenesis of glomerulonephritis should be taken into account. Indeed, as a result of the pathological process, immune destruction and inflammation of the glomerular tubules occurs. It is also necessary to take into account all risk factors and complications that arise during the course of the disease. In the presence of a hypertensive form, there is always a risk of the appearance of pathological processes in the cardiovascular system, or pathology of the retina.

All forms of chronic disease can lead to disability, and this is the main problem of glomerulonephritis. It should also be remembered that renal failure and complete shrinkage of the kidney can always develop, which entails a complete loss of its function. And, as you know, without of this body life is impossible, and such patients have to undergo regular hemodialysis, and organ transplantation is also possible - these are potential problems with glomerulonephritis.

The resulting glomerulonephritis brings the patient's problems mainly in the form of discomfort, which consists in the need for dynamic clinical observation, treatment and constant diagnostics. The usual rhythm of life also changes, many restrictions arise on physical activity, nutrition, etc.

It must be remembered that only acute glomerulonephritis has a chance of complete recovery, and chronic, depending on the form of the course, always leads to the development of chronic renal failure, and even to the death of the patient. And what is most unpleasant about this disease is that the pathology most often affects young people, especially young children, mostly males, can be affected. The occurrence of glomerulonephritis in a child worsens the further prognosis for his health and life. We will consider the course of glomerulonephritis in childhood in more detail in the next article.

Glomerulonephritis in children

Glomerulonephritis is a polyetiological disease with elements of immune inflammation of the renal tissue, mainly the glomeruli. Most often, this pathology is bilateral in nature and occurs as a result of an infectious factor.

Glomerulonephritis in children, etiology

Predisposing factors, such as prolonged hypothermia and the influence of a cold, humid climate, should not be discounted.

All of the above options are a trigger for the processes of antibody production and the deposition of immune complexes on the vascular endothelium and glomerular membranes. As a result, the process occurs local inflammation in the glomerular apparatus.

Glomerulonephritis syndromes in children, pathogenesis, classification

Depending on the various manifestations, both clinical and morphological, as well as along the course, they are distinguished the following types glomerulonephritis in children:

• By pathogenesis:
• The primary variant with the presence of an immune complex, which is characterized by an acute onset and recovery during treatment within one year.
• And secondary glomerulonephritis in children, the pathogenesis of which is an autoimmune variant with the development of inflammatory immune processes of the body’s own against the endothelium of its own renal vessels and glomerular membranes.
• Also classified according to the course into acute and chronic process;
• The stages are divided into the stage of exacerbation, remission, which in turn is divided into complete and incomplete;

Among the forms of clinical course, otherwise called syndromes, are presented:

• Nephrotic
• Hematuric
• Mixed

According to the functional state of the kidneys:

• With saved function
• With impaired kidney function

And according to morphological characteristics they are divided into:

• Proliferative glomerulonephritis in children
• Non-proliferative.
• Let us examine in more detail the syndromes or forms of clinical course in children.

Glomerulonephritis in children, clinical forms

The nephrotic form or syndrome affects children aged one to seven years. The pathology of glomerulonephritis in the general mass covers more males than females. Clinically, this syndrome manifests itself in the form of significant edema, which can be aggravated and present in the chest cavity, pericardial cavity and abdominal cavity. There are also symptoms of general intoxication, nausea, weakness, lethargy, and pale skin. During an objective examination, the doctor notes an increase in the size of the liver; laboratory tests reveal significant proteinuria, and hematuria may appear. In clinical blood test high performance ESR, leukocytosis, in a biochemical study of blood serum - hyperlipidemia, hypoproteinemia.

The clinical picture of glomerulonephritis in children with hematuria syndrome manifests itself in the form of moderate edema, often located on the face, decreased body weight, and most importantly, increased blood pressure. Hypertension may appear within a few hours and last up to several days. The child may experience headache, nausea, and increased body temperature. An objective examination by a doctor notes the presence of tachycardia and muffled heart sounds. Also, in the hypertensive form, urinary syndrome is present with the presence of blood in the urine and protein. Laboratory examination of the patient reveals leukocytosis, increased ESR, and hypercoagulation. This form is typical for the age group after five years.

If a child has a mixed form of clinical course, the symptoms of the disease will be as follows: increased blood pressure with a tendency to progress, the spread of edema in the lower extremities, face, and more. The doctor notes an increase in the size of the child’s liver, as well as symptoms of intoxication of the body ( elevated temperature body, nausea, vomiting, weakness, physical inactivity). Also, post-streptococcal glomerulonephritis in children is also manifested by urinary syndrome, which indicates severe damage to the glomerular apparatus.

Treatment and follow-up of children with glomerulonephritis

The approach to treatment, especially in childhood, is complex and is aimed at the influence of etiological and pathogenetic factors, as well as symptomatic treatment.

Inpatient treatment with strict bed rest.

Diet table No. 7a (b).

Antibiotic therapy with penicillins or macrolides if tolerated.

The use of anticoagulants - chimes, heparin, as well as non-steroidal anti-inflammatory drugs.

Symptomatic therapy consists of reducing and stabilizing blood pressure, reducing swelling and increasing the amount of urine per day.

After achieving clinical and laboratory remission or complete recovery, the child remains under the supervision of nephrologists for a long time and adheres to the necessary recommendations.

In the event of diseases such as pyelonephritis, glomerulonephritis in children, the prognosis for the future is often favorable. But in the event of an episode of relapse of the disease glomerulonephritis within five years after its cure, the pathology is considered chronic. Long-term chronic glomerulonephritis, or rapidly progressing one, always sooner or later leads to the development of chronic renal failure.

Often, parents diagnosed with glomerulonephritis in children use the forum as a hint on what to do in this situation. It is only worth noting that with this pathology it is necessary to seek specialized help in a hospital, since pediatrics considers childhood glomerulonephritis as a rather severe pathology that cannot be dealt with independently at home.

It's two way autoimmune disease kidneys, more often of infectious etiology, with predominant damage to the glomerular apparatus. In this case, the renal tubules and interstitial tissue are affected to a lesser extent and usually secondarily. There are acute, often rapidly progressing, and chronic glomerulonephritis.

Glomerulonephritis together with pyelonephritis and urolithiasis is one of the most common kidney diseases. In Ukraine, the incidence of acute nephritis per 100 thousand population is 10.9 in the city and 13.8 in the village, chronic - 15.1 and 21.9, respectively. In recent years, both around the world and in Ukraine, an increase in the number of patients with glomerulonephritis has been noted. In Ukraine, the prevalence of acute glomerulonephritis is about 90 per 100 thousand population. The medical and social significance of glomerulonephritis is determined by the affection of predominantly young people, the severity of the course and, often, an unfavorable prognosis. Mortality from glomerulonephritis in different countries ranges from 3.1 to 5-6 people per 1 million population per year, with the maximum rate occurring at the age of 20-40 years.

Acute glomerulonephritis is more common in countries with cold and humid climates. Mostly children aged 5-12 years and young men are affected, and no more than 1% of patients are over 60 years of age. In men, acute glomerulonephritis occurs twice as often as in women, but after 45 years this difference is leveled out.

The cause of glomerulonephritis more often are the so-called nephritogenic strains of hemolytic streptococcus group A (acute post-streptococcal glomerulonephritis), which primarily include strains 1, 4, 12 and 25, less often - 13, 20, 39, etc. Strain 12 is more often the cause of small epidemics of glomerulonephritis after respiratory diseases, while others cause sporadic cases of disease.

Acute glomerulonephritis occurs mainly after acute respiratory diseases, tonsillitis, exacerbation of tonsillitis, pharyngitis, otitis, other foci of chronic infection, as well as after pustular skin diseases. The role of scarlet fever in its development has recently decreased significantly. In addition to streptococcal infection, other bacterial pathogens can cause acute glomerulonephritis, especially staphylococcus, pneumococcus, treponema pallidum, protozoal (malaria, schistosomiasis, etc.) and viral infections. Thus, the hepatitis B virus antigen in most cases is the cause of membranous glomerulonephritis. The nephrotropism of other viruses has also been established - hepatitis C, Epstein-Barr, cytomegaloviruses.

In acute non-streptococcal post-infectious glomerulonephritis, infection (general (sepsis), upper respiratory tract, lungs, etc.) often not only precedes the onset of kidney disease, but also persists in the body until the time of its manifestation.

Hypothermia and high air humidity are considered as factors contributing to the occurrence of glomerulonephritis. They can also be injuries, operations, childbirth, alcohol abuse, excessive physical activity. Acute glomerulonephritis can develop after vaccination, administration of serums, medications, toxic substances, in particular alcohol (especially its surrogates).

The pathogenesis of acute glomerulonephritis is based on immunopathological mechanisms:

• immunocomplex (in 80-90% of all cases),
• autoimmune with antibodies of the antibasal membrane of the glomeruli (in 10-20%).

Immune complex glomerulonephritis cause immune complexes, among which, depending on the place of formation, two variants are distinguished:

• glomerulonephritis with circulating immune complexes that form in the vascular bed and are retained in the kidneys for the second time;
• glomerulonephritis, which is caused by the local formation of immune complexes directly in the glomerulus.

Antigens in immune complexes can be of both exo- and endogenous origin. The nature and extent of kidney damage in glomerulonephritis caused by circulating immune complexes depend on their size, localization in the glomeruli, the degree and nature of the damaging effect in the glomerular tissues, as well as the activity of phagocytic systems. Immune complexes activate the coagulation factor (Hageman factor) and, released by the kidneys, locally activate the blood coagulation system. Monocytes are also important mediators of immune inflammation in the glomeruli. Genetic predisposition plays a certain role, as evidenced by the association of glomerulonephritis with certain antigens. Genetic factors also influence the rate of progression of the disease and its prognosis. Several streptococcal antigens have been isolated, which, being part of immune complexes, due to their positive charge, easily pass through the basement membrane. Nephritogenic streptococci contain neurominidases, which are capable of changing the antigenic structure of their own immunoglobulins, in particular class B, and thereby increase their immunogenicity.

At autoimmune glomerulonephritis the main damaging factor is antibodies to glomerular basement membrane antigens, which often cross-react with tubular basement membrane antigens. U healthy people antigens of the glomerular basement membrane, formed by its collagen glycoproteins, are excreted in the urine. For the occurrence of glomerulonephritis, contact with immunocompetent cells is required when they enter the systemic bloodstream, which occurs under the influence of infections, especially viral ones, toxic substances, ischemia, and immunogenetic factors.

The progression of glomerulonephritis is determined by non-immunological mechanisms, primarily arterial hypertension, for example, causes deformation of protein molecules and damage to endothelial cells and small processes of podocytes, and this leads to increased vascular permeability and an increase in proteinuria. By reducing the resistance of afferent arterioles and increasing transcapillary pressure, arterial hypertension leads to ischemic sclerosis of the glomerulus.

Sclerosis of the intrarenal vessels largely determines the prognosis of glomerulonephritis, since it disables the glomerulus and leads to the replacement of the damaged part with scar tissue. The pressure in the glomeruli of the kidneys can increase without the presence of arterial hypertension or precede it. This also applies to sclerosis of intrarenal vessels, the most important pathogenetic mechanisms of which are hypercoagulation and thrombosis of the glomerulus. The development of glomerular sclerosis accelerates hyperfiltration of protein in case of its significant content in the diet, as well as proteinuria more than 2 g per day.

In the initial period of the disease, the kidneys change little. But already from the middle of the 2nd week of the disease, both on their surface and on the “cut”, a picture of the so-called variegated bud is observed; red stripes or small grains also appear along the way.

The consistency of the buds is soft, the capsule is easily removed. Data from intravital biopsy indicate the predominance of glomerular hyperemia and exudative changes at the onset of the disease, and subsequently endocapillary proliferation of the endothelium with narrowing of the lumen of the capillaries and, to a lesser extent, the exocapillary zone. In some cases, the glomerular capsule and the lumen of the tubules contain predominantly protein exudate, in others - erythrocyte exudate. Damage to the basement membrane of the glomerular capillaries is usually minor and is limited to focal thickening in areas of endothelial proliferation, sometimes to splitting. The epithelium of the tubules is swollen, with manifestations of hyaline degeneration. Moderate infiltration of interstitial tissue is often observed. After recovery, a few months from the onset of the disease, complete regression of histological changes is noted.

Acute glomerulonephritis usually occurs on the 5-21st day after an infection or hypothermia, but in some cases earlier (mainly with non-streptococcal nephritis) and later development is observed. Sometimes the cause of the disease cannot be determined. This is often explained by the sluggish, asymptomatic course of the previous infectious process, the presence of an unidentified focus of infection.

The classic clinical picture of acute glomerulonephritis is characterized by a rapid onset of a triad of symptoms: edema, hematuria, arterial hypertension.

Diuresis is often reduced; many patients complain of weakness, headache, and lower back pain (usually aching, less often stinging). These symptoms are most likely associated with stretching of the kidney capsule due to an increase in their volume, which occurs at the onset of the disease.

In addition, shortness of breath due to pulmonary edema and large pleural effusion may be observed.

Swelling, often the first symptom of the disease, develops quickly, appearing first on the face, especially around the eyes, then on the bones, torso, and in cavities. The severity of edema may vary. Latent edema is possible, which can only be determined by systematic weighing. Swelling may appear after some time from the onset of the disease.

Arterial hypertension usually occurs simultaneously with edema and changes in urine in 60-85% of patients. Blood pressure often increases slightly - 150-160 / 90-100 mm Hg. Art., in 2/3 of patients such an increase lasts less than 1 month, often several days, rarely longer.

Most often, signs of the disease appear after a sore throat or acute respiratory viral infection. The patient is found to have proteinuria, the level of which does not exceed 3 g per day, in combination with erythrocyturia and cylindruria. Erythrocyturia is a common sign of the disease. Based on intensity, a distinction is made between macrohematuria (bloody-colored urine is produced) and a hematuria component, when the number of red blood cells is 5*10 in 1 ml of urine or more in the urinary sediment. In some patients, leukocyturia with a predominance of lymphocytes is determined.

The main symptoms of glomerulonephritis persist from 2-6 weeks to 2-6 months or more. Normalization of all clinical and laboratory parameters within 42 months indicates complete remission; absence of changes in urine for 5 years indicates recovery. Identification of urinary syndrome or nephrotic syndrome 12 months after the onset of the disease means that the acute form of glomerulonephritis has become chronic.

How to treat glomerulonephritis?

Treatment of glomerulonephritis is carried out in accordance with the following basic approaches:

• hospitalization in the nephrology (therapeutic) department;
• non-strict bed rest for the period of edema and/or acute hypertensive reaction;
• limiting fluid to 1000 ml (for adults), table salt to 3 g per day, protein to 80 g per day for a period of up to 2 weeks;
• antihypertensive and diuretic therapy (pathogenetically justified prescription of diuretics);
• antiplatelet therapy (aspirin 75-150 mg per day or dipyridamole 225-300 mg per day for 3-6 weeks);
• anticoagulant therapy (for 7-14 days);
• antibacterial therapy (if there are signs of a bacterial infection, and some doctors recommend in all cases of post-streptococcal glomerulonephritis); penicillins, cephalosporins, etc.;
• treatment of complications or concomitant diseases.

The prescription of antibiotics is indicated for patients whose acute glomerulonephritis was preceded by a streptococcal infection (angina, scarlet fever) or another infectious disease of known etiology (pneumonia, etc.). Especially energetic antibacterial therapy should be prescribed to patients with the nephrotic variant of the disease. It is advisable to conduct a bacteriological study of the relevant material (smear from the nasopharynx, sputum), which includes determining both the species composition of microorganisms and their sensitivity to drugs. But even before receiving the results of the antibiotacogram, benzylpenicillin and semisynthetic penicillins should be prescribed.

After receiving an antibiogram, appropriate adjustments are made to the treatment and continue for up to 14-20 days, and if the active infection persists in the outbreak, longer. In case of intolerance to penicillins, macrolides (erythromycin, clarithromycin, etc.) are widely used.

Treatment of glomerulonephritis antibiotics should be combined with the oral administration of desensitizing agents (calcium, suprastin, diphenhydramine, fencarol, diazolin) and vitamins (especially ascorbic acid). From the first days of illness, it is necessary to sanitize foci of infection in the oral cavities and nasopharynx with the help of drug antimicrobial therapy, inhalations, and physiotherapeutic measures.

To reduce swelling and lower blood pressure, diuretics are prescribed. Preference should be given to saluretics, which provide not only a diuretic, but also a hypotensive effect and a beneficial effect on heart failure. Thiazide diuretics are less effective.

If the nitrogen excretory function of the kidneys is preserved, aldosterone antagonists (veroshpiron, aldaggon) are advisable. They, like ACE inhibitors (captopril, enalapril), are especially indicated for arterial hypertension and the presence of circulatory failure (short courses of up to 7 days). In the absence of arterial hypertension and heart failure, osmotic diuretics (20% mannitol solution intravenously) are indicated.

Pathogenetic treatment of glomerulonephritis aimed at eliminating the autoimmune process and intravascular coagulation changes. Most pathogenetic treatments for glomerulonephritis (GCS, cytostatics, heparin, plasmapheresis) have a wide range of action, disrupt homeostatic processes, and often lead to complications.

Glucocorticosteroids and cytostatic immunosuppressants are indicated for nephrotic syndrome, when remission does not occur and all signs of an active autoimmune process in the kidneys persist. General indications for the use of GCS in acute glomerulonephritis are pronounced activity renal process, the presence of nephrotic syndrome without severe arterial hypertension and hematuria, prolonged course of acute nephritis.

When performing pulse therapy with cyclophosphamide, the following conditions should be observed:

• to prevent severe bone marrow suppression, the dose should correspond to the glomerular filtration rate (GFR), since cyclophosphamide metabolites are excreted by the kidneys;
• it is necessary to strictly monitor the level of leukocytes on the 10th and 14th day after pulse therapy;
• to prevent nausea and vomiting, serotonin receptor antagonists are recommended: cerucal, zofran, dexamethasone;
• to prevent toxic effect cyclophosphamide metabolites on the mucous membrane Bladder stimulate frequent urination (increased oral fluid intake).

Indications for the use of heparin for acute glomerulonephritis:

• nephrotic variant of the disease, in the development of which intravascular coagulation with fibrin deposition in the renal glomeruli plays an important role;
• development of acute renal failure in acute glomerulonephritis;
• DIC syndrome in the hypercoagulable phase.

The course of treatment with heparin is 6-8 weeks; if necessary, treatment can be extended to 3-4 months. After completion of treatment, the use of indirect anticoagulants (phenyline) is recommended for 2-3 months. Effective use of heparin is difficult high frequency side effects, mainly bleeding

For long-term acute glomerulonephritis, especially with the presence of nephrotic syndrome, the use of drugs that improve microcirculation in the kidneys is indicated: dipyridamole, trental, acetylsalicylic acid, which is often combined with kurangil.

With significant proteinuria, NSAIDs (indomethacin or voltaren, ibuprofen) are indicated, the effect of which is explained by a decrease not only in the permeability of glomerular capillaries for protein molecules, but also in the pressure inside the capillaries, as well as a decrease in the filtration surface of the latter.

What diseases can it be associated with?

TO frequent complications Acute glomerulonephritis includes renal, acute left ventricular failure and acute renal failure. The frequency of hypertensive encephalopathy and eclampsia in recent years has decreased to 2-3.3%. Encephalopathy can occur in the event of a sharp and significant increase in blood pressure. Its precursors are unbearable headache, nausea, agitation, short-term amaurosis, increased tendon reflexes, positive symptom Babinsky. Subsequently, the patient suddenly loses consciousness, epileptic convulsions appear, and the pupils dilate. The attack lasts 3-5 minutes and can be repeated several times a day.

Renal eclampsia is caused by vasospasm, cerebral edema and increased intracranial pressure. During fundus examination, swelling of the retina and optic nerve head is detected.

Acute left ventricular failure complicates the course of the disease in people with arterial hypertension, especially in older people with concomitant heart and lung diseases. In recent years, the incidence of this complication has decreased significantly.

AKI is more often observed in children and the elderly. Morphological studies It has been established that in patients with glomerulonephritis it is not caused by the necrotic process in the tubular epithelium, which is characteristic of acute renal failure of other etiologies, but by a decrease in the functional parenchyma, mainly due to significant swelling of the endothelium and obstruction of the glomerular capillaries by blood clots.

Treatment of glomerulonephritis at home

All patients with acute glomerulonephritis should be hospitalized. In the hospital, they should be on bed rest until edema, arterial hypertension and oliguria completely disappear. Bed rest for at least 2 weeks is also necessary for the monosyndromic variant of the disease, since staying in bed under a warm blanket ensures uniform warming of the body and improves kidney function. Bed rest is canceled as soon as hematuria or erythrocyturia disappears or significantly decreases. The average duration of bed rest is 3-4 weeks, but in case of severe disease and complications it can last 1.5-2 months.

Patients with acute glomerulonephritis with isolated urinary syndrome without arterial hypertension in the first days of the disease should limit protein intake to 60-80 g with a sufficient content of essential amino acids and salt - up to 3-5 g per day. Protein restriction is indicated taking into account its loss, that is, the amount of daily proteinuria, table salt is limited to 2 g per day, and the amount of fat and simple carbohydrates is slightly reduced (diet No. 7).

The amount of fluid consumed should not exceed the daily diuresis by more than 300-400 ml. In the presence of arterial hypertension, fluid restriction is determined by the degree of heart failure. Protein must contain all essential amino acids, which determines the need to introduce chicken eggs, boiled meat, and fish into the diet. Dishes containing extractive substances (broth, fish soup, jelly, etc.) are contraindicated.

For hematuria or significant erythrocyturia, calcium-rich foods (skim milk, calcined soft cheese, orange juice) are recommended. For improvement taste qualities food, it is allowed to use weak vinegar, boiled and fried onions, peppers, dry dill, cranberries, cumin. All vegetables and fruits can be consumed raw, fried or stewed; meat and fish can be fried only after preliminary boiling.

In patients with severe nephrotic syndrome and high arterial hypertension, fasting and avoidance of fluid intake may be recommended for 1-2 days. After the disappearance of extrarenal symptoms and urinary syndrome, with the exception of minor proteinuria, it is suggested to adhere to the diet recommended above for another 1-2 months, after which patients are transferred to a general diet rich in vitamins (especially ascorbic acid) and with a moderate restriction of table salt (up to 8-10 g).

Sanatorium-resort treatment of patients with acute glomerulonephritis is contraindicated within 12 months from the onset of the disease.

In the case of a favorable course of the disease, if there is no edema, arterial hypertension, changes in urine, the patient should not perform heavy physical work for 2-3 years, work in the open air, in a damp, cold room, especially at night, get hypothermic, overheat, overwork .

For patients who have had acute glomerulonephritis, it is established dispensary observation, carried out within 3 years from the date of the first normal urine test. Dispensary observation includes questioning, examination, blood pressure monitoring, general urine analysis, determination of daily proteinuria, and quantitative study of urinary sediment. The same studies, as well as a general blood test, should be carried out after colds, hypothermia, injuries and surgical interventions.

If a relapse is suspected, it is advisable to conduct a complete biochemical blood test. If the tests worsen, patients are hospitalized. Before removing the patient from the dispensary register, in addition to the above examinations, GFR, blood protein spectrum, and cholesterol levels should be determined.

What drugs are used to treat glomerulonephritis?

• - at a dose of 0.075 to 0.1 g per day;
• - on average 2 g per day;
• - 0.25-0.5 g per day orally;
• - 300,000 - 400,000 units per day intramuscularly every 4 hours;
• (unfractionated) - at a dose of 15,000 - 40,000 units per day (divided into 3-4 doses), occasionally special indications doctor - 50,000 - 60,000 units per day;
• - orally in tablets of 0.025-0.05 g 2-3 times a day for 25-30 days;
• - 40-80 mg per day orally for 4-5 days, followed by a break for 1-2 days; in case of insufficient effect, the dose of the drug is increased to 120-160 mg per day;
• - 4-8 mg orally 3-4 times a day;
• - 10 mg 3 times a day;
• - 0.2-0.3 g per day;
• - at a dose of 0.1-0.2 mg per 1 kg of body weight per day.

Treatment of glomerulonephritis with traditional methods

Treatment of glomerulonephritis folk remedies are not able to have sufficient effect if herbal medicine is used as an independent method of treatment. Typically, glomerulonephritis becomes a reason for hospitalization and the prescription of potent medications. If the severity of the process has subsided, the attending physician may prescribe the patient, for example, diuretics, which are prepared on the basis of:

• birch leaves and buds,
• strawberry leaves,
• cornflower flowers,
• corn columns,
• bee death.

Treatment of glomerulonephritis during pregnancy

Glomerulonephritis does not fall into the category of diseases common among pregnant women. The incidence of glomerulonephritis among pregnant women is only 0.1-0.2%. It is noteworthy that for women who have suffered acute glomerulonephritis, doctors do not recommend becoming pregnant for the next three years after recovery, so as not to provoke a relapse.

If the manifestation or relapse of glomerulonephritis during pregnancy could not be avoided, then it is recommended to adhere to the following therapeutic principles:

• a mode that allows you to spend the day resting in bed;
• in the diet, it is important to limit the amount of table salt and liquid (in case of acute nephritis, up to 3 g of salt per day; as edema is eliminated, salt consumption can be slightly increased); the amount of fluid consumed parenterally should correspond to the diuresis excreted the day before, plus another 700 ml of fluid;
• It is not recommended to limit protein intake, which is generally recommended for patients with glomerulonephritis; in this case, a diet containing an increased amount of protein (120-160 g per day) is justified;
• Only symptomatic treatment is used; etiological therapy is not necessary, since acute glomerulonephritis occurs rarely.

Drug treatment of renal symptomatic hypertension is carried out primarily with calcium antagonists, beta-blockers, diuretics, alpha-blockers. In pregnant women, for the same purpose, it is possible to use physiotherapy: galvanization of the “collar” area or endonasal electrophoresis. Ultrasound on the kidney area in a pulsed radiation mode has a pronounced vasotropic effect (dilates blood vessels) and has an anti-inflammatory, desensitizing effect. These methods allow you to reduce doses antihypertensive drugs, which is important during pregnancy.

At treatment of glomerulonephritis in the chronic form, antiplatelet agents are used (teonicol, trental, chimes or nikoshpan). The use of heparin 20,000 units per day subcutaneously cannot be ruled out.

Contraindicated indirect anticoagulants, since they can cause hemorrhagic syndrome in the fetus and newborn, a decrease in prothrombin levels and death.

Which doctors should you contact if you have glomerulonephritis?

A general urine analysis reveals erythrocyturia, hyaline casts, somewhat less often granular and epithelial, and sometimes waxy. Leukocyturia is not typical and is noticeably inferior in severity to erythrocyturia and is not accompanied by bacteriuria.

Proteinuria varies widely, but in most patients it does not exceed 3 g per day.

A general blood test reveals some features depending on the form of glomerulonephritis:

• with nephrotic syndrome with arterial hypertension and/or hematuria, the content of hemoglobin and red blood cells decreases slightly, and, as a rule, the ESR is increased;
• sometimes moderate leukocytosis is observed, ESR normalizes along with other peripheral blood parameters.

During the study of the functional state of the kidneys at the onset of the disease, a short-term decrease in glomerular filtration and an increase in the level of creatinine in the blood is possible, more often with severe nephrotic syndrome. You can confirm the fact of a recent streptococcal infection using serological tests.

An immunological blood test often reveals an increase in the content of immunoglobulins and circulating immune complexes, and sometimes rheumatoid factor.

Diagnosis of acute glomerulonephritis occurs in the event of the appearance of a characteristic triad of syndromes (urinary with a predominance of erythrocyturia, edema and hypertensive) after an infection, especially after tonsillitis and pharyngitis, even if there is no history of kidney disease.

It is much more difficult to recognize acute glomerulonephritis with urinary syndrome, but without hematuria and extrarenal symptoms. Therefore for him early diagnosis for diseases that often precede the onset of acute nephritis, and in the first days after them, a urine test should be performed. Detection of proteinuria and especially erythrocyturia indicates the possibility of developing acute nephritis and requires further monitoring of such patients to confirm the diagnosis.

Acute glomerulonephritis must be differentiated primarily from exacerbation of chronic glomerulonephritis as a result of infection or hypothermia. Exacerbation of chronic glomerulonephritis is indicated by deeper impairment of kidney function and a decrease in their size according to ultrasound and x-ray studies. IN difficult cases the diagnosis can only be confirmed with a kidney biopsy.

Macrohematuria inherent in acute glomerulonephritis requires differential diagnosis with a similar variant of chronic glomerulonephritis, interstitial nephritis, kidney tumor or urinary tract, tuberculosis of the urinary organs, as well as urolithiasis.

Treatment of glomerulonephritis begins with a full examination, clarification of the form of the disease, differentiation with other diseases, because in different cases individually selected therapy is necessary. At the first signs of illness, you should immediately consult a doctor. Self-medication will worsen the situation and cause dangerous complications.

A person who has been diagnosed needs urgent hospitalization in a therapeutic or nephrology department of a hospital.

The patient should remain there until swelling and hypertension disappear (approximately two weeks). The patient needs constant bed rest to normalize the functioning of the glomeruli of the urinary organ, diuresis and eliminate the likelihood of developing heart failure.

Therapeutic diet

Therapeutic nutrition speeds up recovery and reduces the severity of symptoms. To do this, limit the consumption of simple carbohydrates, protein, and exclude spices and seasonings. Food should be balanced in vitamins and minerals and moderate in calories. Drinking regime prescribed by the doctor depending on the amount of daily urine output.

Drug treatments

When an organ is damaged by streptococcus, antibiotics from the penicillin group are prescribed. Injections are given over several weeks; if necessary, the course is extended. The treatment regimen involves the administration of penicillin 500,000 units six times a day every 4 hours, oxacillin - 500 milliliters 4 times a day every 6 hours.

Hormonal medications are prescribed to suppress autoimmune processes and eliminate the source of inflammation. The drugs are used in the absence of high blood pressure and edema, and are intended for use in cases of kidney failure due to glomerulonephritis. Prednisolone is taken for almost two months, the dosage is calculated based on the patient’s body weight.

Cytostatics are an alternative to hormonal drugs. They are prescribed for hormone-resistant nephrotic syndrome or for the development of hypertension. The most popular are Azathioprine and Cyclophosphamide. The initial dosage is prescribed for the first 1-2 months. After this, it is reduced by half, and the intake continues for another six months.

For glomerulonephritis, treatment is carried out with disaggregants and anticoagulants. To begin with, Heparin is administered 25,000-30,000 milliliters per 24 hours. The duration of treatment is two months, at the discretion of the doctor it can be extended to four months. Chime – popular remedy groups of disaggregants. Able to normalize glomerular filtration and lower blood pressure. NSAIDs contribute to modern kidney treatment: they reduce blood clotting and have an immunosuppressive effect. The drugs are prescribed for prolonged proteinuria, swelling, high blood pressure, and problems with urine output.

Therapy with Ortofen is advisable if the patient does not have gastrointestinal diseases. It is prescribed in a dosage of 75 to 150 milligrams per day. The duration of treatment is one to two months.

Eliminating symptoms

How to treat glomerulonephritis with pronounced symptoms? For this purpose, special therapy is used:

• Hypertension. Nifedipine is used to lower blood pressure. For persistent persistent hypertension, give Capoten tablets under the tongue.
• Swelling. It is eliminated with the help of Furosemide or Hypothiazide (diuretics). Should be taken no more than 5 days. Usually this time is enough to relieve swelling.
• Pathological decrease in red blood cells. Aminocaproic acid is prescribed to stop hemorrhage. It should be taken for no more than a week. In case of advanced disease, the drug is administered intravenously.

Treatment of progressive disease

Rapidly progressive glomerulonephritis is extremely dangerous. Therapy in this case is ineffective even with high dosages of drugs. Good results are achieved by using cytostatics together with glucocorticoid hormones. To remove immune complexes, toxins and waste accumulated in the body, methods of treating glomerulonephritis such as hemodialysis and plasmapheresis are used.

Therapy for chronic disease

Kidney glomerulonephritis during remission requires monitoring. You must not freeze, overheat, or overexert yourself, including physically. Doctors prohibit working in hot shops and at night. For colds, it is necessary to receive timely and correct treatment under the supervision of a doctor in order to avoid exacerbation of the underlying disease.

Nutrition issues

In case of chronic inflammation, you need to adhere to the same diet as during exacerbations. In the absence of swelling and increased blood pressure, it is allowed to add seasonings (garlic, pepper) and salt to food.

Treatment with drugs

Antibiotics of the penicillin group are taken in the early stages of the disease in order to sanitize foci of chronic infection in tonsillitis or endocarditis. With nephrotic or hidden current For diseases lasting less than two years, glucocorticoid hormones are prescribed. The drugs act effectively with minimal damage to the organ. Prednisolone is prescribed in a ratio of one gram per kilogram of the patient’s body weight. The course lasts 4 or 8 weeks. In case of hypertension, renal failure, or a mixed course of the disease, therapy with such medications is prohibited for the treatment of glomerulonephritis.

Cytostatics are prescribed for intolerance to the above medications or when the disease is accompanied by high pressure, inflammation progresses in a mixed form. In the absence of contraindications, the patient can be treated using Prednisolone and a cytostatic drug.

Disaggregants and anticoagulants are used to improve the filtering function of the urinary organs, as well as to prevent the formation of blood clots. The patient is prescribed a course of Heparin by injection for two months, after which Curantil is used for treatment. Its reception lasts for at least a year. The duration of treatment is determined individually for each patient. This therapy is contraindicated for hematuria and problems with the gastrointestinal tract.

For moderate hematuria, erythrocyturia with latent nephrotic course, NSAIDs are indicated. The patient is prescribed Indomethacin for 3-6 weeks. Gradually reducing the dosage, the drug is discontinued.

Signs of the disease may be different for each patient. Therefore, symptomatic treatment is prescribed individually. Herbal medicine is also used. Properly selected infusions and decoctions can reduce kidney inflammation, pressure, and have a diuretic and detoxification effect.

Most popular recipes:

1. Birch leaves. Place two small spoons of dry leaves in 300 ml of boiling water. After infusion, drink up to five times a day.
2. Burdock root. 10 g of rhizome are poured with 200 milliliters of just boiled water, brought to a boil in a water bath, turn off the heat and leave. Then drink half a glass three times a day.
3. Lingonberry leaves. A couple of tablespoons of chopped herbs are poured into 250 ml of boiling water and prepared according to the previous recipe.

Alternative treatment for progressive or chronic glomerulonephritis can only be used after consultation with a doctor and his positive recommendations.

Treatment regimens for inflammation

Can glomerulonephritis be cured with one medicine? Basically, for kidney inflammation, complex therapy is prescribed. There are various therapeutic regimens. The most rational is considered to be four-component therapy, including the following medications:

• Prednisolone (1 mg/kg body weight per day);
• Heparin (20,000 units over 24 hours);
• Cyclophosphamide (2-3 mg/kg per day);
• Curantil (400 to 600 mg per day).

Medicines are prescribed for two months; if necessary, the course is extended. If the patient is recovering, the dosage of drugs is gradually reduced to maintenance.

Nature + therapy

Sanatorium-resort treatment for glomerulonephritis is recommended during the patient’s recovery period, with residual effects diseases. Resorts are indicated for people with a chronic course, but not at the time of exacerbation. Rest is necessary in hot, dry climates, which increase sweating. Thanks to this, nitrogenous compounds leave the body, and the kidneys begin to function well.

Such therapy is contraindicated in case of severe hematuria or exacerbation of the disease.

Why is pathology dangerous?

In acute inflammation, especially with rapid progression, nephroencephalopathy, renal and heart failure, blindness, and sudden stroke may develop. If treatment is ineffective, plasmapheresis and blood transfusion are often required.

Not all forms of glomerulonephritis can be completely cured, so many patients remain permanently disabled. For full treatment It is necessary to consult a doctor at the first manifestations of the disease, undergo a full examination, and do not neglect the recommendations of specialists. The treatment regimen usually includes Prednisolone, Curantil, cytostatics and other drugs, the dosage of which is prescribed individually to each patient.

Glomerulonephritis is a disease in which kidney tissue is damaged. With this disease, the renal glomeruli, in which primary filtration of blood occurs, are primarily affected. 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 the glomerulus and how do the kidneys work?

What is a renal glomerulus?
In the renal glomerulus, the blood flow slows down, as through a semi-permeable membrane, the liquid part of the blood with electrolytes and organic substances dissolved in the blood seeps into Bowman’s capsule (which, like a wrapper, envelops the renal glomerulus on all sides). From the glomerulus, the cellular elements of the blood with the remaining amount of blood plasma are removed through the renal vein. In the lumen of 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, and everything harmful to be excreted in the final urine, primary urine passes through a system of tubes (loop of Henle, renal tubule). It happens constant processes the passage of substances dissolved in primary urine through the wall of the renal tubule. After passing through the renal tubule, primary urine retains its composition toxic substances(which need to be removed from the body) and loses those substances that cannot be removed.

What happens to urine after it is filtered?
After filtration, the final urine is excreted through the renal tubule into the renal pelvis. Accumulating in it, urine gradually flows into the bladder in the lumen of the ureters.

What happens with glomerulonephritis in the kidneys?

1. Because of inflammatory reaction The following changes occur in the wall of the glomerular vessels:

• The wall of the vessels of the renal glomerulus becomes permeable to cellular elements
• Microthrombi form, which clog the lumen of the glomerular vessels.
• The blood flow in the vessels of the affected glomeruli slows down or stops altogether.
• Cellular elements of the blood enter the lumen of Bowman's capsule.
• Blood cells in the lumen of Bowman's capsule clog its lumen.
• Blood cells clog the lumen renal tubules.
• The entire process of filtration of blood and primary urine in the affected nephron is disrupted (nephron is a complex: renal glomerulus + Bowman's capsule + renal tubules).

1. Due to impaired blood flow in the renal glomerulus, the lumen of its vessels becomes empty and replaced by connective tissue.
2. As a result of blockage of the renal tubules by blood cells, their lumen becomes empty and the walls stick together, with the entire nephron being replaced by connective tissue.
3. The gradual “death” of nephrons leads to a decrease in the volume of filtered blood, which is the cause of renal failure.
4. Kidney failure causes toxic substances to accumulate in the blood, and necessary for the body the substances do not have time to return the remaining nephrons of the kidneys to the blood.

From the above, it becomes clear that the cause of kidney dysfunction is the inflammatory process developing in the renal glomeruli. Now briefly about the causes of inflammation of the renal glomeruli.

1. Common infectious diseases

• sore throat, tonsillitis
• scarlet fever
• infective endocarditis
• septic conditions
• pneumococcal pneumonia
• typhoid fever
• meningococcal infection
• mumps (mumps)
• chicken pox (chickenpox)
• infections caused by Coxsackie viruses

1. Rheumatic and autoimmune diseases:

• systemic lupus erythematosus (SLE)
• systemic vasculitis
• Henoch-Schönlein disease
• hereditary pulmonary-renal syndrome

1. Vaccination and blood transfusions

1. Substance intoxication:

• Organic solvent poisoning
• alcoholic drinks
• mercury poisoning

1. Radiation therapy, radiation sickness

Types and symptoms of chronic glomerulonephritis

1. Latent– the most common (accounts for about 45% of all cases of chronic glomerulonephritis). Appears not expressed external symptoms: moderate swelling and increased blood pressure. More evident by laboratory examination data: general urine analysis detects increased levels of protein, red blood cells and white blood cells.

2. Hematuric– a rare form (accounts for no more than 5% of the total number of patients). Manifests as follows external signs: Pink or red urine. In general urine analysis an increased number of altered red blood cells is detected.

3. Hypertensive– a common form (accounts for about 20% of the total incidence). Manifests as follows external symptoms: constant increase in blood pressure, increase in the volume of daily urine excreted, night urge to urinate. In general urine analysis an increased content of protein and altered red blood cells is detected, urine density is slightly below normal or within the lower limit of normal.

4. Nephrotic- a common form (about 25%). The disease manifests itself as follows: external signs: increased blood pressure, severe swelling, reduced amount of daily urine excreted. Laboratory signs V general urine test: increased density of urine, increased protein content in urine; blood chemistry reveals: a decrease in total protein (mainly due to albumin), an increase in blood cholesterol.

5. Mixed (nephrotic-hypertensive)– characterized by symptoms of the two forms described above: nephrotic and hypertensive.

Methods for diagnosing chronic glomerulonephritis

To diagnose all types of chronic glomerulonephritis, the following types of examinations are used:

Stages of chronic glomerulonephritis

Stage of decompensation- associated with the progression of the disease with impaired renal function (decompensation stage). Stage with impaired renal function and the development of chronic renal failure.

Diagnosis of chronic glomerulonephritis

Laboratory signs of acute glomerulonephritis:
General urine analysis :
Urine color: pink, red, meat slop color Changed red blood cells: present, many Casts: erythrocyte, granular, hyaline Urine density: increased/decreased or normal (depending on the stage of the disease) Protein: found to be significantly higher than normal (a symptom characteristic of all types of disease)
Zimnitsky test:
Increase/decrease in daily urine output Increase/decrease in urine density The indicators of the Zimnitsky test depend on the stage of chronic glomerulonephritis and the form of the disease.
Blood chemistry :
Reduced blood protein levels (due to decreased albumin) Detection of reactive protein C Increased blood cholesterol levels Detection of sialic acids Increased levels of nitrogenous compounds in the blood (characteristic of advanced stages of the disease)
Immunological blood test:
increase in the titer of antisteptolysin O (ASL-O), increased antistreptokinase, increased antihyaluronidase, increased antideoxyribonuclease B; increase in gamma globulins of total IgG and IgM decreased levels of complement factors C3 and C4

Treatment of chronic glomerulonephritis

Health prognosis for chronic glomerulonephritis

With active treatment with suppression of the activity of the immune system, the course of the disease significantly improves, 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?

• 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, the child did not have acute glomerulonephritis before.
• The role of irrational treatment of chronic foci of infection (sore teeth, inflamed tonsils), severe hypovitaminosis, hypothermia and malnutrition during acute glomerulonephritis cannot be excluded.
• Slow currents play a role infectious processes: cytomegalovirus infection, hepatitis B, parainfluenza, etc.
• Congenital disorders of the structure of renal tissue.
• Hereditary immunodeficiencies(decreased immune system function due to genetic disorders).

• nephrotic (edema-proteinuric);
• hematuric;
• mixed.

• The disease develops acutely after hypothermia, sore throat, acute respiratory infection, vaccinations, or for no apparent reason.
• The main symptoms are swelling and the presence of protein in the urine.
• The disease lasts a long time, periods of improvement are followed by new exacerbations. Chronic renal failure gradually develops.

• Usually there are no complaints - the child feels normal.
• A small amount of red blood cells and protein are 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.
• Swelling, lower back pain, headache, increased fatigue, and 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.

• A combination of blood and protein in the urine, edema, and increased blood pressure is typical.
• Manifestations of high blood pressure: headaches and dizziness, lower back pain, lethargy, irritability, blurred vision, and sometimes convulsions.
• Anemia and pallor are often noted.
• The disease is severe, and chronic renal failure develops very early.

How is dispensary observation carried out for children suffering from chronic glomerulonephritis?

Dispensary observation is carried out until the child is transferred to an adult clinic:

• Chronic pyelonephritis. A disease in which inflammation predominantly develops in the renal pelvis, calyces, and tubular system of the kidneys.
• Amyloidosis. A disease in which the metabolism of proteins and carbohydrates is disrupted in kidney cancer

  Is it possible to drink alcohol if you have glomerulonephritis?

  Alcohol consumption negatively affects the condition of all organs and systems, and the kidneys are no exception. Alcohol can aggravate the course of chronic glomerulonephritis, so it is recommended to avoid it completely. The taboo also applies to carbonated drinks.
  

  Is it possible to eat watermelons if you have 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 your doctor. Sometimes, with chronic glomerulonephritis, it is even recommended to arrange fasting “watermelon” days.
  latent form– the prognosis is favorable;
• hematuric and hypertensive form– the prognosis is serious;
• mixed and proteinuric form- the prognosis is unfavorable.

is an autoimmune kidney disease. With the onset of this disease, the glomeruli of the kidneys or glomeruli are affected. Symptoms and treatment have some nuances. Therefore, if glomerulonephritis appears, the patient is treated by doctors in stages with a regular full examination.

Symptoms

In most cases, signs of glomerulonephritis are associated with heart failure:

• dyspnea;
• cardiac asthma.

In this case, the disease occurs in a certain category of people who have not previously had any heart problems.

When the first symptoms appear, you should immediately contact a urologist. He, in turn, will order blood and urine tests, as well as a kidney biopsy. Its results will be key in making a diagnosis.

If the disease is still present, then the results of a urine test will show red blood cells (erythrocytes) and protein. During the first 10 days of the disease, protein is quite high. A urine test must be taken several times to monitor the dynamics of changes.

When a patient is suspected of having, it is very important not to confuse it with chronic form diseases. The main thing is to know the time interval from the onset of the disease to its transformation into an acute form. In case of acute glomerulonephritis, this period will be up to 3 weeks, and if the chronic disease begins to worsen, it will take several days.

As for, in this case the following clinical forms are distinguished:

• The most common form of glomerulonephritis is nephrotic. It is also characterized by signs of inflammatory kidney damage. During the development of the disease, symptoms that relate to nephrotic syndrome may be observed for a long time. Then symptoms of glomerulonephritis begin to appear. In chronic renal failure, nephrotic syndrome decreases, but blood pressure increases.
• The latent form of glomerulonephritis also appears quite often. Mainly through mild nephrotic syndrome, blood pressure remains the same, but edema appears. The duration of symptoms is often more than 20 years, but the development of uremia cannot be avoided. Uremia is blood poisoning; accordingly, the entire body will gradually be poisoned through the blood.
• The hypertensive form occurs in 20% of patients who have chronic glomerulonephritis. It appears due to the latent form of acute glomerulonephritis. For quite a long time, the patient has hypertension as a symptom, and urinary syndrome is practically not noticeable. There is a sharp change in blood pressure within 24 hours. This may be affected different reasons. During this form of the disease, hypertrophy of the left ventricle of the heart is formed, the fundus of the eye changes in the form of neuroretinitis, but hypertension does not become malignant.
• The mixed form implies the appearance of both nephrotic and hypertensive symptoms of chronic glomerulonephritis.
• The hematuric form is formed in 10% of cases of chronic glomerulonephritis. According to the results of urine tests, blood is observed.

All forms of this disease can sometimes recur. In most cases, this happens in the spring and autumn seasons.

If no measures are taken during the development of glomerulonephritis, the disease will progress to the last stage - a secondary shriveled kidney.

Causes

Reasons why glomerulonephritis occurs:

• systemic diseases;
• irradiation;
• various infections, such as tonsillitis, sepsis, typhoid fever, scarlet fever, viral hepatitis B;
• administration of serums or vaccines;
• alcohol, lead, mercury and organic solvents.

Glomerulonephritis begins to manifest itself 4 weeks after exposure to factors.

Mode

At acute stage glomerulonephritis, the patient must be hospitalized and prescribed the necessary medications. The patient's regimen is often bed rest, but it can also be strictly bed rest, it depends on the severity of the picture. For normal kidney function, the patient needs uniform heating and temperature conditions.

With acute glomerulonephritis, the patient should stay in the hospital for about a month until the acute symptoms disappear. If this time is not enough, then the therapy will be extended.

During remission, you should not engage in heavy physical activity. The temperature regime must be gentle.

Diet

Plays an important role during the treatment of glomerulonephritis. It is prescribed by specialists and is carried out together with drug therapy, taking into account the form and stage of the disease. If the form of glomerulonephritis is mixed or nephrotic, then sodium chloride in the body should be no more than 2.5 grams per day. Do not consume salt under any circumstances; food must be free of salt.

If the patient does not suffer from edema and the excretory functions of the kidneys are normal, then the patient’s food must contain the required amount of animal protein. It contains an abundance of phosphorus-containing amino acids. With the help of this nutrition, nitrogen balance comes into play normal condition, and the protein is restored.

If a person experiences the former, then foods that contain protein must be completely excluded. It is necessary to eat foods containing carbohydrates.

When a patient is sick with a hypertensive form of chronic glomerulonephritis, the dose of sodium chloride does not exceed 4 grams per day. The diet includes components that contain the required amount of both carbohydrates and proteins.

With glomerulonephritis of the latent form, there are no dietary restrictions. The main thing is that the food is varied, fortified and nutritious.

In addition, when glomerulonephritis develops, it is necessary to eat foods rich in fiber and potassium.

Treatment

How to treat glomerulonephritis? For a disease such as glomerulonephritis, treatment is selected individually. The treatment regimen for this disease is that the patient’s diet must include vitamins such as A, B and C. To eliminate the disease, it is necessary to strictly adhere to a salt-free diet, this promotes favorable well-being. If your kidney indicators are normal, then you can drink a weak red root tea drink as a liquid.

When a patient vomits along with the symptoms of glomerulonephritis, this indicates a loss of sodium chloride. In this case, you need to add a little salt to your food.

In addition to the fact that the patient must adhere to drug therapy and diet, it is necessary to monitor skin hygiene. During the development of the disease, skin itching is observed. With uremia, bedsores form, this must be carefully monitored.

If an infection occurs during the period of illness, the treatment regimen includes additional antibiotics such as Lomflox, Tsiprolet and Avilox. They help increase and also prevent the treatment of urinary tract infections.

Patients with glomerulonephritis have the opportunity to receive spa treatment. Visiting resorts must only be in your own climatic zone. The following categories of citizens can undergo treatment in nephrology sanatoriums:

• patients who received a kidney transplant during the recovery period;
• patients with stable nephrotic syndrome;
• people who have chronic glomerulonephritis without swelling and swelling.

Only a specialist prescribes a specific sanatorium and a climate zone suitable for the patient where complex therapy will take place. This is quite a responsible matter. Thanks to sanatorium treatment, recovery will proceed much faster.

Multicomponent treatment regimens for the disease

Treatment of glomerulonephritis is carried out using three regimens:

• Ponticelli scheme - in this case, pulse therapy is carried out with Prednisolone 1 thousand mg per day. It is carried out for 3 days, after which the remaining 27 days are 30 mg per day. Prednisolone must be changed periodically with a cytostatic agent. Then, over the next month, Chlorambucil 0.2 mg.
• Steinberg's scheme - it involves the following procedure: once a month for a year, intravenously administer drugs such as Cyclophosphamide 1 thousand mg. Then, for two years you need to take the drug once every 3 months, and for the next two years - once every 6 months.
• Four-component scheme. Prednisolone 30 mg per day for 60 days. Gradually it is necessary to give the body a rest. Cytostatic is prescribed until target remission. Heparin 5 thousand units. 4 times a day for a month. Gradually replace with Asperin. Dipyridamole 400 mg. This method is perfect for rapidly progressing glomerulonephritis.

Therapy is quite a complex process for many forms. As a result, people who are still carrying out their work activities develop disabilities. It is very important to monitor the patient during recovery and while in the clinic.

ethnoscience

Treatment of the disease occurs in several stages. In parallel with drug therapy, treatment with folk remedies is recommended. The folk remedy is used during the recovery period or for chronic glomerulonephritis. With the help of herbal medicine, patients can achieve the following effects:

• diuretic;
• anti-inflammatory;
• anticoagulant;
• antiallergic.

According to the recommendations of doctors, therapy using traditional medicine involves the correct selection of the combination and dosage of natural phytocomponents. The result will be the necessary tonic and diuretic effect. Herbal treatment helps reduce the burden of drugs on the human body.