Syndromes characteristic of acute glomerulonephritis. Acute glomerulonephritis. Causes of occurrence in children

Acute glomerulonephritis with nephrotic syndrome - Inflammation of the kidneys (nephritis), Glomerulonephritis (glomerular nephritis)

IN Lately The nephrotic form of glomerulonephritis is rare: 1-6 cases per 10,000 people, it affects people under the age of 40, more often occurs in men and in children from 5 to 14 years old, persons whose profession is associated with hypothermia are at risk. IN old age The disease is less common, but is difficult and often becomes chronic.

general information

Acute glomerulonephritis (AGN) is a group of diseases of an infectious-allergic nature, different in origin, outcome and characteristics of development mechanisms. The reasons why most of them occur remain unclear. On this moment Only the infectious factor has been well studied. This, together with malfunctions in the functioning of the immune system, is the basis for the onset of the disease. The main difference between this group of diseases is damage to the glomerular apparatus of both kidneys.

Causes of occurrence in children

A common cause of acute glomerulonephritis in children is infectious diseases caused by group A streptococcus, especially its 12 strain. The entry point for infection is most often the tonsils, less often inflammation of the paranasal sinuses and middle ear. Parents need to take seriously the treatment of influenza, pharyngitis, sinusitis, otitis, scarlet fever and carefully monitor the child’s condition for 2-3 weeks after recovery; it is during this period that glomerulonephritis manifests itself.

There is a risk of developing the disease due to allergies, after repeated serum vaccination and the use of drugs intolerable to the body.

Pathogenesis Depending on the disruption There are two types of disease development in the body: autoimmune and immune complex. In the first option, antibodies are produced against the body's own kidney tissue, mistaking them for an antigen and creating immune complexes. As these formations grow, they change the structure of the membranes and glomerular capillaries of the kidney. In the second option, antibodies begin to interact with bacteria and viruses, also creating associations that circulate through the blood and then settle on the membranes of the kidneys. In both the first and second cases, the proliferation of complexes leads to changes in the structure of the glomerular apparatus of the kidneys and impaired filtration. This leads to protein excretion from the body and fluid retention.

Types of glomerulonephritis

There are several types of disease: typical (classical), atypical (monosymptomatic) and nephrotic. In the monosymptomatic variant, swelling is poorly manifested and moderate disturbances in urination and changes in the composition of urine are slightly visible. In this regard, there is a high probability of a protracted course of the disease and transition to chronic glomerulonephritis. The nephrotic variant involves, along with other signs, the presence of nephrotic syndrome. This variant exhibits a variety of features that are consistent with other nephrotic diseases, making diagnosis challenging. The classic variant is associated with infectious diseases and is clearly expressed by a number of symptoms; they can vary and be expressed in several syndromes. All variants are characterized by the following types of syndromes:

• uric;
• hypertensive;
• hydropic;
• nephrotic syndrome.

Main symptoms in children and adults

TO important features Characterizing glomerulonephritis is an increase in blood pressure (up to 140 - 160 mm Hg) and bradycardia (heart rate 60 beats per minute). With a successful course of the disease, both symptoms disappear after 2-3 weeks. The main symptoms of nephrotic syndrome include intense proteinuria, impaired water-electrolyte, protein and lipid metabolism, streak and peripheral edema. The disease is also expressed by external signs:

• shortness of breath;
• nausea;
• weight gain;
• thirst bothers you;

Edema syndrome

Often, swelling is the first sign of glomerulonephritis. In nephrotic syndrome, they are characterized by rapid widespread distribution, they appear on the trunk and limbs. Hidden edema occurs; it can be detected by periodically weighing the patient and monitoring the ratio of the volume of fluid consumed and the amount of urine excreted.

Edema with glomerulonephritis has complex mechanisms. Due to impaired filtration in the capillary membranes of the renal glomeruli, water and sodium are not removed from the body. And due to the increase in capillary permeability, liquid and protein come out of the bloodstream into the tissue, which makes the swelling dense. Fluid accumulation occurs in the pleural plane of the lungs, the pericardial sac, in abdominal cavity. Swelling occurs quickly and disappears on the 14th day of treatment.

Diagnostic measures

Diagnostic procedures include laboratory research general and special urine and blood tests, immunological tests. In nephrotic syndrome, kidney tissue is often examined using a kidney biopsy. Important information for differential diagnosis can be obtained by ultrasound examinations, computed tomography and x-ray.

Nephrotic form of acute glomerulonephritis

Nephrotic syndrome is a characteristic symptom of the nephrotic form of glomerulonephritis. This form is common in children. The disease begins gradually, proceeds in waves, temporary weakening (remission) is replaced by exacerbations. For quite a long time, the condition of the kidneys remains within acceptable limits, edema disappears, urine clears, and only moderate proteinuria remains. In some cases, nephrotic syndrome persists during remissions. This course of the disease is dangerous and can lead to the development of kidney failure. Transitions from the nephrotic to the mixed form are also observed.

Treatment of AGN

The principle of treatment is aimed at eliminating the cause of the disease and preventing complications. All patients with suspected acute glomerulonephritis with nephrotic syndrome should be immediately hospitalized with mandatory bed rest, since the restriction in physical activity helps normalize renal blood circulation and filtration. A strict diet is also prescribed. In case of severe disease, the rule of hunger and thirst is applied for 1-2 days; you can only rinse your mouth or consume a very small amount of liquid; in this case, children are allowed some sweet water.

Diet for glomerulonephritis is no less important than medications, as it is aimed at reducing edematous and hypertensive syndromes. The food you eat should not contain sodium. It must contain potassium and calcium in order to restore the balance of these substances in the body. The diet is characterized by a significant reduction in fluid and salt intake, but maintaining calorie content and vitamins. Products that meet these criteria include rice, potatoes, raisins, dried fruits and pumpkin. The diet changes depending on the disappearance of edema, a decrease in blood pressure and the normalization of the ratio of drunk and excreted fluid. However, a low-salt diet is recommended for quite a long time.

Drug therapy

Symptomatic conservative therapy is used in treatment. To eliminate edema and hypertension, Reserpine is used with Furosemide, Hypotezad or Veroshpiron. To increase glomerular filtration, Nifidipine or Cardofen are prescribed. Heparin also has a good deuritic effect, especially in the nephrotic form. To reduce capillary permeability, antihistamines are prescribed, for example, Diphenhydramine, Suprastin, Tavegil. Due to infectious cause When the disease occurs, antibiotics without nephrotoxic effect are prescribed.

Due to the immune origin of acute glomerulonephritis, the use of glucocorticosteroid hormones, such as Prednisolone or Metlprednisolone, is justified. Their use is especially effective in nephrotic syndrome and in the absence of positive result from symptomatic therapy. Under the influence of these drugs, diuresis and urinary syndrome are significantly reduced, swelling practically disappears and blood composition improves. The entire treatment process must be fully controlled by a doctor and adjusted depending on research data and the patient’s condition.

Prognosis and possible complications

Full recovery occurs in most cases. Changes in the glomeruli and tubules undergo reverse development and the microstructure of the kidney is restored. But minor changes in the glomeruli can persist for up to 2 years and, in the case of unfavorable conditions, can give rise to a chronic form of glomerulonephritis or recurrent disease.

Preventive measures

Patients who have had glomerulonephritis need to be carefully monitored by a doctor for another 2-3 years. After suffering an infectious disease, it is necessary to submit urine for examination 2-3 times within a month in order to be able to notice the symptoms of glomerulonephritis in time. Avoid hypothermia and injury. Treat repeated vaccination with caution, especially if there has been allergic reaction accompanied by changes in urine.

The content of the article:

Glomerulonephritis is a diffuse multifactorial disease of the glomerular apparatus of the kidneys of immune or allergic origin.

Chronic inflammatory process in the glomeruli leads to loss functional ability kidneys rid the blood of toxins.

Long-term existing pathology always complicated by the development of chronic renal failure.

We talk about the chronicity of the process when immune inflammation in the kidneys exists for a year.

Code by international classification diseases ICD-10:

N03 Chronic nephritic syndrome

There is a risk of developing the disease due to allergies, after repeated serum vaccination and the use of drugs intolerable to the body.

1. The following changes occur in the walls of the vessels of the renal glomeruli:

Permeability increases vascular wall glomerulus for cellular elements.

Microthrombi form, followed by blockage of the lumen of the vessels of the glomerular apparatus.

Blood circulation in the modified vessels is disrupted, up to complete ischemia.

Erythrocytes settle on important renal structures of the nephron: Bowman's capsule, renal tubules.

The process of blood filtration and the production of primary urine is disrupted.

Poor circulation in the renal glomerulus entails emptying of the lumen and gluing of the walls, followed by the transformation of the nephron into connective tissue. The gradual loss of structural units leads to a decrease in the volume of filtered blood (one of the causes of chronic renal failure). There are fewer and fewer nephrons capable of performing their work normally, which leads to poisoning of the body with metabolic products, while the necessary substances are returned to the blood in an incomplete volume.

Etiology and provoking factors

The etiology of CGN is as follows:

Infectious agents - bacterial (Str, Staf, Tbs, etc.), viral ( hepatitis B, C, cytomegalovirus, HIV)

Toxic agents - alcohol, drugs, organic solvents, mercury

The cause in most cases is group A beta-hemolytic streptococcus.

Diseases contributing to the development of pathology:

Sore throat and chronic tonsillitis,
Scarlet fever,
Infectious heart diseases,
Sepsis,
Pneumonia,
Parotitis,
Rheumatological diseases,
Autoimmune pathology.

Classification of chronic glomerulonephritis

Form of glomerulonephritis	Activity of the renal process	Kidney function status
1. Acute glomerulonephritis With nephritic (hematuric) syndrome - with nephrotic syndrome - with isolated urinary syndrome - with nephrotic syndrome, hematuria and hypertension	1. The period of initial manifestations (height) 2. Period of reverse development 3. Transition to chronic glomerulo-nephritis	3. Acute renal failure
2. Chronic glomerulonephritis Hematuric form - nephrotic form - mixed form	1. Period of exacerbation 2. Period of partial remission 3. Period of complete clinical and laboratory remission	1. Without renal dysfunction 2. With impaired renal function 3. Chronic renal failure
3. Subacute (malignant) glomerulonephritis		1. With impaired renal function 2. Chronic renal failure

Morphological classification of CGN

Diffuse proliferative

With "half moons"

Mesangioproliferative

Membrane-proliferative (mesangiocapillary)

Membranous

With minimal changes

Focal segmental glomerulosclerosis

Fibrillar-immunotactoid

Fibroplastic

The classification is based on clinical assessment - laboratory syndromes, pathogenesis (primary, secondary), functional ability of the kidneys (with loss, without loss, chronic renal failure) and morphology.

The course of hCG is:

Recurrent (remission is replaced by exacerbation).
Persistent (constant activity of immune inflammation in the glomeruli with preservation of the functional abilities of the nephrons for a long time).
Progressive (constant activity of the process with a tendency to renal failure, and a gradual decrease in glomerular filtration).
Rapidly progressing (the process is so active that after a short period of time, chronic renal failure is formed).

Clinical manifestations

In most cases, the pathology is characterized by slow development. Many patients cannot remember when it started and after what they got sick.

The most typical signs:

Diuresis depends on the severity of chronic renal failure: a decrease in daily diuresis (oliguria) by initial stage, with progression - polyuria (a lot of urine) leading to anuria in terminal stage Chronic renal failure, clinical urine analysis shows pathological protein and red blood cell content.
Urination predominates, mainly at night: nocturia.
Swelling: from minor to severe, localization varies.
Weakness, fatigue.
Increased temperature response.
Development of persistent hypertension.
Thirst, the smell of acetone in the exhaled air, itchy skin indicate the advanced state of the disease and the progress of chronic renal failure.

There are several forms of chronic glomerulonephritis

Glomerulonephritis with isolated urinary syndrome

Isolated urinary syndrome is characterized by the following symptoms:

Asymptomatic hematuria

Asymptomatic proteinuria

No complaints

No edema, hypertension

The most common option is characterized by a benign course (aggressive treatment is not prescribed). The patient has no complaints with this form.

When examined, a small amount of protein and red blood cells are found in the urine.

Since the disease is secretive, and the progression of renal failure is slow but constant, sometimes all laboratory and Clinical signs CRF.

Latent form of chronic glomerulonephritis, despite the benign course of timely diagnosis, may cause kidney failure.

Nephrotic form of glomerulonephritis

Occupies just over 20% of cases. It is distinguished by pronounced clinical manifestations, the leading symptom is the appearance of significant edema.

In a clinical urine test, the loss of protein (mainly albumin) is more than 3 g/day, which is why, on the contrary, there is a lack of protein substances in the plasma.

Increased levels of blood cholesterol, triglycerides and low-density lipoproteins.
The nephrotic form of glomerulonephritis is an indication for emergency hospitalization of the patient, since his condition is regarded as serious due to developed ascites, pleurisy, etc. against the background of massive edema. In addition, the patient has a risk of developing a secondary infection against the background of reduced immunity, osteoporosis, blood clots, hypothyroidism, atherosclerosis, heart attack, stroke.

All of the above pathology is a consequence of water disturbances. electrolyte balance(loss of zinc, copper, vitamin D, calcium, thyroid-stimulating hormones, etc. in urine).

The most serious complications of the nephrotic form of glomerulonephritis are cerebral edema and hypovolemic shock.

Mixed variant or hypertensive form of glomerulonephritis

It is characterized by a combination of nephrotic syndrome and persistent hypertension (increased blood pressure). Typically rapid progression to chronic renal failure due to harmful influence hypertension on the renal vessels.

Hematuric form of glomerulonephritis

Chronic glomerulnephritis in men often occurs in a hematuric form.

Swelling does not appear, there is no increase in blood pressure.

There is no pronounced proteinuria (no more than 1 g/day), but there is hematuria (red blood cells in the urine).

Factors that provoke hematuric chronic glomerulonephritis include:

Alcohol intoxication,
poisoning with any substances,
colds with Berger's disease.

Nephrologists note the following pattern: the brighter the clinical manifestations, the greater the chance of complete restoration of the functional ability of the kidneys.

It must be remembered that any form of hCG, under certain circumstances, can go into an acute stage with a clinical picture typical of acute glomerulonephritis.

Chronic glomerulonephritis in the acute stage will be treated according to the regimen used in the treatment of acute immune inflammation of the kidneys.

How to diagnose chronic glomerulonephritis

Clinical and laboratory tests play an important role in the diagnosis of chronic hepatitis. During a conversation between a doctor and a patient, pay attention to the presence infectious diseases history, concomitant pathology, in particular, systemic diseases, clarify the urological history.

General clinical analysis urine

Urine in chronic glomerulonephritis is variable, it depends on the morphology of the pathological process. Typically a decrease in specific gravity; the greater the amount of protein in the urine (up to 10 g/day), the more evidence for the nephrotic form.

Red blood cells are present: gross hematuria or microhematuria. In the urine sediment, hyaline and granular casts (nephrotic and mixed forms), fibrin are found.

The hypertensive form is characterized by a decrease in glomerular filtration.

Blood biochemistry

1. increased levels of cretinin, urea,
2. hypoproteinemia and dysproteinemia,
3. hypercholesterolemia.
4. increasing the titer of antibodies to streptococcus (ASL-O, antihyaluronidase, antistreptokinase),
5. decrease in the level of C3 and C4,
6. increase in all immunoglobulins M, G, A
7. electrolyte imbalance.

Urine culture for flora and sensitivity to drugs.
Zimnitsky's test.
Nechiporenko's test.
Rehberg's test.

Instrumental diagnostics

Kidney ultrasound with Doppler
On initial stages ultrasound diagnostics does not reveal any pronounced changes.
If chronic glomerulonephritis progresses, sclerotic processes in the kidneys are possible with a decrease in their size.

Survey and excretory urography, radioisotope scintigraphy make it possible to assess the function of each kidney separately and general state parenchyma.

ECG
If the patient has persistent hypertension, electrocardiography will confirm hypertrophy (increase in size) of the left ventricle.

Fundus examination

Symptoms are similar to those of hypertension:

1. narrowing of the arteries,
2. dilatation of veins,
3. pinpoint hemorrhages,
4. microthrombosis,
5. swelling.

To determine the morphological component of the form of hCG, a diagnostic biopsy is possible. Based on the results of the morphological conclusion, treatment tactics are selected.

The procedure is considered invasive and has a number of contraindications:

Single kidney or lack of collateral kidney function.
Coagulopathies.
Right ventricular failure.
Infectious processes.
Hydronephrosis.
Polycystic.
Thrombosis of the renal arteries.
Kidney cancer.
Heart attacks, stroke in the acute stage.
Confusion.

Differential diagnosis is carried out with the following diseases:

Chronic pyelonephritis,
hemorrhagic fever with renal syndrome,
nephrolithiasis,
hypertension,
tuberculosis lesion genitourinary organs and etc.

Treatment for chronic glomerulonephritis

The treatment regimen will depend on the form of the disease, clinical manifestations, concomitant pathology, and the presence of complications.

The main aspects of treatment for chronic glomerulonephritis are to normalize blood pressure, eliminate edema and maximize the pre-dialysis period.
It is recommended to normalize the work and rest schedule, avoid hypothermia and work with toxic substances.

Pay attention to the timely sanitation of areas of possible infection: caries, tonsils, throat, etc.

Diet for chronic glomerulonephritis

Importance is given correct regimen nutrition.

Chronic renal failure leads to disruption of the electrolyte balance of the blood, self-poisoning of the body as a result of the accumulation of toxic substances.

Properly selected nutrition can correct the adverse effects of toxins on the body at the initial stage. stage of chronic renal failure. And at all other stages of chronic renal failure, you can’t go without a diet.

What can you eat with glomerulonephritis - unites diet (table No. 7).

Its main points:

Refusal of salt.
Reducing the amount of fluid consumed.
Introduction to the diet of foods with a high content of potassium and calcium.
Limiting the consumption of animal proteins.
Introduction of vegetable fats and carbohydrates into the diet.

Proper nutrition during hCG will allow you to live longer without hemodialysis or kidney transplantation

Medicines for chronic glomerulonephritis

Immunosuppressive drugs

First-line drugs are immunosuppressive drugs. Due to the suppressive effect on the activity of the immune system, pathological processes in the glomerular apparatus of the kidney are slowed down.

Steroids

The dosage of prednisolone is calculated individually, 1 mc/kg per day, for 2 months, with a gradual reduction to avoid withdrawal syndrome. Pulse therapy is periodically prescribed (injection of corticosteroid drugs into high dose short term). With irregular dosage, incorrect dosage, untimely initiation of therapy and severe immune disorders, the effectiveness decreases.

The following conditions are contraindications for treatment with nonsteroidal hormones:

Active tuberculosis and syphilis,
viral ophthalmological diseases,
infectious processes,
lactation,
pyoderma.

Steroids are used with caution in diabetes mellitus, thromboembolism, herpes,
systemic candidiasis, hypertension, Itsenko-Cushing's disease, severe chronic renal failure.

Cytostatics

Used for progressive forms of chronic pyelonephritis in men and women, and in all cases where there are contraindications to the prescription of steroid drugs, or the appearance of complications, or in the absence of effect from therapy.

Sometimes the treatment regimen includes both hormonal drugs and cytostatics.

Contraindications: pregnancy and active phase of infectious processes.

With caution: severe dysfunction of the liver and kidneys, blood pathology.

List of cytostatics for chronic glomerulonephritis in men and women:

Cyclophosphamide,
Chlorambucil,
Cyclosporine,
Azathioprine.

Complications: hemorrhagic cystitis, pneumonia, agranulocytosis ( pathological changes in the blood, inhibition of hematopoiesis).

With developed side effects Cytostatic therapy for chronic glomerulonephritis in men and women is canceled.

Nonsteroidal anti-inflammatory drugs

It was believed that Indomethacin, Ibuklin, Ibuprofen are capable of suppressing the autoimmune response. Not all nephrologists prescribe NSAIDs, since drugs from the NSAID group have a toxic effect on the kidneys and often provoke the development of drug-induced nephropathy even without glomerulonephritis.

Anticoagulants and antiplatelet agents

Promote improvement rheological properties blood. Prevents the processes of thrombus formation in the renal glomeruli and the adhesion of blood vessels. Heparin is most often used for a course of 3 to 10 weeks in individual dosages, which depend on many factors, including coagulogram parameters.

Symptomatic therapy

Symptomatic therapy depends on the clinical manifestations of chronic glomerulonephritis and includes:

Antihypertensive drugs.
Diuretics.
Antibiotics.

Antihypertensive drugs

Some forms of GM are characterized by a persistent increase in blood pressure, therefore the prescription of antihypertensive drugs from the group of ACE inhibitors is justified:

Captopril,
enalapril,
ramipril

Diuretics

To activate fluid flow in the nephron, diuretics are used:

Antibacterial drugs

Sometimes hCG occurs against the background of some kind of infection, in this case it is prescribed antibacterial drugs to prevent secondary infection. Protected penicillins are more often prescribed, since the drugs have less toxicity and are effective against group A beta-hemolytic streptococcus.

If you are intolerant to penicillins, cephalosporin antibiotics can be used. The use of antibiotics is justified when there is a proven connection between the development of glomerulonephritis and an infectious process, for example, in a man or woman, glomerulonephritis after streptococcal tonsillitis appeared 14 days later.

The outcome of chronic diffuse glomerulonephritis is always secondary kidney shrinkage and the onset of chronic renal failure.

If chronic renal failure has led to significant disturbances in the functioning of the body, program hemodialysis is indicated when the creatinine level reaches 440 µmol/l. In this case, it is justified to refer the patient for a disability examination. The diagnosis of CG in itself, without impaired renal function, does not give the right to disability.

For hypercholesterolemia, statins are prescribed to lower cholesterol levels.
Eat good feedback from the use of plasmapheresis for glomerulonephritis.

Chronic glomerulonephritis in children

In pediatrics, glomerulonephritis in children ranks second after urinary tract infections. Children aged 3 to 9 years are most often affected by the disease.

Boys experience immune inflammation in the kidneys 2 times more often than girls. In some cases, pathology develops 10-14 days after a childhood infection. Just like in adult men and women, chronic glomerulonephritis is the outcome of an acute immunological process in the kidneys.

Clinical manifestations, forms, signs are identical.

Treatment is less aggressive due to age.

Chronic glomerulonephritis in children is treated by a nephrologist.

Prevention of exacerbations in chronic glomerulonephritis comes down to timely sanitation of foci of inflammation, regular monitoring clinical and laboratory parameters, adherence to diet, avoidance of hypothermia, timely completion of therapy.

Prognosis for chronic glomerulonephritis depending on the morphological variant

GN of minimal changes - preservation of kidney function after 5 years - 95%;

Membranous GN - preservation of kidney function after 5 years - 50-70%

FSGS - preservation of kidney function after 5 years - 45 -50%

Mesangioproliferative - preservation of kidney function after 5 years - 80%

Membranous-proliferative - preservation of kidney function after 5 years - 45 - 60%

Life expectancy depends on the clinical variant of the disease and characteristics functional state kidney

Favorable prognosis for latent variant (provided timely treatment), doubtful in hematuric and hypertonic variants.

The prognosis is unfavorable for nephrotic and mixed forms of glomerulonephritis.

Acute glomerulonephritis characterized by three main symptoms - edematous, hypertensive and urinary. Mainly protein and red blood cells are found in urine. The amount of protein in the urine usually ranges from 1 to 10 g/l, but often reaches 20 g/l or more. However, a high protein content in the urine is observed only in the first 7-10 days, therefore, with a late urine test, proteinuria is often found to be low (less than 1 g/l). In some cases, slight proteinuria may be present from the very beginning of the disease, and in some periods it may even be absent. Small amounts of protein in the urine of patients who have had acute nephritis are observed for a long time and disappear only after 3-6, and in some cases even 9-12 months from the onset of the disease.

Hematuria is a mandatory and constant sign of acute gpomerulonephritis; in 13-15% of cases there is macrohematuria, in other cases there is microhematuria, sometimes the number of red blood cells may not exceed 10-15 in the field of view. Cylindruria is not a necessary symptom of acute gpomerulonephritis. In 75% of cases, single hyaline and granular casts are found, sometimes epithelial casts are found. Leukocyturia, as a rule, is insignificant, but sometimes 20-30 leukocytes or more are found in the field of view. At the same time, there is always a quantitative predominance of erythrocytes over leukocytes, which is better revealed when calculating the signature elements of urine sediment using the methods of Kakovsky - Addis, De Almeida - Nechiporenko.

Oliguria (400-700 ml of urine per day) is one of the first symptoms of acute nephritis. In some cases, anuria (acute renal failure) occurs for several days. Many patients experience slight or moderate azotemia during the first few days of the disease. Often with acute glomerulonephritis, the hemoglobin content and the number of red blood cells in the peripheral blood decrease. This is associated with hydremia (increased water content in the blood), and may also be due to true anemia as a result of the influence of an infection that led to the development of glomerulonephritis (for example, with septic endocarditis.

Often determined increased ESR. The number of leukocytes in the blood, as well as the temperature reaction, are determined by the initial or concomitant infection (usually the temperature is normal and there is no leukocytosis).

Of great importance in the clinical picture of acute glomerulonephritis are edema, which serves early sign diseases in 80-90% of patients; They are located mainly on the face and, together with the pallor of the skin, create the characteristic “nephritic face”. Often fluid accumulates in cavities (pleural, abdominal, pericardial cavity). Body weight gain over a short time can reach 15-20 kg or more, but after 2-3 weeks the swelling usually disappears. One of the cardinal symptoms of acute diffuse gpomerulonephritis is arterial hypertension, observed in 70-90% of patients. In most cases, blood pressure does not reach high levels (180/120 mm Hg). Increases in blood pressure occur less frequently in children and adolescents than in adults. Acute arterial hypertension can lead to the development of acute heart failure, especially left ventricular failure. Later, hypertrophy of the left ventricle of the heart may develop. The examination reveals an expansion of the boundaries of cardiac dullness, which may be due to the accumulation of transudate in the pericardial cavity and myocardial hypertrophy. Often a functional systolic murmur is heard at the apex, an accent of the second tone on the aorta, and sometimes a gallop rhythm: dry and moist rales in the lungs. The ECG may show changes in the R and T waves in standard leads, often deep tooth Q and slightly reduced voltage of the ORS complex.

Arterial hypertension in acute glomerulonephritis may be accompanied by the development of eclampsia, but there is no uremia. It is more correct to consider eclampsia as acute encephalopathy, since it is caused by arterial hypertension and edema (hypervolemic cerebral edema). Despite the severe clinical picture of eclamptic seizures, they rarely end in death and mostly pass without a trace.

There are two most characteristic forms of acute glomerulonephritis. The cyclic form begins violently. Swelling, shortness of breath, headache, pain in lumbar region, the amount of urine decreases. Urine tests show high levels of proteinuria and hematuria. Blood pressure rises. Swelling lasts 2-3 weeks. Then, during the course of the disease, a turning point occurs: polyuria develops and blood pressure decreases. The recovery period may be accompanied by hyposthenuria. However, often, when patients feel well and have almost completely restored their ability to work, slight proteinuria (0.03-0.1 g/l) and residual hematuria may be observed for a long time, for months. The latent form is common, and its diagnosis is of great importance, since often with this form the disease becomes chronic. This form of glomerulonephritis is characterized by a gradual onset without any significant subjective symptoms and is manifested only by slight shortness of breath or swelling in the legs. In such cases, glomerulonephritis can only be diagnosed with a systematic examination of urine. The duration of the relatively active period in the latent form of the disease can be significant (2-6 months or more).

Acute glomerulonephritis may be accompanied by nephrotic syndrome. Any acute glomerulonephritis that does not end without a trace within a year should be considered to have become chronic. It should be remembered that in some cases, acutely onset diffuse glomerulonephritis can take on the character of subacute malignant extracapillary glomerulonephritis with a rapidly progressive course.

Diseases of this important paired organ in men and women have the same stages of development, but different frequencies: men are more susceptible to some, and women to others. This is due anatomical features the structure of the urinary system of representatives of each sex. Thus, it has been established that men are less likely to have pyelonephritis and kidney prolapse, but more often stones form inside the pelvis of the bean-shaped organ.

Features of the structure of the urinary system

The urinary channel, the urethra, is longer in men than in women. Therefore, the ascending route of infection (through the urinary tract) is uncharacteristic for them; most often the process is limited to urethritis. As a rule, the painful microflora does not succeed in moving to the bladder cavity, which explains the rarer cases of inflammation of this organ among the male part of the population. For the same reason, pyelonephritis is rare in men, and, mainly, they are caused by the presence urolithiasis, which, on the contrary, is more common in men.

Also men's and female system urination differs in that in men this tract is combined with the reproductive system, and in women it is separate from it.

Taking into account the peculiarities of the physiological location of the organs of the urinary system, the main kidney diseases that are more common in men are:

• urolithiasis disease;
• chronic renal failure;
• kidney cancer;
• kidney tuberculosis.

All of them are discussed in more detail in the relevant articles, and this text is intended to talk about the most typical symptoms of kidney disease in men and the signs by which kidney disease can be suspected.

Kidney disease syndromes in men

As the disease progresses, some signs appear earlier, others later. It depends on the individual characteristics the patient’s body, the reasons why the disease occurred, and its specifics. If you group the symptoms of kidney disease in men - such groups of signs are called syndromes - you can see the following picture:

Pain syndrome

Renal colic caused by urolithiasis is characterized by very severe pain, spasms, spreading to the suprapubic region, genitals, thighs. The condition is caused by both the movement of the stone in the kidneys and its movement along the ureter. In the future, moving along the sections of the urethra, the stone will change the localization of pain - which is also characteristic of renal colic. The accompanying signs also attract attention: nausea, vomiting, increased blood pressure (due to compression by a stone renal artery), the presence of sand or blood in the urine.

Pain with glomerulonephritis appears infrequently, usually no longer late stages development. It is unstable, aching, and affects both sides of the lower back.

Pain in renal failure occurs only in the last stages of the disease and, rather, is a manifestation of complications: pericarditis, myositis, etc. Accordingly, the localization of pain can be different.

Pain syndrome in kidney cancer is usually one-sided, the pain is dull and aching, but it can also imitate renal colic. In later stages it becomes the dominant symptom. The painful sensation even causes loss of consciousness, so the patient needs to be anesthetized according to a plan, systematically, since the attack will not go away on its own.

Urinary syndrome

Characterized by changes in the amount of urine or its laboratory parameters.

In chronic renal failure in the initial stages, the volume of urine increases to 2.5 liters per day. When the disease reaches a severe stage, the production and excretion of urine stops completely.

As a calculus moves through parts of the urinary system, urine output may increase or, conversely, stop completely, which is due to the blocking of the canals by the calculus (stone). Leukocytes, red blood cells, and protein appear in the urine.

In acute glomerulonephritis, the patient's urine volume is reduced to 400 ml per day in the first 5 days from the onset of the disease. Then diuresis increases, but urine density decreases (this can be determined laboratory method). The color intensity of urine varies - from a slight pink tint to a rich, almost brown pigment. The appearance of protein in the urine of men is typical.

With the development of cystic neoplasms, polyuria develops - an increase in the volume of daily urine to 4 liters: it is light, low density, and is excreted mainly at night.

There is blood in the urine of a patient with a malignant kidney tumor; if a blood clot clogs the lumen of the ureter, the outflow of urine stops completely.

Intoxication syndrome

It is caused by a violation of the main function of the kidneys - removing toxic substances dissolved in the blood from the body. Other causes of intoxication may be the proliferation of microbes in urinary tract or disintegration of a cancerous tumor.

With chronic renal failure, severe weakness, increased fatigue, the desire and need to be only in horizontal position. Due to the accumulation of nitrogen metabolism breakdown products in the blood, the patient experiences nausea, vomiting, lack of appetite, skin covering takes on a waxy color and an unpleasant taste appears in the mouth.

With pyelonephritis, an increase in body temperature occurs against the background of chills. As the disease progresses, nausea, lack of appetite, weakness, cold hands and feet, and pale skin are noted.

Polycystic kidney disease is manifested by increased fatigue, dry mouth, and the urge to vomit.

With a malignant neoplasm of the kidney, the patient has no appetite, is pale, weak, the skin acquires a characteristic waxy tint, facial features are sharpened due to weight loss, and body temperature is elevated.

Hypertensive syndrome

An increase in blood pressure (BP) is included in the so-called triad of symptoms when diagnosing glomerulonephritis. Polycystic kidney disease and malignant neoplasms are also always manifested by an increase in this vital sign. The movement of sand and stones along the urinary tract during urolithiasis causes not only an increase in blood pressure, but also a hypertensive crisis (a critical increase in pressure).

Edema syndrome

Swelling due to kidney disease is usually located on the face and is noticeable, but hidden swelling is also possible - for example, a wedding ring becomes narrow.

Specific symptoms of kidney cancer in men include the development of varicocele - varicose veins of the spermatic cord.

Cardiac manifestations

In chronic renal failure, as a complication, dystrophy of the heart muscle and circulatory failure occur, resulting in stagnation of blood in the lungs. There is chest pain, disturbance heart rate, shortness of breath, feeling of lack of air, cough with pink, foamy sputum.

Neurological manifestations

With every kidney disease, sleep disturbances, irritability, and worsening mood occur. In pathologies where irreversible processes occur (kidney cancer, chronic renal failure), a tendency to suicide may be observed.

Treatment

Elimination of all of these diseases begins with compliance with bed rest and adjustments to the diet.

• Doctor installs permissible norm salt intake determines how much water a particular patient needs to drink daily.
• Limiting physical activity is necessary not only to reduce the severity of pain syndrome, but also for the purpose of preventing hypothermia, unhindered overcoming the state of weakness and intoxication.
• If the disease is caused by pathogens and an inflammatory process occurs, the specialist will prescribe antibiotics
• When a calculus has formed inside the kidneys, the urologist will recommend medicines, dissolving deposits; will prescribe painkillers and antispasmodics.
• In case of chronic renal failure, hemodialysis is necessary (“ artificial kidney"), transplantation of a healthy organ is indicated.

Features of the diet for kidney disease in men

• The general principles of nutrition for all kidney diseases are to exclude spicy, sour and salty foods, as well as alcoholic and carbonated drinks.
• In order not to overload the digestive tract and not increase the load on the kidneys, forcing them to function at an accelerated pace, you need to eat fractionally - at least 6 times a day. Daily water consumption should not exceed 1 liter.
• At malignant neoplasms food is recommended to replenish hemoglobin lost in urine - these are pomegranates, beef liver, buckwheat, apples, spinach. Meat and poultry dishes should be baked or boiled. But broths - meat, fish - should be excluded, especially strong ones. You cannot drink coffee or strong tea.
• If there are stones inside the kidneys, avoid foods that contain substances whose metabolism has been disrupted and contributed to the formation of the stone. If you have oxalates and phosphates, do not consume dairy products, poultry, or refined carbohydrates; if you have urates, you should include foods rich in vitamin B in your diet.
• In case of inflammatory processes inside the kidneys, it is recommended to consume more cereals, vegetables (including in the form of soups), and fruits (except citrus fruits). It is acceptable to include lean meats in the diet, oatmeal, honey, jam. It is forbidden to eat onions, garlic, mushrooms, river fish, brewed coffee, sweets containing cocoa.

The diet must be followed in conjunction with restriction of physical activity and bed rest.

Anatoly Shishigin

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Glomerulonephritis is a lesion of the glomeruli in the kidneys, which are responsible for the transformation of blood plasma into primary type urine. The most common are acute and chronic types, occurring in different variants.

The causes of the disease and its severity vary, in some cases the changes are visible only in the field of view of a conventional microscope, in other cases an electronic one with high magnification is required. But regardless of the morphology, the doctor suspects glomerulonephritis in cases of high blood pressure, protein and red blood cells in urine tests, as well as general swelling.

Depending on the degree of predominance of certain symptoms and their severity, there are several clinical variants among the types of glomerulonephritis.

Chronic glomerulonephritis with isolated urinary syndrome is more common than other variants, and, as a rule, is discovered completely by chance. The patient has no complaints about the condition, no swelling or high blood pressure, the color of the urine is unchanged and within normal limits. And only during a routine medical examination, urine tests accidentally reveal protein and red blood cells up to 2g per day.

The course of this type of glomerulonephritis (CGN) is benign and does not require the use of aggressive treatment regimens. Because patients cannot detect symptoms, the onset of the disease is often missed and they consult a doctor only at the stage of development of renal failure.

Experts note that in some cases patients experience increased fatigue, weakness and morning facial pastiness. During the examination there are no signs of left ventricular hypertrophy, the fundus of the eye is not subject to changes.

Exacerbation of this form of the disease occurs during infection, hypothermia or pregnancy. An exacerbation is accompanied by an increase in hematuria and proteinuria by a factor of two or more. In this case, the glomerular structure in the kidneys is damaged and immunocomplex pathology develops. At this stage, swelling and high blood pressure levels may appear.

Relapses are quite rare, but lead to the transformation of this type into hypertensive or nephrotic. This type of glomerulonephritis lasts up to 25 years. Patient survival is 90%. Differentiation of the disease occurs with chronic pyelonephritis, on urine tests using the Nechiporenko method, active leukocytes, unchanged erythrocytes, and extraglomerular microhematuria are visible.

Nephrotic appearance

Neurotic glomerulonephritis occurs in 22% of all cases of the disease, and it is very difficult to miss its onset. Nephrotic syndrome is characterized by the following factors:

1. protein excretion in the amount of 3 grams per day along with urine, and a diagnosis of proteinuria is made;
2. severe swelling of the entire face and legs, as well as internal cavities, while pleurisy occurs in the lungs, ascites occurs in the peritoneal cavity, and hydropericarditis occurs in the heart sac;
3. the protein in the blood plasma sharply decreases, a diagnosis of hypoproteinemia is made;
4. Albumin, the lighter parts of protein cells, are lost along with the urine, the diagnosis sounds like hypoalbuminemia;
5. detection of hyperlipidemia, when cholesterol reaches 12 g per liter or higher. Low-density lipoproteins also increase along with triglycerides.

This variant of glomerulonephritis requires serious and long-term treatment, since in addition to the listed symptoms, the patient experiences the following conditions:

• the immune system and resistance to penetrating infections are reduced, since copper and zinc are excreted along with the urine;
• the risk of thrombosis and osteoporosis increases, since the body loses vitamin D along with protein;
• symptoms of initial hypothyroidism appear due to the loss of thyroid-stimulating hormones;
• due to the resulting hyperlipidemia, atherosclerosis is complicated and the risk of stroke or heart attack increases;
• The most dangerous of all complications in nephrotic syndrome is hypovolemic shock and cerebral edema.

Hypertensive appearance

The most striking symptom of this disease is high blood pressure. Urine tests show slight proteinuria and an increase in red blood cells. If the disease is detected, treatment should be started as soon as possible, using antihypertensive drugs in the correct dosage.

Systematic intake and adherence to recommendations can normalize arterial pressure and stabilize the condition for a long time. If you ignore the symptoms and do not start treatment, kidney failure progresses at an accelerated pace.

Mixed view

Mixed glomerulonephritis consists of the addition of nephrotic syndrome with high blood pressure. Thus, all the dangers for the body with high blood pressure are added to the symptoms of nephrotic type. Kidney dysfunction occurs very quickly, and the patient is susceptible to various vascular diseases.

Hematuric appearance

Most often this type occurs in men. It is characterized by the absence of high blood pressure and swelling; there are no obvious abnormalities in urine tests, except for erythrocyturia and slight proteinuria, up to 1 gram per day. Many provoking factors cause gross hematuria, when the urine turns red and more than 100 red blood cell bodies are not detected in the field of view of the microscope.

Unlike urological pathologies and urolithiasis, with the hematuric form of the disease there are no pain syndromes in the lower back or abdominal area. Oddly enough, the brighter the symptoms of this type of disease, the better the prognosis for recovery and preservation of kidney function.

Sharp look

The acute form of the pathology is not the most common option, but it is not the best either. It often begins with nephrotic syndrome, but then becomes chronic. An acyclic variant is possible, when the change is noticeable only in urine tests and slightly high blood pressure. In this case, there will be no transition to the chronic stage.

The classic course of acute glomerulonephritis is cyclical. A week or 2 after infection, symptoms of nephrotic syndrome appear in the form of hematuria, edema and high blood pressure. Pain in the lower back or abdomen may occur, but after 2 or 3 days there will be an improvement.

Rapidly progressive species

Subacute glomerulonephritis in the initial stage resembles acute glomerulonephritis with symptoms. Nephrotic syndrome occurs, but recovery is not observed over time. Swelling increases, diuresis appears and pressure increases. Literally a month later, kidney failure develops.

Diagnosis and choice of specialist for treatment

Neurologists treat glomerulonephritis, but diagnosis is made by therapists and pediatricians. If necessary, seek the help of a cardiologist, especially in cases of high blood pressure.

Diagnosis of glomerulonephritis is very diverse and consists of different components. Evaluation of patients suspected of having this disease involves examination of the kidneys, the rate of progression of the disease, and many other factors.

The following examination methods are considered traditional:

• general urine test, where the most informative indicators will be red blood cells, proteins and leukocytes;
• general blood test to detect ESR, biochemistry;
• laboratory testing of urine based on specific gravity;
• identifying the total level of protein in the blood;
• performing an electrocardiogram on the patient;
• Ultrasound ultrasound, which is Dopplerography of blood vessels in the kidneys;
• ultrasound examination of the kidneys;
• in some cases a kidney biopsy is needed;
• examination of microspecimens in the kidneys.

Treatment

Chronic glomerulonephritis requires strict adherence to the doctor’s recommendations, which can stop the spread of the disease and its exacerbation.

1. The patient must adhere renal diet, limiting spicy foods, salt and alcohol. Daily norm protein should be increased, since most of the proteins are excreted in the urine during proteinuria;
2. It is necessary to exclude high humidity, overwork and being in a cold place for a long time;
3. It is important to avoid infection viral infections, do not vaccinate or come into contact with allergens.

A typical drug regimen for the treatment of glomerulonephritis consists of the use of immunomodulatory and immunosuppressive drugs, non-hormonal anti-inflammatory drugs, anticoagulants for detected hematuria, cytostatics and glucocorticosteroids.

Medicines are also used to relieve edema, this is a diuretic group, and lower blood pressure, antihypertensive drugs. Experts recommend going to a hospital during an exacerbation, and when remission occurs, maintaining therapy on an outpatient basis and preferably going to a sanatorium-resort treatment.

Forecast

For glomerulonephritis, the prognosis depends on the form of the disease and the degree of spread in the body:

№	Helpful information
1	Latent glomerulonephritis with isolated urinary syndrome does not manifest itself for many years and progresses quite slowly. In 20% of patients, the hematuric form can be cured with a combination of steroid drugs and medications - coagulators
2	inflammation without complications that are detected in a child school age, when carrying out hormone therapy gentle properties in combination with cytostatics, allow you to achieve success in 80% of cases
3	Hypertensive glomerulonephritis is treated with drugs of various dosages that lower blood pressure. If therapy is prescribed incorrectly, heart failure, atherosclerotic plaques and an increased risk of stroke may occur.
4	With the edematous variety of the disease, the prognosis is most often unfavorable. Nephrotic types are evidence of kidney dysfunction and lack of filtration. The development of renal failure occurs quite quickly
5	mixed form of glomerulonephritis is marked by the most negative prognoses

Prevention

Must pass preventive actions that will help prevent the occurrence of glomerulonephritis, in particular:

• try to avoid hypothermia. If a person's feet or whole body freeze, this directly affects the kidneys, which can become inflamed. Against this background, the development of glomerulonephritis, chronic neuritis and pyelonephritis is possible;
• Don't irritate your kidneys junk food and alcohol in excess, this also applies to carbonated drinks, since they provoke the occurrence of pathology;
• with glomerulonephritis chronic form it is important to be regularly examined by a doctor and receive recommendations for treatment;
• try to lead a healthy lifestyle, sleep enough hours, and devote some time to sports when awake. This helps strengthen the immune system and protect against many types of diseases.