Chronic glomerulonephritis - Causes, Symptoms, Diagnosis and Treatment

Under chronic glomerulonephritis in urology understand the different etiology and Pathomorphology primary glomerulopathy, accompanied by inflammatory and destructive changes, and lead to renal scarring and chronic renal failure. Among all therapeutic pathology of chronic glomerulonephritis is about 1-2%, which is indicative of its relatively high prevalence. Chronic glomerulonephritis can be diagnosed at any age, but often the first signs of nephritis develop in 20-40 years. Symptoms of chronic process are long-term (over one year) for the progressive glomerulonephritis and diffuse bilateral renal involvement.

acute glomerulonephritis. However, often there are cases of primary chronic glomerulonephritis without prior episodes of acute attacks.

The cause of chronic glomerulonephritis can not figure out not in all cases. The leading value is given nefritogennym strains of streptococcus and the presence in the body of foci of chronic infection (pharyngitis, tonsillitis, sinusitis, cholecystitis, dental caries, periodontal disease, adnexitis, etc.), Persistent viruses (influenza, hepatitis B, herpes, chickenpox, infectious mononucleosis, rubella, cytomegalovirus infection).

In some patients chronic glomerulonephritis caused by hereditary predisposition (defects in the system of cellular immunity or complement) or congenital renal dysplasia. There is also a non-infectious factors include chronic glomerulonephritis Allergic reactions to vaccinations, alcohol and drug intoxication. Calling diffuse lesion of the nephrons are other immunoinflammatory diseases - hemorrhagic vasculitis, rheumatic fever, systemic lupus erythematosus, bacterial endocarditis, etc.

The emergence of chronic glomerulonephritis promote cooling and general weakening of the body's resistance.

In the pathogenesis of chronic glomerulonephritis leading role of immune disorders. Exogenous and endogenous factors induce the formation of specific CEC consisting of antigens, antibodies, complement, and its fractions (C3 C4), which are deposited on the glomerular basement membrane and cause its deterioration. In chronic glomerulonephritis glomerular damage is intracapillary character that violates the microcirculation with subsequent development of reactive inflammatory and degenerative changes.

Chronic glomerulonephritis is accompanied by a progressive reduction in the weight and size of kidney, renal tissue seal. It determined microscopically fine-grained surface of the kidney, bleeding in the glomeruli and tubules, loss of clarity, and cerebral cortex.

nephrotic syndrome), mixed (with nephrotic syndrome, hypertensive). Each of the forms takes place with the periods of compensation and decompensation azotovydelitelnoy renal function.

hypertension. It is characterized by mild hematuria, proteinuria, leyotsituriey. The course is slowly progressive (10-20 years), uremia development comes later.

When hematuric variant of chronic glomerulonephritis (5%), there is persistent hematuria, gross hematuria episodes, anemia. The course of this form of relatively favorable, uremia is rare.

Hypertensive form of chronic glomerulonephritis develops in 20% of cases and occurs with hypertension with mild urinary syndrome. Blood pressure rises to 180-200 /100-120 mm Hg. Art., is often subject to significant daily fluctuations. Observed changes in the fundus (neyroretinit), left ventricular hypertrophy, cardiac asthma, as a manifestation of left ventricular heart failure. Current hypertensive form of jade long and steadily progressing with the outcome in renal failure.

Nephrotic variant of chronic glomerulonephritis, occurring in 25% of cases, occurs with massive proteinuria (more than 3 g /day.), Persistent diffuse edema, hypo- and dysproteinemia, hyperlipidemia, dropsy of serous cavities (ascites, hydropericarditis, pleurisy) and related dyspnoea , tachycardia, thirst.

Nephrotic syndrome and hypertensive at the heart of the most severe, mixed forms of chronic glomerulonephritis (7% of cases). Proceeds from hematuria, severe proteinuria, edema, hypertension. An unfavorable outcome is determined by the rapid development of renal failure.

urine is the appearance of red blood cells, leukocytes, cylinders, protein, urine specific gravity change. To assess kidney function tests are carried out and Zimnitsky Rehberg.

The blood found in chronic glomerulonephritis and Dysproteinemia hypoproteinemia, hypercholesterolemia, increased titers of antibodies to streptococci (SLA-O antigialuronidaza, antistreptokinaza), reduced content of complement components (DS and C4), increased levels of IgM, IgG, IgA.

Renal ultrasound with progressive course of chronic glomerulonephritis detects a decrease in organ size due to the hardening of the kidney tissue. Excretory urography, pyelography, nefrostsintigrafiya help assess the condition of the parenchyma, the degree of renal dysfunction.

To detect changes in the other systems is performed ECG and echocardiography, ultrasound examination of the pleural cavities, fundus examination.

Depending on the clinical variant of chronic glomerulonephritis requires a differential diagnosis with chronic pyelonephritis, nephrotic syndrome, polycystic kidney disease, kidney disease, renal tuberculosis, renal amyloidosis, arterial hypertension. To determine the histological forms of chronic glomerulonephritis and its activity, as well as the exclusion of pathology with similar manifestations of renal biopsy performed with morphological study obtained a sample of kidney tissue.

urologist.

The most favorable prognosis is the latent form of chronic glomerulonephritis; more serious - and hypertensive hematuric; unfavorable - nephrotic mixed form. Complications, worsening outlook include plevropnemnoniya, pyelonephritis, thromboembolism, renal eclampsia.

Since the development or progression of irreversible changes in the kidney is most often triggered by streptococcal and viral infections, wet hypothermia, of paramount importance to prevent them.

When concomitant chronic glomerulonephritis pathology is necessary to observe related professionals - otolaryngologist, dentist, gastroenterologist, cardiologist, gynecologist, rheumatologist, etc.
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