Glomerulonephritis

Chronic diffuse glomerulonephritis is a chronic inflammatory process in the glomeruli of the kidneys, leading to the gradual death of inflamed glomeruli with the replacement of their connective tissue. At the same time, the tubules also suffer, in which the inflammatory process and necrosis develop with the formation of scar tissue, then the renal tissue of the connective tissue is replaced. In 10-20% of patients, the cause of the disease is acute glomerulonephritis. But 80-90% have a slow, gradual, latent onset with a random detection of changes in the analysis of urine.

Pathogenesis

This is an autoimmune disease in which immune complexes are brought into the glomeruli of the kidneys from the blood, which damage the glomeruli, causing inflammation in them. Chronic glomerulonephritis is the most common cause of chronic renal failure . Due to the fact that the process is autoimmune, the disease is steadily progressing. It is more common in men under 40 years old. In childhood, it can be accompanied by an increase in blood pressure to 130/90, nosebleeds and back pain.

Pathanomy

The process is always two-way; the kidneys are reduced in size, the entire surface is covered with scars, the renal tissue is dense - this is called a second wrinkled kidney. The incision has a lot of connective tissue that replaces the kidney. There are very few functioning glomeruli. The border between the cortical and cerebral layer is erased.

Clinical picture

There are 5 options for chronic diffuse glomerulonephritis.

1. Hypertensive (20% of cases) severe hypertension - diastolic pressure higher than 95 mm Hg. Art.
2. Nephrotic (20%) - a large loss of protein in the urine up to 10-20 grams per day, blood hypoalbuminemia , severe swelling of the extremities, hydrothorax , ascites , anasarca .
3. Combined form. The most typical combination of the two previous, steady, progressive course. In all three forms of the disease, there are necessarily changes in the analysis of urine (hematuria and proteinuria).
4. Hematuric form. Berger's disease, IgA nephritis (recurrent hematuria, edema and hypertension).
5. Latent or urinary form. The most common form. It manifests itself only in a change in the analysis of urine - microhematuria, moderate proteinuria - a small amount of protein.

The course is long - more than 15 years. With this option, there is no edema, the increase in blood pressure is negligible. An average of 10-25 years, renal function persists, but always progresses steadily and leads to chronic renal failure . It flows cyclically with periods of exacerbations, remissions. In the period of remission, patients do not show any complaints, and only arterial hypertension, changes in the analysis of urine allows us to talk about the disease. Changes in the analysis of urine always remain, only in the period of remission they are less. Exacerbations are caused by hypothermia, infection, and the use of alcoholic beverages. During exacerbations, the clinic is the same as in acute glomerulonephritis. A patient with chronic glomerulonephritis has dry skin.

Chronic Glomerulonephritis Stages

Preserved Renal Function Stage

Stage of compensation. The patient feels satisfactorily, but the disease progresses progressively, gradually the renal tissue is replaced by scar tissue, and renal function is impaired. The kidneys are unable to concentrate urine. The specific gravity of urine is equal to the specific gravity of plasma. Can be diagnosed by urine analysis: urine collection according to Zimnitsky - if the specific gravity does not change, then this is the initial sign of chronic renal failure.

Stage with impaired renal function and the development of chronic renal failure

Stage of decompensation. Urea and creatinine accumulate in the blood, which the kidneys cannot secrete, since kidney function is impaired. As a result, intoxication occurs. This is called uremia (azotemia, urinary tract (obsolete concept)). Signs of intoxication appear: weakness, headache, nausea, vomiting, thirst, dry tongue, dry skin, cracking, diarrhea, rapid weight loss, degeneration of internal organs, cachexia due to the fact that the kidneys cannot remove harmful substances, and the body tries to excrete in other ways: through the skin, through the intestines. In severe cases, the smell of ammonia from the mouth. In the terminal stages, a uremic coma occurs.

Uremia

Uremia is a clinical syndrome that develops in patients with impaired renal excretory function of the kidneys - this is the final stage of chronic renal failure, when a lot of urea, creatinine, residual nitrogen accumulate in the blood, intoxication occurs.

The final stage of uremia is a uremic coma . There is a respiratory failure ( Cheyne-Stokes breathing ), periods of sudden inhibition are replaced by periods of excitement - hallucinations, delirium. There is a sharp urenous or ammonia smell from the mouth. On dry skin, a whitish coating of urea crystals, high blood pressure , anemia in the blood, leukocytosis .

Other diseases that cause uremia: chronic pyelonephritis , vascular damage to the kidneys, diabetic nephropathy .

Prevention

Diagnosis and treatment of acute glomerulonephritis, identification of changes in urinalysis with good health of the patient. Treatment of chronic glomerulonephritis and chronic renal failure. Radical treatment is impossible, since the process is autoimmune. Without exacerbation, in most cases, nephroprotection is indicated . A prolonged stay in bed, physical activity, avoiding hypothermia, working in a dry, warm room, preferably sitting, dieting, limiting salt to 2-3 grams per day, protein, and foods rich in vitamins are contraindicated. Remediation of foci of chronic infection. In severe cases, glucocorticosteroids ( dexamethasone , hydrocortisone ), cytostatics ( mercaptopurine , azathioprine , cyclophosphamide ), chimes. Spa treatment in a dry, hot climate. Treatment during exacerbation: hospitalization. Deterioration in urinalysis should be considered an exacerbation. Treatment during an exacerbation is the same as with acute glomerulonephritis. Contraindications for the treatment of glucocorticosteroids: gastric ulcer , diabetes mellitus , renal failure , the first 15 weeks of pregnancy, chronic glomerulonephritis with very high hypertension.

Chronic GN is divided into membranous, membrane-proliferative, mesangioproliferative ( IgA nephropathy ), focal segmental glomerulosclerosis.

Unlike humans, focal nephritis predominates in animals. In the acute stage of the disease, an extracapillary exudative process is observed in the glomeruli, as a result of which the glomeruli are enlarged, their vessels are full of blood, the cavity of the Shumlyansky-Bowman capsule contains serous-fibrinous exudate. The capillary endothelium swells, in their lumens there is a significant number of leukocytes, and homogeneous or granular protein cylinders are visible in the lumens of the tubules. In swine fever and pig mug, inflammation develops as a hemorrhagic one, and red blood cells predominate in the Shumlyansky-Bowman capsule and tubules. ^[3]

• Uremia

1. ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
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2. ↑ Acute glomerulonephritis (Russian) . Date of treatment November 12, 2018.
3. ↑ A.V. Zharov, V.P. Shishkov et al. Pathological anatomy of farm animals. - M .: Kolos, 1995 .-- 543 p.