Glomerulonephritis is an infectious allergic disease of both kidneys with a predominant lesion of the glomerular glomeruli, characterized by edematic, hypertensive, intoxicating syndromes, hematuria, proteinuria and cylinduria.
The role of hemolytic streptococci in group A has been proved. It is impossible to exclude the importance of viral infection and non-bacterial factors (introduction of vaccines, serums, drugs, excessive insolation, low back injury, wet cold effect, etc.)
Pathogenesis of glomerulonephritis
The first stage of pathogenesis is the sensitization of an organism with a high content of antibodies circulating in the blood. The latter interact with exo- or endogenous antigens. There are immune complexes that are fixed on the inner wall of the glomerular capillaries or settle on the basement membrane with the participation of the complement system. In the development of inflammation in the glomeruli involved a system of hemocoagulation, fibrinolysis, as a result, there are movements of microcirculation, fibrin microthrombi, obliteration and sclerosis of capillaries. Leukocytes, monocytes, falling into the area of immunopathological damage to glomeruli, contribute to a sharp increase in local coagulation activity. The lysosomal enzymes of these cells (proteases, hydrolases, collagenases) depolymerize the proteins of the basal membranes, disrupt their integrity, increase permeability, which contributes to sclerosis and process chronicization. There are such changes in the structure of the glomerulus: minimal, membranous, membrane-proliferative, proliferative, fibroplastic.
Clinic of glomerulonephritis
Intoxication syndrome: the general condition of the child is broken, weakness, fatigue, headache, nausea, vomiting, and fever. Edema syndrome: pastosis or swelling of the face, hands, feet, sometimes fluid in the pleural, peritoneal, pericardial cavities, the weight of the child increases. Edema causes weakened heart sounds, tender systolic murmur, pain in the heart, myocardial hypoxia.
With severe edema, lesions of the nervous system are observed: headache, insomnia, loss of consciousness, convulsions, coma. Hyper-nzhny syndrome: the indices of arterial pressure exceed the norm by an average of 20-30 mm Hg. (2.6-3.9 kPa) for acute glomerulonephritis and 40-60 mm Hg. (5.3-8.0 kPa) with subacute (malignant) glomerulonephritis. Urinary syndrome: oliguria, proteinuria, hematuria, cylinduria. There is hypoproteinemia due to albumins, hyper -? 2? - globulinemia, increased cholesterol, lipids, sometimes residual nitrogen, urea, creatinine in the blood. Reduced glomerular filtration, tubular reabsorption, hypo- and isostenuria occurs.
1. Acute glomerulonephritis: with nephritic, nephrotic syndromes, with isolated urinary
syndrome, a mixed form with proteinuria, hematuria and hypertension.
Periods: initial manifestations, acceleration, reverse development, transition to chronic glomerulonephritis.
Functional state of the kidneys without violation, with impaired, acute renal failure.
2. Chronic glomerulonephritis: nephrotic, hematuric, mixed forms.
Periods: exacerbation, partial and complete clinical and laboratory remission.
Functional state of the kidneys without violation, with impaired, chronic renal failure.
3. Pidgestria (malignant) glomerulonephritis.
Bed rest, diet № 7а, № 7б, № 7 antibiotic therapy 2-4 weeks (penicillins, macrolides), antihistamines, antiaggregants, diuretics and antihypertensives. If the basic therapy is ineffective, appoint (in 3-4 weeks) pathogenetic therapy (nonsteroidal anti-inflammatory drugs, glucocorticoids, heparin, cytostatics). Treatment of chronic glomerulonephritis depends on the form. In hematuric form with hypercoagulable phenomena, heparin and antiaggregants (curantyl, dipyridamole), anti-inflammatory drugs (indomethacin, diclofenac, orthophene, ibuprofen), ochinolinovi (delagil, plaquenil) are used. The hormone-sensitive variant of the nephrotic form is an indication for prescribing prednisolone, and with signs of hypercoagulation and heparin. With the hormone-resistant variant, 4-component therapy (prednisolone, chlorbutin, heparin, quarantil) is used. The mixed form requires the use of combined therapy with the inclusion of a zathioprine or cyclophosphamide. Systemic enzyme therapy is indicated (in the enzyme or phlogenzyme). Rehabilitation therapy is carried out for 3-5 years. Then the children who have undergone acute glomerulonephritis are removed from the register. Patients with chronic glomerulonephritis are not taken off the register.