Acute and chronic inflammation of the glomeruli of the kidneys is called glomerulonephritis, which mainly affects the glomeruli and capillaries of the kidneys, resulting in impaired renal function. Gelomerulonephritis has different aspects from pyelonephritis. That is, in pyelonephritis, the cups and sacs of one kidney are usually damaged, while in glomerulonephritis, both kidneys are equally inflamed.
Mainly after suffering from angina, pharyngitis, scarlet fever and other infectious and inflammatory diseases (sometimes after diphtheria, pneumonia, rashes, diarrhea and other diseases caused by streptococci), as well as extreme cold weather. Increased exposure to harmful substances (alcohol, mercury, lead, acetone, gasoline, etc.) and systemic diseases (lupus erythematosus, hemorrhagic vasculitis, infectious endocarditis) can damage the kidney tissue.
Swelling around the eyelids
pumpkin-around-tumors
There are three types of glomerulonephritis (acute, subacute, chronic). Patients with acute forms of the disease have three conditions (swelling of the body, increased blood pressure, changes in the urine). In some patients, the disease begins suddenly, while in others it is gradual and subtle. In most cases, the legs are swollen, there is weakness and headache, and there is little urination. If treatment is not started on time, 80-90% of patients develop swelling around the eyelids and face, pale skin, narrowed eyes, and a swollen face. During this time, fluid builds up under the skin, between the lungs and the pericardium, and in the abdomen, and the body weight increases to 15 to 20 kilograms. When treatment is started on time, the swelling gradually starts again within two to three weeks.
There are some causes of swelling in patients. For example, capillary wall permeability changes, renal glomerular damage results in decreased filtration activity, fluid retention, increased antidiuretic (ADG) hormone, renal tissue becomes sensitive to aldosterone, and fluid from the blood leaks out of the arteries and into porous cells. All this accelerates the development of glomerulonephritis. There is also a mixed form of acute glomerulonephritis, in which the glomeruli of the kidneys become enlarged and red, and red and white blood cells accumulate there. Later, the color of the balls may fade and the veins may rupture. The main symptom of the disease is an increase in arterial blood pressure as a result of circulatory disorders in the kidneys.
Patients have oliguria (less than 1-1,5 liters of urine per day) and hematuria (blood in the urine). The color of the urine is similar to that of meat. Increased blood pressure can lead to pulmonary edema and acute heart failure. As the disease progresses, there may be pain on both sides of the lower back.
The acute form of the disease is more common in young people. During this time, the patient's urine changes, forming proteins, erythrocytes and cylinders. Arterial blood pressure rises and edema is observed in the body. If treatment is not started in time, in a short time there is a sharp deterioration of renal function and the terminal stage of chronic renal failure. Most patients need dialysis therapy.
Manifestations of the chronic type
In the chronic form of glomerulonephritis, renal function decreases due to the gradual injury of the renal glomeruli, arterial blood pressure increases, and renal failure develops as a result of impaired renal function. This type of disease manifests itself in several forms, depending on the course.
Approximately 44% of patients develop latent glomerulonephritis. In this type of glomerulonephritis, blood pressure does not rise constantly, and the swelling is almost imperceptible. Patients do not lose their ability to work for many years, and even live without feeling sick. Latent glomerulonephritis can only be diagnosed by consulting a doctor or undergoing a medical examination for certain diseases.
Patients with nephrotic glomerulonephritis excrete large amounts of protein (more than 3,5 g per day) in the urine. Cholesterol increases. In the blood, the protein content decreases. Patients develop tumors as a result of protein depletion. The swelling, which initially started in the legs, gradually spreads throughout the body. It can even spread to internal organs, such as the heart, lungs, and abdomen. The mucous membranes of the skin dry out, resulting in wrinkles.
The nephrotic form of the disease is accompanied by signs of inflammation of the kidneys (presence of erythrocytes in the urine, impaired renal function). In the early stages of the disease, blood pressure is normal. As the disease progresses, blood pressure rises.
Hypertensive glomerulonephritis may present with elevated blood pressure and some symptoms (eg, ischemic heart disease, angina pectoris, and changes in the blood vessels at the base of the eye). There is a risk of bleeding into the fundus and even serious irreversible changes in the retina.
Mixed-type glomerulonephritis is characterized by edema, hypertension, and changes in urine (proteinuria, hematuria, and cylinduria). Over time (if not treated at the time), renal insufficiency develops.
Diagnosis, treatment, prevention
Necessary tests from the patient to make a definite diagnosis (ie, general analysis of urine and blood, general analysis of blood and urine protein, blood protein fractions, biochemical analysis of blood - urea, creatinine, blood cholesterol and lipids, ultrasound examination of the kidneys, kidneys) , i.e. puncture biopsy) must be obtained. If the disease is detected early and treated in a timely manner, about 14-18% of patients can recover completely.
Over time, as a result of glomerulonephritis, the kidneys do not shrink and lose their function, followed by the development of renal failure - uremia intoxication. Uremic intoxication may be characterized by general weakness, nausea, vomiting, loss of appetite, more or less urinary excretion, and pruritus.
To prevent the development of glomerulonephritis, patients should be under constant medical supervision, timely elimination of foci of infection, regular diet and protection from the effects of cold and humid weather. Patients should adhere to a strict diet during treatment. It is necessary to reduce the amount of salt and water entering the body, as well as the amount of protein. The amount of salt in the diet should not exceed 1,5-2,0 grams per day, the consumption of vegetable protein products - soy, cottage cheese and egg protein, the daily amount of fat is 50 grams, the daily amount of fluid is + 200 ml, depending on the amount of urine excreted. should
Pathogenetic treatment includes corticosteroids, antiplatelet agents, immunosuppressive agents, antibiotics, diuretics, antihypertensive drugs, and symptomatic therapy. Treatment is carried out in inpatient and outpatient settings for many years.
Anvar ZUFAROV,
Tashkent city Nephrology
chief physician of the hospital,
doctor of medical sciences, professor.
