KIDNEY DISEASE : JADE CHRONIC NEPHRITIS CHRONICA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
The outcome of untreated acute nephritis. Less likely to develop without the acute phase of nephritis in the past. Chronic nephritis depends primarily on the presence in the body of infectious foci and emerging infections, adverse environmental conditions and inadequate treatment of nephritis in the acute period. In the development of recurrent nephritis and chronic progressive course should recognize the essential role of complex influences of the Central nervous system on the circulation and trophic kidney, as well as other regulatory activity of the renal organs, although this influence of the Central nervous system is studied more completely insufficient. Anatomical changes in the kidneys are reduced to the organization of the cellular exudate in capsules in the so-called paulonia to degenerative changes in tubular epithelium, to the widespread loss of renal vessels, further - to the shrinkage of the body due to the complete atrophy of individual sections of the renal parenchyma.
Symptoms. Dominate the clinical picture symptoms of two kinds: on the one hand, chronic edematous syndrome with large swelling, massive albuminuria, cholesterolemia and other signs of nephrotic disorders of metabolism - the so-called nephrotic type of chronic nephritis (formerly chronic parenchymatous nephritis). On the other hand, hypertensive syndrome in vascular forms with constant high blood pressure, severe hypertrophy of the left heart and the prevalence of vascular and cardiac complaints - hypertensive type chronic nephritis (corresponding to part of the cases still chronic interstitial nephritis). Often forms mixed nefroticeskih-hypertensive syndrome. Both types of chronic nephritis - nephrotic before, hypertensive later, sometimes after a dozen years - lead to uremic betacea period with a slight albuminuria, hyposthenuria and azotemia.
For. We can distinguish recurrent type of chronic nephritis with a number of acute nephritic flares; next latent type, when the initial acute period and late uremic stage goes a prolonged period of good health and full health of patients, often with periods of normal blood pressure and a slight albuminuria; and, on the contrary, malignant subacute type (extracapillary jade), leading to death from uremia within the first 6 to 24 months. Chronic nephritis only as a rare exception ends with recovery; the usual outcome is death from uremia, if the patient does not die earlier from attending diseases or heart failure.
The recognition is based on history, resistant hypertension, hypertrophy of the left ventricle, low specific gravity of urine, scanty quantity (late stage).
In the stage of the adequacy of renal function are limited to the holding of General hygiene regime, regulation of work, rest and sleep, the appointment of a benign mixed power is excluded from diety canned food, excess spices, alcoholic beverages and reasonably restrict animal protein and salt; then follow the skin, regulate the action of the intestines, protect the patient from infections (flu, sore throat). During acute outbreaks of treatment, as in acute nephritis. Nephrotic type of chronic nephritis requires mainly the treatment principles of treatment of lipoid nephrosis. With the prevalence of hypertensive syndrome have to pay more attention to circulation, normalizing the physical work, periodically cardiotonic therapy (digitalis) with restriction of salt and water. On the course of chronic nephritis beneficial stay in a warm, dry climate, due to a better functioning in these conditions skin with its excretory function and the effect on the whole body, particularly to the kidneys, due to the lesser risk of respiratory tract infections, etc. For permanent residence nephritis patients can be recommended, for example, the surroundings of Tbilisi; edematous forms with normal blood pressure, as with principally shown the climate is desert - Bairam-Ali, Ashgabat. Spa treatment in Zheleznovodsk, with its carbon-semilinearity sources shown, rather, for jade on the ground arthritic diathesis or in combination with urinary sand and pilita. The best time to treat kidney patients in Zheleznovodsk from July to September. During the development of renal failure (hyposthenuria, polyuria, increased residual nitrogen) even before the development of clinical symptoms of uraemia should increase fluid intake to 2 to 2.5 liters (due to induced polyuria); only in the most recent phase uremic period, with a sharp drop in cardiac fluid intake is necessary to limit 1 - 1.5 l Simultaneously lower protein diet to 0.5 of protein per 1 kg of body weight, and in later stages include, for example, once every 5 - 7 days fruit and sugar days with a large amount of liquid. It is desirable to introduce a little denatured, rich in vitamins and grounds vegetarian food or partial syroedenie, campolo, especially when the anemia.