KIDNEY DISEASE : NEPHRITIS ACUTE (NEPHRITIS ACUTA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Infectious diseases of the upper respiratory tract, usually caused by hemolytic Streptococcus: tonsillitis, pharyngitis independent and with scarlet fever, influenza, and other infections - pneumonia, typhoid, malaria, cooling of the body, usually in connection with infection (so-called catarrhal nephritis, military jade).
The pathogenesis. Inflammatory lesions of the kidney (clubockova-vascular system) is due to the indirect impact infection that causes in connection with the development of the immune system or allergic changes in the body a kind of vascular inflammatory lesions of glomerular apparatus, as well as tubules and interstitial tissue of the kidney. In the development of vascular-allergic kidney damage, such as acute nephritis, as well as the basis of the mechanism of origin of individual symptoms of this disease (hypertension, edema, cerebral phenomena), should be considered a significant role in the Central nervous system, affecting the activity of the kidneys and other organs and systems in the field and through the interstitial-endocrine regulation; however, this part of the nervous system in the formation and course of acute nephritis has not been sufficiently studied.
Symptoms of diffuse lesions of the kidneys come mostly after a certain time, most often through I - 2 weeks after infection (postinfection).
Symptoms. Major triad: increased blood pressure, edema, hematuria. Hypertension give utmost importance, it is often an early symptom; perseverance or persistence of hypertension identifies all over jade. Systolic pressure rises to 160 - 180 mm, diastolic - to 100 - 120 mm; even more increase the pressure come before atlanticheskii attacks. Edema develops rapidly, reaching a largely localized on the face, legs; lower back; the skin is often cyanation, due to heart failure. Urine is excreted few; it is typical of the kind of meat slops from impurities of the blood, contains 1 - 20 protein and often much more (up to 10 - 150 and above); cylinders, leukocytes. In severe nephritis always obvious shortness of breath, increased heart dullness (due to the expansion of the cavities of the heart, hydroperiod later due to hypertrophy of the left ventricle), congestive liver, swelling of veins with increased venous pressure and an increase in the mass of blood (swelling of the blood) when usually rare pulse.
Course and complications. Typical cyclic over with quickly advancing fracture disease, increase diuresis, reduce swelling, decrease in blood pressure. Significant swelling usually kept for no longer than 1 to 2 weeks, as well as massive albuminuria; the same selection negligible amounts of protein (less than 10) and blood may continue for months. Hematuria during reduce swelling often even increasedby. However, sometimes, especially in the presence of active foci of infection in the body (tonsillitis, otitis, abrasions), jade takes more persistent during the re-strengthening of edema, hypertension, hematuria, sometimes leading to more severe anatomical changes in the glomeruli. Frequent complication of acute nephritis - atlanticheskie attacks, emerging unexpectedly after a hypertensive crisis and sharp headaches; seizures or equivalents eclampsia - amaurosis caused angiospastic ischemia and brain oedema (angiospastic encephalopathy), and not delay nitrogenous toxins; the True toxic uremia occurs in acute nephritis in contrast to the late stages of chronic nephritis exceptionally rare; slight delay nitrogenous toxins in the blood (instead of the normal 20 to 40 mg of urea nitrogen or 1 - 1.5 mg creatinine increase to 60 to 100 mg of urea nitrogen and up to 2 - 4 mg creatinine) was observed often, especially if there is a sudden oliguria, and has no serious prognostic significance.
Recognition Express rich symptoms of acute nephritis easily. It is necessary to exclude exacerbation of chronic nephritis occurring in the form of an acute outbreak, says the history, persistent hypertension, enhanced apical impulse of the heart in the first days of the disease, indicating left ventricular hypertrophy, a relatively low proportion even when the allocation of scarce urine, persistent acyclic for other symptoms, and also to eliminate amyloid nephrosis. Acute nephritis is also easy to mix with infectious myocarditis; at last, however, blood pressure is often not increased, and urinary symptoms are closely associated with the state of heart failure.
Mostly acute nephritis ends full recovery. Death in the acute period occurs rarely. The causes are haemorrhage, heart failure, acute pulmonary edema, prolonged anuria, primary or secondary infection (e.g. fever, diphtheria, suppuration, sepsis).
Bed rest; for shortness of breath and significant edema elevated position with the upper body. Treatment should start with 2 - 3 sugar days in which the patient receives only 150 - 200 g of sugar and no more food or drink, or at most a few slices of lemon, Mandarin orange, Apple or a Cup of lemonade (hunger and thirst). At the same time give laxatives. Depending on height, blood pressure, degree of swelling, shortness of breath, headaches, this mode may be reduced, or after a broader regime repeated for several days. In the event of failure of the heart muscle - bloodletting (200 - 400 ml), digitalis preparations; in more severe cases, intravenous strophanthin or tincture of strophanthus on hypertonic glucose solution. Diuretic effect also provides a systematic introduction into the vein glucose by 20 - 40 40 ml of solution, preferably with ascorbic acid, and calcium chloride inside. In more severe cases, especially when a complete anuria, you should try procaine perirenal blockade, diathermy renal region, intensely or decapsulation kidney, chromosone banks on the kidneys, phlebotomy, intravenous diuretics - diuretin. At high specific weight of urine valid cautious use of Mercosul. In a state of pre-eclampsia or developed convulsive seizures - rich bloodletting (500 - 600 ml or more), intramuscular and intravenous injections of sulphate of magnesia, also giving chloral hydrate, luminal, morphine, lumbar puncture, kidney recapsulation. Against angiospastic phenomena is also used intravenous solution of nicotinic acid, papaverine. When started decreasing rich edema patients transferred to a wider, mostly lacto-vegetarian diet. With the rapid complete disappearance of urinary symptoms soon move to a common table, checking the impact of meat and salt loads by repeated analysis of urine. When tightening forms, especially in the presence of focal infection or severe nephrotic slope (swelling, cholesterolemia etc), shouldn't Deplete the sick; we need to translate them to a wider table, including complete protein - cottage cheese, eggs, meat; swelling or edema ready - strict salt restriction. Surgical removal of foci of infection (tonsillectomy) should be made, or by no longer symptoms of nephritis, or when tightening the forms in the comparative periods of remission urinary and General symptoms. For leading wrestling fight with primary streptococcal infection appropriate designation of sulfa drugs. For overall strengthening of the body shown iron, vitamins.