Mesangioproliferative chronic glomerulonephritis( MZPHG) is called glomerulonephropathy, especially frequent among men, characterized by a benign course.
Mesangioproliferative chronic glomerulonephritis
Glomerulonephropathy caused by immunoinflammatory transformations in the glomerular apparatus, caused by the growth of mesangium, the accumulation of protein complexes in it, is called mesangioproliferative.
Glomerue-nephropathy of this variety is diagnosed much more often than other forms. MZPGG is provoked by concentrating in mesangium conglomerates of proteins associated with the antibody, which is most often IgA.In addition to it, the immunoglobulins G, M.
can accumulate in mesangium. Depending on the species, glomerulonephropathies of IgA, IgM, IgG are classified. Of all the species, the most frequent is IgA nephropathy. Excess IgA becomes a trigger, provoking the formation of mesangioproliferatin glomerulonephritis.
Reasons for
MZPHG is a form of hemorrhagic vasculitis when the own IgA affects only the endothelium of small kidney vessels. A common cause of MZPGH is a transferred infectious disease, complicated by post-streptococcal glomerulonephritis.
Glomerulonephropathy is caused:
- by ankylosing spondylitis;
- with psoriasis;
- obliterating bronchiolitis;
- with cirrhosis;
- by cancer;
- by toxoplasmosis;
- adenocarcinoma.
The pathogenesis of
MZPHG is induced by mesangial growth due to active cell proliferation. The expansion of mesangium is due to the appearance of monocytes in it.
IgE glomeronephropathy is classified as follows:
- primary - has an unclear origin;
- secondary - formed when accumulation in mesangium IgA1 in pathologies of intestines, skin, liver, oncology.
The mechanism of deposition of IgA1 is triggered by the change in IgA caused by:
- of respiratory infections;
- with gastroenteritis of different etiology;
- vaccination;
- ultraviolet irradiation, radiation.
Predisposing condition for the emergence of nephropathy IgA is heredity. There is a predisposition for the deposition of IgA1, due to the carriage of the genes IGAN1, IGAN2, IGAN3 at the loci, respectively, 6q22-23, 4q26-31, 17q12-22.
Clinical picture
MZPHG refers to a long-term progressive. It is characterized by IgA-nephropathy. The majority of the sick( 60%) are men under 30 years old.
Renal symptoms are often noted at the same time or a little after the debut of infection of the ENT organs, digestive system, urinary tract. The duration of the symptoms roughly coincides with the effect of the infection.
Mesangioproliferative glomerulonephritis is able to flow:
- without symptoms, which is observed in adults over 40;
- with macrohematuria - a phenomenon of darkening of urine due to the presence of red blood cells;
- is atypical - the signs are similar to the manifestation of other types of nephropathy, and analyzes indicate the presence of IgA.
There is often a variant of the course of IgA-nephropathy with repeated cases of the appearance of blood in the urine.
IgA nephropathy is characterized by:
- with small swelling;
- darkening of urine;
- pain in the lower back, in the side;
- with reversible hypertension.
Laboratory tests show:
- a slight increase in protein;
- hematuria in a third of patients, erythrocyte cylinders in the urine.
Nephropathy progresses slowly, only a part of patients( 10%) have acute-nephrophic syndrome. MZPGG can develop in 20-40% of patients within 5-25 years.
Diagnosis
Diagnosis of mesangioproliferative glomerulonephritis is based on the detection of IgA deposition in mesangium.
Diagnostic tests include:
- light microscopy - the extent of mesangium proliferation is assessed;
- immunofluorescence method - confirms the predominant( up to 85%) presence of IgA deposits in combination with immunoglobulins G, M;
- electron microscopy - assesses the nature of deposition of IgA deposits.
Differential diagnosis should rule out:
- pyelonephritis;
- acute glomerulonephritis;
- diabetes;
- alcohol damage.
Treatment
With proteinuria 0.5-1 g / day.is prescribed nephroprotective therapy aimed at reducing protein levels. To do this, resort to prolonged treatment with drugs Captopril, Enalapril. Control over arterial pressure helps to reduce intra-tubular hypertension, to eliminate edema.
With proteinuria greater than 1 g / day, in addition to nephroprotective therapy, immunosuppressive treatment with glucocorticosteroids is performed. Prednisolone, methylprednisolone is used. If hormones are contraindicated, cytotoxic drugs are prescribed, cyclophosphamide preparations, cyclosporine are used.
Treatment is monitored by analyzing the level of creatinine in the blood, daily protein, blood pressure values. The prerequisite for the successful treatment of MZPGH is the rational nutrition, as well as the timely removal of any foci of infection.
The dietary peculiarities of mesangioproliferative glomerulonephritis are:
- salt restriction - less than 5 g / day;
- reduced consumption of food containing gluten - milk, meat;
- protein restriction;
- introduction of polyunsaturated fats;
- decrease in the consumption of animal fat to persons suffering from obesity.
A diet with a low amount of protein is prescribed at the rate of 0.3 g / kg of weight per day, essential amino acids are taken for the purpose of the nephrologist( example - up to 12 tablets Ketosteril per day).
A mandatory condition for the treatment of mesangioproliferative chronic glomerulonephritis is the complete cessation of smoking and the consumption of alcoholic beverages.
Forecasts
Forecast of mesangioproliferative chronic glomerulonephritis with protein loss less than 0.5 g per day favorable. With an adequately chosen treatment regimen, the disease does not progress.
With an increase in proteinuria up to 1 g / day, the likelihood of impairment increases. And with the indices exceeding 3.5 g / day, creatinine level above 150 mmol / l, high blood pressure, the prognosis deteriorates significantly.
Progression of mesangioproliferative glomerulonephritis is complicated by advanced age, existing nephropathology, heredity features.