Acute and chronic nephritic syndrome: ICD code, symptoms, diagnosis, treatment

Inflammatory diseases are quite common among renal pathologies. It is for such pathological renal conditions characterized by the presence of a specific symptom-complex - nephritic syndrome. Do not confuse it with nephrotic, because these are different states.

Nephritic syndrome

A complex of manifestations is called a nonphritic syndrome, in which against the background of an inflammatory process the filtration capacity of the glomeruli decreases, pronounced hyperthermia and hematuria, proteinuria and salt retention in the body are formed. Subsequently, against the background of the above-described changes, hypertension develops.

According to the international classification, the nephritic syndrome is assigned the code for ICD-10 N00-N08, with:

• Acute nephritic syndrome is encoded as N00;
• Rapidly progressive nephritic syndrome - N01;
• Chronic nephritic syndrome - N03;
• Unspecified nephritic syndrome - N05.

This is not an independent pathology and not a diagnosis. The nephritic syndrome is a combination of symptomatic manifestations in certain renal pathologies.

Forms of

There are several varieties of nephritic syndrome:

1. Acute - occurs against the background of acute glomerulonephritis. Acute nephritic syndrome is characterized by inflammation of the glomeruli, which forms in a few days;
2. Chronic - often accompanies chronic glomerulonephritis. This is a slowly progressive syndrome, which is formed against the background of renal pathologies. Usually a similar form of the syndrome is detected accidentally in 85-90% of patients.

In addition, there is also a rapidly progressing form of nephritic syndrome. Its symptoms are similar to the acute form of the syndrome, but only kidney dysfunctional changes( insufficiency) develop here abnormally quickly - for several months.

Pathogenesis of

In the etiology of nephritic syndrome development, nephritis is predominantly predominantly post-streptococcal or of another form. Any of the nephritic syndromes begins to form gradually and imperceptibly( even the acute form), but at a certain stage of nephritis, under the influence of certain factors, its rapid manifestation occurs, for example, against streptococcal angina or severe hypothermia. Thus, an acute type of nephritic syndrome manifests itself. If the symptoms appear erased and not expressed, periodically disappear and appear again, then we are talking about the chronic recurrent form of the syndrome.

In general, such factors can cause the development of pathology:

1. Bacterial: endocarditis and sepsis, meningococcal and pneumococcal infection, typhoid fever, etc.;
2. Viral: hepatitis B, chicken pox or infectious mononucleosis, ECHO viruses, mumps and the Coxsackie virus;
3. Autoimmune factors such as hereditary pulmonary-renal syndrome, systemic lupus erythematosus and vasculitis, Shenlen-Henoch pathology, etc.;
4. Glomerulonephritis of post-streptococcal and non-streptococcal type;
5. Primary renal lesions such as Berger's disease, mesangioproliferative or mesangiocapillary glomerulonephritis;
6. Other forms of glomerulonephritis, in which the syndrome is formed against the background of an already developed infection;
7. Mixed factors like radiation, vaccinations, Hyena-Barre syndrome, etc.

With any etiology in children and adults, if the nephritic syndrome develops, this indicates a serious deterioration in the condition and an exacerbation of the primary disease.

Symptoms of

All the symptoms included in the nephritic syndrome are divided into classical and nonspecific.

The classical clinical picture includes such manifestations:

• The presence of a hematuric trait( urine with blood);
• Approximately 30% of patients get blood in the urine of the hematoma when urine acquires the color of meat slops;
• Approximately half of patients have a constant thirst with oligoanuria( acute reduction or absence of diuresis);
• Hyperintelligence. Practically all patients with nephritic syndrome( ≈85%) have strong edema, which differ from cardiac by the time of onset. For nephritic edemas, the appearance of swelling of the face( especially on the eyelids) is characteristic in the second half of the day, and by the evening puffiness reaches the lower extremities. Then, as edema of cardiac origin occurs in the morning, and already at dinner dissipate;
• Hypertensive disease. Practically all patients( 83%) suffer from hypertension, which gradually leads to the development of left ventricular failure with increased pulsation and pulmonary edema.

To manifestations of nonspecific character, one can attribute symptoms like:

• Painful symptoms in the abdomen and lower back;
• Weight gain;
• Nausea and vomiting;
• Weaknesses and anorexia;
• In rare cases, hyperthermia;
• Some patients show signs of infectious airway disease, in particular acute tonsillitis or pharyngitis;Symptoms of impetigo or scarlet fever.

For the rapidly progressive form of nephritic syndrome, in addition to the above features, the rapid development of kidney failure is common( usually in a few weeks).

Diagnosis

Diagnosis of nephritic syndrome is similar to the definition of glomerulonephritis and involves laboratory tests of urine that show the presence of proteinuria and oliguria, sediment in the urine in the form of leukocytes, erythrocytes and cellular structures of the renal tubules and many others.etc. In addition, ultrasonic diagnostics of renal structures is performed, which visualizes the size of the organs and determines the filtration capacity of the glomeruli.

Treatment of

The basis for the treatment of nephritic syndromes is the elimination of the underlying etiologic factor. In acute nephritic syndrome, there is no specific treatment. If there is an infectious focus, then antibiotic therapy is prescribed. If a history of proteinuria took place for more than a month, Prednisolone is indicated. In addition, plasmapheresis with maintenance doses of Cyclophosphamide or Chlorambucil may be performed.

If there is myocardial insufficiency and hypertension or severe hypertension, the patient is strictly limited to the consumption of sodium-containing products, and loop diuretics are prescribed. Persistent hypertension requires the administration of Trimetaphene, Hydralazine, Diazoxide and Labetololoma. The formation of kidney deficiency leads to the need for dialysis.

Within a month the patient is shown the administration of Prednisolone, and maintenance therapy is prescribed for 3-4 months. Additionally, anticoagulants and NSAIDs, antiplatelet and other drugs are individually prescribed.

Forecasts

Acute nephritic syndromes usually have good prognostic data. Within a few weeks, the proliferation of renal cellular structures passes, although an inflammatory reaction can lead to residual sclerosis. But hematuric and proteinuric manifestations can persist for several years.

According to statistics, approximately 90% of patients complete restoration of renal function after 1.5-2 months, but this is provided that the treatment was timely and correct, and the etiologic factor was completely eliminated. In chronic nephritic syndrome, predictions can sometimes worsen, as chronic chronic kidney failure develops with chronic consequences of the syndrome, with all the ensuing consequences.
On the video about the forms, symptoms and treatment of nephritic syndrome: