Glomerulonephritis refers to pathological immunocomplex conditions, accompanied by glomerular lesions, as well as involvement of other renal structures into the inflammatory-infectious process. Postovreptococcal or postinfection acute glomerulonephritis is quite common.
Acute poststreptococcal glomerulonephritis
Poststreptococcal glomerulonephritis is a bilateral inflammatory lesion of the renal glomeruli that develops against the background of streptococcal infections. Due to the pathological process, there is a violation of glomerular filtration. Pathology is most typical for people of young and children, mostly male 12-40 years of age. Such a pathology is associated with hypothermia, therefore, in regions with high humidity and cool climate, the highest incidence of post-streptococcal renal inflammation is recorded.
But still more common pathology occurs in children, and the prevalence of pathology in such patients is about 30 cases per 100 thousand children. In spring and winter, poststreptococcal inflammation of the kidneys is caused by acute respiratory viral infection, and in summer-autumn - with pyoderma. The peak of childhood morbidity is observed at 5-9 years of age.
Types and forms of
Post-streptococcal glomerulonephritis can develop in the form of a sporadic disease, or as an epidemic.
- Post-streptococcal proliferative diffuse glomerulonephritis is more common in children aged 2-6 years;
- Subclinical forms are more common, which are more pronounced in the male population.
Etiology
The main cause of the pathology is streptococcal infection, which damages the basic structures of the kidneys, causing their dysfunction. Pathology develops for a long time, after some time( one and a half to three weeks) after an infection like sore throat, pyoderma, scarlet fever, impetigo and other diseases. The risk of a pathology after infection with nephritogenic streptococci is determined by the focal location of the infection. For example, after a skin infection caused by 49 serotypes of streptococcus, the likelihood of earning glomerulonephritis is many times higher than after pharyngitis.
Pathogenesis of
Glomerulonephritis of post-streptococcal type occurs against the background of infection with group A streptococci, after which the synthesis begins, in which antibodies that bind with antigens are released. Such processes lead to the formation of immune complexes that act on kidney tissues, gradually damaging them, disrupting nephron structures, etc.
Actually, the disease takes autoantibody characteristics, although at first it developed as an immunocomplex pathology. As a result, the inflammatory and allergic process is simultaneously developing in the kidney structures. Patients should take into account that the pathology can periodically arise again, therefore appropriate prevention is necessary: avoid overcooling, do not sit on the cold or not walk in raw clothes, etc.
Symptoms and signs
Usually the first renal or extrarenal manifestations of post-streptococcal glomerulonephritis occur about a week or two later.
To extrarenal manifestations include:
- Changes in arterial pressure;
- Appearance of swelling on the body;
- Cardiac disorders, etc.
The group of renal signs includes such symptoms as hematuria, oliguria, etc. Also, signs of poststreptococcal glomerulonephritis include nausea and vomiting symptoms, migraine headaches, painful sensations in the lumbar region, etc. The patient begins swelling that is more noticeable on the limbs and face, especially in the morning. Similar signs are typical for 90% of patients.
Also, post-streptococcal glomerulonephritis is characterized by changes in the shade of urine, which may even be brownish. But the amount of excreted urine against the background of postinfection inflammation is significantly reduced. Pathology occurs suddenly and is particularly acute in the first three days of exacerbation. In addition, at the initial stage of the patient's pathological process, oliguria starts to worry, which consists in reducing the amount of urine produced, which indicates the need for urgent diagnosis and therapy.
The peculiarity of the course of postinfection glomerulonephritis is the erasure of symptoms soon after the initiation of therapy, but it still needs to be continued. If there was no treatment, and the symptomatology has been present for several months, it indicates a lingering form of acute postinfection glomerulonephritis. Such a picture threatens to pass into a chronic form of pathology, therefore, the treatment will take quite a long time.
Diagnosis
For the detection of pathology, a thorough diagnosis is required, including the following procedures:
- Blood tests( general and biochemical);
- Laboratory diagnosis of urine;
- Obtaining amnestic data;
- Ultrasonic examination of the kidneys;
- X-ray;
- MRI of kidney structures;
- Uroflowmetry;
- Radioisotope diagnostics, etc.
In the presence of oliguria, elevated creatinine and urea can be detected, indicating a failure of renal activity. And with ultrasound, differential disorders and increased renal volume are detected. If necessary, consult other specialists such as a dentist( if there are carious problems), an ophthalmologist( to check the eyes to exclude vascular angiopathy of the retina), an otolaryngologist and other narrowly specialized doctors.
Treatment of
Because post-streptococcal glomerulonephritis is closely interrelated, therapy presupposes the administration of antibiotics from a penicillin group such as Phenoxymethylpenicillin, and if they are intolerant, Erythromycin. Such therapy is indicated in cases when the pathology arose on the background of tonsillitis or pharyngitis, skin lesions, positive plantings from the area of throat, skin, etc.
Forecasts and complications of
In general, the prognostic data for postmenstrual glomerulonephritis type have a favorable character. In children of the child age from positive, and failure occurs only in 2% of cases. Adults also have good predictions, although there may sometimes be a rapid progression of insufficiency, uncontrolled hypertension, or an abundance of half-moon in a kidney biopsy.
Fatal outcome can be observed in less than 2% of patients. Although in young patients, the predictions are much better than in the adult generation. The picture is much worse with patients after 40 with rapidly developing kidney failure and glomerulonephritis of extracapillary type. But in general, there are chances of recovery in almost all patients, although in rare clinical cases several years after the disease, persistent hypertension or renal failure may appear in patients.
On the video about acute glomerulonephritis in children: