Chronic glomerulonephritis: forms, symptoms and treatment

Chronic glomerulonephritis ICD 10

Digital disease code, according to ICD 10 No. 3 . If necessary, this code is supplemented with another order of numbers, indicating the characteristics of the disease and the nature of changes in the kidneys.

• Minor glomerular changes (No. 03.0).
• Segmental or focal glomerular changes (No. 03.1).
• Diffuse membranous glomerulonephritis (No. 03.2).
• Diffuse mesangial proliferative changes (No. 03.3).
• Diffuse endocapillary proliferative glomerular disorders (No. 03.4).
• Diffuse mesangiocapillary glomerulonephritis (No. 03.5).
• Dense sediment disease (No. 03.6).
• Extracapillary disorders (diffuse crescentic glomerulonephritis) (No. 03.7).

Other types of changes in glomerular inflammation are coded No. 03.8, unspecified types of changes No. 03.09.

Prevention

First of all, you need to maintain your immunity and protect it from diseases. To do this, you need to eat well and varied, harden yourself and do exercises. If a person gets sick, it is necessary to treat him in time in order to prevent a chronic form or complications on internal organs. You need to eat in moderation and not overeat, otherwise you may become overweight or obese, which can negatively affect your kidneys. Periodically you need to donate blood and urine for tests to detect high blood sugar and bacteria.

Light physical activity should be observed. All exercises must be done in moderation, otherwise, on the contrary, you can harm the kidneys. Swimming is very beneficial. The amount of salt consumed in food should be limited. Salt in large quantities causes swelling and harms the functioning of the kidneys. It is better not to add salt to all food. If a person abuses alcohol or cigarettes, this can also have a negative effect.

You should avoid hypothermia, dress appropriately for the weather, do not swim in icy water, and do not create drafts at home.

Causes

Chronic glomerulonephritis can be a complication of an acute disease. However, a primary chronic course of the disease is also possible, without an acute attack. The causes of the disease include:

• The presence of nephritogenic strains of streptococcus.
• Infectious foci in the body.
• Hereditary predisposition or congenital kidney defects (dysplasia).
• Cooling the body.
• Weakening the body's resistance to diseases.

Pathogenesis and forms

Experts propose the following classification of chronic glomerulonephritis:

• Latent – ​​it is characterized by the absence of pronounced symptoms;
• Hypertensive – characteristic increases in pressure occur;
• Hematuric – accompanied by hematuria of varying severity; elevated blood pressure or hyperedema may be of concern. This form is the most common;
• Nephrotic – when nephrotic syndrome with edema, proteinuria, etc. predominates in the clinic;
• Mixed - may be accompanied by any of the above symptoms.

Most primary forms of chronic glomerulonephritis are immunocomplex in nature and are symptomatically similar to the acute form of the pathology. Forms of chronic glomerulonephritis:

Symptoms

In approximately half of patients, this disease occurs latently or the symptoms are not clearly expressed.

With a latent course of the disease, an increase in blood pressure and edema occur infrequently. The disease may not manifest itself in any way for up to 20 years, until uremia develops against the background of disease progression (replacement of dead glomeruli with connective tissue).

Hematuric form . A distinctive feature of this type of glomerulonephritis is anemia, since red blood cells are released along with urine. Sometimes blood in the urine is detected visually. There is no edema, the kidneys are functioning normally.

Hypertensive variant . It is distinguished by elevated blood pressure and fuzzy urinary syndrome. The blood pressure level “jumps” during the day from normal to values ​​of 180-200 mm. The consequences of hypertension are cardiac dysfunction.

Nephrotic form . According to statistics, nephrotic syndrome occurs in approximately 25% of patients. This form is characterized by loss of protein along with urine, pronounced edema, both external and internal (hydropericardium, pulmonary edema). The main signs of the nephrotic form include:

• Severe edema, including hidden edema (unmotivated weight gain).
• Increased cholesterol levels.
• The daily amount of protein in urine exceeds 2.5 g.

All these phenomena are not accompanied by an increase in blood pressure. There are no significant impairments in renal function.

Mixed type . This is the most unfavorable scenario for the development of the disease, combining the symptoms of two forms: nephrotic and hypertensive. Manifestations of a mixed type of disease include:

• Swelling.
• Increased blood pressure.
• Presence of protein and blood in the urine.
• Anemia.
• Decreased urine density.

The filtering ability of the kidneys in this form is impaired.

Differential diagnosis

Differential diagnosis

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Diagnostics

Making a diagnosis of a disease begins with taking an anamnesis . It is necessary to pay attention to whether the patient has suffered acute inflammation of the kidneys, whether there are systemic diseases or infectious foci. Often the disease is almost asymptomatic or with vague symptoms, so you need to focus on laboratory diagnosis.

• Urinalysis (general) . It makes it possible to detect the presence of red blood cells, protein, as well as a decrease in its specific gravity.
• Rehberg analysis, Zimnitsky test . These are specific tests, the purpose of which is to determine the filtering capacity of the kidneys by the density of urine and the volume of its excretion during the day.
• Blood analysis . In the presence of chronic glomerulonephritis, it shows a decrease in protein levels, increased cholesterol, and disproportions of various protein forms in the blood plasma.

In addition to laboratory studies, these types of studies are carried out.

1. X-ray diagnostics allows you to assess the degree of change in renal tissue.
2. Ultrasound of the kidneys. Data obtained from ultrasound examination determines a decrease in the size of the kidneys due to tissue sclerosis.
3. A kidney tissue biopsy is performed if there is difficulty with the diagnosis.

Kidney biopsy

An ECG and lung examination can reveal internal edema. When examining the fundus, changes characteristic of arterial hypertension are determined.

The diagnosis of “Chronic glomerulonephritis” is differentiated from pathologies such as polycystic kidney disease, urolithiasis, and other kidney diseases. Differentiation from hypertension of extrarenal origin is also necessary.

Etiology of the disease

Pyelonephritis develops as a result of the activation and spread of pathogenic microbes under the influence of various factors. Most often this is infection with E. coli, streptococci, enterococci and other microorganisms.

Additional causes of inflammation in the kidneys are:

• improper treatment of the acute form of the disease;
• urolithiasis, prostate adenoma, urine reflux and other diseases of the genitourinary system that were not promptly diagnosed and treated;
• proliferation of bacteria that remain in the kidney tissues for a long time;
• decreased immunity as a result of prolonged infectious diseases or immunodeficiency states;
• chronic pyelonephritis can be a complication after ARVI, tonsillitis, measles, pneumonia or scarlet fever (children are most susceptible);
• chronic pathologies such as diabetes, tonsillitis, obesity or bowel dysfunction;
• in women, pyelonephritis develops during pregnancy, after childbirth or during the onset of sexual activity;
• unidentified congenital diseases of the genitourinary system.

Hypothermia and the presence of autoimmune reactions can trigger the development of the pathological process.

Treatment

Compliance with the protective regime helps to stop the progression of the disease.

• Special diet. It provides for the 100% exclusion of alcohol-containing drinks, smoking, eating spicy foods, and limiting salt. If there is protein in the urine, increase the daily intake of protein foods.
• Elimination of physical activity, hypothermia (especially wet!), and occupational hazards.
• Avoiding contracting infectious diseases.

Drug treatment comes down to taking such drugs.

• Anticoagulants (in the presence of hematuria) - Heparin, Dipyridamole, Ticlopidine.
• Cytostatics – Cyclosportn, Cyclophosphamide.
• Non-hormonal anti-inflammatory drugs - Indomethacin.
• Glucocorticosteroids - Prednisolone.

Diuretics (Hypothiazide, Uregit, Furosemide) are prescribed symptomatically. For high blood pressure - Enalapril, Ramipril. The dosage of drugs is prescribed by a specialist based on laboratory test data. In the presence of infectious foci - antibiotics.

Disease Prevention

To avoid the development of inflammation in the kidney tissues, a number of preventive measures should be followed. Experts recommend:

• avoid hypothermia;
• Healthy food;
• strengthen immunity;
• promptly treat infectious diseases.

Compliance with preventive measures will help reduce the risk of developing pyelonephritis and avoid possible consequences.

The chronic form is dangerous because it may not manifest itself for a long time. The disease is diagnosed through the diagnosis of other pathologies. If symptoms occur, you should consult a doctor, since the acute form always develops into a chronic form, which is difficult to treat.

Traditional methods of treatment

Experts recommend folk remedies.

• Hawthorn infusion. Has a hypotensive and diuretic effect.
• Pumpkin juice. Has an anti-inflammatory and restorative effect.
• Aloe with honey. Strengthens the immune system and has a restorative effect.
• A decoction of dead bees. Helps reduce swelling, improves kidney function.
• Cranberry infusion (can be drunk instead of regular tea).

During an exacerbation, it is recommended to be treated in a hospital. In case of remission, sanatorium-resort treatment and maintenance therapy are recommended. All treatment measures must be coordinated with a doctor.

Clinical picture

The chronic form of pyelonephritis can be asymptomatic. Signs do not appear during remission. They become pronounced during the acute stage. The main clinical manifestations of pyelonephritis include:

1. Intoxication of the body . It is characterized by the presence of general weakness, nausea, vomiting, malaise, decreased appetite, fever and headaches and chills. When diagnosed, pale skin and tachycardia are noted.
2. Painful sensations . Localized mainly in the lumbar region.
3. Unpleasant urine odor can especially occur early in the morning, after sleep.
4. Pain when urinating , frequent urge to go to the toilet.

Against the background of chronic pyelonephritis, water and electrolyte disturbances occur, which manifest themselves in the form of dry mouth, the appearance of cracks on the lips, peeling of the horse's coat and constant thirst.

The disease has several stages, each of which is manifested by special symptoms, in the presence of which the doctor can determine the degree of development of the pathology and prescribe the necessary treatment.

1. Exacerbation . At this stage, the signs are clearly expressed. Severe pain and intoxication of the body are observed. A laboratory blood test reveals an increase in the number of leukocytes and an acceleration of ESR. Anemia is also observed. Lack of treatment at this stage leads to the development of renal failure, the diagnosis and treatment of which is difficult.
2. Latent . The symptoms are not pronounced. Patients often complain of increased fatigue and constant weakness. In exceptional cases, hyperthermia is noted. There is practically no pain in the lumbar region and when urinating. Against the background of a pathological process, the ability of the kidneys to concentrate urine decreases, which affects its density. Laboratory testing of urine reveals the presence of bacteria and leukocytes.
3. Remission . At this stage there are no symptoms. The disease does not manifest itself with any signs, which complicates diagnosis. During a laboratory test of urine, a slight deviation from normal values ​​may be detected. When exposed to negative factors, the remission stage goes into the exacerbation stage, the symptoms become aggressive, and the patient requires medical attention.

Possible complications and consequences

The most common complications of the disease are:

1. Renal eclampsia.
2. Pneumonia, pleurisy.
3. Pyelonephritis.
4. Thromboembolism.
5. Acute renal failure.

As for the prognosis, recovery is possible. Another thing is that it is impossible to predict exactly when it will come. The prognosis depends not only on the form, severity and stage of the disease, but also on other factors. Colds and respiratory infections can provoke the progression of kidney disease. At the same time, adherence to the regimen and timely prescribed treatment contribute, if not to recovery, then to long-term remission.

Glomerulonephritis: clinical and morphological features

Glomerulonephritis is not a separate disease, but a whole group of pathologies united by a number of common features that reflect the kidney’s response to an infectious and inflammatory lesion. The main pathogenetic moment in the development of GN is damage to the renal glomeruli. It leads to the following violations:

• isolated urinary syndrome – proteinuria, hematuria of varying severity;
• oliguria – decrease in the volume of daily diuresis;
• decreased glomerular filtration rate.

As the disease progresses, inflammation of the interstitium and functional disorders of the tubules occur. In the clinical picture, this is manifested by disturbances in ion transport and a decrease in the concentrating ability of the kidneys. The terminal stage of the disease is accompanied by renal failure and uremia.

Diagnostic procedures

Diagnosis of acute glomerulonephritis is based on what symptoms acute glomerulonephritis exhibits, what changes occur in the composition of urine and blood, as well as the results of ultrasound examination and kidney tissue biopsy.

A kidney biopsy is performed to determine the nature of the disease; as mentioned earlier, it can be acute or chronic. In addition, it is determined how quickly the disease progresses.

After the doctor diagnoses the patient with acute glomerulonephritis, effective treatment will be prescribed.