Nephrology qualifying tests (2019) with answers - part 4

What to do if you suspect a disease

• Blood chemistry

  With glomerulonephritis, an increase in plasma urea levels may be observed; decreased levels of total protein (hypoproteinemia).

• Biochemical examination of urine

  With glomerulonephritis, a decrease in the concentration of urea, creatinine, and potassium in the urine is observed.

• Zimnitsky test

  High density of urine (in one portion exceeds 1035 g/l) can be observed in acute glomerulonephritis.

• Immunological studies

  Acute glomerulonephritis is characterized by an increase in the content of immunoglobulin A (IgA), an increase in the concentration of antistreptolysin-O, a marker of the presence of streptococcal infection in the body.

• Blood test for lipid profile

  With glomerulonephritis, cholesterol levels are elevated.

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Causes of the disease

The causes of glomerulonephritis are as follows:

• Pathologies of the structure of the renal glomeruli, which are inherited.
• Bacterial infections - scarlet fever, tonsillitis, pneumonia, bacterial endocarditis.
• Viral infections - chickenpox, infectious mononucleosis, hepatitis, mumps.
• Exposure to toxins – alcohol, drugs, vaccinations, radiation exposure.
• Autoimmune diseases - among them are lupus erythematosus, vasculitis, periarthritis.
• Endocrine diseases. For example, in diabetes mellitus, diabetic damage to the walls of blood vessels occurs, spreading to the kidneys.
• Various tumors.
• Toxoplasmosis.
• Regular hypothermia causes disruption of blood flow in the organ due to prolonged exposure to cold.

Most often, acute glomerulonephritis is diagnosed, the causes of which lie in streptococcal infection. There is also a high probability of the disease occurring during prolonged exposure to cold and high humidity (“trench jade”).

Important: studies have shown that in most cases glomerulonephritis is caused by strains of group A streptococcus ( b-hemolytic “nephritogenic”).

When this streptococcus appears in a group of children, the disease is diagnosed in 3-15% of children, and characteristic changes in the urine are observed in 50% of adults and children who have been in contact with the sick.

Principles of well-designed therapy

In the initial stage of kidney failure, all attention is aimed at eliminating the root cause of the disease, however, with functional changes, treatment also affects the symptoms of the disease. For symptomatic treatment, drug therapy is prescribed to combat signs of anemia and possible inflammatory processes. Such drugs include Ampiox, Erythromycin, Furosemide, Hypothiazide, the latter two have a pronounced diuretic effect, the vitamin complex includes vitamin D and Calcium Gluconate. In addition, he maintains a strict diet, during which he uses a high-calorie, low-protein diet. It is also recommended to limit the amount of salty foods, and in case of high blood pressure, eliminate salty foods altogether.

Traditional treatment methods can be dangerous, so they are rarely used and only with the permission of the treating specialist.

Penicillin is an antibiotic prescribed for the treatment of glomerulonephritis.
Therapy for grosserulonephritis takes place in a hospital setting; the patient is prescribed antibacterial drugs such as Penicillin, Ampicillin + Oxacillin. To increase the level of the body's protective functions, non-hormonal drugs (Cyclophosphamide, Azathioprine), as well as hormonal drugs (Prednisolone), are prescribed. During therapy, attention is paid to inflammatory processes. For the treatment of which Diclofenac is used, as well as to eliminate symptoms in the form of swelling and high blood pressure. An important step is maintaining proper nutrition during the rehabilitation process. therefore, diet No. 7 is prescribed. As an additional treatment, sanitary and spa procedures are prescribed; they will help support the body after inpatient therapy.

Complications of acute glomerulonephritis

In general, with timely treatment, the prognosis of acute glomerulonephritis is favorable and complications occur relatively rarely. The cause of the transition from acute to chronic is hyperplastic dysplasia of the organ. Some people are more susceptible to developing complications:

• children;
• aged people;
• weakened and exhausted patients;
• patients with a hyperergic form of the disease.

Kidney and heart failure

Renal failure, as a complication of acute diffuse glomerulonephritis, rarely develops - approximately 1% of cases. Acute heart failure develops somewhat more often - in slightly less than 3% of cases, but can lead to hemorrhagic stroke. If you think about it, the percentage is not very large, but people from risk groups are exposed to it somewhat more often:

• Acute renal failure is the loss of basic kidney functions, which determines the clinical picture characteristic of this complication. Symptoms include the following: rare urination;
• increased blood pressure;
• acidosis;
• swelling;
• red color of urine;
• dyspnea;
• nausea and vomiting.

Acute renal hypertensive encephalopathy

Acute renal hypertensive encephalopathy occurs in patients with stable malignant elevation of blood pressure. The frequency of cases with this complication varies from 0.5 to 15%. Encephalopathy is accompanied by the following symptoms:

• bursting headache;
• decreased cognitive abilities;
• drowsiness;
• confusion;
• vomit;
• double vision;
• convulsions;
• twitching of the muscles of the limbs;
• coma.

Articles on the topic

• Diagnosis of glomerulonephritis - determination of the form of the disease
• Treatment of chronic glomerulonephritis - nutrition rules, herbal medicine
• Treatment of acute glomerulonephritis - nutrition rules, prevention

Intracerebral hemorrhage

Intracerebral hemorrhage is a hemorrhage into the substance of the brain that occurs when cerebral vessels rupture or effusion. The most common cause is a sudden increase in blood pressure to individually high levels. Common symptoms are:

• unbearable headache;
• nausea and vomiting;
• loss of consciousness;
• coma;
• symptoms of damage to the cranial nerves.

Other negative consequences

First of all, it is worth mentioning the transition of acute glomerulonephritis to chronic. The clinical picture shows the same symptoms as in the acute form, but in a less pronounced form. In addition, as a result of the action of toxic waste products of the body on the brain, it is possible to develop a transient visual impairment, which disappears as the underlying disease is compensated.

Diet for glomerulonephritis

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Even ancient healers noticed that the food a person eats can both provoke the appearance of various diseases and help cure them. This is how a whole field of knowledge arises aimed at studying the safety and rationality of nutrition - dietetics. Today, the treatment of many serious diseases includes in its complex special nutritional systems - diets, or as they are commonly called in medicine - tables. Diet for kidney glomerulonephritis also plays an important role in therapy.

Occurrence of disease

The kidney contains two types of filtering units - nephrons - superficial and those that lie in the deep layers. And although these nephrons differ in the duration of some sections, what is common to their structure is the presence of a glomerulus of capillaries, which is the main renal filter. Filtration passes through three layers of membranes, the first passes particles with a size of 50-100 nm, the second – 6 nm, the last – 3 nm. Thus, only plasma and water are filtered into the primary urine, but proteins and blood cells are not.

The pathogen introduces antigens into the blood - substances foreign to our body. Blood circulates through the kidneys and antigens are deposited on the glomerular membranes. The immune system, in response to antigens, produces special protective proteins - antibodies. In places where antigen-antibody complexes are deposited, inflammation begins (the immune system destroys its own cells). At points of damage to the glomeruli, microthrombosis subsequently forms, microdeath of kidney tissue develops and its replacement with connective tissue. The kidney loses its functionality.

Glomerulonephritis is characterized by catarrh of the filtering glomeruli and is of an immune nature. Chronic glomerulonephritis may be due to a genetic predisposition or be a consequence of acute glomerulonephritis

Impaired glomerular filtration capacity causes the symptoms of the disease:

• The appearance of blood and protein in the urine.
• Swelling of the face upon waking.
• Decreased urine output.
• Increased blood pressure.
• Cough and shortness of breath due to fluid accumulation in the lungs.

Nutrition therapy

Diet therapy for glomerulonephritis is primarily aimed at facilitating the functioning of damaged kidneys and reducing the severity of symptoms.

1. The diet is prescribed immediately after the diagnosis is confirmed.
2. Meals - in small portions, every 2-3 hours, avoiding overeating.
3. The optimal temperature for hot dishes is 57-62 °C, cold - not less than 15 °C. Food can be boiled, stewed, baked, lightly fried.
4. Alcohol is strictly prohibited.
5. The volume of fluid consumed is calculated according to the principle - the volume of urine excreted the day before plus 300-500 ml, including soups and drinks. This helps reduce the load on the kidneys, reduce blood pressure, and prevents the appearance of edema. It is important to remember that many fruits and vegetables also contain water.
6. Limiting protein foods.

When the kidney's glomerular filters are unable to filter the blood, eating extra protein increases the load on the kidneys. Also, in the process of protein metabolism, urea is formed - a substance that can lead to damage primarily to the nervous system. However, it is impossible to completely eliminate protein from food, because it is constantly lost in the urine. The diet for glomerulonephritis includes a small amount of high-quality protein with a full range of amino acids - lean meats, fish, chicken breast, egg whites.

Sodium salts are also limited. Sodium helps regulate the amount of fluid retained in the body. An increase in its concentration leads to an increase in blood volume and accordingly increases blood pressure. And high blood pressure increases the load on the kidneys, worsening their condition. If the patient has severe swelling and high blood pressure, then salt is completely excluded for 7-14 days.

To avoid additional sodium intake, food is not salted, but a weak solution of vinegar, tomato or other acidic juices, boiled onions, and moderately resolved spices are used. You must also ensure that the foods you eat do not contain a flavor enhancer - monosodium glutamate. It is forbidden to eat processed cheeses, pickles, canned foods, snacks, potassium-based salt substitutes (Sanasol limited).

Potassium will also be retained in the body because the kidneys will not be able to filter it out. High potassium levels affect neuromuscular transmission and can trigger arrhythmia or even a heart attack. You should not overuse foods that are rich in potassium: bananas, oranges, spinach, tomatoes, nuts, legumes, potatoes, dairy products.

Control of phosphorus content in products. In acute glomerulonephritis, patients experience difficulty excreting phosphorus. Its amount should be in the range of 800-1000 mg/day, otherwise elevated levels can provoke heart and bone diseases. It is necessary to control the consumption of dairy products, peas, beans, peanut butter, and nuts. Avoid drinks such as Coca-Cola, cocoa and beer, as well as fast foods that contain phosphorus to enhance flavor and extend shelf life.

Nutrition for glomerulonephritis in case of deterioration of the condition includes carbohydrate fasting days - sugar, rice, vegetable, fruit, compote. These “unloadings” limit the consumption of proteins and fats against the background of a sufficient amount of carbohydrates, microelements and insoluble dietary fiber.

1. Sugar fasting day – 200 g of sugar in the form of tea, up to 1 liter per day.
2. Apple day – 1.5 kg of apples with skin, divided into 5 doses per day, with the addition of 50-100 g.
3. Potato fasting day - 1.5 kg of boiled or baked potatoes, without salt, for 5 doses per day.
4. Rice fasting day - sweet rice porridge made from 50 g of rice and 120 g of sugar - in two doses per day, washed down with fresh and dried fruit compote, no more than 1 liter per day.
5. During the compote, grape or kefir fasting day, other liquids are not consumed at all. In case of severe exacerbation, complete abstinence from liquids and food for 1-2 days may be recommended.

Features of dietary tables

A certain variability of diets for a group of urological diseases allows them to be changed depending on the patient’s condition.

In severe and moderate forms of acute glomerulonephritis, diet No. 7A is prescribed, and after the severity of symptoms decreases, they switch to table No. 7B. Then, with a significant improvement in the condition, you can eat the products of the main diet number 7. If the form of acute glomerulonephritis is mild, then you can immediately prescribe food according to diet number 7B.

The chronic form of the disease requires adherence to dietary nutrition according to table No. 7B. But with the development of renal failure, nutrition for glomerulonephritis is tightened and diet 7A is prescribed.

Course of the disease

We have figured out what glomerulonephritis is, but we also need to understand the peculiarities of the course of the disease. There are two forms of acute glomerulonephritis:

1. Cyclic (typical). This form is characterized by a rapid onset of the disease and visible severity of clinical symptoms.
2. Acyclic (latent). This is an erased form of the disease. It is characterized by a gradual onset and mild symptoms. This variety is the most dangerous due to late diagnosis and the high likelihood of becoming chronic.

If the course of the disease is favorable, if the diagnosis of glomerulonephritis is carried out in a timely manner and the treatment is correctly selected, the disappearance of symptoms is noted after three weeks, and complete recovery occurs after two months.

The course of chronic glomerulonephritis can take one of the following forms:

1. The nephrotic form is characterized by a predominance of urinary symptoms.
2. The hypertensive course of the disease is marked by increased blood pressure and mild urinary syndrome.
3. The mixed form combines nephrotic and hypertensive syndrome.
4. The latent type of chronic hepatitis is considered quite common and is characterized by the absence of hypertension and edema against the background of mild nephrotic syndrome.
5. The hematuric form is distinguished by the presence of red blood cells in the urine. However, other symptoms may be absent or mild.

All forms of glomerulonephritis are characterized by a relapsing course. In this case, the clinical symptoms of the disease in the acute stage completely repeat or partially resemble the symptoms of the first episode of the acute stage of the disease. The risk of relapse usually increases in the autumn-spring period. This usually occurs a couple of days after the body is exposed to an irritant (in most cases, a streptococcal infection).

Why complications develop

Complications of acute and chronic glomerulonephritis are dangerous to the same or greater extent than the disease itself. In a broad sense, complications arise due to the following reasons:

• untimely diagnosed disease;
• late treatment;
• incorrectly selected therapy;
• low patient adherence to treatment.

In a narrower sense, each complication arises due to its own pathophysiological mechanism.

Below are the mechanisms of formation of the most common and dangerous complications:

• eclampsia - caused by spasm of cerebral vessels and swelling of its substance;
• acute renal failure - a decrease in the filtration capacity of the kidneys, and, as a result, the accumulation of toxic metabolic products;
• chronic renal failure - caused by the replacement of nephrons with connective tissue, which leads to their loss of their physiological functions;
• edema of the lungs and other organs - occurs due to fluid retention in the body due to renal failure and heart failure.

Glomerulonephritis in animals [edit | edit code]

Unlike humans, focal nephritis predominates in animals. During the acute stage of the disease, an extracapillary exudative process is observed in the glomeruli, as a result of which the glomeruli are enlarged, their vessels are filled with blood, and the cavity of the Shumlyansky-Bowman capsule contains serous-fibrinous exudate. The endothelium of the capillaries swells, in their lumens there is a significant number of leukocytes, and homogeneous or granular protein cylinders are visible in the lumens of the tubules. With swine fever and erysipelas, inflammation develops as a hemorrhagic one and erythrocytes predominate in the Shumlyansky-Bowman capsule and tubules. [3]

Glomerulonephritis is a group of diseases associated with pathological processes in the renal glomeruli. Symptoms of each type of glomerulonephritis may differ slightly depending on the morphology of the disease. However, with differences in clinical manifestations, the result of untreated glomerulonephritis will be acute renal failure, which can result in uremic coma. The essence of treatment is to quickly normalize kidney function. To do this, it is necessary to eliminate the cause of the disease, carry out long-term symptomatic therapy, and also follow a diet and strict regimen. The most radical measure in the treatment of this disease is kidney transplantation.