The main symptoms of glomerulonephritis are determined by the pathogenetic processes of the patient. Each form of the disease as acute and chronic, has its own characteristics in the clinic, laboratory data and treatment approaches.
Kidney diseases always occur with a sufficiently clear clinical picture, because this interferes with the function of not only the affected organ but also the work of the whole organism.
Below we describe clinical and laboratory features of course of the most common variants of acute and chronic glomerulonephritis, and more talk about their methods of differential diagnosis (laboratory and instrumental).
Acute diffuse glomerulonephritis
The first signs of the acute process occur after 2-3 weeks after the patient has suffered any streptococcal infection (or acute tonsillitis exacerbation of chronic tonsillitis, erysipelas, scarlet fever and others).
All the symptoms of glomerulonephritis can be grouped into the following syndromes.
The syndrome of inflammatory changes in the glomerular apparatus of kidneys. It is characterized by the appearance of pain in the lumbar region on both sides. In patients with increased body temperature, all symptoms of intoxication (weakness, lethargy, malaise, reduced work capacity, sleepiness, etc.).
Often the patient suffers from pain hauling-aching, the intensity does not change in the supine position or in a state of complete rest
The urine of such patients becomes dark in color (“meat slops”) that is explained by the content of erythrocytes (microscopic hematuria, rarely gross hematuria), protein, and cylinders of epithelial cells. Reduced filtering ability of the glomerular apparatus, reduces the amount allocated per day of urine (oliguria).
In the blood increased levels of erythrocyte sedimentation rate, white blood cells, increased concentration of acute phase proteins. Immunological study revealed different classes of immunoglobulins, circulating immune complex and antibodies to the streptococcal antigens.
The characteristic pathological changes in the coagulation of blood in the direction of increased blood clotting (increasing PTI, reduced levels of antithrombin III, etc.). With the progression of the disease there is a tendency to hemorrhage, which threatens the development of DIC.
Syndrome cardiovascular disorders. It is characterized by dyspnea, increased numbers of blood pressure, in severe cases, there is a failure on the part of the left ventricle that threaten the development of pulmonary edema.
Patients EKG results can determine changes in the myocardium diffuse, and when viewed from the fundus visualized constricted blood vessels and swelling of the nipple of the optic nerve.
Otechny syndrome, usually is the earliest manifestation of the disease. Swelling located on the face and surface of the eyelids. Women with edematous syndrome noted a daily weight gain that is associated with abnormal fluid retention in the body (ascites, anasarca, hydrothorax, etc.).
Swellings appear in the morning, as soon as the patient got out of bed, during the day the intensity decreases
The syndrome of cerebral disorders occur when edematous processes in the substance of the brain. Critical condition must be diagnosed as early as possible, because there is a risk of progressive edema with a fatal outcome. Such patients complain of sudden attacks of visual disturbances, nausea and vomiting, painful headaches, hearing loss, and emotional arousal. Prolonged diagnosis occurs eclampsia – a condition characterized by development of seizures, respiratory failure and heart.
Clinical variants of diffuse glomerulonephritis
There are several clinical forms of the process:
- acute onset disease, in which there are all the typical symptoms of kidney damage and other systems of life (most often found in patients of pediatric age groups);
- the protracted course of the disease, the development of all symptoms and syndromes occur gradually, with swelling and the phenomenon of hypertension mild (duration 6-12 months);
- an expanded version of the disease when the patient has a typical triad of symptoms: hypertension, swelling of the face and changes in urinary sediment (urinary syndrome);
- bicentary variant of the pathological process, it is characterized by a combination of any two of the above syndromes;
- oligosymptomatic variant of the disease can occur with isolated urinary, hypertension, edematous or hematuric syndrome (diagnosis of glomerulonephritis in this case is complicated);
- nephrotic form is characterized by the process of all clinical and laboratory data of nephrotic syndrome (severe edema, not only individuals, but also of internal organs, massive proteinuria, decreased protein concentration in blood serum and increased level of cholesterol, while the patient has little blood pressure numbers and microhematuria).
In addition to the bright clinic, patients are always sudden changes in the cellular composition of the urinary sediment
Acute rapidly progressive glomerulonephritis
Signs of glomerulonephritis develop very quickly, they resemble the classic picture of an acute process. The disease most often registered among the adult men suffer more often than women.
Main symptoms: pain in the lumbar region from both sides, General weakness, fatigue, fever, headaches and muscle aches a lack of appetite.
Swelling very fast growing, engaging in a process of internal organs and tissues. Hypertension is difficult to treat patients have persistent blood pressure numbers, there is shortness of breath, interruptions in heart work, disturbed vision.
Unfortunately, such patients is very quickly comes renal and heart failure, leading to death within a year (most often in the first months of onset).
There are several clinical variants of the process, depending on the predominance of the patient of a syndrome.
The latent form of the disease. It is characterized by isolated urinary syndrome, that is, the patient has only changes in the cellular composition of the urinary sediment (proteinuria 1-2 g/day, moderate cylindruria, and hematuria, the density of urine is reduced slightly).
The condition of such patients remains satisfactory, no swelling, no increased pressure, they don’t complain about anything.
As a rule, the definition of the latent form of the disease occurs quite by chance (during medical examination)
Nephrotic form of the disease. Patients complain of severe weakness, reduced work capacity, lack of appetite. They have a pronounced and progressive swelling of the face, which tend to spread to internal organs and cavities of the human body (hydrothorax, ascites, etc.). In this figure the blood pressure remain within the age norm or only slightly increased.
In the urinary sediment sharply elevated protein levels (>3 g/day) and cylinders, microhematuria, are little known. In the blood there is a decrease in protein, while increasing protein fractions inflammatory phase, increased erythrocyte sedimentation rate, decreased hemoglobin level.
Hypertensive form of glomerulonephritis. A typical manifestation of this form of process is intolerable headaches on the background of elevated blood pressure. Patients reduced vision, there is a “fog” before the eyes and dizziness. Gradually increasing shortness of breath, heart rate changes, there are disruptions of the heart.
When the fundus examination in such patients, there are signs of swelling of the nipple of the optic nerve and kinking of the vascular plexus. On ECG are recorded hypertrophic changes of the left ventricle.
In the urinary sediment of a small increase in protein and red blood cells, decreases its density. Reduced the level of glomerular filtration.
Hematuric form of glomerulonephritis. It is quite rare. A typical manifestation is persistent hematuria, the patient. The loss of protein with urine is insignificant.
The mixed form is characterized by a combination of patient characteristics hypertensive and nephrotic forms of the disease. This variant of glomerulonephritis are prone to the most rapid progression.
Differential diagnosis of acute and exacerbation of chronic glomerulonephritis
The following table will facilitate the process of dif.the diagnosis between these two forms of the disease.
|The symptom of the disease||Acute glomerulonephritis||Chronic glomerulonephritis|
|Communication with streptococcal agent (illness earlier in history)||The disease begins 2-3 weeks after acute tonsillitis, scarlet fever, erysipelas and other||The aggravation occurs a few days after infection (1-2 days)|
|The period of increase of antibodies against antigens of Streptococcus||To all of the clinical manifestations||After the development of symptoms|
|The density of urinary sediment||Remains unchanged||Gradually reduced|
|The severity of proteinuria and hematuria||More pronounced hematuria||Dominated by proteinuria|
|A disturbance in the protein level and its fractions||Significantly increased globulins of different factions||Observed hypoalbuminemia|
|Characteristic changes in size on ultrasound||Significantly increased||Reduced (they were gradually wrinkling)|
|The presence of nitrogenous metabolic products in the blood (azotemia)||Not typical||Typical|
A diagnosis like glomerulonephritis is a very serious, and requires the patient’s long and difficult treatment, especially in severe forms process. If you experience the first signs of the onset of the disease, or symptoms indicating a worsening of the disease, should immediately seek help from a doctor or Nephrology therapeutic profile.