Chronic glomerulonephritis (nephritic form)

Chronic glomerulonephritis (nephritic form) is the variant of glomerulus's injury that characterized by the prevalence in clinic of nephritic syndrome signs.

Clinical features

The clinical features more frequently develop gradually accordantly to the proteinuria level.

The main complaint in patients with nephritic syndrome is edema that initially arises on the face and in disease progression spreads from the face downward up t hydrothorax, hydropericardium and anasarca.

Objective examination: General patient's condition is from moderate grave 1 extremely grave. In general examination is detected "fades nephritica " - the face is edematous and often pale. Swelling usually appears first around the eyes in the morning and eyes may become slit like when edema is pronounced.

The color of the skin characterized by pathological pale, observed decreased turgor and elasticity of the skin, scars on the abdomen and hips due to the over stretching of the skin.

Edema in patients with nephritic syndrome (edema renalis) characterized by symmetrical localization, in initial stages arises on the face in the morning, has descending character and spreads on extremities, loin region with next fluid accumulation in cavities (hydrothorax, hydropericardium and anasarca). The skin over edema is glossy.

In heart auscultation detects decreased loudness of the heart sounds. The data of percussion and renal palpation aren't specific.

Complications: renal failure, heart failure, encephalopathy, stroke, eclampsia.

Outcomes of disease: fast progression with poor prognosis, renal failure and death.

Additional methods of examination

Clinical blood analysis: leukocytosis and increase of accelerated ESR, anemia.

Clinical urine analysis: in macroscopic study - urine is "meat wastes" color, cloudiness, without odor, olyguria, low specific gravity and significant proteinuria: in microscopic study observed large amount of altered erythrocytes (hematuria), cylinders (hyaline, erythrocytes and waxy casts) and leucocytes (non-constant).

Zimnitsky's test: olyguria, nocturia, izostenuria.

Nechiporenko's method: prevalence of erythrocytes under leucocytes; casts more 250 in ml.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels, hypoproteinemia (hypoalbuminemia) and dysproteinemia, increased potassium, magnum, sulphatis and phosphates level with sodium, calcium, chloral and hydrocarbonatis concentration is decreased. Decrease of Glomerulus's filtration rate.

Renal biopsy: use for differential diagnosis and determination of the glomerulonephritis origin.

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CHRONIC GLOMERULONEPHRITIS (hypertensive form)

Chronic glomerulonephritis (hypertensive form) is the variant of glomerulus's injury that characterized by the stable blood pressure increase.

Clinical features

The clinical features more frequently develop gradually accordanly to the proteinuria level.

The main complaint in patients are headache, lost of vision, dizziness, lost of sleeping and edema that initially arises on the face and in disease progression spreads from the face downward up to hydrothorax, hydropericardium and anasarca.

Objective examination: General patient's condition is from moderate grave to extremely grave. In general examination detects "faces nephritica ", pale color of the skin and visible mucus, edema renalis.

In heart percussion detect displacement of the left heart border outward and downward.

In heart palpation - apex beat displaced outward and downward, diffuse, high and strong strength.

In heart auscultation detects decreased loudness of the heart sounds, accentuated II heart sound over aortic valve. Stable blood pressure increases (with high diastolic blood pressure level).

Complications: edema of the brain, edema of the retina, myocardial infarction, cardiac asthma, encephalopathy and chronic renal failure.

 

Additional methods of examination

Clinical blood analysis: without significant changes.

Clinical urine analysis: decrease of specific gravity, proteinuria; in microscopic study cylinderuria, microhematuria.

Zimnitsky's test: olyguria, nocturia, izostenuria.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels, decrease of Glomerulus's filtration speed, non-constant - hypoproteinemia and dysproteinemia.

ECG: the signs of left ventricle hypertrophy and systolic overload.

In ophthalmoscope examination: the signs of renal retinopathy- edema of the retina, spasm of the arteries, dilation of the veins, hemorrhages.

Renal biopsy: use for differential diagnosis and determination of the chronic gromerulonephritis origin.

 

CHRONIC GLOMERULONEPHRITIS (mixed form).

Chronic glomerulonephritis (mixed form) is the variant of glomerulus's injury that characterized by the presence of hypertensive and nephritic syndromes.

Clinical features

The clinical features more frequently develop gradually accordantly to the proteinuria level. The main complaint in patients is edema that initially arises on the face and in disease progression spreads from the face downward up to hydrothorax, hydropericardium and anasarca.

Also may be present general weakness, thirst, and loss of appetite, headache, vision changes and dizziness.

Objective examination: General patient’s condition is from moderate grave to extremely grave. In general examination detects "faces nephritica" and edema renalis with next fluid accumulation in cavities.

The color of the skin characterized by pathological pale, observed decreased turgor and elasticity of the skin, scars on the abdomen and hips due to the over stretching of the skin. The skin over edema is glossy.

In objective examination detect displacement of the left border of the heart to the left, tachycardia, decrease loudness of the heart sounds and stable secondary arterial hypertension.

Complications: cardiac asthma, pulmonary edema, stroke, shock and chronic renal failure

Additional methods of examination

Clinical blood analysis: moderate leukocytosis and increase of accelerated ESR (in stage of aggravation), anemia.

Clinical urine analysis: in initial stage - poliuria, in late - olyguria with low specific gravity and significant proteinuria: in microscopic study observed non-constant hematuria, cylinders (hyaline) and leucocytes (non-constant).

Zimnitsky's test: olyguria, nocturia, hypo- or izostenuria.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels, decrease of creatinin clireance, non-constant - hypoproteinemia and dyspro-teinemia.

ECG: the signs of left ventricle hypertrophy and impaired repolarization.

Renal biopsy: use for differential diagnosis and determination of the glomerulonephritis origin.

CHRONIC GLOMERULONEPHRITIS (latent form)

Chronic glomerulonephritis (latent form) is the variant of glomerulus's injury that characterized by the non-symptomatic duration or clinical manifestation with isolated urinary syndrome.

Clinical features

As usual the patients don't have any complaints.

Objective examination: General patient’s condition is from satisfactory to moderate grave. During general examinations in the early stages of disease aren't detect any particularities. In later stages may appears clinic of nephritic and hypertensive syndromes.

Complications: development of chronic renal failure.

Additional methods of examination

Clinical blood analysis: anemia.

Clinical urine analysis: in initial stage - normal specific gravity and non-significant proteinuria: in microscopic study observed non-constant hematuria, cylinders (hyaline) and leucocytes (non-constant).

Nechiporenko's method: prevalence of erythrocytes under leucocytes; casts more 250 per ml.

Biochemical blood analysis: increase of creatinin, ammonium and urine acid levels and decrease of creatinin clireance detect in 25 % of patients, non-constant - hypoproteinemia and dysproteinemia.

Renal biopsy: use for differential diagnosis and determination of the glomerulonephritis origin.

PYELONEPHRITIS

Pyelonephritis - inflammatory renal disease with obligatory renal parenchyma and pelvis injury.

Classification

I. According to the duration:

- acute;

- chronic.

II. According to the complication development:

- complicated;

- non-complicated.

Etiology

I. Primary infection of renal structures (more frequently bacterial, protozoa, fungus).

II. Secondary to the:

1. Renal system pathology:

- urine tract infection and injury (cystitis, urethritis, strangulation of stones or foreign bodies in the urethra; phimosis);

- prostate gland diseases (prostatitis, prostate adenoma, prostate tumor);

- uterus and uteri cervical diseases.

2. Extra renal pathology:

- sepsis;

- diabetes;

- inflammatory process with different localization;

- immune deficiency states;

- post operative period.

Pathogenesis