Chronic kidney inflammation of the kidney

2021-01-26 12:00 AM

The glomerulus is hyaline, has lost normal shape or is surrounded by a fibrous organization around the Bowman membrane, or in the Bowman membrane. As a result of prolonged urinary infection, recurrence many times, the treatment does not stop.

Pathology

General

Kidney atrophy is small, both sides but disproportionate, or only atrophy on one side.

The kidneys are rough and unevenly concave.

The renal pelvis is distorted, pulled, distorted.

Sometimes the kidneys are pus or a sack of pus.

Micro

Organ fibrosis, infiltrates many lymphocytes, cytoplasm, polymorphonuclear leukocytes.

Many kidney tubules are destroyed, the rest dilate.

The glomerulus is hyaline, has lost normal shape or is surrounded by a fibrous organization around the Bowman membrane, or in the Bowman membrane.

Renal vessels are hardened, squeezed by the fibrous tissue.

Symptom learning

History: Patients often have recurrent urinary system infections, with favourable factors blocking urine: stones, prostate fibroids, urinary tract malformations ...

Clinical symptoms

Possible bladder syndrome: painful urination, urinary retention, cloudy urination, haematuria.

Non-oedema, on the contrary, there are signs of dry skin, reduced elasticity, dehydration pattern.

An enema only when there is severe renal failure, poor nutrition.

Damp pain in the back hip area, 1 or 2 sides.

Urinating a lot, urinating at night.

Anaemia, high blood pressure often appears late.

Subclinical symptoms

Urine:

Protein < 1g/24h.

WBCs> 6000 / min or> 5 / microscope in the 40 objectives.

Germs> 105 / ml.

The ability to concentrate urine reduces early: testing methods of concentration often with maximum density <1.018.

Dissociation of kidney and tubular function: reduced concentration, low density, but normal glomerular filtration rate. This is an early sign of chronic pyelonephritis.

In the presence of kidney failure:

Red blood cells decreased blood haemoglobin.

Blood urea, creatinine increased.

Kidney X-ray and ultrasound:

Kidney disproportionately small atrophy, rugged, unevenly concave.

Evolution

Progress is generally slow. Sometimes, the bacteria in the urine are gone.

There are often exacerbations.

Eventually, lead to chronic kidney failure. Kidney failure as quickly as:

Many exacerbations.

Increased blood pressure.

Use antibiotics that are toxic to the kidneys.

It is impossible to eliminate the favourable factors: stones, prostate fibroids.

Diagnose

Definite diagnosis: Mainly based on history, clinical and subclinical symptoms.

Differential diagnosis: Need to distinguish from chronic glomerulonephritis, based on:

oedema is more common, increased blood pressure occurs earlier

Urine: Red blood cells more than white blood cells, no pus in the urine, more proteinuria, mainly Albumin.

The kidneys are small but symmetrical, with equal margin.

Treatment

Treat infection

Mainly exacerbations or stages with bacteriuria, although there are no clinical symptoms, are detected by monitoring of bacteriuria.

Use antibiotics according to the antibiotic map, avoid antibiotics that are nephrotoxic.

Eliminate favourable factors

gravel ...

Treatment of hypertension, alkaline disorders, electrolytes, anaemia.