Pathology of chronic glomerulonephritis

2021-01-28 12:00 AM

Chronic glomerulonephritis is a disease with progressive glomerular lesions over many years with clinical manifestations possibly with a history of oedema, proteinuria, and red blood cells.

Chronic glomerulonephritis is a disease with progressive damage to the glomeruli that leads to chronic kidney failure, has many causes, and the possibility of many dangerous complications. If detected early and properly adjusted, it can limit the progression of the disease and limit the possible complications. 

Define

Chronic glomerulonephritis is a disease with progressive glomerular lesions over many years with clinical manifestations with a history of edema, proteinuria, erythrocytosis, high blood pressure, but possibly only erythema. urethritis, Proteinuria alone. Eventually leads to chronic kidney failure with symptoms:

Prolonged abnormalities in urine (erythrocytes and Masuria).

Gradually impaired kidney function. 

Epidemiological characteristics

Chronic glomerulonephritis is a relatively common disease in the community. According to PGS. Tran Van Chat and BS. Tran Thi Thinh (1991 - 1995) at the Department of Urology at Bach Mai Hospital, chronic glomerulonephritis accounts for 31.5% of which the common age group is 16-44 years old, accounting for 88.32%. Thus, many diseases at working age affect the working capacity in the community. Also, according to the two authors above, the disease is not related to gender and geography. Treatment is mainly conservative, it is necessary to have an early detection plan for cases of chronic glomerulonephritis in the community, trying to avoid factors that cause acute phase, especially infection to prolong the patient's life.

Reason

Due to acute glomerulonephritis (10-20%).

Due to glomerulonephritis with nephrotic syndrome.

Due to general diseases such as Lupus, systemic diseases such as rheumatoid arthritis ...

Metabolic diseases: diabetes ...

Hereditary glomerulonephritis.

Undefined reason.

Except for primary glomerulonephritis with minimal damage, most glomerulonephritis leads to chronic glomerulonephritis. Therefore, early detection and prevention of the causes of acute glomerulonephritis, improving the environment and health in the community and the good resolution of infections are of great importance in disease prevention and delay. progression of chronic glomerulonephritis, prolonging the life span of the patient. 

Symptom

Proteinuria 

Less than 2-3 g / 24h during the stage of latent chronic glomerulonephritis. 
If an increase of more than 3.5 g / 24h is a sign of nephrotic syndrome. 

Whew

White edema, soft, concave, sometimes only heavy on the eyelids, the stage of potential edema is not clear. If nephrotic syndrome is present, generalized swelling can cause membrane effusion.

Urinary retention of a small amount varies depending on the patient and the stage of the disease. 

Hypertension

In the stage without renal failure or mild renal failure the proportion of patients with low blood pressure. When kidney failure stage III, IV, the rate over 80% has high blood pressure. 

Red blood cells

Usually, rarely there is gross hematuria. 

Urinary cylinder, erythrocyte pillar, inner cylinder, granular cylinder

When there is kidney failure often has enlarged pillars.

Anemia

Usually, the more severe the kidney failure is, the more severe anemia is. Red blood cells, hemoglobin decreased in the presence of renal failure, isochromatic anemia or hypochromia is difficult to recover. 

Symptoms manifesting high urea syndrome (in the presence of apparent renal failure)

Vomiting, gastrointestinal disturbances, hemorrhage, cardiovascular and neurological manifestations of clinical acidosis: (deep breathing, breathing disorder) and most severe, coma due to hyper uremia. 

X-ray

Bilateral atrophy of both sides in the stage of kidney failure. In the absence of renal failure, if UIV was taken, the picture of normal pyelonephritis was shown. 

Kidney ultrasound

Kidney size is normal in the absence of renal failure. The kidneys are atrophy of both sides when there is kidney failure. The degree of atrophy depends on the stage of progression of kidney failure and on the underlying cause.

Kidney biopsy

In the period without renal failure or mild kidney failure degree 1, 2 can conduct kidney biopsy. The kidney biopsy will reveal the type of histopathological damage. 

Diagnose

Implementing the quadrants 

Whew.

Proteinuria.

Red blood cells.

Urinary cylinder.

Hypertension.

Blood urea.

Increased blood creatinine.

X-ray image, kidney scan.

However, in the latent stage to diagnose a kidney biopsy. 

Differential diagnosis

Chronic pyelonephritis. In chronic pyelonephritis, patients often have a history of urinary infections, nephrolithiasis - urinary tract but no edema, low proteinuria, rarely too lg / 24h, many leukocytes, bacteria urinary. If there is a pillar, it is a leukocyte cast. The two kidneys are large and small, unevenly, the kidneys are often rough, and the pyelonephrite can expand (UIV).

Benign renal artery (ie, high blood pressure) in chronic glomerulonephritis, proteinuria usually appears before high blood pressure or at the same time. In high blood pressure, proteinuria, if present, appears late and in small numbers.

Malignant renal artery (malignant hypertension) in chronic glomerulonephritis, the two kidneys are often atrophy and with anemia, in malignant hypertension, two kidneys are not atrophy, disease usually progresses rapidly, kidney failure severe but no severe anemia.

In this case, benign proteinuria in this case is usually only intermittent, infrequent, and never leads to kidney failure such as chronic glomerulonephritis.

Acute glomerulonephritis: patient has a history of infection in the throat and skin, followed by edema, low urination, hematuria, high blood pressure. Diagnosis is confirmed by ultrasound or kidney scan if two kidneys are smaller than normal is chronic glomerulonephritis.

Acute glomerulonephritis rapidly progresses: the patient has a history of infection in the throat and skin, followed by edema, low urination, hematuria, high blood pressure, blood urea and increased blood creatinine. Diagnosis is confirmed by kidney scan or kidney ultrasound, kidneys are smaller than normal is chronic glomerulonephritis.

Diagnose the form of the disease

Potential form:

Based on the patient with a history of glomerulonephritis, test with erythrocytes, prolonged urinary cylinder. The definitive diagnosis is based on kidney biopsy.

Exacerbation of chronic glomerulonephritis:

Patients with a history of chronic glomerulonephritis and have favorable factors such as:

Malignant hypertension.

There are episodes of infection.

Pregnant...

Chronic glomerulonephritis is a chronic disease caused by progressive glomerulonephritis that lasts for months to years. Early detection is based on patients who already have glomerulonephritis but with persistent erythrocytosis and proteinuria and appear more symptoms: edema, high blood pressure, anemia, so it is easy to detect early in the community.

Treatment

Treatment of symptoms and complications

Rest, binge eat, and use diuretic in case of swelling and high blood pressure. 

Eat bland, limit water intake. 

When there is renal failure, it is necessary to limit protein in the diet.

Diuretic: Lasix 40mg x 1 tablet / 24h. A higher dose may be given if swelling persists.

Antihypertensive drugs all groups of drugs can be used. When heart failure is present, do not use sympathomimetic β blockers.

Nifedipine 20mg x l-2 tablets / 24h.

Coversyl 40mg x 1-2 tablets / 24h.

If the patient responds well to the ACE inhibitor group, the long-term protection of renal parenchyma can be expected.

Give antibiotics in case of an infection:

Need to use appropriate antibiotics, avoid antibiotic toxicity to the kidneys, lasting from 7-14 days. For sore throats it is best to be either Penicillin or Ampicillin.

Treatment of the main disease

Systemic, systemic, metabolic disease: Systemic lupus erythematosus or diabetes ... 

Treatment of combination diseases

Nephrotic syndrome (if any).

Prevention

Prevention of acute glomerulonephritis

Prevention of sore throats and foci of infection in the skin.

Early detection of disease

By periodically testing urine in patients with glomerulonephritis 

Prevention and treatment of factors that aggravate chronic glomerulonephritis

Treat high blood pressure if present.

Treat foci of infection if present.

Restricted should not get pregnant in patients with chronic glomerulonephritis.

Protein restriction when patients present with renal impairment.

Do not use nephrotoxic drugs.

Chronic glomerulonephritis is a common disease. long patient's life.