Internal illnesses. Diffuse glomerulonephritis (clinic of chronic glomerulonephritis) (most important)

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Internal illnesses. Diffuse glomerulonephritis (clinic of chronic glomerulonephritis) (most important)

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44. Diffuse glomerulonephritis (CHRONIC GLOMERULONEPHRITIS CLINIC)

The main syndromes of chronic glomerulonephritis: urinary, hypertensive, edematous, hyperlipidemia, hypoproteinemia, anemic, chronic renal failure.

The forms of the course are: latent, hypertensive, nephrotic, mixed, malignant (subacute), terminal.

The latent form is more often detected by chance, during the clinical examination. Characterized by long-term preservation of working capacity without signs of disease (up to 10-20 years), the presence of isolated urinary syndrome, isohypostenuria, low specific gravity of urine, nocturia, possibly increased blood pressure, hypoproteinemia, hypercholesterolemia, increased ESR.

For a long time, the leading and only symptom of the hypertensive form is arterial hypertension. Initially, hypertension is intermittent in nature, in the future - permanent. On examination, there is an apex beat visible to the eye, an expansion of the relative dullness of the heart to the left, an accent of the II tone over the aorta, a gallop rhythm, with the progression of heart failure, there are manifestations of stagnation in the pulmonary circulation, hemoptysis, attacks of cardiac asthma, rarely - pulmonary edema. The fundus of the eye: neuroretinitis is moderate, only narrowing of the arteries persists for a long time.

In the nephrotic form, trophic changes appear: dry skin, a decrease in its elasticity, muscle hypotrophy, edema develops due to a decrease in oncotic pressure, initially minor in the morning under the eyes, on the ankles, then permanent with a transition to the trunk; hydrothorax, ascites, hydropericardium. There is a dissociation of protein-lipid ratios (hypoproteinemia, hypercholesterolemia), urinary syndrome may appear: hematuria, decreased filtration function, blood pressure does not increase.

The mixed form is characterized by the severity of edema, urinary syndrome, arterial hypertension, as well as the progressive course and development of renal failure (within 2-5 years).

The malignant (subacute form) is characterized by a rapid and persistent decrease in kidney function, increasing changes in the fundus.

The terminal form refers to the stage of renal decompensation and is associated with insufficiency of nitrogen excretory function. Nephrotic and hypertensive syndromes are expressed, levels of urea, creatinine, indican are increased, glomerular filtration is reduced, and the filtration fraction increases.

Left ventricular heart failure, chronic renal failure, anemia, uremic stomatitis, gastritis, colitis, bronchitis, polyserositis.

Differential diagnosis: hypertension, left ventricular heart failure, diabetic glomerulosclerosis, liver cirrhosis, amyloidosis, congestive kidney.

Author: Myshkina A.K.

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