Internal illnesses. Diffuse glomerulonephritis (treatment, prognosis, prevention) (most important)

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Internal illnesses. Diffuse glomerulonephritis (treatment, prognosis, prevention) (most important)

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46. Diffuse glomerulonephritis (treatment, prognosis, prevention)

They also conduct an ECG study (signs of left ventricular hypertrophy), an examination of the fundus (exudation, retinal edema, changes in the papillae of the optic nerve that appear with the development of chronic renal failure).

Treatment. Patients are prescribed a diet and regimen: with sufficient kidney function, protein restriction (within 1 g/kg body weight), with the development of arterial hypertension, salt restriction, with edema - salt and water, restrictions during the period of severe inflammatory process.

Glucocorticoids are prescribed (immunosuppressive, anti-inflammatory and desensitizing effects) - initial dose of 60 mg/day for 3 weeks, then reduced by 5 mg for 4 days to 40 mg, then by 2,5 mg for 2-3 days, maintenance therapy with persistent urinary syndrome.

Cytostatics are administered (with a long process, the presence of a hypertensive syndrome, initial signs of renal failure, with the ineffectiveness of hormone therapy): azathioprine (daily dose of 150 mg), cyclophosphamide (daily dose of 200 mg) to suppress final immune responses; delagin, rezoquin, chloroquine.

Anticoagulants and antiplatelet agents are also indicated - heparin 20 thousand units per day for 5 days, then 5 thousand units daily for up to 3-4 weeks, chimes up to 300 mg per day orally on an empty stomach for 6-8 months; for severe renal bleeding, aprotinin (an anti-fibrinolytic drug), non-steroidal anti-inflammatory drugs (metindole) 100-150 mg per day for 1-2 months or more for acute glomerulonephritis with the presence of nephrotic syndrome. Calcium channel blockers, angiotensin-converting enzyme inhibitors (as pathogenetic therapy), and reduction of proteinuria are prescribed.

Symptomatic therapy is carried out: antihypertensive, diuretic drugs, calcium salts, cardiac glycosides, desensitizing agents, large doses of vitamin C are prescribed. In case of uncomplicated AGN, in the first days, complete exclusion of salt, fluid restriction, ascorbic acid, calcium gluconate, if necessary, correction electrolyte disorders. With a persistent course of arterial hypertension, it is necessary to connect pathogenetic, antihypertensive, diuretic therapy. Programmed hemodialysis is carried out (in the absence of the effect of treatment, with an increase in renal failure), plasmapheresis.

Flow. In acute glomerulonephritis, there is usually a complete recovery or recovery with persistent proteinuria. In chronic glomerulonephritis, depending on the form, the course is progressive, with the development of chronic renal failure.

Forecast. In acute glomerulonephritis, the prognosis is favorable (mortality rate is 2%), in chronic glomerulonephritis, it is favorable in the latent form and unfavorable in other forms.

Prevention. Primary prevention - rehabilitation of foci of infection, their adequate treatment, only appropriate vaccination.

Secondary prevention - dispensary observation, treatment of complications and exacerbations, rational employment.

Author: Myshkina A.K.

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