Hospital therapy. Clinical picture of acute grosserulonephritis (most important)

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Hospital therapy. Clinical picture of acute grosserulonephritis (most important)

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54. Clinical picture of acute gromerulonephritis

Acute glomerulonephritis (AGN) is an acute diffuse kidney disease of an infectious-allergic nature, localized in the glomeruli. AGN can be an independent disease (primary) or be secondary as part of another disease, complicating the clinical picture and diagnosis of the latter. AGN usually affects young and middle-aged men.

clinical picture. The clinical picture of the disease consists of the following syndromes.

urinary syndrome.

1. Proteinuria due to the passage of protein molecules through the spaces of the capillary wall of the glomerulus, formed during the deposition of immune complexes on them. Proteinuria is selective in nature, in which predominantly albumins pass through the glomerular "filter".

2. Hematuria due to involvement in the pathological process of capillary mesangium and interstitial tissue. Erythrocytes penetrate through the smallest breaks in the basement membrane, changing their shape.

3. Cylindruria - urinary excretion of cylindrical cells of the tubules. During dystrophic processes in the tubules of the disintegrated cells of the renal epithelium, granular cylinders are formed, consisting of a dense granular mass; waxy cylinders have sharp contours and a homogeneous structure; hyaline casts are proteinaceous formations.

Hypertensive syndrome is observed due to:

1) sodium and water retention;

2) activation of the renin-angiotensin-aldosterone and sympathoadrenal systems;

3) decrease in the function of the depressor system of the kidneys.

Edema syndrome is associated with the following factors:

1) a decrease in glomerular filtration due to their defeat;

2) a decrease in the filtration charge of sodium and an increase in its reabsorption;

3) water retention due to sodium retention in the body;

4) an increase in BCC;

5) secondary hyperaldosteronism;

6) an increase in the secretion of ADH and an increase in the sensitivity of the distal nephron to it, leading to fluid retention;

7) an increase in the permeability of the capillary walls and the release of plasma into the tissues;

8) a decrease in plasma oncotic pressure with massive proteinuria.

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