Hospital therapy. Diagnosis of acute grosserulonephritis (most important)

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Hospital therapy. Diagnosis of acute grosserulonephritis (most important)

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55. Diagnosis of acute gromerulonephritis

Diagnostics. In 100% of cases, urine tests are diagnosed with proteinuria of varying severity, cylindruria and, most importantly for diagnosis, hematuria of varying severity - from microhematuria (up to 10 erythrocytes per field of view) to macrohematuria (although quite rare). However, if AGN is suspected, it is necessary to conduct a series of repeated urine tests or put a Nechiporenko test (determination of the number of formed elements in 1 μl), since erythrocytes may not be detected in a single portion of urine.

A blood test reveals acute phase indicators (increased levels of fibrinogen and a2-globulin, C-reactive protein, accelerated ESR), the number of leukocytes changes little, moderate anemia. With an uncomplicated course of AGN, the content of nitrogenous substances (creatinine, indican, urea) in the blood does not change.

In the initial phase of the disease, a change in the Reberg test is observed - a decrease in glomerular filtration and an increase in tubular reabsorption, which normalizes as it recovers.

An x-ray examination in patients with severe arterial hypertension may show a moderate increase in the left ventricle, which takes on the same size as the patient recovers.

There are 3 clinical variants of AGN.

1. Monosymptomatic variant: minor complaints, absence of edema and arterial hypertension, there is only urinary syndrome; the most common variant of the course of the disease (86% of cases).

2. Nephrotic variant: edema, oliguria are pronounced, it is possible to increase blood pressure to relatively low numbers, it is detected in 8% of patients.

3. Extended version: arterial hypertension, reaching high numbers (180/100 mm Hg), moderately pronounced edema, circulatory failure, occurs in 6% of cases.

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