56. Treatment of acute gromerulonephritis

Treatment. Treatment for AGN is complex and includes the following activities.

1. Mode. If AGN is suspected or immediately after the diagnosis is established, the patient should be immediately hospitalized. Strict bed rest must be observed for about 2-4 weeks until the elimination of edema and normalization of blood pressure. Staying in bed provides uniform warming of the body, which leads to a decrease in vasospasm (hence, to a decrease in blood pressure) and to an increase in glomerular filtration and diuresis. After discharge from the hospital, home treatment is indicated for up to 4 months from the date of onset of the disease, which is the best prevention of the transition of AGN to the chronic stage.

2. Diet. Depending on the severity of clinical symptoms, it is very important to restrict fluid and sodium chloride. With an expanded and nephrotic form, a complete fast is recommended for 1-2 days with fluid intake in an amount equal to diuresis. On the 2-3rd day, the consumption of food rich in potassium salts (rice porridge, potatoes) is shown. The total amount of water drunk per day should be equal to the volume of urine allocated for the previous day plus 300-500 ml. After 3-4 days, the patient is transferred to a diet with protein restriction (up to 60 g per day), and the total amount of salt is not more than 3-5 g / day. Such a diet is recommended until the disappearance of all extrarenal symptoms and a sharp improvement in urinary sediment.

3. Drug therapy includes, first of all, antibacterial therapy, which, however, should be carried out only if the infectious nature of AGN is reliably established (the pathogen has been isolated and no more than 3 weeks have passed since the onset of the disease). Usually prescribed penicillin or its semi-synthetic analogues in conventional dosages. The presence of obvious foci of chronic infection (tonsillitis, sinusitis, etc.) is also a direct indication for antibiotic therapy. Diuretics in the treatment of AGN are indicated only with fluid retention, increased blood pressure and the appearance of heart failure. The most effective furosemide (40-80 mg), used until the elimination of edema and hypertension. There is no need for a long-term prescription of these drugs, 3-4 doses are enough.

In the absence of edema, but persistent hypertension or with an insufficient antihypertensive effect of saluretics, antihypertensive drugs (clophelin, dopegyt) are prescribed with a duration of administration that depends on the persistence of arterial hypertension.

With prolonged proteinuria, indomethacin or voltaren is prescribed at 75-150 mg per day (in the absence of hypertension and oliguria). The prognosis is favorable, however, with prolonged forms, there is a possibility that the process will become chronic.

Prevention of AGN comes down to effective treatment of focal infection, rational hardening. In order to timely detect the onset of the disease after vaccination, transferred ARVI in all patients, it is necessary to examine the urine.

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