Chronic pyelonephritis swelling
Nephritis is an especially frequent disease with whichthe therapist faces. The most characteristic for this nosological group is glomerulonephritis. This immunoinflammatory disease, in which the glomerular apparatus of the kidneys is affected, tubules and interstitial tissue are involved. The primary lesion of tubules and interstitial tissue is observed with interstitial (tubulo-interstitial) nephritis.
There are acute, chronic, and subacuteglomerulonephritis. The disease develops most often after streptococcal infections taking place in the form of pharyngitis, tonsillitis, dermatitis, after pneumonia, viral respiratory diseases and other infections.
A typical beginning of nephritis: develops 10 to 12 days after the infection, quickly there are edema with pyelonephritis, arterial hypertension is noted.
Today, "classic" acute nephritis in adultsrare, more often its erased course is observed, the symptoms of kidney disease are often similar, and therefore the differential diagnosis of pyelonephritis is especially relevant.
Chronic nephritis is often hidden, revealing itself in such cases only in the study of urine. Sometimes it is accompanied by swelling, increased blood pressure.
The following variants of chronic nephritis have been identified: latent, nephrotic, hypertonic and mixed (edematous-hypertonic). It is also expedient to isolate the hematuric variant.
Latent jade is manifested only by changes in urine, small erythrocytic and leukocyturia, a moderate increase in blood pressure. Hematuric nephritis occurs with a constant significant hematuria (when there is a lot of blood in the urine). Nephrotic nephritis occurs with pronounced proteinuria (more than 3.5 gramsprotein per day), decreased diuresis, persistent edema, hypoproteinemia and hypoalbuminemia. Characteristic increase in serum cholesterol. When hypertensive nephritis leading hypertonic syndrome,hypertrophy of the left ventricle of the heart, changes in the fundus. The combination of a nephrotic syndrome with high arterial hypertension indicates a mixed (edematous-hypertonic) nephritis. There are more and more reports about subacute (fast-progressing) nephritis in the press. The disease proceeds with a rapid (within a few months) development of renal failure.
Nephrites with a typical clinical and laboratory picturecan develop not only as an independent disease, but also in the framework of many common and systemic diseases. This determines the sequence of the differential diagnosis of pyelonephritis. In order to establish an accurate diagnosis of nephritis, it should be clarified whether this disease actually exists. We must exclude diseases that require a different therapeutic tactic. We are talking about pyelonephritis, kidney tumors, interstitial nephritis, amyloidosis, tuberculosis, kidney stones, etc. Then, after diagnosing nephritis, it is necessary to establish: it is primary or secondary nephritis.
Acute glomerulonephritis should be differentiated first of all with acute pyelonephritis and acute drug damage of the kidneys - first of all, what antibiotics for pyelonephritis took the patient. Unlike pyelonephritis in acute nephritis, high leukocyturia, persistent low back pain, high fever with chills are rare. With acute pyelonephritis, there are no swelling and cardiac asthma. The acute drug damage of the kidneys (interstitial nephritis or tubular necrosis) should be considered in the development of kidney damage in the background of antibiotic treatment (which antibiotics were used for pyelonephritis - methicillin, ampicillin, rifampicin), sulfonamides or aminoglycosides, cephalosporins (acute tubular necrosis) medicinal allergy (fever, eosinophilia, skin rashes), a rapid increase in azotemia with a preserved diuresis and a sharp depression of the relative density of urine.
All clinical signs of acute nephritis canarise when exacerbation of chronic nephritis. This is the so-called "acute nephropathic syndrome," which characterizes the high activity of the process. In these cases, the diagnosis of pyelonephritis - a biopsy of the kidney - can contribute to clarifying the diagnosis, in addition to the history.
Chronic latent nephritis followsdifferentiate primarily with chronic pyelonephritis, gouty kidney and amyloidosis. With pyelonephritis, periodic fever with chills, early anemia, high leukocyturia, bacteriuria, decreased urine density, asymmetry of kidney damage (according to the data of X-ray and isotope studies) are observed. Although, it would seem, the differential diagnosis of pyelonephritis and nephritis is not so complicated, yet at the first detection of urine pathology the district doctor for some reason begins usually with the diagnosis of pyelonephritis, even often despite significant proteinuria, prescribing immediately unnecessary (and often harmful) antibacterial drugs . Isolated urinary syndrome can be observed in gouty nephropathy, which is characterized mainly by interstitial damage and kidney stone disease. Typical attacks of gouty arthritis, the presence of subcutaneous tofusov, as well as an elevated level of uric acid in the blood helps to establish the correct diagnosis.
Chronic hematical nephritis follows infirst of all to differentiate with urological diseases - to exclude nephrolithiasis, tumor, kidney infarction, nephroptosis. Hematuria can be associated with disorders of coagulation and diseases of the blood system. Hematuria in combination with moderate proteinuria and a decrease in the relative density of urine may be a sign of chronic interstitial nephritis when abusing analgesics or hereditary nephritis.
Hematuria can be a sign (even the first) of a subacute infectious endocarditis.
Chronic nephritis nephritis follows in the firstturn to differentiate with amyloidosis of the kidneys, especially with the appearance of changes in the urine of patients with rheumatoid arthritis, Bechterew's disease, suppurative, infectious diseases, tumors. The possibility of amyloidosis of the kidneys is indicated by such signs as the stability of the nephrotic syndrome, the preservation of its signs in the stage of chronic renal failure, a combination with hepato- and splenomegaly, a syndrome of impaired absorption, hyperfibrinogenemia, and blood thrombocytosis. The most reliable method of distinguishing between nephritis and amyloidosis is the laboratory diagnosis of pyelonephritis - a morphological examination of the kidney tissue; Amyloid can be found in the rectal mucosa or (more rarely) in the gum tissue.
Often, massive proteinuria develops withparaproteinemia ("proteinuria overflow"), primarily in myeloma. However, hypoalbuminemia and hypoproteinemia - characteristic signs of a nephrotic syndrome - are usually absent (except for cases of amyloidosis).
It should be borne in mind the frequency of nephroticsyndrome in diabetic nephropathy, the diagnostic value is also the detection of signs of widespread microangiopathy (change of the fundus, etc.).
If you suspect a systemic nature of the disease, you should first exclude systemic lupus erythematosus, especially when developing nephrotic syndrome in young women.
Nephrotic nephritis can also occur with hemorrhagic vasculitis, subacute infective endocarditis, drug and serum sickness.
In chronic hypertensive nephritis followsfirst of all, exclude diseases whose surgical treatment can lead to a reduction in AD - renovascular hypertension and adrenal tumors (aldosteroma and pheochromocytoma). In the presence of severe hypertension, especially diastolic or malignant, resistant to standard antihypertensive therapy, the renovascular nature of hypertension is very likely; in the area of the projection of the renal arteries, in 50% of patients in these cases, systolic murmur is heard, and asymmetry in the blood pressure values on the limbs can be observed. Renovascular hypertension is excluded by X-ray methods of investigation (excretory urography, aortography). The aldosterome should be considered in the presence of hypokalemia and its clinical signs - muscle weakness, fatigue, seizures. The diagnosis is confirmed by the detection of low plasma renin activity and hypersecretion of aldosterone; a tumor or an adrenal gland can be detected by instrumental methods. Pheochromocytoma should be excluded in hypertensive crises with sharp fluctuations of blood pressure.
Mixed chronic nephritis (edematous-hypertonic) should be differentiated first of all with systemic diseases - lupus nephritis, hemorrhagic vasculitis.
Rapidly progressive nephritis with renal diseaseinsufficiency as an independent disease in recent years began to be observed less often. However, this form has become frequent in systemic diseases (systemic lupus erythematosus, Goodpasture's syndrome, mixed cryoglobulinemia). That is why it is important to establish the very fact of rapidly progressing nephritis and to prescribe its active therapy.
Until complete cure and end of medication, pyelonephritis and alcohol are categorically incompatible.