It is a bacterial inflammation or not with lesion of the kidney glomeruli.
Acute glomerulonephritis (GNA)
This inflammation often occurs as a result of an inappropriate immune response. It occurs approximately 1 to 4 weeks after a streptococcal infection often (tonsillitis, otitis, sinusitis). They are called post-infectious GNA.
The GN are often found in children 5 to 12 years.
It can sometimes be linked to an autoimmune disease that will gradually worsen renal function and lead to kidney failure (with need for dialysis).
In response to the body to infection, are formed antibodies directed against the germs in question. The immune response causes the formation of immune complexes “which are arrested in the glomerular filter of the kidney and cause inflammation.

Etiology:

  • The beta-hemolytic streptococcus group A is most commonly involved.
  • Other bacteria: pneumococci, meningococci, staphylococci …, hepatitis viruses




Signs and symptoms:

  • Definition of angina, pharyngitis or skin infections: impetigo and scarlet fever within 10 to 15 days earlier
  • asthenia,
  • headache,
  • hyperthermia,
  • back pains,
  • pain in the kidneys,
  • edema, with feeling faces “inflated” sudden onset of diffuse, steep, which may affect the legs, loins, hands, face, abdominal pain with effusion, lung, brain, with weight gain,
  • discoloration of urine (red-brown) due to hematuria,
  • Hypertension in a person usually normo tense (as a result of GNA)
  • oliguria (urine rare), urine “stock sale”
  • hyperhydration with overload at heart (as a result of oliguria), which can lead to pulmonary edema.
  • anorexia
  • pallor



Diagnosis:

  • ECBU reveals leucocyturia and significant proteinuria, hematuria and a microphone or even macroscopic cylinder with presence of erythrocytes and erythrocytes deformed.
  • blood tests: The ESR is increased (indicating inflammation), leukocytosis. The balance is disturbed kidney with urea and creatinine levels.
  • Renal ultrasound: it allows the differential diagnosis between chronic ANG and NG (CNG). When the CNG, will indeed find a kidney size decreased.
  • looking for a site of infection, including streptococcal (ENT, stomatology, skin) and search for streptococcal antigens

Treatment:

  • Penicillin in cases of post-streptococcal GNA.
  • corticosteroids
  • cyclophosphamide (Endoxan ®)
  • azathioprine (Imurel ®)
  • Symptomatic treatment of hypertension, edema and heart failure.
  • bed rest 3 to 4 weeks, especially in cases of hypertension, edema or significant increase in serum creatinine (risk of renal failure)
  • control pulse / voltage regular, and measuring the weight and temperature
  • Monitoring urine with achieving a balance fluid
  • monitoring of regular blood levels (urea, creatinine, electrolytes)
  • Food: reduced intake of salt, liquid and protein. If hyperkalemia because of renal failure, lower potassium intake (bananas)
  • required dialysis.

Prognosis:
Good in most cases.

  • Renal failure, if it exists, will disappear in a few days.
  • Hypertension was cured in a week.
  • The macroscopic hematuria is microscopic in 2 to 3 weeks.
  • Proteinuria decreased rapidly.
  • Hematuria and proteinuria disappeared after no more than 18 ° month.
  • Relapses are exceptional.

Long-term prognosis: no hypertension or renal disease.
Bad in the case of GN of autoimmune origin, with need for dialysis early.
A biopsy should be performed in cases of:

  • anuria,
  • renal failure for more than 2 weeks
  • syndrome during beyond the 2nd week;
  • Persistent hypertension after 2 weeks;
  • proteinuria> 1g/24 h after 1 month;
  • hematuria persisting after 18 months of evolution;
  • relapse

Complications:
In the acute phase:

  • threatening hypertension with cerebral edema, retinopathy and hypertensive pulmonary edema,
  • anuria, which may take several sessions of extra renal treatment, but whose long-term prognosis is as good as the non-anuric forms.
  • rapid deterioration of renal function.

Subsequently:

  • Chronic renal failure

Chronic glomerulonephritis (CNG)
GN that develops over years, combined with a slowly progressive renal insufficiency. They may be secondary to another disease or looked so primitive.
The glomerular lesions are induced by antigen-antibody complex.

Etiology:

  • often unknown
  • complication of systemic lupus erythematosus (presence of circulating anti-DNA and antinuclear cell)
  • complication of rheumatoid purpura (disease Schonlein-Henoch)
  • complication of diabetes
  • HIV infection

Signs and symptoms:

  • Asymptomatic.
  • Small hematuria, proteinuria, sometimes with nephrotic syndrome.
  • Over time, appears hypertension, and signs of chronic renal failure.
  • Histologically, the glomeruli are normal by light microscopy.

The renal biopsy (PBR) allows to establish the diagnosis, prognosis and treatment
Treatment:
There is no specific treatment. It is to this day on steroids.
Rest, diet low in protein. Symptomatic treatment.

Prognosis:
Rather bad. Patients find themselves inevitably one day in dialysis.

Be Sociable, Share!