What Is Chronic Nephritis?

Chronic glomerulonephritis is referred to as chronic nephritis, which refers to the basic clinical manifestations of proteinuria, hematuria, hypertension, and edema. The onset of the disease is different, the disease is prolonged, the disease progresses slowly, and renal function can be reduced to varying degrees. A group of glomerulopathy of chronic renal failure. Due to the different pathological types and stages of the disease in this group, the main clinical manifestations are different, and the disease manifestations are diverse.

Basic Information

Causes of chronic nephritis

Chronic nephritis is a group of multiple etiological chronic glomerular diseases, but the etiology of most patients is unknown, and there is no clear relationship with streptococcal infection. According to statistics, only 15% -20% Change over. In addition, most patients with chronic nephritis have no history of acute nephritis, so at present, many scholars believe that there is no positive relationship between chronic glomerulonephritis and acute nephritis. It may be due to various bacterial, viral or protozoal infections through immune mechanisms, Inflammatory mediators and non-immune mechanisms cause the disease.

Clinical manifestations of chronic nephritis

According to different clinical manifestations, it is divided into the following five subtypes:

1. common type

More common. The course of the disease is prolonged, and the condition is relatively stable, mostly manifested as mild to moderate edema, hypertension and impaired renal function. Urine protein (+) ~ (+++), microscopic hematuria and cast urine. Pathological changes include IgA nephropathy, non-IgA mesangial proliferative nephritis, and focal mesangial proliferative disease are more common. It can also be seen in focal segmental glomerulosclerosis and (early) mesangial proliferative nephritis.

2. Nephrotic massive proteinuria

In addition to the common type, some patients can show a large amount of nephrotic proteinuria. The pathological classification is more common in micropathic nephropathy, membranous nephropathy, membranoproliferative nephritis, and focal glomerulosclerosis.

3. Hypertension

In addition to the above-mentioned common manifestations, the main manifestations are persistently moderately elevated blood pressure, especially the persistently increased diastolic blood pressure, often accompanied by narrow fundus retinal arteries, tortuous and arterial and venous cross compression, and a few may have flocculent exudation And / or bleeding. In pathology, focal segmental glomerulosclerosis and diffuse hyperplasia are more common or late indefinite or have glomerular sclerosis.

4.hybrid

There are both clinical manifestations of nephropathy and hypertension, and they are often accompanied by signs of varying degrees of renal dysfunction. Pathological changes can be focal segmental glomerulosclerosis and advanced diffuse proliferative glomerulonephritis.

5. Acute type

In the course of relatively stable disease or continuous progression, due to bacterial or viral infection or overwork, the clinical manifestations similar to acute nephritis appear after a short incubation period (1 to 5 days), which can be recovered after treatment and rest To the original stable level or deterioration of the condition, uremia gradually occurred; or after repeated episodes, renal function suddenly decreased and a series of clinical manifestations of uremia occurred. The pathological changes were diffuse hyperplasia, glomerular sclerosis and crescentic body and / or obvious interstitial nephritis.

Chronic nephritis test

Laboratory and other inspections:

(1) Urinary abnormality is a basic sign of chronic nephritis. Proteinuria is the main basis for the diagnosis of chronic nephritis. Urine protein is generally 1 ~ 3g / day. Urine sediment can be seen in granular casts and transparent casts. Most may have microscopic hematuria, and a few patients may have occasional gross hematuria.

(2) Renal function test: Most patients with chronic nephritis may have a reduced degree of glomerular filtration rate (GFR), with early manifestations of decreased creatinine clearance and increased serum creatinine thereafter. May be associated with varying degrees of renal tubular dysfunction, such as distal renal tubular urinary concentrating function and / or proximal renal tubular reabsorption function.

Differential diagnosis of chronic nephritis

Chronic glomerulonephritis needs to be distinguished from the following diseases:

Secondary glomerulonephritis

Such as lupus nephritis, allergic purpura nephritis, etc., can be identified based on the corresponding system performance and specific laboratory tests.

2. Hereditary nephritis (Alport syndrome)

Often onset in adolescents, patients have eye (spherical lens), ear (neurological deafness), renal abnormalities, and have a positive family history (mostly sexually linked dominant inheritance).

3. Other primary glomerulopathy

(1) Occult glomerulonephritis is mainly manifested by asymptomatic hematuria and / or proteinuria, without edema, hypertension, and impaired renal function.

(2) Acute nephritis after infection: There is a precursor infection and it starts with an acute attack. Chronic nephritis needs to be distinguished from this disease. The incubation period of the two is different, and the dynamic changes of serum C3 are helpful for identification; the prognosis of the disease is different, and chronic nephritis has no tendency to self-heal and shows chronic progression.

4. Primary hypertension renal damage

There is long-term hypertension, and then renal damage occurs. Clinically, distal renal tubular damage is earlier than glomerular damage, and urine changes are slight, with only a small amount of protein, and there are often other target organ complications of hypertension.

Chronic nephritis treatment

In the early stage of chronic glomerulonephritis, corresponding treatment should be given according to its pathological type to suppress immune-mediated inflammation, inhibit cell proliferation, and reduce renal sclerosis. And the main purpose should be to prevent or delay the progressive deterioration of renal function, improve or alleviate clinical symptoms, and prevent comorbidities. The following comprehensive treatment measures can be used:

1. Actively control hypertension

Prevent renal dysfunction or improve already impaired renal function, prevent cardiovascular complications, and improve long-term prognosis.

(1) Principles of treatment Strive to reach the target value. For example, the blood pressure of patients with urinary protein <lg / d should be controlled below 130 / 80mmHg; if the proteinuria is 1g / d, those without cardio-cerebral vascular comorbidities should be controlled at 125 / 75mmHg or less. The pressure drop should not be too low or too fast, and keep the pressure drop stable. Start to adjust a small dose of a drug and combine it if necessary until the blood pressure control is satisfactory. Antihypertensive drugs that have a renal protective effect and can delay the deterioration of renal function are preferred.

(2) Treatment methods Non-drug treatment restricts dietary sodium intake. Patients with hypertension should limit sodium intake. Sodium intake should be controlled at 80-100 mmol. Antihypertensive drugs should be performed on the basis of a restricted sodium diet: adjust diet protein. And intake of potassium-containing foods; quit smoking, limit alcohol consumption; lose weight; exercise appropriately. Antihypertensive drugs commonly used in drug treatment include angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), long-acting calcium channel blockers (CCB), diuretics, and -receptor blockers. Stagnation and so on. Since ACEI and ARB have the effect of reducing blood pressure, they also have a renal protective effect of reducing urinary protein and delaying the deterioration of renal function, which should be preferred. Patients with renal insufficiency should use ACEI or ARB to prevent hyperkalemia and elevation of serum creatinine. When serum creatinine is greater than 264 mol / L (3mg / dl), it must be used with close observation, with particular attention to monitoring renal function and preventing hyperkalemia. A few patients have persistent adverse reactions to dry cough with ACEI and can be switched to ARB.

2. Reduce urine protein

To delay the decline of renal function, proteinuria is closely related to renal dysfunction, so it should be strictly controlled. ACEI and ARB have the effect of reducing urinary protein, and the dosage of ACEI and ARB often needs to be higher than that required for lowering blood pressure. However, the occurrence of hypotension should be prevented.

3. Limit protein and phosphorus intake in food

Low-protein and low-phosphorus diets can alleviate glomerular hypertension, high perfusion and high filtration status, and delay glomerular sclerosis. Patients with renal insufficiency azotemia should limit the amount of protein and phosphorus, adopt a high-quality low-protein diet or add essential amino acids or -keto acids.

4. Factors to Avoid Aggravating Kidney Damage

Infection, hypovolemia, dehydration, fatigue, disturbances in water-electrolyte and acid-base balance, pregnancy, and application of nephrotoxic drugs (such as aminoglycoside antibiotics, non-steroidal anti-inflammatory drugs, contrast agents, etc.) may damage the kidneys Should be avoided or used with caution.

5. Glucocorticoids and Cytotoxic Drugs

Because chronic nephritis is a clinical syndrome that includes many diseases, its etiology, pathological type and degree, clinical manifestations, and renal function vary greatly. Therefore, whether to apply glucocorticoids and cytotoxic drugs should be based on the etiology and pathological type. determine.

6. Other

Antiplatelet aggregation drugs, anticoagulants, statins, lipid-lowering drugs, and Chinese medicine can also be used.

Prognosis of chronic nephritis

Chronic nephritis is prolonged and progresses slowly, eventually leading to chronic renal failure. The rate of progression varies greatly from one individual to another, with pathological type being an important factor, but also related to whether attention is paid to protecting the kidneys, whether treatment is appropriate, and whether deteriorating factors are avoided.