What Is a Glomerulus?

Glomerulonephritis, also known as nephritis syndrome (nephritis for short), is a common kidney disease, which refers to diseases that occur in bilateral renal glomeruli due to various reasons and have clinical manifestations as a group of symptoms. The common manifestations of glomerulonephritis are (can not occur at the same time): edema, proteinuria, hematuria, hypertension, decreased or no urine output, normal or decreased renal function.

Basic Information

nickname

Nephritis syndrome

English name

glomerulonephritis

Visiting department

Nephrology

Common causes

Etiology unknown, may be related to heredity, infection, immunity, metabolism, tumor, etc.

Common symptoms

Edema, proteinuria, hematuria, hypertension, decreased urine output or anuria

Causes of glomerulonephritis

Glomerulonephritis is actually a group of diseases, the cause of which is different, and some of the causes are unclear. Generally speaking, it may be related to heredity, infection, immunity, metabolism, tumor and other factors.

Glomerulonephritis classification

Cause classification

Can be divided into secondary and primary glomerulonephritis. Secondary glomerulonephritis is caused by other diseases (such as diabetes, hypertension, systemic lupus erythematosus, allergic purpura, vasculitis, etc.) and is a kidney disease involving systemic diseases. Primary glomerulonephritis refers to nephritis that is primary in the kidney after excluding secondary glomerulonephritis.

2. Clinical classification

Can be divided into: acute, chronic and progressive nephritis syndrome, occult nephritis (asymptomatic hematuria and / or proteinuria). Generally referred to as glomerulonephritis often refers to primary chronic nephritis if not explained.

(1) Acute nephritis syndrome often manifests as acute episodes of hematuria, proteinuria, edema, and hypertension, which may be accompanied by decreased renal function. Can be seen in various glomerular diseases: common such as post-infection nephritis, typical acute nephritis is post-streptococcal nephritis, and other bacteria and pathogenic microorganisms such as viruses, mycoplasma, chlamydia, fungi, parasites can cause ; Primary glomerulonephritis at the onset or at some stage in the course of the disease; secondary to systemic diseases such as systemic lupus erythematosus and allergic purpura, vasculitis, etc.

(2) Chronic nephritis syndrome can be seen at any age, especially in young men and young men. It is a disease with clinical manifestations of proteinuria, hematuria, edema, and hypertension. The disease is common, but there are individual differences in symptoms and progression of kidney disease, and the manifestations are diverse. In general, the condition is prolonged, the disease progresses slowly, and renal insufficiency may develop in the later stage. Patients may develop anemia, elevated blood pressure, etc., and renal function deteriorates further and chronic renal failure occurs. Renal biopsy of the kidney pathological type is an important factor in determining the rapid progress of renal function.

(3) Acute nephritis syndrome has a decrease in urine output or anuria in the short term based on hematuria, proteinuria, edema, and hypertension, and renal function declines sharply. The patient is critically ill and has a poor prognosis. In general, prompt renal biopsy is required for early diagnosis and treatment.

(4) Occult nephritis lacks local symptoms of the urinary system and no systemic symptoms. Generally, hematuria (and / or proteinuria) is found during routine physical examination or screening for other diseases, and there is no edema or hypertension.

3. Pathological classification

According to renal biopsy, the pathology of chronic nephritis can be divided into mesangial proliferative glomerulonephritis; focal segmental glomerulosclerosis; membranous nephropathy; mesangial capillary glomerulonephritis; sclerosing Nephritis. The pathological changes of acute nephritis are characterized by crescent formation in the glomerulus, also known as crescentic nephritis. Except for nephritis which can be recovered and alleviated after treatment of most acute streptococcal infections, other glomerulonephritis manifested by acute nephritis syndrome may have a large difference in treatment schemes. Therefore, for glomeruli that do not meet the typical acute nephritis, Nephritis should be promptly diagnosed by renal biopsy.

Clinical manifestations of glomerulonephritis

Edema

Edema can occur on the eyelids, face, lower extremities, perineum and genitals. The lighter ones only gain weight (recessive edema), and the heavy ones can swell throughout the body, and even pleural and abdominal effusions appear.

Proteinuria

During glomerulonephritis, certain proteins in the blood that cannot be filtered from the kidney are filtered into the urine, and proteinuria occurs. Mainly manifested as increased foam in the urine and does not disappear for a long time.

3. Cast urine

When there is both protein and cast in the urine, it is suggestive of glomerular disease.

4. Hypertension

The kidneys affect the circulating blood volume in the blood vessels by expelling water and sodium salts; at the same time, it produces renin, which produces vasoconstrictive effects and participates in regulating blood pressure. During glomerulonephritis, the kidney's ability to drain water and sodium is reduced, renin production increases, and hypertension develops.

5. Anemia

The kidney can produce erythropoietin, the progress of nephropathy, and damage to kidney function, the production of this hormone decreases, and anemia occurs.

6. Renal insufficiency and uremia

It is a gradual process in which glomerular disease progresses gradually and reaches the end stage, but not all patients with glomerulonephritis.

Glomerulonephritis test

Urine

Urine routine can be used for preliminary observation of urine protein, occult blood, white blood cells, casts, bacteria, pH and specific gravity. Urine phase contrast microscope is used to observe the morphology of red blood cells, used to observe whether hematuria originates from the kidney. 24 hour urine protein quantification can help determine the amount of proteinuria.

Blood

Generally includes blood routine, blood biochemistry, creatinine clearance; others include infections, tumors and immune tests to help diagnosis.

3. Imaging

B-ultrasound examination of the urinary system to observe the size of the kidney can help judge the progress of renal disease; chest radiographs and ultrasound examinations can help find pleural effusion and ascites.

4. Renal biopsy

It is a trauma examination, but it is very important for the diagnosis and prognosis of glomerulonephritis.

Glomerulonephritis treatment

Basic principles

According to pathological type and etiology treatment, prevent and delay the progression of kidney disease, improve clinical symptoms and prevent complications.

2. Treatment plan

(1) Non-drug treatment Under the guidance of a doctor, take appropriate rest exercises, adjust the intake of dietary protein, sodium and potassium, and pay attention to monitoring blood pressure, weight and urine volume.

(2) Drug treatments are commonly used such as hormones and immunosuppressants (such as cyclophosphamide, mycophenolate mofetil, tacrolimus, cyclosporine A, traditional Chinese medicine triptolide), others include blood pressure control drugs, diuretics and anti- Platelet aggregation drugs, anticoagulants, lipid-lowering drugs, cordycepin preparations and other kidney-protecting and detoxifying drugs. The above drugs should be used under the guidance of a doctor, and dynamically adjusted according to changes in laboratory indicators to avoid or reduce possible side effects of the drug.

(3) Avoid factors that aggravate kidney damage, infection, low blood volume (shock), dehydration (vomiting or diarrhea, high fever), fatigue, imbalance of water electrolyte and acid-base balance, pregnancy, and medications that may cause kidney damage (such as antipyretic Pain medicines, contrast agents, Chinese medicine containing aristolochic acid, certain antibiotics, etc.) may all aggravate kidney disease and should be avoided or used under the guidance of a doctor.

(4) If necessary, dialysis treatment should be performed by the doctor according to the condition judgment.