Chronic glomerulonephritis. Glomerulonephritis ultrasound

Glomerulonephritis – inflammatory disease kidney The inflammatory process spreads to the glomeruli and renal tubules. The disease is independent in nature, but is sometimes accompanied by infective endocarditis, lupus or hemorrhagic vasculitis. Diagnosis of glomerulonephritis is based on ultrasound of the kidneys and urine tests according to Zimnitsky.

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When the disease occurs, both kidneys are affected. It quickly turns into an acute form. In case of timely application for medical care treated for 2 months. Subacute nephron damage is acute early in the disease and worsens over time. Possible development renal failure. The chronic form has asymptomatic at the beginning of the disease. Gradually developing pathological changes. They lead to replacement connective tissue nephrons.

Diagnostics

Diagnosis of glomerulonephritis disease involves laboratory confirmation using urine and blood tests. In case of rapid development or occurrence chronic stage A kidney tissue biopsy is required. Quite a lot important factor instrumental examinations for correct diagnosis and differential diagnosis are used. Conducted in a timely manner diagnostic procedures provide beneficial influence during treatment.

Basic Research

First visual inspection the patient is directed to determine external ones. Next, the doctor determines the presence of recent infectious diseases and measures blood pressure.

The symptoms of glomerulonephritis have many similarities with acute pyelonephritis, so the doctor always refers the patient to diagnostic procedures.

The patient is examined in the clinic, after which he is admitted to the hospital. The attending physician determines for him bed rest and appoints strict diet. When conducting medical examinations, doctors often, after patients undergo laboratory tests, discover that they have glomerulonephritis, which occurs without characteristic symptoms.

Urine tests

To formulate correct diagnosis laboratory tests are required. Examinations for glomerulonephritis include a dynamic study of the composition of urine. Such examinations give a correct picture of the changes and course of the inflammatory process. Appointed general analysis urine, according to Nechiporenko and according to the Kakovsky-Addis method.
Characteristic signs of the disease are:

• oliguria – decrease in urine volume;
• hematuria - an increase in blood cells in the urine;
• proteinuria – increased content of protein compounds in urine.

Glomerulonephritis always occurs with proteinuria, which is typical when filtration in the kidneys is impaired. Diagnosing hematuria is important. It occurs as a result of inflammation of the glomeruli and, along with proteinuria, most qualitatively reflects the course of the disease and the dynamics of recovery. These symptoms indicate the persistence of the inflammatory process. On the 3rd day, oliguria can be observed, which is subsequently replaced by polyuria. If this symptom lasts more than 6 days, there may be a danger to the patient’s life.

Other research methods

It is acceptable to hold a special instrumental diagnostics. Inspection with the help of technical devices greatly simplifies the placement, especially in young children. For a more detailed study of the course of the disease, its treatment and determination of the onset of dangerous consequences for the patient’s health, various technical tools are used: endoscopy, X-ray, CT scan and ultrasonic radiation.

Blood analysis

Using a blood test, you can determine the level of nitrogen in protein compounds. The composition begins to change if the amount of water increases. To exclude diagnosis acute pyelonephritis a special immunological test is used to determine the real reason diseases. It is two-level - the first helps to identify disorders in the body’s immune system, and the second helps to identify changes.

Differential diagnosis

Diagnosis of differential is based on study using the exclusion method. The presence of symptoms and laboratory tests allows you to compare data using logical analysis algorithms and separate diseases with similar characteristics. Glomerulonephritis is similar in its symptoms to many kidney diseases. This is the difficulty of determining by differential diagnosis. By exclusion, tuberculosis, pyelonephritis, kidney tumor and nephropathy must be excluded.

Ultrasound

The diagnosis of glomerulonephritis using ultrasound is quite easy to distinguish from other diseases by some specific signs: changes in the tubules and connective tissues, tissue thickening, diffuse transformations of the glomeruli, increased volume. A characteristic feature is also a cluster excess liquid in internal organs, which confirms the diagnosis.

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Timely and correct diagnosis is half successful treatment. If the classic course of glomerulonephritis - glomerular inflammation of the kidneys - has its bright characteristics, then latent forms of the disease can imitate the most various pathologies. In order for the doctor to make the correct diagnosis, the patient must undergo a comprehensive clinical, laboratory and instrumental examination.

Why early diagnosis is so important

Glomerulonephritis is an acute or chronic infectious-allergic disease with predominant defeat The main functional apparatus of the kidneys is the glomeruli. The main role in its development is played by the action of bacteria or viruses, as well as autoimmune processes.

According to statistics, the acute form of glomerulonephritis develops more often in children (3-7 years old) or young people (20-30 years old). Males are more susceptible to the disease. Chronic inflammation renal glomeruli occurs among all age groups. This pathology accounts for up to 1% of all therapeutic patients.

In acute glomerulonephritis clinical diagnosis usually does not cause problems. In more than 70% of cases, the pathology responds well to therapy, and patients are completely cured. Without timely medical treatment, the disease becomes chronic, which can cause:

• progressive renal failure;
• heart failure;
• purulent-inflammatory lesions skin And internal organs;
• atherosclerosis at a young age.

The sooner a patient with glomerulonephritis addresses his complaints to a doctor, will undergo examination and begins treatment, the higher his chances of recovery from full restoration functional activity of the kidneys.

First stage: conversation and clinical examination

The first thing a patient’s examination begins with is the collection of complaints and anamnesis. Most often the patient is concerned about:

• unstable increase in blood pressure (mainly due to the diastolic component);
• headaches, attacks of dizziness;
• flickering of flies before the eyes;
• noise, ringing in the ears;
• decrease in the number and volume of urination (oliguria, anuria);
• change in urine color: it becomes dirty brown, rusty in color (the color of “meat slop”);
• constant feeling of thirst;
• the appearance of swelling, first on the face and upper torso, then spreading to the chest, abdominal cavity(hydrothorax, anasarca);
• stupid aching pain, discomfort in the lumbar region;
• increase in body temperature to 38.5-39°C;
• signs of intoxication - fatigue, weakness, loss of appetite.

Possible glomerulonephritis is also indicated by recent bacterial (angina, acute rheumatic fever) or viral infection, vaccination, interaction with toxic substances.

The doctor then conducts a clinical examination, including an assessment of habitus ( appearance patient), palpation and percussion of the kidneys, auscultation of the heart, lungs and blood pressure measurement. Objective signs glomerulonephritis can be considered swelling (the favorite localization is the eyelids), pain on palpation of the kidneys, a weakly positive Pasternatsky sign, and hypertension.

Based on the data obtained, the specialist makes a preliminary diagnosis and draws up a plan for further examination. Differential diagnosis of glomerular inflammation is carried out with pyelonephritis, amyloidosis, urolithiasis, tuberculous changes and tumors in the kidneys.

Second stage: laboratory tests

If glomerulonephritis is suspected, the following laboratory methods are prescribed:

• general blood analysis;
• biochemical analysis blood;
• clinical urine analysis;
• tests according to Nechiporenko, Zimnitsky, Reberg - according to indications;
• allergy tests;
• immunological blood test.

The results of the CBC of patients with glomerulonephritis show signs acute inflammation– leukocytosis and acceleration of ESR. Also noteworthy are the manifestations of anemia - a decrease in the level of red blood cells (erythrocytes) and hemoglobin.

Biochemistry is accompanied by hypoproteinemia (decrease in the level total protein and albumin against the background of an increase in globulins). With the development of renal failure, the level of urea and creatinine progressively increases.

General urine test is the most important laboratory method in the diagnosis of exacerbations of glomerulonephritis. The following pathological changes are observed in it:

• increase in relative density of urine;
• color change;
• proteinuria – from microalbuminuria to massive protein excretion in the urine (3 g/day or more);
• hematuria, erythrocyturia.

Immunological examination and allergy tests can identify various disorders in the functioning of the body's defense system and confirm the autoimmune nature of the disease.

Third stage: instrumental examination methods

Instrumental tests allow you to confirm the doctor’s assumptions, determine the morphological form, features of the course of glomerular inflammation and make a clinical diagnosis.

Kidney ultrasound is an effective, safe and non-invasive method for diagnosing diseases of internal organs. Acute or chronic glomerulonephritis has following signs on ultrasound:

• the kidneys acquire blurry, indistinct contours;
• bilateral thickening of the parenchyma (functional layer);
• increased echogenicity, heterogeneity of the structure of the renal tissues: both hypo- and hyperechoic foci (“pyramids”) appear.

Ultrasound examination of blood flow (Dopplerography) shows a decrease in vascular resistance in the arcuate (arc) arteries. At the same time, blood flow in segmental and interlobar vessels can remain normal.

Confirming the diagnosis and determining the nature of changes in tissues can only be done with the help of morphological research. The role of kidney biopsy is especially important in chronic glomerulonephritis.

The diagnostic procedure is minimally invasive surgical interventions and is carried out only in inpatient conditions. Under local anesthesia the surgeon inserts a thin hollow needle through the skin of the lower back, grabbing small piece kidney tissue. Then microslides are prepared from the resulting biomaterial, which a cytologist carefully examines under a microscope. The histological examination data obtained reflect morphological features inflammation, make it possible to determine the type of glomerulonephritis (for example, membranous, mesangioproliferative, mesangial, etc.) and even make a prognosis of the disease.

If complications develop, plan diagnostic measures may include additional laboratory and instrumental tests.

With the help of timely comprehensive examination glomerulonephritis can be diagnosed by early stage, and begin treatment of the disease before the kidney tissues develop irreversible changes. This will allow you to quickly get rid of unpleasant symptoms, avoid the development of complications and achieve a full recovery.

Three classic symptoms will appear: swelling, reddish urine and increased blood pressure, which may be accompanied by a headache or not bother the patient, determined only by measurement. The first appearance of these symptoms in young people is likely to lead to a diagnosis of acute glomerulonephritis. In old age, these changes in most cases will be attributed to primary chronic glomerulonephritis. Chronic glomerulonephritis is also diagnosed when acute glomerulonephritis exists within 12 months from the onset of the disease.

The diagnosis of rapidly progressive glomerulonephritis is usually made if, just a month and a half after the onset of the acute process, the density of urine decreases, nephrotic syndrome develops and blood pressure rises. This is accompanied by an increase in urea and creatinine in the blood.

Urine and blood tests and, if necessary, a kidney biopsy help confirm the diagnosis of glomerulonephritis. A general urine test reveals protein, a large number of red blood cells, casts (casts of renal tubules). A biochemical blood test for glomerulonephritis shows a decrease in total protein and an increase in its individual types.

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Ask your question to the doctor.

Glomerulonephritis is a group of kidney diseases that are accompanied by damage to the glomerular apparatus of the kidneys with the participation of autoimmune mechanisms. In this case, the filtration function is disrupted, which leads to the development of a characteristic clinical picture.

It is glomerulonephritis that is the main cause of chronic renal failure, which requires a kidney transplant or hemodialysis sessions. But what forms of the disease are most common in the population? What is its clinical picture? And what are the signs of kidney glomerulonephritis on ultrasound? All about this in our article.

What is glomerulonephritis

Glomerulonephritis is a combination various diseases kidneys, which are united by the fact that the glomerular apparatus is damaged. Regardless of the cause of the pathology, he actively participates in the process the immune system. Specific forms of antibodies, proteins of the complement system and cytotoxic cells appear that affect the epithelial wall of the glomerular apparatus. This leads to a disruption of the filtration function, due to which protein molecules and even shaped elements blood (mainly red blood cells).

Usually this disease is a bilateral process - both organs are affected. That is why, without proper diagnosis and treatment, the symptoms of renal failure quickly develop.

Causes of development of glomerulonephritis

Among the reasons for the development of this pathology, it is necessary to highlight the following:

Forms of glomerulonephritis

The modern classification of glomerulonephritis is not based on clinical picture, and based on kidney biopsy data followed by cytological examination. This is what made it possible to determine following forms diseases:

Clinical picture of glomerulonephritis

Expressed clinical symptoms depends on the form of the disease. However, it is customary to distinguish several groups of leading syndromes that occur most frequently:

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Ultrasound signs of glomerulonephritis

Ultrasound diagnosis of the kidneys is mandatory if glomerulonephritis is suspected. It allows you to quickly differential diagnosis with other pathologies that are accompanied by the development of similar symptoms (pyelonephritis, urolithiasis, congenital anomalies development, malignant tumors).

Special preparation before the study (if ultrasound of the kidneys is performed exclusively) is not necessary. The method for detecting glomerulonephritis on ultrasound retains its informative value also during pregnancy and does not harm the development of the fetus.

Glomerulonephritis on kidney ultrasound does not lead to initial stage to change their sizes. The sizes of the pelvis also remain standard. It is also not possible to detect stones or wall deformations in their lumen. This allows us to exclude pyelonephritis and urolithiasis.

What are the special signs of glomerulonephritis on ultrasound? Be sure to pay attention to the structure of the parenchyma. The severity of its changes depends on the activity of the inflammatory process. The echogenicity changes (especially with the proliferation of connective tissue).

It becomes impossible to determine the boundary between the cortical and medulla layers of the kidneys, which becomes blurred due to swelling and inflammation. In certain cases, protruding pyramids appear, which, with their hypoechogenicity, stand out well in the general plan. An example can be seen in the following photo.

If an ultrasound scan of the kidneys is performed for chronic glomerulonephritis in terminal stage, then the picture changes. There is a sharp decrease in the size of the kidneys, their outer surface becomes uneven (with “wrinkles”). Echogenicity decreases sharply. Typically, patients with such an ultrasound picture of glomerulonephritis are already on hemodialysis and require transplantation.

Kidney failure and other kidney problems are often detected through a standard urine test. TO laboratory diagnostics A blood test may also be added. More complex instrumental diagnostic methods are used only to track the dynamics of changes in the structure of the kidneys. So, for example, glomerulonephritis on ultrasound, depending on the form of the pathology, may not give visible changes at all. Below you can find out how the pathology is formed and what is visible during ultrasound examination.

Glomerulonephritis: general picture of the disease and causes of its occurrence

Glomerulonephritis is a disorder of the glomerular filtration system in the kidneys. In this case, as a rule, both kidneys are affected at once. As a result of decreased glomerular performance, urine volume and quality decrease. That is, kidney failure develops.

The most common cause of the onset of the disease is infectious diseases such as tonsillitis, scarlet fever, tonsillitis or purulent skin infection. In all these cases, the causative agent is streptococcal bacteria. The process of onset of glomerulonephritis in this case looks like this:

• The patient suffers from the above infections. After 10-14 days, visible complete recovery occurs.
• However, during the period of illness, the human body begins an internal struggle, which is expressed in allergic reaction. As a result, antibodies are produced, which subsequently bind pathogenic microbial cells and carry them throughout the body along with the bloodstream.
• Next, the associated bacterial cells settle in the glomerular apparatus of the kidneys, which are responsible for filtering the blood. Thus, glomerulonephritis begins.

In addition, the causes of the onset of the disease can be:

• Banal and prolonged hypothermia in water;
• Past illnesses such as malaria or tuberculosis;
• Also, vaccination can be a provocateur of glomerulonephritis (if the body is weakened);
• An allergic reaction to certain groups of medications or toxins that have entered the body.

Forms of glomerulonephritis and their symptoms

Nephrologists divide the course of the disease into two forms - chronic and acute. In the first case, the patient may have virtually nothing to worry about. Only occasionally weakness and headache, as well as loss of appetite and fatigue will accompany the patient. But most often such symptoms are attributed to fatigue, vitamin deficiency and stress. The disease can be detected at this stage only through a general urine test.

Important: this is why it is necessary to regularly submit urine for general analysis in order to diagnose possible pathological changes in time.

If glomerulonephritis manifests itself in acute form, then all the symptoms will already be evident. So, the general picture during exacerbation of renal failure will be as follows:

• Long-term nagging pain in the lumbar region.
• Reducing daily urine volume.
• Morning swelling that goes away by lunchtime.
• Discoloration of urine in a reddish tint. Moreover, urine can be barely visible color redness and look like meat juice.
• Possible nausea, vomiting, loss of appetite.
• Headache and increased body temperature up to 37.5 degrees also occur.

Important: if such symptoms appear, you must immediately go to the hospital to receive further treatment. Since acute glomerulonephritis has a negative effect on the cardiovascular system and brain.

Diagnosis of glomerulonephritis: blood and urine tests, ultrasound

In order to select the maximum effective tactics treatment, it is necessary to identify the nature of the disease (infectious/non-infectious) and establish the severity of its course (to what extent the kidneys cannot cope with their function). Main laboratory research when diagnosing glomerulonephritis are:

• General urine analysis. Here, specialists will identify the level of protein, which will indicate an inflammatory process in the urinary system. Also, during the analysis, the laboratory technician will determine the concentration of red blood cells in the patient’s urine. Their presence indicates that there is blood loss along with urine. And red ones blood cells You can either see it in the urine with the naked eye (macrohematuria) or see it only under a microscope (microhematuria). Determining the concentration of protein and red blood cells in the urine allows the attending physician to adjust the patient’s diet with glomerulonephritis. The diet will be aimed at reducing the amount of salt and protein, as well as correcting the drinking regime.

Important: within acute period illness, the patient must be on bed rest. This will relieve vasospasm and reduce blood pressure. As a result, the stress on the kidneys will be minimal, and the volume of urine will increase. This in turn neutralizes swelling.

• General blood test for inflammatory processes will show increased ESR(erythrocyte sedimentation rate).
• In addition, a biochemical blood test will be performed to diagnose the nature of the disease. And if it is determined that streptococcus is the causative agent of the pathology, then antibacterial therapy is used to treat the patient.

Ultrasound diagnosis of glomerulonephritis

Carrying out ultrasound examination, as a rule, is not particularly informative method diagnostics In this case, it is only possible to identify structural changes kidneys and their location. It is worth knowing that if glomerulonephritis is in chronic form, then the specialist will not see any special changes on the ultrasound. The structure of the kidneys and their shape will remain unchanged.

If glomerulonephritis is in an acute form, then the following changes can be noted on an ultrasound of the kidneys:

• Thickening of the parenchyma of both kidneys;
• Change in the contours of the kidneys to unclear;
• It is also possible to detect increased echogenicity, and against its background the presence of hypoechoic pyramids may be noted;
• Also, if ultrasound angiography is performed, the vascular pattern will be combined;
• If Doppler sonography is performed, then a reduced peripheral resistance index will be noted in the arcuate arteries. At the same time, in the segmental and interlobar arteries the resistance index values ​​will be normal.

Important: the nephrologist specialist uses all the data obtained to prescribe as much as possible. effective treatment glomerulonephritis.

To completely recover from the disease, you must strictly adhere to all the recommendations of your doctor. Because often it is diet therapy and bed rest for 2-5 weeks that are the key to successful treatment. Drug therapy in this case, it relieves only the symptoms of the disease (normalizes blood pressure, reduces swelling, increases the volume of urine).

After successful treatment, patients who have suffered glomerulonephritis are contraindicated for at least two years from active sports, heavy physical labor, hypothermia and overheating, swimming in ponds and working with chemicals. If possible, sanatorium-resort treatment is indicated.