Nephritic syndrome

Nephritic syndrome is a complex of clinical and laboratory signs characterizing pathological changes in the kidneys in a number of primary and secondary nephropathies that lead to the defeat of vital organs. This state of the body progresses due to infectious diseases, so it often occurs under the name of postinfection glomerulonephritis. The inflammatory process affects the glomeruli of the kidneys, fluid, metabolic products, salts are also retained in the body, pronounced hematuria and proteinuria are observed.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the nephritic syndrome

The causes of nephritic syndrome can be various forms of nephritis (most often streptococcal form), autoimmune diseases, and autoimmune reactions more common in daily life (with tonsillitis, viral diseases, trauma to internal organs), etc.

[10], [11]

Risk factors

Factors that cause nephritic syndrome can be divided into:

• Bacterial: pneumococcal infection, sepsis, endocarditis, typhoid fever;
• Post-streptococcal glomerulonephritis (glomerular nephritis);
• Other types of postinfection glomerulonephritis (diffuse membranous, diffuse mesangial proliferative, diffuse endocapillary proliferative, diffuse mesangiocapillary, diffuse sickle-shaped);
• Viral (hepatitis B, ECHO virus, etc.);
• Kidney diseases such as amyloidosis, mycoses, drug nephropathies, interstitial nephritis;
• Autoimmune diseases (vasculitis, systemic lupus erythematosus, pulmonary-renal syndrome, hereditary transmission).

[12], [13], [14], [15], [16], [17]

Symptoms of the nephritic syndrome

Below are listed the characteristic features that indicate the nephritic syndrome:

• Hematuria (admixture of blood in the urine);
• Macrogamaturia;
• Edema formation;
• Most people suffering from the syndrome have arterial hypertension;
• Development of hypocompleteemia (decrease in hemolytic activity of complement and C3 level);
• Oligoanuria (delayed urine formation) and thirst.

There is also a large number of symptoms, after analyzing the aggregate of which, we can speak of a nephritic syndrome:

• Morning headache;
• Dark frothy urine (often in the morning);
• Lumbar pain (at night);
• Increased temperature;
• Vomiting, nausea;
• Some respiratory diseases that are infectious.

Nephrite syndrome in children

Nephritic syndrome in childhood is determined by the pediatrician on the basis of a combination of laboratory and clinical signs. In small patients, there are various glomerular disorders, edema, arterial hypertension, developing against the background of previous diseases. This syndrome can be provoked by high physical stress, stress, and supercooling of the body.

The course of the course of the nephritic syndrome is less dangerous for the child's organism than for the adult, as the children's organism is well aware of the treatment with corticosteroids. But recovery also depends on many factors, such as the age of the child, the cause of the illness, the treatment methods used, and the presence of various complications.

Forms

There are two forms of nephritic syndrome: acute and chronic.

Acute nephritic syndrome occurs when:

• Postinfectional glomerulonephritis;
• Acute secondary glomeruli (vasculitis of small arteries, lupus-nephritis, ABM-nephritis);
• Malignant arterial hypertension;
• Acute tubulointerstitial nephritis and glomerulitis (drug and toxic);
• An acute gouty gout;
• An acute rejection reaction of the transplant.

In all these cases, the development of acute renal failure (acute renal failure)

Chronic nephritic syndrome occurs when:

• Various types of proliferative glomerulonephritis;
• Secondary glomerulopathies (Shenlaine-Henoch, diabetes, lupus-nephritis, alcohol, drugs);
• Chronic tubulointerstitial nephritis;
• Chronic immunopathy (AIDS, hepatitis, rheumatoid arthritis, yagudpascher disease, etc.);
• Chronic nephropathy of the graft.

In all these cases, the development of chronic kidney disease is possible.

[18], [19], [20], [21], [22]

Complications and consequences

The consequence of the course of nephritic syndrome is its modification into a chronic form. The chronic form, in the main, proceeds secretly, is diagnosed late and has fuzzy general symptoms. Another complication of the consequences of the syndrome is the development of chronic kidney failure.

[23], [24], [25]

Diagnostics of the nephritic syndrome

Methods of diagnosis of nephritic syndrome:

1. Clinical blood test.
2. Blood chemistry:
   • Protein, lipid and water-electrolyte metabolism;
   • Calculation of the glomerular filtration rate by one of the formulas;
   • Search for markers of systemic diseases (antibodies to the cytoplasm of neutrophils, hepatitis markers, cryoglobulins, etc.)
3. Daily proteinuria.
4. Immunological analysis of blood.
5. Instrumental diagnostics:
   • Reaction of radial hemolysis;
   • CT scan;
   • Ultrasonography;
   • Radiography;
   • Angiography;
   • In some cases - a kidney biopsy.

To obtain the most accurate display of the course of this syndrome, a number of additional studies are also carried out. Here is a list of some of them:

• A smear from the throat;
• Infectionist consultation;
• Bacterial culture of urine;
• The filtering index according to Schwartz;
• Inspection of the patient's eye fundus;
• X-ray of the chest;
• Measurement of blood pressure;
• Consultation of an otolaryngologist.

[26], [27], [28], [29], [30], [31], [32]

Differential diagnosis

In medicine, there is also the concept of nephrotic syndrome. The difference between a nephrotic syndrome and a nephritic syndrome is that the nephritic indicates symptoms resembling the signs of acute nephritis-inflammation of the kidney. A nephrosis is a whole complex of kidney lesions, this is its main difference. Nephrotic syndrome is also often transmitted by heredity.

The nephritic syndrome, unlike nephrotic syndrome, occurs suddenly, and indicates that the underlying disease is progressing. Consequently, there are visible differences between the nephrotic and nephritic syndrome.

The main signs indicating the emergence of nephritic and nephrotic syndromes are given in the table:

Non-freezing : Trace proteinuria; Micro- and macrohematuria; Arterial hypertension; Azotemia;

Nephrotic: Swelling of soft tissues; Poliserozity; Oliguria; Proteinuria; Lipiduria; Hypo- and dysproteinemia; Ghercholesterolinaemia.

Treatment of the nephritic syndrome

Treatment of nephritic syndrome involves the treatment of the disease that caused the onset of this syndrome. Treatment of nephritic syndrome of acute and chronic forms is significantly different. So, in the treatment of acute nephritic syndrome, first of all it is necessary:

1. Hospitalization in a specialized hospital;
2. Elimination of the etiologic factor - antibiotics, restoration of hemodynamics, reduction of arterial pressure, elimination of toxic drugs;
3. With the development of acute renal failure dialysis is necessary;
4. In very turbulent flow - require the pulse of corticosteroids, plasma exchange;
5. To clean the tubules, diuretics are used;
6. Use of anticoagulants and thrombolytic agents in thrombosis;
7. An order to comply with bed rest, limiting the amount of liquid, excluding salt, limiting the intake of various proteins in the body, increasing the number of vitamins.

In the treatment of chronic nephritic syndrome it is necessary:

1. The primary task is the treatment of the main disease;
2. The use of antibiotics, plasmapheresis - if necessary;
3. Decreased elevated blood pressure;
4. Fighting hypercholesterolemia;
5. Nonsteroidal anti-inflammatory drugs according to indications (with caution);
6. Improvement of microcirculation;
7. Limit the access of protein to the body;
8. Changing the lifestyle of the patient - fatty foods, alcohol, smoking, etc.

Treatment of the underlying disease, namely glomerulonephritis, which is accompanied by nephritic syndrome, combines medication and non-drug treatment.

Children in the treatment of acute nephritic syndrome in the first place need urgent hospitalization. Then follows a list of actions similar to those in the case of an adult patient: removing the child from an acute condition, eliminating azotemia, edema, seizures, reducing proteinuria, hematuria, etc.

In the treatment of chronic form of nephritic syndrome, a planned hospitalization is carried out. The purpose of this stage is the adoption of a number of procedures aimed at the final recovery of the child, excluding the occurrence of relapse.

In both cases (chronic and acute forms of nephritic syndrome) after discharge of the patient, adults must ensure that the child adheres to the regime, diet, as well as periodic dispensary observation.

Non-drug treatment:

• Restriction of admission to the body of a sick table salt;
• Limitation of the amount of liquid;
• Exclusion from the diet of spicy dishes, seasonings, spices, spirits, strong tea, coffee, canned food.

Medication:

Treatment is carried out with the obligatory condition of finding the focus of infection in the body.

• With a certain poststreptococcal acute glomerunonephritis, cephalexin is prescribed . Dosage: 50 mg per kilogram of body weight, 2 times a day, duration of admission - 10 days. Contraindications for taking this drug are children under three years of age and increased sensitivity to beta-lactam antibiotics.
• When pneumonia is transmitted, sinusitis is prescribed: amoxicillin with clavulanic acid 500-700 mg, 2 times a day, duration of admission - 7 days. The drug is contraindicated for patients with bronchial asthma, with hepatic insufficiency, infectious mononucleosis, during lactation.
• When allergies to antibiotics related to beta-lactam are prescribed macrolide preparations: azithromycin 250-500 mg, once a day, duration of admission - 4 days (contraindicated for children under 12 years old, with liver failure, during lactation); Spiramycin - 150 mg, also 2 times a day, duration of admission - 7 days (contraindicated for children and adolescents under 18 years, during lactation, with increased sensitivity to the drug).
• With strong edema, it is also possible to prescribe antiaggregants and anticoagulants, such as heparin (the methods of application of the drug and doses are individual in different cases), quarantil (dosage from 75 to 225 mg, also individually).

It should be noted that the above drugs for the treatment of nephritic syndrome - this is one of many options for therapy. In each case, the doctor prescribes treatment individually, it depends on the complexity of the medical history and the results of a comprehensive survey.

Operative treatment: there is no need.

Treatment with alternative means:

For the treatment of nephritic syndrome in the people use a variety of herbs and herbs, for example:

• Infusion of dried dogrose: fruits of dried dogrose pour boiling water - 2 teaspoons to 300 milliliters - insist in a sealed container and take 50 ml every 2 hours;
• Infusion of birch leaves (first fresh leaves pour hot boiled water at a rate of 100 grams to 2 cups of water, insist for 4.5-5 hours) drink ½ cup several times a day;
• Infusion of herbal collection (flowers of marigold, St. John's wort and immortelle - for 40grams, chicory (flower) and buckthorn bark - 30 grams each, sporegrass, chamomile - 20 grams, 1 tbsp L. Pour 250 ml of boiled water, 35-45 minutes ) Drink 1/2 cup 2 times a day.
• Infusion of herbal collection (field horsetail, bear ears, dry birch leaf: 1 item L. All ingredients 600 ml boiling water, insist 30 minutes) drink 100 ml 3 r. In a day.

It is necessary to know that broths of herbs prepared for children should be less concentrated. The number of dry ingredients is determined depending on the age: children under 1 year - based on ½ tsp dry mix per day, children from 1 to 3 years - 1 teaspoon, children from 3 to 6 years - 1 dessert spoon, children from 10 years - 2 tablespoons. In addition, it is necessary to take into account the possible intolerance of plant components for each patient with nephritic syndrome individually.

The use of vitamins:

One of the important components of a fast recovery of a patient is the support of his body with natural microelements and vitamins. For this, the food of a person undergoing therapy with nephritic syndrome should be filled with "useful" products. These are foods that contain vitamin A (carrots, cabbage, lettuce), vitamins in the group (nuts, apples, oats, buckwheat, beets), vitamin C (sea-buckthorn, black currant, rosehip), vitamin E (sweet Bulgarian pepper, olives , wheat germ oil), vitamin D (caviar, parsley, vegetable oils), etc.

Prevention

Prevention of nephritic syndrome is the prevention of diseases that can lead to the emergence of this syndrome. These are viral infections, bacterial infections, electrolyte imbalance, cardiovascular insufficiency, etc. Also, in case of occurrence of the above listed diseases, it is necessary to seek medical help, not to let the disease "on its own" and strictly follow the doctor's recommendations on the regime of work and rest.

[33], [34], [35], [36], [37], [38], [39]

Forecast

With preservation of proteinuria, hypercholesterolemia and high blood pressure, patients with nephritic syndrome can develop:

• Nephrosclerosis (a disease in which functional kidney cells die, as a result, the kidney decreases and does not fulfill its basic functions);
• Defeat of the cardiovascular system.

Lethal outcome in patients happens very rarely. And timely measures to treat the nephritic syndrome often give a favorable prognosis.

[40], [41], [42], [43], [44]