acute nephritic syndrome
Introduction
Introduction to acute nephritic syndrome Acute nephritic syndrome is a pathological manifestation of diffuse inflammatory changes in the glomerulus. The clinical manifestations are sudden onset of hematuria, red blood cell cast, mild proteinuria, often accompanied by hypertension, edema and nitrogenous blood. Symptomatic syndrome. basic knowledge The proportion of illness: 0.0031%-0.0042% Susceptible people: no specific population Mode of infection: non-infectious Complications: congestive heart failure, hypertension, acute renal failure, urinary tract infection
Cause
Causes of acute nephritis syndrome
The underlying diseases that can cause acute nephritic syndrome are:
(1) Infectious diseases: diseases caused by bacteria, viruses, and parasites.
(2) Systemic diseases: such as systemic lupus erythematosus, systemic vasculitis, allergic purpura, spontaneous cryoglobulinemia.
(3) Primary glomerular disease: membrane proliferative nephritis, IgA nephropathy, mesangial proliferative nephritis, focal segmental proliferative nephritis.
(4) Others: such as serum diseases.
Prevention
Acute nephritis syndrome prevention
Because acute nephritis is a disease caused by autoimmune reaction in the body after hemolytic streptococcal infection, the most fundamental preventive measure is to prevent infection of hemolytic streptococcus. If it can strengthen physical exercise, enhance physical fitness, increase resistance, pay attention to individuals. Hygiene, to avoid or reduce infection of the upper respiratory tract, throat and skin, can reduce the incidence of acute nephritis, once the above infection occurs, should be treated with appropriate antibiotics in a timely manner, including injection of penicillin (800,000 units, intramuscular, daily 2 times) the best effect, because penicillin is a bactericide, can kill local bacteria, remove local lesions, eliminate antigens, avoid autoimmune reactions, although this may not absolutely avoid the occurrence of acute nephritis, but It can eliminate the prevalence and spread of "lephritis-producing strains" in time, reduce the occurrence of acute nephritis, and should continuously check the urine routine within 2 to 3 weeks after penicillin injection, so that the disease can be detected early and treated in time for repeated occurrences. Pharyngitis, tonsillitis should be actively treated.
Prevention of acute nephritis The main prevention and treatment of other related diseases that can cause nephritis (also known as the prodromal disease of nephritis), especially the prevention and treatment of some diseases caused by hemolytic streptococcal infection, such as respiratory tract infection, acute tonsillitis, pharyngitis, scarlet fever, erysipelas Sore, etc., the human body infects the above diseases to cause nephritis after a period of time, called incubation period, such as respiratory infection, acute tonsillitis, the incubation period is about one to two weeks; scarlet fever is about two to three weeks; abscess disease is about two to four weeks, the incubation period is The process of the body's reaction, when infected with the above-mentioned precursor disease, can prevent the occurrence of immune reaction if it can be treated in time. According to clinical observation, tonsillitis, pharyngitis and other chronic infections can cause acute nephritis and turn it. It is chronic nephritis, so if it is confirmed that acute nephritis is caused by tonsillitis, when the tonsils are removed as appropriate, it will help to cure and prevent recurrence. Other bacteria, viruses, protozoa, etc. can cause nephritis. Therefore, it causes nephritis prodromal disease. Active and timely prevention and treatment, prevention of acute nephritis and Only acute nephritis to chronic nephritis has important significance.
Complication
Acute nephritic syndrome complications Complications, congestive heart failure, hypertension, acute renal failure, urinary tract infection
(1) Acute congestive heart failure: acute left heart failure in children can become the first symptom of acute nephritis. If not identified and rescued in time, it can be quickly killed. In acute nephritis, due to water and sodium retention, systemic edema and increased blood volume Pulmonary circulatory blood stasis is very common, so in the absence of acute heart failure, patients often have shortness of breath, cough and a little wet rales at the lungs and other symptoms of pulmonary circulation and blood stasis, because the patient also has respiratory infections, so the pulmonary circulation is bloody. The existence is easy to be ignored. On the contrary, this kind of circulatory blood stasis phenomenon is mistaken for acute heart failure. Therefore, it is very important to correctly understand the pulmonary blood stasis caused by water and sodium retention or acute nephritis complicated with acute heart failure.
(2) Hypertensive encephalopathy: In the past, the incidence of hypertensive encephalopathy in acute nephritis was 5% to 10%. In recent years, like acute heart failure, the concomitant rate is significantly lower, and it is less common than acute heart failure. This may be related to Timely and reasonable treatment related, common symptoms are severe headache and vomiting, followed by visual impairment, confusion, lethargy, and may have paroxysmal convulsions or epileptic seizures, after the blood pressure control, the above symptoms quickly improved or disappeared, no sequelae.
(3) Acute renal failure: acute phase of acute nephritis, mesangial cells and endothelial cells proliferate in a large amount, capillary stenosis and capillary coagulation, and the patient's urine volume is further reduced (oligour or no urine), protein When the catabolic products are largely retained, uremic syndrome can occur in the acute phase.
(4) secondary bacterial infection: acute nephritis due to reduced systemic immunity, easy to secondary infection, the most common is lung and urinary tract infection, once secondary infection occurs, it should be actively symptomatic treatment, so as not to cause the original disease to aggravate .
Symptom
Symptoms of acute nephritis syndrome Common symptoms Edema nephropathy edema face nouria proteinuria hematuria urinary heart failure with hypertension
Acute glomerulonephritis according to the history of pioneer infection, edema, hematuria, accompanied by hypertension and proteinuria, diagnosis is not difficult, acute anti-streptolysin "0" hemolysin increased, serum complement concentration decreased, urine Increased FDP content in the middle is more helpful for diagnosis.
Individual patients have acute congestive heart failure or hypertensive encephalopathy as the initial symptoms, or only edema and hypertension at the beginning of the disease with only mild or no urinary changes. For atypical cases, the medical history should be detailed, and the system should be combined with laboratory tests. Analysis, in order to avoid misdiagnosis, for patients with clinical diagnosis, if necessary, kidney biopsy can confirm the diagnosis.
Examine
Examination of acute nephritic syndrome
Urinary protein excretion can be >0.5~2g/m 2 daily; any urine protein/creatinine ratio may be <2 (normal 0.1~0.3), urinary sediment contains abnormal red blood cells, white blood cells and renal tubular cells, and the cast type includes red blood cell casts and Hemoglobin casts are characteristic, and leukocyte casts and granular casts (protein drops) are more common.
Antibody titers against pathogenic infectious agents usually rise within 1 to 2 weeks, and increased antibody against streptococcal antigen products can be detected: anti-streptolysin-O (ASO) is the best indicator of upper respiratory tract infection. And the anti-hyaluronidase and anti-deoxyribonuclease B of pyoderma usually decrease in C3 and C4 during the active period of the disease, and can return to normal within 6-8 weeks of the complement level of 80% of PSGN cases, but there is actually no case. This is the case with membrane proliferative glomerulonephritis (MPGN), which often lasts for several months, and circulating immune complexes can only be detected within a few weeks.
The function of the tubules is often disordered by the change of inflammation in the interstitial, resulting in decreased urine urinary capacity and acid secretion capacity, nephron solute exchange disorder, because of the ability of certain intrinsic glomerular hypertrophy, tubule function defects usually occur in GFR Before a significant reduction, as glomerular dysfunction progresses, total filtration area decreases significantly, GFR decreases, and azotemia occurs. GFR can be estimated from serum creatinine concentration or urine creatinine clearance, although GFR is usually 1 to 3 It will return to normal within a month, proteinuria may last for 6 to 12 months, microscopic hematuria may last for several years, and transient changes in urine sediment may occur again in mild upper respiratory tract infections.
Before the onset of this syndrome 1 to 6 weeks, there is a history of sore throat, impetigo or culture-confirmed streptococcal infection, and an increase in anti-streptococcal antibody serum titer can help diagnose, red blood cell cast It can be seen in any glomerulonephritis, but when it is associated with clinical manifestations, it strongly suggests acute nephritic syndrome. Ultrasonography can help identify acute illnesses (usually normal or slightly larger kidneys) and chronic disease exacerbations (kidney shrinkage).
Diagnosis
Diagnosis and diagnosis of acute nephritis syndrome
Acute glomerulonephritis according to the history of pioneer infection, edema, hematuria, accompanied by hypertension and proteinuria, diagnosis is not difficult, acute anti-streptolysin "0" hemolysin increased, serum complement concentration decreased, urine Increased FDP content in the middle is more helpful for diagnosis.
Differential diagnosis
1. Thermal proteinuria During acute fever, patients may have proteinuria, tubular urine or microscopic hematuria, which is easily confused with atypical or mild acute glomerulonephritis, but there is no incubation period for thermal proteinuria. , no edema and high blood pressure, urine routine quickly returned to normal after hot retreat.
Second, chronic glomerulonephritis acute seizures Chronic glomerulonephritis often occurs 2-4 days after respiratory infection, its clinical manifestations and changes in urinary routine and acute glomerulonephritis, but chronic history of nephritis , may have anemia, hypoproteinemia, hyperlipidemia, serum complement concentration, occasionally continuous reduction, urine volume is uncertain and the proportion is low, according to which identification is not difficult, in some cases can be clearly acute or Chronic glomerulonephritis, in addition to renal pathology for pathological differential diagnosis, can be judged clinically based on the course of the disease and the dynamic changes in symptoms, signs and test results.
Third, acute rheumatism acute rheumatism with renal lesions as a prominent manifestation of rheumatoid nephritis, gross hematuria is rare, often under the microscope hematuria, urine protein to a small amount to moderate, blood pressure is generally not high, often with acute rheumatism Other manifestations of heat, urine protein improved significantly after anti-rheumatic treatment, but microscopic hematuria lasted longer.
Fourth, allergic purpura nephritis or systemic lupus erythematosus (SLE) nephritis allergic purpura or systemic lupus erythematosus nephritis can appear acute nephritis syndrome, but both have obvious skin, joint changes, allergic purpura beam arm Positive test, lupus erythematosus can find lupus erythematosus cells, anti-DNA antibody and anti-nuclear factor positive, SLE often accompanied by fever, so as long as detailed medical history and selective comprehensive examination can be distinguished, if necessary, kidney biopsy can be identified.
