Description glomerulonephritis
It is a disease of the kidneys, more specifically glomerular,which are microscopic bodies stored in the kidney is responsible for filtering the blood.
It is more or less a general term, because types of glomerulonephritis, differing mainly in the way in which it was induced glomerular disorder, there are several. We distinguishprimary glomerulonephritis, which are affected only kidneys, andsecondary, which are complications of other diseases.
Furthermore glomerulonephritis can advantageously be divided according to a time point of view (the length of the course), which will be used in the following text. This time perspective has had a significant correlation with prognosis, to professional prerequisite for the success of treatment and the degree of consequences that the disease can leave.
Glomerular function and their indispensability in the human body
Glomeruli are invisible to the eye bodies, whose number in the healthy kidney exceeds 1 million. They are essentially a ball of small vessels whose loops are coated with a very fine screen. Blood that tangles constantly in progress, through a sieve filtered to afford primary urine. It is a fluid that is later in the renal tubules further adjusted, in terms of both quality and quantity. Then the final form of the definitive urine, which is drained into the bladder and urination has no further modification of the body removed.
Driving engine filtration is blood pressure that blood through a sieve “pasíruje”. Sieve pore size and also its electrical charge have a decisive influence on what ingredients can leave the blood. Into the primary urine normally excreted water, salts, and small molecules (like e.g. urea, creatinine, etc.).
These ingredients, including water, are either eliminated from the body, or using other processes responsive to the current state and needs of the body are returned to the bloodstream.
In contrast, the primary urine through healthy glomerulus never not undergo blood cells andplasma proteins (having large molecule). Renal tubules are not suitable for it to return these large elements into the bloodstream. Thus, if blood cells (mainly red blood cells) and / or the proteins themselves the final urine, it is a sure sign of glomerular damage sieve.
Likewise, it may be a screen inflammatory process “blocked” so that even small molecules, including water, it will not pass through and accumulate in the bloodstream. The presence of excess water, salts and waste products in the body, as well as the reaction of the regulatory mechanisms of the body, then usually leads to the development of observable symptoms such as swelling,reduced urine output (oliguria) or arrest urination (anuria) etc.
If the affected glomeruli inflammation, scarring, and threatens them with complete loss of function (which is lost kidney function throughout). Above all, the nature of the mechanism that caused the damage depends on whether the disease can affect therapeutic intervention.
Why glomeruli are damaged?
Glomerulonephritis are one of the evidence that the immune system may not always beneficial to man, on the contrary, may, at its malfunction inflict fatal damage.
Human immunity is based inter alia on the formation of antibodies, which bind to the pollutant, thereby suppressing harmful. Bound antibody complex (immunocomplex) with impurity then attracts immune cells that ultimately destroyed the entire complex. However cells at the disposal activities can also damage nearby tissue.
Said complexes may circulate in the blood and settle on the filter sieve in the glomeruli (the large molecules that do not pass through a sieve). Their presence attracts immune cells that liquidation complexes deplete the entire glomerulus.
In other cases, they said complexes may be formed on site. This time, when the immune system due to an error of the glomeruli identified as a pollutant. Then, against this part of the antibody produced by incorporating complex formed, which again attracts immune cells.
The last possibility is that the antibody that captures excessively in the glomerulus, is itself identified as a pollutant. As against other pests against it created another antibody and mutual relations again produces immune complexes.
The antibodies and complexes which are glomeruli degraded may arise for many reasons. These reasons (e.g. bacterial or viral infections, metabolic, cancer, immune disorders, etc.). Therefore they are own, though somewhat indirect, causative glomerulonephritis.
Signs and symptoms of glomerulonephritis
The disease can be asymptomatic and discovered incidentally is then only laboratory finding in urine. Depending on the specific type of glomerulonephritis, however, there are some of the following, either separately, or rather in various combinations.
These could be symptoms total, including fatigue, nausea to vomiting and fever. The following are dull ache in the lower back. Because fluid retention arise swelling (are first seen on the face, especially on the eyelids) and increases blood pressure (cause headaches).
Sick urine less (smaller volume of urine per day than usual), or in serious cases of sickness(anuria). Sometimes it may be evident in urine presence of blood (macroscopic hematuria). In the case of glomerulonephritis arising from the autoimmune response (antibodies generated against the own tissues of the body) may be present even seemingly unrelated symptoms as e.g. coughing blood.
examination of glomerulonephritis
Doctor listens to the patient with regard to the difficulties formerly prevalent and present diseases.Performs basic tests, including blood pressure measurement. Is bled urine and biochemical tests. In the blood indicators include especially after inflammation and after circulating antibodies, in urine may be detected blood cells and proteins.
A useful indicator of glomerular function is the current creatinine concentration (one of the waste products of metabolism) in the blood. Creatinine is removed from the body mainly by glomerular filtration back into circulation are then no longer absorbed. Its higher blood concentration means that the filtering is limited.
In suspected glomerulonephritis it is necessary (but usually not in acute glomerulonephritis, viz. Below) to confirm and refine the diagnosis of kidney biopsy. A sample of kidney tissue is then microscopically examined by a pathologist to determine a definitive diagnosis. Importance is also an ultrasound examination of the kidneys.
Glomerulonephritis according to length during their treatment and prognosis
Acute glomerulonephritis occurs suddenly, often in response to a disease caused byStreptococcus pyogenes (strep tonsillitis, scarlet fever, impetigo). Prevention is consistent treatment of these diseases with antibiotics. Furthermore they may cause e.g. staphylococci, salmonellae, EB virus, hepatitis B virus and others.
Swelling, high blood pressure and urination usually return to normal within a few days after starting treatment. This includes administration of penicillin for 7-10 days and the sleep mode, the length and severity depends on the severity of the disease (several weeks, but a few months).
Sick consume foods with reduced salt content, fluid intake must adapt swelling and blood pressure. To reduce pressure are prescribed antihypertensives. In poor urination are prescribeddiuretics during prolonged anuria (urination arrest) must be on hemodialysis.
Kidneys are usually fully heal, especially among young people are permanent effects are rare. A relatively long time after the disease is possible in urine examination capture blood cells and proteins.
Rapidly progressive glomerulonephritis (RPGN) are disproportionately severe. If treatment is not started early, can in a matter of weeks to months, be complete kidney failure with consequent need regular hemodialysis.
Conversely, early initiation of therapy leads to saving the kidney to 80% of patients. Delayed initiation of treatment is in connection with the usually insufficiently developed symptoms.
To a rapidly progressing form of chronic glomerulonephritis can go. Develop may also be based on the formation of pathological immune response against glomerulům (anti-GBM nephritis)antibodies are also target the lung, so-called. Goodpasteur syndrome), which may occur expectoration of blood and for him typical current finding on chest X-ray .
It may also be to blame poststreptococcus infections and certain systemic diseases. Presence. ANCA antibodies (antibodies against cell mass of one type of immune cell) is another possible reason RPGN (appears more frequently as part of other diseases, e.g. Wegener’s granulomatosis).
Diagnosis is based on the presence of specific antibodies in the blood, ultrasound (kidneys are enlarged) and quickly made a renal biopsy.
Treatment consists of corticosteroids and cyclophosphamide intravenously, to cleanse the blood of antibodies used so. Plasmapheresis. Treatment is long-term, planting cortisone is usually possible only after six months, sleep and other measures to conserve the kidneys must, however, adhere much longer.
Among chronic glomerulonephritis include. Focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy or membrane-proliferative glomerulonephritis.
Mechanisms of their formation are relatively complex and their description goes beyond the scope of this text. Always, however, his role is played by the immune system. The actual cause of chronic glomerulonephritis often is not understood. Other times, showing a connection with a hereditary metabolic diseases (eg. Diabetes) or vascular disorders (then called glomerular secondary glomerular disease).
Determination of the specific type of chronic glomerulonephritis is only possible through a kidney biopsy, it is important to select the appropriate therapy and prognosis of the disease. Treatment is long-term (years), among its tasks include corticosteroids, cyclophosphamide, or cyclosporineand blood pressure lowering drugs. It required a diet with a controlled intake of fats and proteins.
Favorable prognosis of all chronic glomerulonephritis has perhaps nephrotic syndrome with minimal changes glomeruli. There will be at his renal biopsy and treatment is initiated only on the basis of symptoms (swelling and discovery of the protein albumin in the urine mostly in preschool children). In the case of other types of chronic glomerulonephritis and supportive treatment of renal failure in a large number of cases occur in the next one or two decades, with the subsequent need regular hemodialysis.
Other Names: glomerulonephritis, nephritis, inflammation of the glomeruli, Bright’s disease, acute glomerulonephritis, rychleprogredující glomerulonephritis, chronic glomerulonephritis
