Chronic glomerulonephritis symptoms and treatment in adults. Glomerulonephritis - symptoms, causes and treatment of glomerulonephritis. What is the renal glomerulus and how do the kidneys work?

Glomerulonephritis is an insidious and dangerous disease, when it occurs, dysfunction and degradation of the entire urinary tract gradually develops. As a result of the progression of nephritis, the entire body of the patient exposed serious danger , because barrier role the kidneys are gradually lost.

Glomerulonephritis is an inflammatory process that occurs in the renal glands, the consequence of which is deformity of the kidney body, which significantly decreases in volume (shrinks) and sharply loses its filtration and barrier properties. Symptoms and treatment of glomerulonephritis in adults are discussed in detail in our article.

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Causes of the disease

Total damage to the renal structures in the form alcohol intoxication or poisoning with synthetic drugs are factors in the occurrence of the primary episode of this urological pathology with numerous relapses.

The reason for the development renal pathology Oncology, both benign and malignant, can also develop. Often morphological (qualitative) structural disturbances renal vessels are hereditary.

The insidiousness of glomerulonephritis is that both kidneys are involved in the pathological process How paired organ, which is affected simultaneously. This situation leaves no reserve functionality that cleanses the body of toxic liquids - decay products.

Glomerular nephritis is the second name of the disease, since pathological changes occur in the renal glomeruli - the vessels (glomeruli), in which physiological filtration of blood plasma and the formation of primary urine are carried out. The disease manifests itself as renal and extrarenal syndromes, which have various symptoms.

Pathological changes in the glomeruli that occur as a result of untreated inflammatory process, deform the kidney tissue. Gradually, the fibers of the tubules are replaced by connective (scar) tissue and stop filtering bodily fluids organism with serious health consequences. Deadly renal dysfunction occurs gradually and leads to intoxication of all life-supporting structures of the body. At running forms this pathology is also impaired water-salt balance and general metabolism.

Uremia, dialysis, transplantation

The most dangerous stage This urological disease - renal failure (uremia) occurs during the period of decompensation, disruption of the excretory activity of paired renal glands.

It can be popularly said that the system of protective barriers (vascular filtration chambers) is dying off.

The formation of urine and its removal from the body stops, and poisoning of all vital organs occurs.

Uremic coma is a complication of chronic glomerulonephritis and a tragic end to the course of this renal disease. At this stage, hemodialysis is used - blood purification using a specialized medical equipment which is carried out in a hospital. A radical solution to the problem of restoring the barrier function of the renal apparatus is healthy kidney transplant from a biologically compatible donor.

During the period of preserved renal gland function, the patient may feel quite satisfactory. If the disease is not detected and occurs latently (in a latent form), the pathological inflammatory process progresses unnoticed within six to twelve days.

Diagnosis of glomerulonephritis

A diagnostic examination based on clinical symptoms is prescribed to the patient after urine and blood tests. The results of the study reveal an increase in the level of protein in the urine, which is excreted from the body along with the fluid. Protein deficiency (protein loss) - proteinuria syndrome, provokes thinning and high permeability of blood vessel walls, formation of edema.

Blood sample examination demonstrates high performance toxic metabolic products: urea and creatinine.

High ESR indicator(erythrocyte sedimentation rate) and leukocytosis indicate an ongoing inflammatory process, which may be a complication of the disease.

After discovery clinical changes in urine and blood count, an experienced nephrologist prescribes a complex diagnosis of glomerulonephritis:

• ultrasound examination (ultrasound) of the kidneys;
• biopsy;
• urography - x-ray of the kidneys (in the acute stage);
• Renal nephroscintigraphy is an optimal and highly accurate diagnostic method for detecting disorders and pathologies of the genitourinary tract.

Important! Hardware urological diagnostics can be expensive, but these procedures are very effective in determining all pathological factors.

Symptoms of glomerulonephritis

When discomfort occurs after an infectious disease or exposure to other risk factors, acute glomerular nephritis manifests itself the following symptoms requiring treatment in adult patients:

• swelling in the tissues of the subcutaneous tissue;
• decreased urinary excretion (diuresis);
• steady increase blood pressure(not amenable to treatment with pharmacological drugs);
• fatigue;
• fever (increased temperature);
• nagging pain in the lumbar region;
• the appearance of protein cells in the urine;
• the appearance of blood cells (erythrocytes) in the urine.

During the period of exacerbation chronic form For this urological disease, the clinical symptoms are identical. Primary glomerulonephritis becomes chronic and leads to gradual deterioration of health, decreased ability to work and subsequent disability of the patient.

A rare form of glomerulonephritis

The hematuric form of glomerulonephritis is diagnosed solely on the basis laboratory tests the patient's urine, which shows the presence of blood in the test portion.

This factor is called hematuria, and is statistically recorded in five percent of urological patients.

Hematuric glomerulonephritis has acute and chronic relapsing form, which occurs latently (unnoticeably) and periodically.

During the remission stage, urine sample analysis may not have significant deviations from the norm and indicates the absence of disease. Exacerbation of nephritis is accompanied by pain in the lumbar back, increased body temperature and, accordingly, medical test results.

The causes of acute hematuric glomerulonephritis are risk factors identical to other forms of this urological pathology. Patients suffering from chronic hematuric nephritis are required to undergo regular laboratory examination urine and blood samples. The purpose of such a preventive intervention may be to detect the presence of blood and protein in the urine and immune reactions to a possible inflammatory process in the body.

On initial stage the clinical picture may be typical, as with other diseases of an infectious and inflammatory nature - arterial hypertension, decrease in the volume of urine excreted, swelling, thirst and heart failure.

An indicative symptom is high body temperature (up to 38-39 degrees) in the acute phase of the disease.

Experienced nephrologists prescribe complex treatment according to a scheme that includes both pharmacological drugs and symptomatic remedies alternative medicine. Such professional approach allows you to avoid complications of glomerulonephritis and achieve full recovery or prolonged remission.

Prevention and treatment

Qualified diagnostics and a well-prescribed treatment regimen involve the use of herbal medicine as a supportive method. Typical (encyclopedic) glomerulonephritis in adults proceeds with positive dynamics of treatment, taking into account the manifested symptoms.

Important advice for prevention urological diseases is careful attention to personal health.

Experienced therapists It is recommended to avoid hypothermia as a trigger that starts an infectious process - a typical risk factor. Prevention of glomerulonephritis involves trying to protect yourself from colds that provoke dangerous complications.

Phytotherapeutic treatment using herbal preparations can be used after consultation with an experienced nephrologist. Urological mixtures prepared from plant materials are distinguished by the following medicinal qualities:

• lower blood pressure;
• increase urine output;
• regulate and stimulate immunity;
• remove toxins;
• improve the chemical qualities of physiological body fluids.

Herbal preparations act mildly, so taking herbal preparations must be calculated according to long term regular intake(for approximately one year). Complete cure can be predicted after two years, subject to optimal combination therapy and a strict dietary regime. It is useful to take a drinking course of natural mineral waters.

Important! During the period of remission it is necessary to register daily results blood pressure measurements and examination by an ophthalmologist to determine the condition of the retina.

Video: symptoms and treatment of glomerulonephritis

Conclusion

When glomerulonephritis is diagnosed for the first time, what it is will be explained by the attending physician - a therapist or urologist. It is necessary to understand that the causes of this disease, as well as severe consequences, can be prevented. With glomerulonephritis, there is a great danger of forever losing the opportunity to be a completely healthy person.

Renal glomerulonephritis is a disease that affects the renal glomeruli, tubules of interstitial tissue, and is classified as an infectious-allergic pathology. Autoimmune forms of kidney tissue damage are recorded, while the human immune system produces antibodies to its own organs. Let's consider the main causes of the development of glomerulonephritis, its symptoms, methods of treatment and prevention.

Glomerulonephritis is primary, that is, resulting from pathological changes in kidney tissue, and secondary - appearing against the background of various changes in the body.

Acute glomerulonephritis develops in a patient as a complication of streptococcal throat infection. Poststreptococcal glomerulonephritis affects the kidneys of a child under 10 years of age. Damage to the glomeruli can also occur as a result of the following pathologies:

• pneumococcal infection;
• chicken pox;
• malaria;
• immunoglobulin A nephropathy;
• thrombotic thrombocytopenic purpura;
• lupus erythematosus;
• Wegener's granulomatosis.

Rapidly progressing glomerulonephritis occurs in humans due to a pathological reaction of the immune system.

Chronic form of this disease occurs in humans as a consequence of untreated acute glomerulonephritis. In some cases, it develops in patients against the background of unfavorable family heredity. Application of some medical supplies, especially against the background of self-medication or failure to comply with the doctor’s requirements, in a significant number of cases contributes to damage to the renal tubules.

Idiopathic glomerulonephritis is stated when its cause cannot be established.

General symptoms of the disease

The chronic form of the disease progresses over approximately 15 years. Until approximately 25 years of age, kidney function may still be preserved, but the final result of such a pathology is chronic renal failure. Without correction - diet and supportive treatment - it will certainly develop to terminal stage, when the patient’s vital activity is maintained solely due to hemodialysis. Such a person can only be saved through a kidney transplant.

The disease progresses with alternating periods of exacerbations and remissions. During remission, the symptoms subside and are practically not felt. Exacerbations occur due to hypothermia, drinking alcohol, and infections.

For glomerulonephritis acute form The patient shows signs of illness:

• weakness;
• severe fatigue;
• fever;
• sudden loss of appetite;
• pain in the abdomen and joints;
• swelling;
• anuria;
• a slight jump in blood pressure (rarely observed).

Chronic glomerulonephritis can sometimes be asymptomatic, so patients do not even realize that they are progressing to severe kidney disease. If, nevertheless, the disease makes itself felt, the patient may notice the appearance of slight swelling or a slight decrease in the amount of urine produced. It is dark in color because it contains a large number of blood. Some patients experience drowsiness and confusion.

The disease often results in symptoms renal failure: itchy skin, loss of appetite, nausea, vomiting.

Specifics of acute glomerulonephritis

The development of this form of renal pathology is possible in humans at different ages. As a rule, manifestation occurs before the age of 40. If a person has an infectious lesion, symptoms of diffuse glomerulonephritis occur a week or two after the illness.

In children, the pathology proceeds very rapidly, is characterized by cyclicity and ends in recovery. But with the erased form common symptoms no, but the urine takes on a dark color.

Glomerulonephritis always begins abruptly and with an increase in temperature. Sometimes it rises to very high numbers. Characterized by chilling and lack of appetite. A person complains of pain in the lumbar region; he turns pale, swelling of the face is observed. Diuresis, reduced in the first 3, rarely in 5 days of illness. Then the amount of urine produced increases, but its density decreases, which indicates that the renal glomeruli are still not sufficiently coping with the necessary filtration.

To constant and obligatory manifestations acute variety glomerulonephritis includes hematuria. In some cases, it takes on the shade of “meat slop”. TO specific signs Acute glomerulonephritis includes swelling of the eyelids and face. It is most pronounced in the morning. It decreases during the day. Sometimes the swelling may not be pronounced. In children, there may be a slight thickening of the tissue under the skin.

Hypertension appears in more than half of patients. In case of severe glomerulonephritis, it can last up to several weeks. Children may develop heart and vascular diseases. The acyclic form of acute glomerulonephritis is dangerous due to the erasure of the main symptoms. Due to late diagnosis, significant damage to the renal glomeruli and the development of renal failure are possible.

Subject to a favorable course and early detection of the disease acute symptoms gradually disappear over 2–3 weeks. A person recovers completely within 2 months.

Some types of chronic glomerulonephritis

The chronic version of this disease is characterized by a relapsing course. During an exacerbation, a person develops certain symptoms acute lesion renal glomeruli. The likelihood of relapse increases during transitional periods of the year.

Experts identify the following variants of the course of the chronic form of pathology:

• nephrotic (in this case, urinary symptoms mainly predominate, the most important of which are oliguria and anuria);
• hypertensive (in such patients blood pressure increases significantly, but urinary symptoms weakly expressed);
• mixed (urinary symptoms are combined with a pronounced increase in blood pressure);
• latent (this variant of the disease is recorded quite often and is characterized by the absence of edema on the body with mild severity of nephrotic syndrome);
• hematuric (the patient experiences a significant increase in the number of red blood cells in urine, and other symptoms are not pronounced or are completely absent).

The greatest danger to humans is the atypical, erased form of the disease. With this variant of the course, the patient does not show signs of developing kidney damage. Diagnosis can be late because, considering himself healthy, such a person does not see a doctor.

How is the disease diagnosed?

The diagnosis is determined on the basis of anamnesis, examination of the patient, laboratory and instrumental examinations, biopsy. Laboratory tests show the following changes, indicating that the patient has glomerulonephritis:

1. Hematuria. Sometimes it can be massive. Because of increased amount red blood cells, urine may be black in color and the consistency of meat slop.
2. Albuminuria is mild and persists for several weeks.
3. With microhematuria, granular and hyaline casts are found in the urine, and with massive hematuria, erythrocyte casts are found.
4. Nocturia is detected.
5. When performing the Zimnitsky test, a decrease in diuresis is noted while maintaining the concentration properties of the glomeruli (this is evidenced by high concentration urine).

A general blood test notes an increase in the erythrocyte sedimentation rate and an increase in the number of leukocytes. Blood biochemistry shows an increase in the concentration of urea, cholesterol, creatinine, and an increase in nitrogen content in the blood.

An ultrasound is mandatory. A kidney biopsy for glomerulonephritis is indicated if the results of the previously mentioned tests are insufficiently informative. This diagnosis provides more accurate answers, because a biopsy examination involves a thorough morphological examination of the renal tissue.

Why is the rapidly progressing form of the disease dangerous?

Such glomerulonephritis is dangerous with the risk of developing acute failure kidney It is necessary to treat glomerulonephritis at this stage, because it can cause kidney failure.

Acute failure is accompanied by severe azotemia and a pronounced drop in the excretory function of the kidney. At the same time, a pronounced disturbance occurs in the body acid-base balance. In most cases, acute renal failure is a reversible process, and with proper treatment, the functions of the excretory system are gradually restored. IN in some cases(with the formation of a deep lesion), the disease passes into a progressive chronic form.

In the oliguric phase of acute renal failure, diuresis does not exceed 0.5 l per day. Urine contains a large amount of protein. Symptoms of this phase:

• severe nausea and vomiting;
• alternating diarrhea and constipation;
• dyspnea;
• moist wheezing (may indicate the development of pulmonary edema);
• increased blood pressure;
• arrhythmia caused by hyperkalemia;
• An increase in the amount of free nitrogen can cause damage to internal organs.

In the diuretic phase there is a gradual recovery daily diuresis; Sometimes patients experience polyuria. In this regard, the body may develop hypokalemia. It is accompanied by muscle paresis and severe weakness.

What you need to know about chronic kidney failure

Chronic kidney failure is characterized by a progressive course. It is the outcome of chronic untreated glomerulonephritis. The higher the rate of sclerosis of the kidney parenchyma, the faster the pathology develops. In the initial stage (filtration rate is at least 40 ml per minute), polyuria, pollakiuria, nocturia and hypertension occur.

If the filtration rate drops further, a conservative stage develops. It continues until this figure exceeds 15 ml per minute. The previously described symptoms are joined by asthenic syndrome, decreased ability to work and decreased appetite. The patient's azotemia increases and body weight decreases.

When the kidney filtration rate decreases to less than 15 ml per minute, the patient develops oliguria and overhydration. Symptoms of end-stage chronic renal failure:

• uncontrolled hypertension;
• dysfunction of the left ventricle;
• pulmonary edema;
• visual impairment;
• drowsiness;
• anorexia;
• muscle twitching;
• ammonia odor from the mouth;
• pericarditis;
• dryness and pallor of the skin, its jaundice;
• human apathy.

During the conservative stage of the disease, the patient is given drugs that support kidney activity and strengthen the body. The amount of table salt and protein products is limited. In the terminal stage, hemodialysis is used, and issues related to kidney transplantation are resolved.

Principles of pathology treatment

Treatment of the acute form of the disease occurs only in a hospital setting. A diet for kidney glomerulonephritis is mandatory; The patient is assigned table No. 7. Bed rest is also required. The following medications are used:

• antibiotics (Erythromycin, Penicillin, Ampicillin, Oxacillin);
• Prednisolone;
• Cyclophosphamide;
• Azathioprine;
• Diclofenac and other non-steroidal anti-inflammatory drugs.

Symptomatic medications are prescribed to reduce the intensity of edema. If hypertension is diagnosed, pressure correction is performed. Subsequently, after the acute period, it is shown spa treatment. All patients must be under the supervision of a urologist or nephrologist.

Features of nutrition in glomerulonephritis

Target therapeutic diet for glomerulonephritis - restriction of water and proteins in order to normalize renal function. The diet must be constant, that is, observed not only during an exacerbation, but also during remission.

• limiting the consumption of salt and all dishes that contain it in large quantities;
• protein restriction (up to 40 g per day);
• limiting fat;
• menu exception fatty meat and fish;
• exclusion of strong rich broths;
• exclusion of cereals;
• exclusion of hot spices, vegetables (including onions, garlic, radishes and radishes).

In the first days of pathology it is necessary fasting days. The patient may be prescribed mono-diets - cucumber, melon, watermelon. They minimize the load on the kidneys and heart.

In the acute stage of glomerulonephritis in therapeutic nutrition present:

• bread (no added salt);
• a small amount of meat;
• fermented milk and dairy products;
• potatoes, carrots;
• pasta.

In the future, the diet expands slightly: more meat and a little sodium chloride are introduced into the diet. All products containing ascorbic acid and other beneficial substances are shown. All dishes must be boiled or cooked in a steam bath. It is necessary to monitor the drinking regime and consume water depending on how much urine is released, otherwise the person will develop edema. The amount of protein should be limited.

Prevention of glomerulonephritis

It is much easier to prevent such a disease than to treat it later. Everyone is advised to follow these tips:

1. Physical activity should be dosed. Physical fatigue must be avoided.
2. You always need to maintain a normal psycho-emotional state. Stress should be avoided.
3. Sleep should be complete and of sufficient duration.
4. The kidneys really don't like hypothermia. Avoid exposure to drafts and sudden temperature fluctuations.
5. Alcohol, especially beer, is very harmful to the kidneys. To keep them healthy, you don’t need to overuse the foamy drink.
6. It is recommended to stop smoking.
7. Eating large amounts of spices, smoked meats, and salt is very harmful. All products containing such components should be limited.

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Glomerulonephritis is also called glomerular nephritis. This disease is an inflammation of the kidney glomeruli of an infectious-allergic or autoimmune nature. It manifests itself as edema and disorders of the urinary and cardiovascular systems. In the absence of timely and adequate medical care there is a risk of developing severe complications that can lead to fatal outcome.

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  Causes

  Glomerulonephritis in women can be triggered by various pathogenic microorganisms. Streptococci, staphylococci, malaria, plasmodia and other types of viruses act as probable causative agents of the inflammatory process in the renal glomeruli.

  Glomerulonephritis is often a consequence of diseases of other organs, occurring in acute or chronic form. It is usually provoked by diseases such as pneumonia, tonsillitis, scarlet fever, streptoderma (skin lesions with purulent discharge). Measles, ARVI, and chicken pox also contribute to the development of glomerulonephritis. Therefore, the infectious factor of exposure is considered one of the main ones when considering this disease.

  There is another reason that provokes inflammation in the glomeruli of the kidneys. This is possible when the body becomes hypothermic in conditions of high humidity. With this option, jade is usually called “trench jade”.

  When the kidneys become hypothermic, disorders develop at the reflex level that affect the renal blood supply, resulting in an impact on a number of immunological processes.

  Glomerulonephritis may be a consequence of toxic effects on the body. TO hazardous substances include mercury, lead, organic solvents ( ethanol, gasoline, xylene, acetone) and so on. The cause of the disease can also be vaccinations, the administration of serums or any medications.

  Symptoms

  Symptoms of glomerulonephritis in women may vary depending on the form of the disease. The disease is classified according to several principles:

  Classification	Form of glomerulonephritis	Characteristic features of the course of the disease
  With the flow	Acute	Has a sudden development. It is curable, but has the ability to transform into a latent (hidden) form
  	Chronic	It is the result of acute glomerulonephritis. Aggravates periodically
  	Subacute	Rapidly progressive or malignant glomerulonephritis. Characterized by poor dynamics even when prescribed specific drug therapy. Represents a risk of complications. In most cases (up to 80%) it leads to death
  By features clinical picture	Nephrotic	The main signs are frontal and peripheral edema
  	Hematuric	Characterized by a high content of protein and blood in urine, absence of swelling and increase in blood pressure (BP) from the first days of the development of the disease
  	Hypertensive	There are no changes in the process of urination, urine tests do not show the presence of protein and blood, but there is a steady increase in blood pressure
  	Mixed	Has a combination of all the above symptoms, manifesting with varying severity
  	Latent	The only way to diagnose the pathology in this case is to carry out laboratory research urine - large amounts of protein and blood will be found in it
  According to the mechanism of disease development	Primary	Glomerulonephritis is an independent disease
  	Secondary	It is a consequence of other systemic pathologies (rheumatoid arthritis, lupus erythematosus, etc.)

  Acute post-streptococcal glomerulonephritis, which occurs after a streptococcal infection, is distinguished as an independent type of disease.

  Symptoms of the disease also depend on the stage of its development:

  Stage of glomerulonephritis	Symptomatika
  Acute	At acute glomerulonephritis In women, the following are noted: Clinical signs: Edema. In the morning they appear in the face area. In severe pathogenesis, swelling leads to an increase in total body weight up to 20 kg in a few days. Thirst. Oliguria - urination of less than 1-1.5 liters of urine within 24 hours. Increase in body temperature to +38...+38.9 degrees. General weakness. Arterial hypertension. Increase in blood pressure to 170/100 mm Hg. Art., which can provoke pulmonary edema or acute heart failure. In children, an increase in blood pressure is observed more often than in adults. Hematuria is the presence of blood in the urine. Pain on both sides of the lower back
  Subacute	This is the most difficult stage, mainly occurring in adult women. Clinical signs: 1. Hematuria. 2. Constant increase in blood pressure. 3. Swelling. All these symptoms are characteristic of the acute stage of the disease, but the subacute variety can be distinguished by a lower, but longer lasting temperature. Subacute glomerulonephritis often causes complications. Just a few weeks of illness at this stage leads to complete loss of kidney function, requiring dialysis and organ transplantation
  Chronic	It develops over a long period of time, sometimes without any symptoms. With chronic glomerulonephritis, the performance of the kidneys slowly decreases, and blood pressure gradually increases. At long absence treatment there is a risk of developing chronic renal failure, leading to a significant deterioration in the patient’s general well-being and death in the absence of therapeutic measures. In most cases, it provokes uremia, which is accompanied by excessive accumulation of urea in the blood, damage to various organs and systems human body, especially the brain. The following symptoms indicate uremia: decreased visual acuity; smell of urine from the mouth; convulsive conditions; dry mouth; drowsiness

  If the above symptoms occur, you should immediately consult a doctor. Parents whose children have had a sore throat or scarlet fever need to be more attentive to the child’s health. Glomerulonephritis in girls can appear only 2-4 weeks after the illness.

  

  Diagnostics

  Detection of glomerulonephritis in women is carried out on the basis of identifying symptoms, laboratory tests and various instrumental studies. Only a combination of all these methods allows differential diagnosis with pyelonephritis, amyloidosis, autoimmune vasculitis, and interstitial nephropathy.

  After establishing a preliminary analysis based on the clinical picture, anamnesis, complaints and examination, the doctor prescribes additional research. The form of glomerulonephritis, namely primary or secondary, is determined by studying recent infectious diseases. Diagnostics includes the following methods:

  Type of study	Short description	Result for glomerulonephritis
  Laboratory research
  General urine analysis	Diagnostic manipulations are aimed at determining the function urinary system. This is what is being done for general analysis urine from the morning urine collected immediately after waking up	Hematuria - myoglobin and hemoglobin are detected. Proteinuria - leukocytes, red blood cells and casts are determined - protein casts of the renal tubules. Urine for proteinuria is also examined over time using test strips. The specific gravity of urine remains normal or increased
  General blood analysis	Examined to determine signs of inflammation	Shift leukocyte formula to the left. Leukocytosis due to neutrophils. Increasing ESR levels
  Blood chemistry	Determines the level total protein, fibrinogen, creatinine, urea, ratio of protein fractions	The ratio of protein fractions changes due to a decrease in albumin and an increase in a1 and a2 globulins. Creatinine and urea increase
  Immunological blood test	Determines changes in the content of immune complexes	Antibodies to streptococcus are detected - antistreptolysin O, antihyaluronidase, antistreptokinase (for streptococcal glomerulonephritis). There is a decrease in complement factors - C3 and C4 (with post-streptococcal glomerulonephritis, the indicators are normalized after 1.5 months, and with membranoproliferative - they persist for life)
  Urinalysis Nechiporenko, Zimnitsky	Detects and determines the severity of renal failure	More than 1000 units of red blood cells are noted
  Instrumental research methods
  Fundus examination	Performed for hypertensive form of glomerulonephritis	At the beginning of the development of the disease, clinical signs indicate angiospastic retinitis: hyperemia of the fundus; dilatation of veins and arteries. In the later stages, the retinal arteries narrow, forming small narrowings of the latter at the intersection of arterioles and venules. In rare cases, swelling of the nipples is observed optic nerves, blurring of their boundaries and pinpoint hemorrhages in the retina
  ECG, echocardiography, radiography of the heart and lungs	Subject to availability arterial hypertension(AG) to determine pathologies of these organs associated with intoxication and disturbances of electrolyte metabolism	Swelling and fluid accumulation in the pleural and pericardial cavities are detected
  Kidney ultrasound	Held ultrasound examination For differential diagnosis with pyelonephritis and other kidney diseases	1. In acute glomerulonephritis, no morphological changes are detected. 2. With long-term chronic glomerulonephritis, fine scarring of the kidney tissue and a decrease in kidney size are observed. 3. At the subacute stage - shriveled bud. There is a significant decrease in the size of organs, a change in their structure due to scarring and hypertrophy of individual nephrons, the surface becomes fine-grained, uneven or bumpy
  Intravital puncture biopsy of the kidneys	Allows you to study the morphological composition of renal tissue	Scar changes are detected
  Percutaneous biopsy	Allows you to determine the histological form of the disease, differentiate glomerulonephritis and select the best treatment tactics. Indications for this study are: latent, chronic course diseases; monitoring the pathological process, complications and treatment progress	Histological analysis shows changes in the renal tissue of an inflammatory nature, signs of autoimmune damage to the membrane of the renal glomeruli

  

  Treatment

  Treatment of glomerulonephritis in women has a number of fundamental approaches. The treatment regimen is as follows:

  • hospitalization in the nephrology or therapeutic department;
  • non-strict bed rest during edema and/or acute hypertensive reaction;
  • reducing daily fluid intake to 1 liter (for adults), table salt to 3 g, protein to 80 g for a period of up to 14 days;
  • diuretic and antihypertensive therapy;
  • antiplatelet treatment (Dipyridamole 250-300 mg per day or aspirin 80-150 mg per day for 3-6 weeks);
  • anticoagulant therapy (duration up to 14 days);
  • antibacterial treatment;
  • therapy of concomitant diseases and complications.

  Also, depending on the results of tests and instrumental studies, treatment is combined. All therapeutic measures are prescribed strictly by a doctor, who also monitors the dynamics of the disease. As a supplement, a dietary menu is used. With the permission of the attending physician, after overcoming the acute stage of the disease, the patient can use folk remedies.

  Antibiotics

  Antibacterial treatment is prescribed to patients if glomerulonephritis was preceded by streptococcal infection(scarlet fever, sore throat) or other infectious disease known etiology, for example, pneumonia. Antibiotic therapy is especially important for patients with the nephrotic form of the disease.

  Before prescribing drugs and their dosage regimen, it is advisable to conduct a bacteriological study of the relevant material (smear from the oropharynx, sputum). This is necessary to determine the sensitivity of infections to drugs. However, since the antibiogram takes time, treatment begins with benzylpenicillin and semisynthetic penicillins (Amoxiclav, Amoxicillin).

  
  

  After receiving the results of the analysis, appropriate adjustments are made to the therapy. Further treatment other groups of antibiotics continue for another 3 weeks, and if active infection persists longer. At allergic reaction Macrolides (Clarithromycin, Erythromycin, etc.) are widely used in addition to penicillins.

  
  

  From the first days of the disease, foci of infections in the oral cavity and nasopharynx are sanitized. For this purpose they use antimicrobial agents With antibacterial effect(Furacilin, Lifuzol, etc.).

  

  Antihistamines

  Since glomerulonephritis is infectious and toxic in nature, antibiotics are combined with desensitizing agents. These include Suprastin, calcium, Fenkarol, Diphenhydramine, Diazolin.

  
  

  They are taken orally. They help relieve swelling, relieve the toxic effects of waste products from infections, and also have anesthetic and antispasmodic effects.

  Diuretics

  Diuretics are prescribed to reduce swelling and lower blood pressure. Preference is given to saluretics. Tyrazide diuretics are less effective.

  
  

  If the kidneys retain nitrogen excretory function, then usealdosterone antagonists (Veroshpiron, Aldakgon). They, like ACE inhibitors (Enalapril, Captopril), are used for high blood pressure (arterial hypertension) and circulatory failure. The courses are short - up to 1 week. In the absence of hypertension and heart failure, osmotic diuretics are prescribed. For example, a 20% solution of Mannitol is administered intravenously.

  

  Other drugs

  They are used to eliminate autoimmune process, intravascular coagulation shifts. Mostly the drugs (heparin, cytostatics, corticosteroids, plasmapheresis) have a wide range of action. They disrupt homeostatic processes that can lead to complications.

  For nephrotic syndrome, cytostatic immunosuppressants and glucocorticosteroids (GCS) are indicated, especially in the absence of remission and persistence of symptoms autoimmune disease in the kidneys. GCS is prescribed for acute glomerulonephritis with pronounced activity of the renal process, the presence of nephrotic syndrome without hypertension and hematuria, protracted current acute nephritis.

  
  

  For example, when pulse therapy with Cyclophosphamide (Cyclophosphamide) the following conditions must be met:

  • select the dose so that it corresponds to the glomerular filtration rate;
  • control the level of leukocytes at 10 and 14-1 after pulse therapy;
  • increase daily fluid intake;
  • take serotonin receptor antagonists (Dexemethasone, Zofran, Cerucal) to prevent nausea and vomiting.
  
  

  Heparin is prescribed for acute glomerulonephritis and the following indications::

  • development of acute renal failure;
  • nephrotic form of the disease;
  • DIC syndrome in the hypercoagulable phase.

  Heparin is treated for 6-8 weeks. If necessary, the course is extended to 3-4 months. After graduation therapeutic activities within 2-3 months it is recommended to use anticoagulants with indirect action(Phenilin). For long-term acute stage glomerulonephritis, especially with nephrotic syndrome, medications are used that improve microcirculation in the kidneys. These include Dipyridamole, acetylsalicylic acid in combination with Curantil, Trental.

  
  

  For significant proteinuria, non-steroidal anti-inflammatory drugs (Ibuprofen, Voltaren, Indomethacin) are used. They reduce the permeability of glomerular capillaries for protein molecules, the pressure inside the capillaries and their filtration surface.

  Diet

  Diet plays an important role in the treatment of glomerulonephritis. To maintain the effect of drug therapy, you should avoid eating:

  • white cabbage in any form (boiled, pickled, stewed, raw);
  • sweet apples;
  • raisins and fresh grapes;
  • cottage cheese and fermented milk products;
  • apricots in any form;
  • potatoes.

  Pickled, salted, fried and smoked foods should be completely excluded. During periods of exacerbation and acute course of glomerulonephritis, only steamed or boiled foods are allowed.

  Strong tea and coffee are undesirable. It is better to replace them with rosehip decoction or pumpkin juice. The first promotes excretion excess liquid from the body, and the second - cleansing the blood of toxins and increasing immunity.

  Folk remedies

  As complementary therapy funds can be used traditional medicine. Under no circumstances should they replace antibiotics and other medications.

  1. 1. Infusion of corn silks and cherry tails. Take 1 tsp. raw materials, pour 500 ml of boiling water and leave until the medicine cools to room temperature. Take 1/4 cup 3 times a day 30 minutes before meals. The course of treatment is continued until the symptoms of glomerulonephritis are completely eliminated.
  2. 2. Black elderberry infusion. Take 1 tbsp. l. dried flowers of the plant, pour a glass of boiling water and leave until completely cool. Take 1/3 cup 3 times a day before meals. The duration of treatment is 3-4 weeks.
  3. 3. Infusion from a collection of herbs. Connect 4 tbsp. l. flax seeds, 3 tbsp. l. dried birch leaves, 3 tbsp. l. steelweed rhizomes. The mixture is poured with 500 ml of boiling water and left for 2 hours. Take 1/3 cup 3 times a day. The course of treatment is 7 days.

  To increase immunity, take 1 tsp. next remedy: mix 1 glass of honey, 1 tbsp. l. walnuts and hazelnuts, peel of 1 lemon. Store in a warm place.

  Consequences

  Glomerulonephritis is a serious disease that can lead to the following complications:

  • pulmonary edema - provoked by cardiac dysfunction, a steady increase in pressure and stagnation of fluid in the body;

When the disease is glomerulonephritis, treatment and prognosis depend on the form and course of the disease. In case of acute glomerulonephritis, the patient requires treatment in a hospital setting, in a department specializing in the treatment of kidney disease. Children are hospitalized in specialized nephrology departments of children's hospitals. Pregnant women with glomerulonephritis and gestosis should be hospitalized in a specialized maternity hospital.

The doctor prescribes strict bed rest, and its duration can be from 10 days to 6 weeks. difficult cases. The total period of temporary disability is about 50 days. At the end of the disease, patients who have suffered acute glomerulonephritis are advised to follow a work regime for 2 years; heavy physical labor, work with temperature changes and chemicals are prohibited.

During the entire hospital stay, it is necessary to monitor diuresis, determining the amount of proper fluid intake in accordance with diuresis.

In addition, the patient is prescribed a strict diet for glomerulonephritis, which is based on limiting protein, simple carbohydrates, and excluding extractive substances - broths, spices, coffee, tea. It is recommended to observe the ban on salt, alcohol and smoking. The need for vitamins is met both through diet and by taking synthetic vitamin complexes. Juice intake is limited.

Drug therapy for acute glomerulonephritis is carried out according to several principles:

• Etiotropic treatment. For post-streptococcal glomerulonephritis, the doctor prescribes penicillin antibiotics intramuscularly.
• Pathogenetic treatment aimed at the mechanisms of disease development.
• Immunosuppression carried out using glucocorticoids, the main representative of this group is prednisolone. They reduce the manifestation of inflammation, suppress the pathological immune response, and reduce sensitization of the body. These drugs are prescribed for glomerulonephritis in the case of nephrotic form, prolonged course and renal failure.
• Non-hormonal immunosuppressants, or cytostatics, are prescribed for resistance to glucocorticoid therapy, with the development of dependence on glucocorticoids, with severe side effects. Sometimes glucocorticoids and cytostatics are combined.

You should be aware of the side effects associated with the use of cytostatics and carry out treatment under supervision shaped elements blood.

Anticoagulant therapy with heparin based not only on its anticoagulant effect, but also on its anti-inflammatory properties. Heparin suppresses autoimmune inflammation, reduces the permeability of glomerular capillaries, has diuretic effect, helps eliminate sodium and reduce lipid levels.

Indications for use heparin is the nephrotic form of the disease, the development of acute renal failure, DIC - syndrome in the hypercoagulation phase.

For nephrotic, hypertensive, prolonged glomerulonephritis, the use of antiplatelet agents. A prominent representative of this group is chimes. In addition to its antiplatelet effect, it has a moderate hypotensive effect Due to the effect on prostaglandin E2, it increases the glomerular filtration rate.

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Application NSAIDs possible with prolonged proteinuria in the absence of signs of inflammatory process activity. NSAIDs for acute glomerulonephritis should be prescribed with caution due to its high activity side effects during periods of severe kidney inflammation.

Symptomatic treatment of glomerulonephritis is aimed at eliminating the symptoms of the disease and includes control of blood pressure, edema syndrome, and hematuria syndrome.

• For hypertensive syndrome purpose shown antihypertensive drugs, preference is currently given to drugs from the group of ACE inhibitors.
• Edema syndrome primarily corrected through diet. If it is ineffective, then diuretics that do not have a nephrotoxic effect are prescribed - furosemide, hypothiazide, veroshpiron, triampur. Diuretics are prescribed in short courses.
• Also with pronounced nephrotic syndrome Infusion of plasma and albumin is recommended.
• With pronounced hematuria syndrome aminocaproic acid, dicinone, and ascorutin are prescribed to strengthen the vascular wall.

Attention

In case of malignant or rapidly progressive course of glomerulonephritis, intensive therapeutic measures are carried out, in combination with plasmapheresis and hemodialysis.

Chronic glomerulonephritis in remission is subject to outpatient treatment, at home, and compliance with the regimen and diet comes to the fore. The patient is advised to avoid hypothermia, excessive physical stress, and psycho-emotional stress. Business trips, work in cold and hot workshops, and night work are not recommended. Any colds in such a patient are an indication for release from work. The child should be protected from hypothermia and contact with infection.

Exacerbation of chronic glomerulonephritis is an indication for hospitalization in nephrological or therapeutic department. Diet No. 7 or 10 is recommended. This is a predominantly dairy-vegetable diet, including potatoes, vegetables, fruits, lean meat and fish. Fasting days are held. Salt and water are also limited; mineral water is prohibited.

There is no etiotropic treatment for chronic glomerulonephritis. The main direction is pathogenetic treatment.

If the cause of chronic glomerulonephritis is systemic vasculitis, then the modern drug Alprostan is used, which is an analogue of prostaglandin E1. It has an angioprotective effect and stimulates collateral blood flow.

• For chronic glomerulonephritis, glucocorticoids are used. They are effective in the following forms - minimal changes, mesangioproliferative, mesangiomembranous, membranous glomerulonephritis. They are contraindicated in hypertension, mixed form, as well as in the formation of chronic renal failure.
• Cytostatics can be prescribed for resistance to glucocorticoids, they are effective in the same cases as glucocorticoids, but also including the mesangiocapillary variant. When treating glomerulonephritis with cytostatics, significant changes in the hematopoietic system are possible; they should be prescribed only when necessary and under the control of a blood test.
• Possible use of anticoagulants and non-steroidal anti-inflammatory drugs. Hemosorption and plasmapheresis are also performed.

Symptomatic therapy for chronic glomerulonephritis, as well as for acute glomerulonephritis, consists of controlling blood pressure, and the selection of medications is recommended to begin with diuretics. The administration of beta blockers and drugs of the angiotensin converting enzyme group is also indicated.

Patients are advised to stay in resorts and sanatoriums in dry, sunny and hot climates. In addition, during non-exacerbation periods, it is possible to use physiotherapy methods.

Homeopathy, herbs, leeches, reception bee death according to the scheme, medicine beetle and other methods evidence-based medicine are not prohibited, but are recommended exclusively during periods of stable remission.

In case of glomerulonephritis, treatment of acute forms and exacerbations of chronic glomerulonephritis, as well as clinical observation in Russia and Ukraine are included in the compulsory health insurance program.

Treatment of glomerulonephritis in Germany will cost from 6,500 to 130,000 euros, depending on the length of hospital stay and treatment measures. Examination and treatment in China and Israel are not much different in price.

Prices in Moscow depend on the level of the clinic and the conditions of stay; the cost of a consultation with a nephrologist starts from 1,500 rubles. You can also rely on reviews from the forum when choosing a clinic.

Glomerulonephritis: treatment with folk remedies and homeopathy

In case of glomerulonephritis, treatment with folk remedies is possible during the period of recovery or stable remission. The use of traditional medicine is aimed at restoring the immune system, anti-inflammatory, desensitizing, detoxifying effects. Application folk remedies also indicated to reduce complications drug therapy. Also, with the help of folk remedies, you can achieve a hypotensive effect and a diuretic effect on the kidneys.

Herbal medicine consists of using herbal infusions and decoctions, both in mono form and in the form of collections. As a rule, the dosage is a tablespoon several times a day. It is also possible to use baths and herbal applications to help reduce pain due to glomerulonephritis.

Among the medicinal plants shown are birch leaves and buds, cornflower flowers, knotweed herb, lingonberry leaves, kidney tea. Black elderberry flowers and burdock root are used. You can take the juices of dandelion, plantain, lungwort, nettle, and chicory.

In case of glomerulonephritis, herbal treatment must be agreed with the attending physician and restrictions on fluid intake must be observed.

Homeopathy in the treatment of glomerulonephritis

Homeopathy for glomerulonephritis is not aimed at treating symptoms, it is based on the principle of treating the person as a whole. For correct selection homeopathic remedies require consultation with a homeopathic doctor who will prescribe certain drug in accordance with the patient's constitution, history of disease and clinical manifestations. There are good reviews about the treatment of infusions made from dead bees and the medicine man's beetle.

Hirudotherapy or treatment with leeches during remission is indicated for systemic diseases . The drug hirudin, contained in the saliva of leeches, improves blood rheology and has an anticoagulant effect.

Infections caused by Coxsackie viruses, etc.)

Glomerulonephritis appears within 1-4 weeks. after exposure to a provoking factor.

Manifestations of glomerulonephritis

• Blood in urine - urine the color of “meat slop”
• Swelling of the face (especially the eyelids), as well as the feet and legs
• Increased blood pressure
• Decreased urine output, thirst
• Increased body temperature (rare)
• Lack of appetite, nausea, vomiting, headache, weakness
• Weight gain
• Dyspnea

Depending on the various forms glomerular lesions may be dominated by certain manifestations of glomerulonephritis.

Acute glomerulonephritis develops 6-12 days after an infection, usually streptococcal (tonsillitis, tonsillitis, scarlet fever), including skin infection (pyoderma, impetigo).

In the classic cyclic course, acute glomerulonephritis is characterized by changes in urine (red urine due to blood), edema, and a decrease in the amount of urine excreted.

Diagnostics

• General urine analysis. In urine - red blood cells, leukocytes, casts, protein
• Urine specific gravity is normal or increased
• Increased titer of antibodies to streptococcus in the blood (antistreptolysin-O, antistreptokinase, antihyaluronidase)
• Decrease in the content of complement components C3, C4 in the blood serum with a return to original level after 6-8 weeks for post-streptococcal acute glomerulonephritis; with membranoproliferative glomerulonephritis, these changes persist for life
• The content of total protein in the blood serum is reduced, in the proteinogram there is an increase in a1- and a2-globulins
• Radioisotope angiorenography
• Ocular fundus
• Kidney biopsy allows you to clarify the morphological form of chronic glomerulonephritis, its activity, and exclude kidney diseases with similar symptoms

Treatment of glomerulonephritis

• Hospitalization in the nephrology department
• Bed rest
• Diet No. 7a: protein restriction, salt is limited for edema, arterial hypertension

Antibiotics (for acute post-streptococcal glomerulonephritis or the presence of foci of infection)

Immunosuppressants and glucocorticoids are ineffective for post-infectious, post-streptococcal acute glomerulonephritis.

Immunosuppressive therapy - glucocorticoids and cytostatics - for exacerbation of chronic glomerulonephritis.

Glucocorticoids

indicated for mesangioproliferative chronic glomerulonephritis and chronic glomerulonephritis with minimal changes glomeruli. In membranous chronic glomerlonephritis, the effect is unclear.

In membranoproliferative chronic glomerulonephritis and focal segmental glomerulosclerosis, glucocorticoids are ineffective.

Prednisolone

prescribed 1 mg/kg/day orally for 6-8 weeks, followed by rapid decline up to 30 mg/day (5 mg/week), and then slowly (2.5-1.25 mg/week) until complete withdrawal.

Pulse therapy with prednisolone is carried out with high CGN activity in the first days of treatment - 1000 mg IV drip 1 time per day for 3 days in a row. After the activity of chronic glomerulonephritis decreases, monthly pulse therapy is possible until remission is achieved.

Cytostatics

• cyclophosphamide 2-3 mg/kg/day orally or intramuscularly or intravenously,
• chlorambucil 0.1-0.2 mg/kg/day orally,

as alternative drugs:

• cyclosporine - 2.5-3.5 mg/kg/day orally,
• azathioprine 1.5-3 mg/kg/day orally)

they are indicated for active forms of chronic glomerulonephritis with high risk progression of renal failure, as well as in the presence of contraindications for the use of glucocorticoids, ineffectiveness or complications when using the latter (in the latter case prefer combined use, which allows reducing the dose of glucocorticoids).

Pulse therapy with cyclophosphamide is indicated for high activity of chronic glomerulonephritis, either in combination with pulse therapy with prednisolone (or against the background of daily prednisolone), or alone without additional prescription of prednisolone; in the latter case, the dose of cyclophosphamide should be 15 mg/kg (or 0.6-0.75 g/m2 body surface) IV monthly:

Multicomponent treatment regimens

The simultaneous use of glucocorticoids and cytostatics is considered more effective than glucocorticoid monotherapy. It is generally accepted to prescribe immunosuppressive drugs in combination with antiplatelet agents, anticoagulants - the so-called multicomponent regimens:

• 3-component regimen (without cytostatics): prednisolone 1 - 1.5 mg/kg/day orally for 4-6 weeks, then 1 mg/kg/day every other day, then reduced by 1.25-2.5 mg/week until cancellation + heparin 5000 IU 4 times / day for 1-2 months with a transition to phenindione or acetylsalicylic acid at a dose of 0.25-0.125 g / day, or sulodexide at a dose of 250 IU 2 times / day orally + Dipyridamole 400 mg /day orally or intravenously.
• Kinkaid-Smith 4-component regimen: prednisolone 25-30 mg/day orally for 1-2 months, then dose reduction by 1.25-2.5 mg/week until discontinuation + Cyclophosphamide 100-200 mg for 1 - 2 months, then half the dose until remission is achieved (cyclophosphamide can be replaced with chlorambucil or azathioprine) + Heparin 5000 units 4 times a day for 1-2 months with a transition to phenindione or acetylsalicylic acid, or sulodexide + Dipyridamole 400 mg/ days orally or intravenously.
• Ponticelli regimen: start of therapy with prednisolone - 3 days in a row at 1000 mg/day, the next 27 days prednisolone 30 mg/day orally, 2nd month - chlorambucil 0.2 mg/kg (alternating prednisolone and chlorbutine).
• Steinberg's regimen - pulse therapy with cyclophosphamide: 1000 mg IV monthly for a year. In the next 2 years - 1 time every 3 months. In the next 2 years - once every 6 months.

Antihypertensive therapy: captopril 50-100 mg/day, enalapril 10-20 mg/day, ramipril 2.5-10 mg/day

Diuretics - hydrochlorothiazide, furosemide, spironolactone

Antioxidant therapy (vitamin E), but there is no convincing evidence of its effectiveness.

Lipid-lowering drugs (nephrotic syndrome): simvastatin, lovastatin, fluvastatin, atorvastatin at a dose of 10-60 mg/day for 4-6 weeks, followed by a dose reduction.

Antiplatelet agents (in combination with glucocorticoids, cytostatics, anticoagulants; see above). Dipyridamole 400-600 mg/day. Pentoxifylline 0.2-0.3 g/day. Ticlopidine 0.25 g 2 times a day

Plasmapheresis in combination with pulse therapy with prednisolone and/or cyclophosphamide is indicated for highly active chronic glomerulonephritis and lack of effect from treatment with these drugs.

Surgery. Kidney transplantation is complicated in 50% by graft relapse, and in 10% by graft rejection.

Treatment of individual morphological forms

Mesangioproliferative chronic glomerulonephritis

With slowly progressing forms, incl. with IgA nephritis, there is no need for immunosuppressive therapy. With a high risk of progression - glucocorticoids and/or cytostatics - 3- and 4-component regimens. The effect of immunosuppressive therapy on long-term prognosis remains unclear.

Membranous chronic glomerulonephritis

Combined use of glucocorticoids and cytostatics. Pulse therapy with cyclophosphamide 1000 mg IV monthly. In patients without nephrotic syndrome and normal function kidneys - ACE inhibitors.

Membranoproliferative (mesangiocapillary) chronic glomerulonephritis

Treatment of the underlying disease. ACE inhibitors. In the presence of nephrotic syndrome and decreased renal function, therapy with glucocorticoids and cyclophosphamide with the addition of antiplatelet agents and anticoagulants is justified.

Chronic glomerulonephritis with minimal changes

Prednisolone 1 - 1.5 mg/kg for 4 weeks, then 1 mg/kg every other day for another 4 weeks. Cyclophosphamide or chlorambucil if prednisolone is ineffective or cannot be discontinued due to relapses. For ongoing relapses of nephrotic syndrome - cyclosporine 3-5 mg/kg/day (children 6 mg/m2) for 6-12 months after achieving remission.

Focal segmental glomerulosclerosis

Immunosuppressive therapy is not effective enough. Glucocorticoids are prescribed for a long time - up to 16-24 weeks. Patients with nephrotic syndrome are prescribed prednisolone 1 - 1.2 mg/kg daily for 3-4 months, then every other day for another 2 months, then the dose is reduced until discontinuation. Cytostatics (cyclophosphamide, cyclosporine) in combination with glucocorticoids.

Fibroplastic chronic glomerulonephritis

In case of a focal process, treatment is carried out according to the morphological form that led to its development. The diffuse form is a contraindication to active immunosuppressive therapy.

Treatment by clinical forms carried out if it is impossible to perform a kidney biopsy.

• Latent form of glomerulonephritis. Active immunosuppressive therapy is not indicated. For proteinuria >1.5 g/day, ACE inhibitors are prescribed.
• Hematuric form of glomerulonephritis. Inconsistent effect of prednisolone and cytostatics. For patients with isolated hematuria and/or slight proteinuria, ACE inhibitors and dipyridamole.
• Hypertensive form of glomerulonephritis. ACE inhibitors; target blood pressure level is 120-125/80 mm Hg. During exacerbations, cytostatics are used as part of a 3-component regimen. Glucocorticoids (prednisolone 0.5 mg/kg/day) can be prescribed as monotherapy or as part of combination regimens.
• Nephrotic form of glomerulonephritis - indication for a 3- or 4-component regimen
• Mixed form - 3- or 4-component treatment regimen.