5. Acute nephritic syndrome (acute glomerulonephritis)
REASONS: violation of glomerular filtration due to an infectious allergic process, damage to the basement membrane of glomerular capillaries with the development of syndromes of arterial hypertension, edematous and urinary.
SYMPTOMS.
Complaints: swelling on the face, lower limbs, headache, dizziness, noise in the head, shortness of breath, discoloration of the urine (in the form of "meat slop"), a decrease in the daily amount of urine.
Examination: pale edematous face, swelling on the legs.
Palpation: apical impulse displaced to the left, strengthened, high, diffuse; the pulse is firm, intense.
Percussion: displacement of the left border of the relative dullness of the heart to the left.
Auscultation: accent II tone in the second intercostal space on the right.
Blood pressure: increased, especially diastolic.
ECG: signs of left ventricular overload.
Blood test: hypoproteinemia, dysproteinemia (an increase in the content of α2 - and γ - globulins), azotemia.
Urinalysis: oliguria, color of "meat slops", hyperstenuria, hematuria, cylindruria, cells of the renal epithelium.
Reberg test: reduced glomerular filtration.
Chronic nephritic syndrome (chronic glomerulonephritis)
CAUSES.
Chronic nephritic syndrome accompanies diseases of various etiologies, characterized by
diffuse sclerosis of the glomeruli of the kidneys and leading to chronic renal failure.
Chronic nephritic syndrome usually develops against the background of focal or segmental sclerosis of the kidney, membranous or membranous - proliferative glomerulonephritis.
SYMPTOMS.
Complaints: often patients have subjective complaints at the beginning of the development of the syndrome. In more severe cases, signs of uremia can be detected - nausea, vomiting, shortness of breath, itchy skin, increased fatigue.
Laboratory and instrumental manifestations: proteinuria, cylindruria, hematuria and arterial hypertension. In the general analysis of urine in patients, proteinuria, hematuria, erythrocyte and hyaline cylinders are detected. In the blood there is an increase in the level of urea and creatinine, anemia, signs of metabolic acidosis, hyperphosphatemia.
Diagnosis is by biopsy.
7. Edema syndrome (renal edema)
REASONS: hydremia, increased capillary permeability, hypoproteinemia, hyperaldosteronemia, increased hydrophilicity of tissues.
SYMPTOMS:
The speed of occurrence: first, hidden edema (McClure-Aldrich test), and after a few hours, days - obvious.
Edema first appears on the eyelids and face (Facies nephritica round, puffy, swollen face and eyelids, narrow eye slits), then on the abdominal wall and lower back, on the extremities. Up to the anasarca.
The swelling is pale, the skin is smooth, shiny.
Swelling is soft, like dough, easily displaceable.
Pic 5.1 renal edema