Acute nephritis

Etiology. Acute infections practically always precede the onset of acute nephritis. Diphtheria, measles, chicken-pox, suppurative lymph glands, chills, appendiceal abscess, or almost any infection in the body may be responsible for nephritis, but tonsillitis, septic sore throat, and otitis media are the main predisposing diseases.

Pathology. Acute glomerular nephritis is not merely a disease of the kidney, but may involve various systems of the body as well as the glomerulae tufts. The term "acute glomerular nephritis" is used, because the capillaries of the glomeruli are practically always the site of the initial lesion. The chief changes occurring in acute glomerular nephritis are swelling and disintegration of the endothelial cells which line the capillaries of the tufts. The process is a diffuse one involving all glomeruli in the tufts.

Symptoms. Following an acute infection, for example, an upper respiratory infection, the patient may develop the clinical picture of acute nephritis within a period of from two to eight days. The classical textbook picture of hematuria, hypertension, edema, and nitrogen retention is not always present; in fact, it seldom is. Only the rare cases present the typical well-known clinical features. More often the patient has only evidences of renal inflammation as shown by the urine examination. Albuminuria, red blood cells, pus cells, and casts in the urine are frequently the only signs, and are often overlooked if symptoms are absent. Edema, hypertension, and nitrogen retention may be present or absent. Disturbances of urination characterized by a scanty outflow of urine or even complete anuria may be present.

Hypertension is the most characteristic symptom. If hypertension makes its appearance and the blood pressure keeps rising little by little after the renal disease is in progress, this is a sign of unfavourable prognosis. Sometimes the blood pressure rises rapidly to 200/ 120 mm Hg. The eye fundus in these cases often shows evidences of the so-called albuminuric retinitis. This is a grave sign, though some of these patients do recover.

Edema is not an important syndrome unless it makes its first appearance after the disease is in progress for a week or two. Sometimes the edema is very mild and hardly recognized by the examining physician.

The rise in the nonprotein nitrogen is a sign of renal insufficiency. Frequently the rise is rapid in the early stages of acute anuria.

Exercise 4. Answer the questions:

1. What always precedes the onset of acute nephritis?

2. What are the main predisposing diseases?

3. Why is the term acute glomerular nephritis used?

4. Where is the site of the initial lesion?

5. What is the clinical picture of acute nephritis?

6. How are evidences of renal inflammation shown?

7. What are disturbances of urination characterized by?

8. What is sign of unfavourable prognosis?

Exercise 5. Find English equivalents to the following word combinations:

Початок захворювання, лімфатичні вузли, будь-яка інфекція, септичний фарингіт, різні системи організму, місце первинного ураження, симптом, що загрожує життю, набухання та розпад, велике залучення, відкладення азоту, незначний набряк, дифузний процес, підвищуватись, порушення виділення сечі, несприятливий прогноз, небілковий азот.

Дата добавления: 2015-11-16