What is Focal Nephritis?
Focal nephritis – infectious non-purulent inflammatory nesting diseases of the kidneys, manifested only by changes in the composition of urine. Men are more often sick, people of a young age (20-30 years) predominate.
Pathogenesis during Focal Nephritis
This is a non-purulent lesion of part of the glomeruli of the kidneys, the development of which is possible with general infections, with an exacerbation of the process in chronic infectious foci, due to embolism in acute septic endocarditis.
According to E. M. Tareev and several other authors, focal nephritis differs from diffuse nephritis in the following features:
- arises interinfectious;
- due to direct bacterial exposure, only a part of the glomeruli is affected, not all loops are changed in the affected glomeruli;
- isolated urinary syndrome is the main clinical manifestation of the disease;
- the course of the disease is favorable.
It was noted that small amounts of anti-renal bodies can also be produced with focal nephritis. With significant activity of the infectious process, their number increases, which in the presence of altered immune reactivity of the body can lead to a generalization of the process in the kidneys. Therefore, if infectious and toxic effects are repeated, the process from the focal can go into diffuse as a result of the summation of repeated nesting lesions, and as a result of the inclusion of immunoallergic mechanisms.
Macroscopically, the kidneys are usually little altered. In some cases, renal hemorrhages in the cortical substance are noted. In histological studies, not all loops are affected in the changed glomeruli. In the affected areas, both endo- and extracapillary proliferation are observed, the basement membrane is often swollen, hyalinization and fibrinoid necrosis are less common.
Symptoms of Focal Nephritis
The main complaint of patients is pain in the lumbar region, in rare cases, macrohematuria. When examining changes from the internal organs may not be noted. The symptom of Pasternatsky is positive on the one hand. Palpation of the affected kidney may result in soreness. The most characteristic for focal nephritis are changes in the urine: protein-microhematuria, less commonly, cylindruria. These changes may appear during an infectious disease. There is no correspondence between the severity of infection and the severity of urinary syndrome. Usually, symptoms of a general or focal infection come to the fore, so only a urinalysis can detect kidney damage.
E. M. Tareev and other clinicians distinguish three main clinical forms of focal nephritis: acute, recurrent, chronic.
The acute form of focal jade is characterized by the appearance of lower back pain, changes in the urine. In rare cases, macrohematuria is possible, which after 1-2 days passes into microhematuria. When the underlying disease is cured, complete recovery usually occurs. Rarely, the disease becomes recurrent and chronic.
The recurring form of focal nephritis is characterized by periodic “attacks” of hematuria that appear during outbreaks of focal infection. The chronic form of focal nephritis is manifested by a long, stable microhematuria, proteinuria, often cylindruria in the absence of impaired renal function.
Diagnosis and differential diagnosis. It is most difficult to distinguish between recurrent and chronic forms of focal nephritis from the latent form of primary diffuse chronic nephritis. In favor of the latter indicates the presence of extrarenal symptoms: arterial hypertension, edematous syndrome, impaired renal function. The most reliable data can be obtained with a puncture biopsy of the kidneys. In the differential diagnosis of focal nephritis with a latent form of pyelonephritis, leukocyturia, bacteriuria, changes in the renal pelvis and calyx, and the presence of Terngamer-Malbin cells speak in favor of the latter.
In acute forms, it is favorable, especially when radical sanitation of foci of infection is possible. With recurrent and chronic forms of focal nephritis, when it is not possible to establish its connection with the infectious process, the prognosis is less favorable. However, in these cases, focal nephritis can be completely cured. Rarely, there is a transition of these forms of focal nephritis to chronic diffuse nephritis.
Treatment of Focal Nephritis
A sodium chloride-restricted diet rich in vitamins and potassium salts is recommended. Heavy physical labor, hypothermia are contraindicated. For hematuria, calcium chloride, rutin, ascorbic acid are recommended; with increased fibrinolysis, epsilonaminocaproic acid has a good effect, 2-3 g 4 times a day for 5 days with repeated courses. Corticosteroids are recommended to be prescribed in the absence of active foci of infection with short courses only with a recurring or chronic form of focal nephritis, when a membranous or membrane-proliferative process is noted in patients.