Subscribe
Acute glomerulonephritis
Is acute nephritis prone to "excessive internal heat"?
Acute nephritis indeed tends to cause "fire-up," which refers to the viral infection in patients. Typically, the appearance of herpes on the upper lip is colloquially known as "fire-up," but in reality, this is an active manifestation of the herpes virus when the body's immune capacity is low. The human body often carries this virus, and symptoms appear when immunity is low. In the state of acute nephritis, it is easy to result in reduced immunity in patients, thus activating the dormant virus in the body, causing herpes in corresponding areas including the upper lip and corners of the mouth.
Acute nephritis etiology and pathogenesis
The primary cause of acute nephritis is related to antigen-antibody mediated immune damage. This means that when patients with acute nephritis are infected by streptococci, certain components within the streptococci can act as antigens and bind to corresponding antibodies produced in the body, forming immune complexes. These immune complexes circulate through the bloodstream and eventually deposit in the glomeruli. When the complement system is activated, inflammatory cells infiltrate, ultimately leading to the development of acute nephritis. Acute nephritis is a common group of primary glomerular diseases, characterized by a sudden onset, with hematuria, reduced urine output, proteinuria, edema, and hypertension as its most significant features. Once acute nephritis occurs, bed rest is usually required, along with active treatment. After treatment, most patients with acute nephritis can recover fully, with few recurrences.
Acute nephritis clinical manifestations
Acute nephritis is commonly seen in pediatric patients. One to three weeks before the onset of acute nephritis, infections often occur in the throat, upper respiratory tract, and skin. Once acute nephritis occurs, the typical clinical manifestations of the patient are hematuria, which can be gross hematuria or microscopic hematuria. There is also edema, especially noticeable swelling of the eyelids and face after getting up in the morning. Due to the edema and reduced urine output, the patient often experiences a significant increase in blood pressure. Of course, in addition to these clinical manifestations, the patient may also experience irritability, back pain, nausea, loss of appetite, and poor spirit. Patients with acute nephritis can also experience severe complications, such as hypertensive encephalopathy, acute heart failure, acute renal failure, etc. Therefore, acute nephritis must be given sufficient attention and actively treated.
Does acute nephritis cause fever?
Acute nephritis is actually a sterile inflammation, with significant proliferation of cells within the glomeruli, primarily related to immune dysfunction. Therefore, from this perspective, acute nephritis does not show symptoms of fever. However, due to the inflammatory response within the glomeruli causing acute nephritis, patients may experience renal failure. In the state of renal failure, the patient's immune capability further decreases, which could lead to complications from infections, with respiratory infections being the most common, including pneumonia, bronchitis, and acute tonsillitis. These inflammations may cause fever, but this fever is not a direct result of the acute nephritis itself.
Causes of Anemia in Acute Nephritis
Patients with acute nephritis often do not experience anemia. If a patient with acute nephritis develops anemia, further examination is necessary to determine whether rapidly progressive glomerulonephritis is present. The mechanisms of anemia include hemorrhagic anemia, anemia due to the destruction and dissolution of red blood cells, and anemia due to decreased bone marrow hematopoietic capacity. Hemorrhagic anemia is commonly seen in cases of excessive menstrual flow or chronic blood in stools, which can occur in conditions such as liver cirrhosis, gastric ulcer, enteritis, and intestinal cancer. Anemia resulting from the breakdown of red blood cells often occurs in cases of splenomegaly or when the body produces antibodies against red blood cells, leading to autoimmune hemolysis. A decrease in bone marrow hematopoietic capacity is typically seen in related diseases such as leukemia, myeloma, or renal anemia, or when the patient's dietary intake of nutrients is insufficient, leading to reduced bone marrow hematopoietic capacity. Overall, for acute nephritis, if anemia occurs, it is important to identify the cause, which may not be closely related to acute nephritis itself.
Symptoms of acute nephritis include back pain.
Patients with acute nephritis usually have hematuria as their main symptom. Initially, the condition presents as gross hematuria, but within 1-2 days, the patient transitions to microscopic hematuria, and the gross hematuria disappears. Patients may also experience edema, particularly noticeable in the eyelids and facial area upon waking up in the morning, along with varying degrees of increased urine protein. Typically, acute nephritis patients may also experience nausea, vomiting, abdominal distension, and discomfort in the lower back, but not back pain per se, as back pain is not a symptom of acute nephritis. However, if a patient with acute nephritis does develop back pain, it is crucial to rule out other diseases, such as kidney stones, ureteral stones, acute pyelonephritis, and acute renal infarction, all of which can cause sudden back pain in patients with acute nephritis. Back pain should be taken seriously, and appropriate exams, such as an immediate ultrasound, should be conducted.
What to do if acute nephritis worsens?
Typically, after two to three weeks of treatment, the condition of most patients with acute nephritis can recover. However, if the condition of acute nephritis worsens, patients should return to bed rest and adopt different treatment methods based on their clinical symptoms. If the patient presents with edema, it is essential to maintain a low-salt diet, with daily salt intake less than 2-3 grams. Additionally, the patient's blood pressure must be addressed. If there is a significant rise in blood pressure, it is advisable to start with a low dose of diuretics, which can facilitate urination, fluid excretion, and lower blood pressure. If blood pressure control is inadequate, calcium channel blockers should be considered. Moreover, if a patient with acute nephritis develops acute renal failure, dialysis treatment may be necessary; similarly, if acute heart failure occurs, medications to control blood pressure and dilate blood vessels should be used to reduce the cardiac workload, thereby facilitating recovery from acute nephritis. (Specific medications should be used under the guidance of a physician.)
Acute nephritis pathological characteristics
The changes in acute nephritis are characterized by diffuse intracapillary proliferative glomerulonephritis, and the main structures in the kidney are the glomeruli, renal tubules, and renal interstitium. Therefore, pathological examination can be divided into light microscopy, immunofluorescence, and electron microscopy examinations. Under light microscopy, the pathological changes in acute nephritis mainly include proliferation of mesangial and endothelial cells in the glomeruli. In the acute phase, there is significant infiltration of neutrophils and mononuclear cells. Masson's trichrome staining can reveal subepithelial immune complex deposits, and there is also edema and infiltration of inflammatory cells in the interstitium; Immunofluorescence examination shows diffuse coarse granular deposits of immune complexes along the capillary walls and in the mesangial areas, mainly composed of IgG and C3; Under electron microscopy examination, there are hump-like electron-dense deposits beneath the epithelial cells.
Early symptoms of acute nephritis
The occurrence of acute nephritis is related to streptococcal infections and is commonly seen in children. Typically, 1-3 weeks before the onset of acute nephritis, patients often have a history of infections in the throat, upper respiratory tract, or skin. Once acute nephritis occurs, the initial symptoms include hematuria, which can manifest as either gross or microscopic hematuria. There is also the appearance of edema, especially noticeable swelling of the eyelids and facial area upon waking up in the morning, and even a decrease in urine output. Additionally, patients with acute nephritis often experience increased foam in the urine, indicating the presence of proteinuria, as well as general weakness, back pain, nausea, and vomiting. After the onset of acute nephritis, some patients may experience elevated blood pressure and even transient renal failure.
post-acute nephritis sequelae
Acute nephritis is a self-limiting disease, and most patients can fully recover, so the vast majority of patients generally start to show improvement in routine urine tests three to four weeks after onset, with normal kidney function and resolution of edema, resulting in few, if any, sequelae. Of course, a small number of patients may experience prolonged unhealed conditions that can progress to chronic nephritis. These patients may then develop complications, including hypertension and renal anemia, which are long-term potential issues. However, the vast majority of patients with acute nephritis do not experience complications or sequelae.