Inflammation of the kidneys and upper tract may be acute or chronic. Acute or chronic inflammatory disease resulting from infection may involve the kidneys and upper Urinary tract (pyelonephritis) or the bladder and lower tract (cystitis).
Onset of disease based on the ground of acute bacterial and viral infections.
Diagnostic clinical criteria
Disuria-frequent and painful urinations
Painful syndrome-Lumbar region pains are present in the majority of school age children
The temperature, as a rule, is febrile or subfebrile.
Urinary syndrome consists of leucocyturia, normal or elevated diuresis, monotonous, decreased specific gravity of the Urine in different portions. Urine inoculation-positive in 85% of cases.
Edematic syndrome is absent
Hypertension is not typical
Syndrome of intoxication-weakness, indisposition, bad appetite, loss of weight, vomiting, toxicosis, exicosis.
Main indices of renal function are normal. Morphologic changes of kidneys are primary lesion of interstitial renal tissue.
Acute poststreptococcal glomerulonephritis
Glomerulonephritis is an infectious allergic renal disease with primary lesions of glomerulus.
Diagnostic clinical criteria
Extra-renal symptoms, Edema, Arterial hypertension, and Renal symptoms such as
1. `Oliguria and anuria are present in the initial period of acute glomerulonephritis, in this case Urine has high specific gravity (1.030-1.040 and more).
2. Hematuria of different degree-microhematuria and macro-hematuria.
3. Proteinuria: moderate
4. Leucocyturia: moderate
5. Leucocyturia- is not typical for glomerulonephritis; may be transitory leucocyturia of lymphoid character
6. Cylindruria- hyaline, epitherlial, granular, waxy casts.
Nephrotic syndrome: massive proteinuria, hypoproteinemia, hyperlipidemia, hypercholesterolemia, edemas.
Nephrytic syndrome: hypertension, hematuria, moderate proteinuria, edemas.
Acute renal failure (ARF)
ARF is an acute impairment of renal functions. When the kidneys suddenly are unable to regulate the volume and composition of Urine appropriately in response to food and fluid intake and the needs of the organism.
Diagnostic criteria: There are prerenal, renal and posternal (obstructive) ARF. The principal features is oligoanuria associated with rised levels of serum nitrogen, acidosis, and diverse electrolyte disturbances. ARF is not common in childhood, but the ourcome depends on the cause, associated findings, and prompt recognition and treatment.
The terms:"nitrogenemia" and "Uremia" are often used in relation to renal failure. Nitrogenemia is the accumulation of nitrogenous waster within the blood. Uremia is a more advanced condition in which retention of nitrogenous products produces toxic symptoms. Nitrogenenia is not life threatening, whereas Uremia is a serious condition that often involves other body systems.
Important causes of ARF
Prerenal (decreased perfusion)
1. acute gastroenteritis (vomiting, diarrhea, nasogastric tubes).
2. Acute anemia (hemolytic crisis, including sickle cell crisis)
3. shock
4. congestive heart failure
Renal;
1. Acute tubular necrosis;
Fluid loss, hemorrhage, shock
Intravascular hemolysis
Sepsis
Nephrotoxic drugs, chemical radiocontrast substances
Major surgical procedures, road accidents, extensive burns
Hepatic failure, congestive cardiac failure
2. Glomerular diseases;
Acute glomerulonephritis
Hemolytic uremic syndrome
3. Interstitial nephritis
4. Acute bacterial pyelonephritis
5. Miscellaneous
Snakebite
Renal vein thrombosis
Post renal (obstructive): calculus, blood dots, crystals of Uric acid, sulphonamides.
