Pregnancy with chronic glomerulonephritis
Introduction
Introduction to pregnancy with chronic glomerulonephritis Primary glomerulonephritis is a primary renal disease characterized by bilateral renal glomerular lesions. Acute glomerulonephritis (acute nephritis) is associated with streptococcal infection, chronic glomerulonephritis (chronic Nephritis can be developed from acute nephritis, but most chronic nephritis is the beginning, not from acute nephritis. Women with glomerulonephritis have a heavier burden on the kidneys during pregnancy, which affects kidney function. In severe cases, the life of pregnant women and fetuses is often endangered. Patients with mild illness are often confused with pregnancy-induced hypertension syndrome, and lack of due attention to delay the disease. basic knowledge The proportion of sickness: 0.00251% Susceptible population: pregnant women Mode of infection: non-infectious Complications: hypertension, anemia, fetal growth restriction, premature delivery
Cause
Pregnancy with chronic glomerulonephritis
(1) Causes of the disease
The clear cause has not been confirmed, but it is speculated that it is related to infection, especially virus infection. It is reported that there is contact with gasoline and hydrocarbon (hydrocarbon) compounds before the disease, so it is considered that these chemicals and/or viruses may be pathogenic factors. .
(two) pathogenesis
It has been recognized that the principle of kidney disease is the immune response process against the basement membrane antibody type nephritis. Due to certain pathogenic factors, the primary lesions of the alveolar septum and the pulmonary capillary basement membrane, the latter stimulate the body to produce anti-lung basement membrane antibodies, in complement, etc. Under the action, a series of immune responses to alveolar cells are caused. Because of the cross antigen between the alveolar wall basement membrane and the glomerular basement membrane, the endogenous anti-lung basement membrane antibody can react with the glomerular basement membrane to damage the glomerulus. .
The pathological changes of chronic glomerulonephritis vary with the etiology, course and type, and can be expressed as diffuse or focal segmental mesangial proliferation, membrane proliferation, membranous, microscopic lesions, focal sclerosis, advanced glomerular fibrosis Or can not be shaped, in addition to glomerular lesions, may be associated with varying degrees of renal interstitial inflammation and fibrosis, renal interstitial damage aggravated renal dysfunction, advanced glomerulonephritis, renal cortical thinning, glomerular capillaries The sputum shrinks and develops into glassy or fibrotic, and the residual glomeruli can be compensated for increase, and the tubular atrophy.
Prevention
Pregnancy with chronic glomerulonephritis prevention
1, to avoid infection, fatigue and other factors that aggravate the condition.
2. Strictly control the diet to ensure adequate nutrition.
3. Actively control and treat complications.
4. Use drugs that are nephrotoxic and susceptible to kidney damage with caution or exemption.
5, the use of traditional Chinese medicine treatment, according to the patient's condition, syndrome differentiation and treatment, legislation and medicine, using traditional Chinese medicine to improve and delay the progress of kidney failure.
6, do a good job in the kidneys during pregnancy.
Complication
Pregnancy with complications of chronic glomerulonephritis Complications, hypertension, anemia, fetal growth restriction, premature delivery
If the blood pressure is high or medium, the incidence of complication during pregnancy is increased from 40% to 80%, mainly due to severe hypertensive disorder complicating pregnancy, fetal growth restriction and anemia. The preterm birth rate is increased from 57% to 100%. %, the perinatal mortality rate is 100.
Symptom
Pregnancy with chronic glomerular neuritis symptoms Common symptoms Proteinuria nephrotic syndrome urinary urinary hemorrhagic edema during pregnancy
The clinical manifestations of this disease can be varied, from asymptomatic proteinuria or microscopic hematuria to obvious gross hematuria, edema, anemia, hypertension or nephrotic syndrome, and even uremia.
According to the main performance, it can be classified as follows:
Normal type
Onset can be similar to acute nephritis, edema, hematuria and high blood pressure are very obvious, after the disease temporarily relieved, or progressive deterioration, most patients can be asymptomatic when onset, after the examination of urine was found this disease, urine Most of the protein is below 3.5g/24h; there are often red blood cells in the urine, even a little tube type; although the blood pressure is elevated, it is not the main performance.
2. Kidney disease type
The pathological changes of this disease are mainly based on basement membrane hyperplasia. The patients have significant proteinuria and caste and edema. The daily output of urinary protein is above 3~3.5g, the plasma protein is decreased, the ratio of albumin to globulin is inverted, and cholesterol is present. Raise.
3. Hypertension
Proteinuria can be small, accompanied by high blood pressure, blood pressure often continues to rise, clinical manifestations are very similar to essential hypertension (also known as hypertension).
Kaplan is classified into 3 types according to the severity of clinical manifestations: Type I only has proteinuria. Type II has proteinuria and high blood pressure. Type III also has proteinuria, hypertension and nitrogen retention.
Examine
Pregnancy with chronic glomerulonephritis
Urine routine examination
Often in the pre-pregnancy or 20 weeks before pregnancy, there is proteinuria and the disease is found. In the kidney disease type, the most urinary protein, in the late stage of chronic nephritis, the majority of the glomerulus is destroyed, and the protein leakage is gradually reduced, so less urine protein does not necessarily indicate the disease. The improvement of the urinary protein can not be used as a standard for induction of labor. Healthy kidneys should be able to concentrate to make the urine specific gravity reach 1.020 or more. In the late stage of chronic nephritis, due to the decrease in concentration and dilution, the urine specific gravity is fixed at 1.010 or so. Different degrees of severity, how many red and white blood cell casts appear in the urine.
2. Blood routine
Chronic nephritis due to massive loss of protein and destruction of renal parenchyma, reducing renal erythropoietin, so often accompanied by anemia, is a normal hemoglobin and red blood cell anemia, chronic renal insufficiency accompanied by anemia is difficult to treat, should be a small number of multiple blood transfusions .
3. Determination of renal function
In the early stage of the disease, renal function is less affected. In the late stage, various renal functions such as phenol red test, endogenous creatinine and urea clearance, ie, concentration and dilution function, have different degrees of decline.
4. Fundus examination can show bleeding, exudation and typical retinitis associated with nephritis, mild chronic nephritis, fundus examination can be normal.
5. Renal biopsy In some hospitals in China, kidney biopsy is performed during pregnancy. This is helpful for definitive diagnosis and understanding of the extent of the disease. However, during the pregnancy, the opinions of various scholars are different. The main concern is biopsy. Not only does it have more harm than good.
Diagnosis
Diagnosis and differential diagnosis of pregnancy complicated with chronic glomerulonephritis
diagnosis
Chronic nephritis is more common in young women. In the past, there was a history of acute or chronic nephritis. The symptoms were mainly proteinuria, or accompanied by edema and hypertension. It was more common in 20 weeks before pregnancy, so the diagnosis was not difficult.
Differential diagnosis
If there is a lack of reliable history of nephritis, or the gestational examination has reached the late stage of pregnancy, it must be differentiated from pregnancy-induced hypertension, chronic nephritis with pregnancy-induced hypertension, pyelonephritis, essential hypertension and orthostatic proteinuria.
Pregnancy-induced hypertension
The disease occurs after 20 weeks of gestation, no edema before pregnancy, a history of proteinuria, edema first after onset, hypertension and proteinuria occur later, without obvious abnormal urine sediment, 6 weeks to 3 postpartum More months return to normal.
2. Pyelonephritis
The amount of urinary protein in pyelonephritis is generally 1 ~ 2g / 24h, if > 3g / 24h, it is mostly glomerular lesions, urine routine examination of pyelonephritis is mainly white blood cells, sometimes white blood cell cast, and glomerulonephritis More red blood cells can be found, sometimes red blood cell casts, urinary bacterial culture positive in pyelonephritis, and low fever, frequent urination and other symptoms can help identify.
3. Essential hypertension
The disease has a high incidence after 40 years old, and the disease develops slowly. In the early stage of hypertension, there is no protein, tube type and blood chemical changes in the urine, no renal dysfunction, and fundus examination is often based on arteriosclerosis.
4. Postural (upright) proteinuria
It can occur in 3% to 5% of young people. When standing upright or lordosis, there are more chances. It may be related to renal venous congestion. The urine protein of this disease generally does not exceed 1g/d, and there is no urine sediment abnormality. Hypertension, supine can reduce or disappear the proteinuria, and collect urine specimens before the morning to get up, can be identified.
