Kidney rheumatism

Recognized is the idea that the basis of renal pathology in rheumatoid arthritis is the defeat of the cardiovascular system, kidneys, first of all its capillary link. This position is well-grounded as clinical research with special functional tests, and the results histomorphological and electron-microscopic studies of materials biopsy and autopsy.
Information on the relative weight of renal lesions among other localizations active rheumatism are very contradictory. For example, on summary statistics S. M. Apelsinoviy (1967), kidney damage in rheumatoid arthritis was noted in 3-22%, according to Century A. Sumarokov and S. O. Androsove (1972) - 4-57% of patients. The latter authors examined 280 patients with rheumatism, found glomerulonephritis in 7% of patients, thus reflecting the experience of the clinic of Nephrology bias. The frequency of kidney failure in patients with rheumatism, being on treatment in General medical or rheumatic hospital, is from 0.67 (E. M. Tareev, 1958) to 1% (by A. I. Nesterov, 1973). However, all the authors note that at showdown kidney damage is detected in 2-242 times more often than in the clinic, and D. A. Graziano (1955) found jade, principally focus, in 30 out of 35 cases.
You can agree with the opinion Century A. Sumarokov and S. O. Androsove (1972)that the diversity of statistical data due to the lack of clear criteria for the diagnosis of rheumatic glomerulonephritis, so in this category include febrile proteinuria acute phase of the disease and other transient changes associated with infectious pathology. Above we have already pointed out the high frequency of such a nature and chronic kidney disease detected by electron microscopic study bioperegnoy tissue.
Morphological substrate of rheumatic affection of kidneys is a vascular pathology. So in. A. Serov (1958) in the active phase of rheumatoid arthritis have discovered a widespread change of blood vessels, increasing permeability. Inflammatory changes related both to the main stem of the renal artery and its branches, however, were hit especially hard lobular artery and bring the vessels of the glomeruli. In these arteries prevailed sclerotic changes, the severity of which was related to the number of rheumatic attacks. These studies as carried out in recent years in vivo studies of the kidneys in primary acute rheumatic fever (Grishman et al., 1967; Cohen et al., 1971), show that the most frequent form itself rheumatic affection of kidneys is the focal glomeruli that, recurring every rheumatic fever, may progress to diffuse glomerulonephritis with outcomes in the withered kidney (Century A. Sumarokov, S. O. Androsov, 1972).
When treating a patient with rheumatoid arthritis, the Clinician should keep in mind that renal pathology is not limited to the above forms. Acute primary rheumatism with a degree in this period of streptococcal infections and strep sensitization occurs (and this is shown morphologically) acute infectious defeat by type transient infectious jade (infectious kidney, E. M. Tareeva). On the other hand, severe heart failure is often observed the development of congestive kidneys, while certainly play a role in vascular sclerotic processes along with hemodynamic disturbances. So important is, obviously, not always take into account the fact that, at different stages of development of rheumatic process with its differences in the nature of the flow, activity, the degree of autoimmune disorders, circulatory disorders can be detected diverse manifestations of renal pathology in many different combinations. In particular, our observations in the clinic of the Institute of rheumatism AMS of the USSR was established that in patients with acute period and the maximum activity of rheumatism at the height of ekssoudativeh attacks frequently detected short proteinuria, quickly disappearing erythrocyturia and relatively rarely cylindruria. Other correlations between kidney and other forms of visceral pathology observed in the group of patients with persistent and particularly with the ever-recurrent versions of current rheumatism. They described different ways flow of glomerulonephritis: most often the focal manifested persistent urinary syndrome (proteinuria), less diffuse glomerulonephritis, until the development of nephrotic syndrome. It must be emphasized that the symptoms of kidney failure in specified clinical group as the disease progresses be quite logical. The presence of persistent urinary syndrome with persistent proteinuria and microhematuria becomes one of the standard features of the clinical picture in such patients. While the exact nature of renal pathology in these cases it is usually necessary to differentiate inflammatory lesions of the syndrome of congestive kidneys that can be difficult. Difficulties stem from the fact that long-term changes in the kidneys, in addition to oliguria, nocturia, reduction in renal blood flow and glomerular filtration, accompanied nerezko expressed proteinuria, appearing in urine sediment small number of leukocytes, erythrocytes, sometimes hyaline cylinders. When the inherent rheumatism hypotension significant increase in blood pressure may not be detected at all and when glomerulonephritis. Does not help in the diagnosis and presence of edema, which in such cases can be symptoms of heart failure. For both processes similar nature and severity often and urinary syndrome, and the results of some functional tests. All this, of course, complicates the diagnosis of rheumatic glomerulonephritis. The differential diagnosis, however, it is necessary to consider a lower resistance of urinary syndrome in patients with congestive Bud: it often disappears completely under the influence of cardiac and diuretic therapy. With glomerulonephritis, on the contrary, the more effective are Antirheumatic drugs. Uncommon congestive kidney and expressed erythrocyturia, the decrease of the concentration function.
Among the reasons for changes in urinary sediment with active rheumatoid arthritis should be called as rheumatic thrombovascular and heart attacks, kidney, often when prolonged, continuous recurrent variants of flow. According to A. I. Strukova (1959), A. I. of Gritsyuk (1973), heart attacks, kidney find at showdown in more than 1/3 of cases.
In addition to these changes, it is a rare renal amyloidosis. For example in. A. Serov and I. A. Shamov (1977) 232 monitoring of amyloidosis was diagnosed with rheumatism only one patient.
Thus, erased, low manifestation symptoms of rheumatic inflammation of the kidneys, and the developing normally in the final stage of rheumatism on the background of severe cardiac pathology that is the reason that clinically rheumatic glomerulonephritis is diagnosed is many times less than the postmortem. Rheumatic glomerulonephritis, complicating usually the most severe clinical forms of rheumatic process, should attract attention for its timely diagnosis and persistent therapy primarily Antirheumatic means.