avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2020-10-3-198-208avk-1056Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESСовременное состояние этиопатогенетических, морфологических, диагностических и терапевтических аспектов острого гломерулонефритаEtiopathogenetic, Morphological, Diagnostic and Therapeutic Aspects of Acute Glomerulonephritis: Current Statushttps://orcid.org/0000-0001-8513-9279МуркамиловИ. Т.MurkamilovI. T.

Илхом Торобекович Муркамилов

Бишкек

Ilkhom T. Murkamilov

Bishkek

murkamilov.i@mail.ruhttps://orcid.org/0000-0002-8387-5800СабировИ. С.SabirovI. S.

Бишкек

Bishkek

https://orcid.org/0000-0002-2682-4417ФоминВ. В.FominV. V.https://orcid.org/0000-0002-7653-0433МуркамиловаЖ. А.MurkamilovaZh. A.

Бишкек

Bishkek

https://orcid.org/0000-0003-4973-039XАйтбаевК. А.AytbaevK. A.

Бишкек

Bishkek

Кыргызская государственная медицинская академия имени И.К. Ахунбаева; ГОУ ВПО Кыргызско-Российский славянский университетКыргызстанI.K. Akhunbaev Kyrgyz State Medical Academy; Kyrgyz Russian Slavic UniversityKyrgyzstanГОУ ВПО Кыргызско-Российский славянский университетКыргызстанKyrgyz Russian Slavic UniversityKyrgyzstanФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationНаучно-исследовательский институт молекулярной биологии и медициныКыргызстанResearch Institute of Molecular Biology and MedicineKyrgyzstan202031052020103198208Copyright © Муркамилов И.Т., Сабиров И.С., Фомин В.В., Муркамилова Ж.А., Айтбаев К.А., 20202020Муркамилов И.Т., Сабиров И.С., Фомин В.В., Муркамилова Ж.А., Айтбаев К.А.Murkamilov I.T., Sabirov I.S., Fomin V.V., Murkamilova Z.A., Aytbaev K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1056

В обзоре представлены современные сведения об этиологических факторах и патогенетических механизмах развития, морфологических изменениях, клинико-лабораторных проявлениях острого гломерулонефрита, а также терапевтических возможностях его лечения. Представлены эпидемиологические вопросы острого постстрептококкового гломерулонефрита, с указанием особенностей воздействия нефритогенных штаммов стрептококковой инфекции. Показаны иммунопатологические реакции организма при остром гломерулонефрите на возбудителя заболевания и его антигены с развитием дисбаланса субпопуляций Т-лимфоцитов, нефритогенного потенциала стрептококковых белков, маркера активной пролиферации мезангиоцитов, С3 и С4-фракций комплемента, а также ренин-ангиотензин-альдо-стероновой системы. В статье подчеркивается, что информативность серологических тестов при остром гломерулонефрите повышается при одновременной оценке С3 и С4 фракций комплементов сыворотки крови. Представлены патологические эффекты ангиотензина II и альдостерона на почечную ткань с хронизацией острого гломерулонефрита, развитием протеинурии нефротического уровня и быстрым снижением почечной функции. Показаны данные прямой корреляционной связи между выраженностью гистологических изменений и клиническими проявлениями острого гломерулонефрита и, возможно, прогнозом. Представлены современные данные оценки основных клинических проявлений острого гломерулонефрита (мочевой синдром, отечный синдром и артериальная гипертензия). При обсуждении вопросов терапии острого гломерулонефрита, отмечены спорные вопросы использования антибиотикотерапии, профилактической тон-зиллэктомии. Представлены данные литературы о возможностях терапии отечного синдрома и артериальной гипертензии с использованием тиазидных и петлевых диуретиков, антагонистов кальция, бета-адреноблокаторов, ингибиторов ангиотензин превращающего фермента, блокаторов рецепторов ангиотензина II. Обсуждены вопросы иммуносупрессивной терапии с использованием глюкокортикоидов, а также прогностические критерии острого гломерулонефрита.

The review provides up-to-date information on the etiological factors and pathogenic mechanisms of development, morphological changes, clinical and laboratory manifestations of acute glomerulonephritis, as well as therapeutic possibilities for its treatment. The review provides up-to-date information on the etiological factors and pathogenetic mechanisms of development, morphological changes, clinical and laboratory manifestations of acute glomerulonephritis, as well as therapeutic possibilities for its treatment. The epidemiological issues of acute post-streptococcal glomerulonephritis are presented, indicating the characteristics of the effects of nephritogenic strains of Streptococcal infection. The immunopathological reactions of the body in acute glomerulonephritis to the causative agent of the disease and its antigens with the development of an imbalance of subpopulations of T-lymphocytes, the nephritogenic potential of streptococcal proteins, a marker of active proliferation of mesangiocytes, C3 and C4 fractions of complement, and also the renin-angiotensin-aldosterone system are shown. The article emphasizes that the informational content of serological tests in acute glomerulonephritis increases while assessing the C3 and C4 fractions of serum complement. The pathological effects of angiotensin II and aldosterone on the renal tissue with the chronization of acute glomerulonephritis, the development of nephrotic proteinuria and a rapid decrease in renal function are presented. The data of a direct correlation between the severity of histological changes and the clinical manifestations of acute glomerulonephritis, possibly the prognosis, are shown. Presented are modern data on the assessment of the main clinical manifestations of acute glomerulonephritis (urinary syndrome, edema syndrome and arterial hypertension). When discussing the treatment of acute glomerulonephritis, the controversial issues of the use of antibiotic therapy, preventive tonsillectomy are noted. The literature data on the treatment options for edematous syndrome and arterial hypertension using thiazide and loop diuretics, calcium antagonists, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers are presented. The issues of immunosuppressive therapy using glucorticoids, as well as prognostic criteria for acute glomerulonephritis are discussed.

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