Acute nephritis is a common kidney disease. It is a group of diseases characterized by acute onset, varying degrees of hematuria, proteinuria, edema, hypertension, oliguria, and transient egg massemia. There is often a pioneer infection, about 2 to 4 weeks before onset, and streptococcal infections are common. In addition, it is occasionally seen after infection with other bacterial or pathogenic microorganisms. Acute post-streptococcal nephritis is the most common, so this section focuses on this disease. Acute post-streptococcal infection nephritis (post streptococcal glomeru-lonephritis) is caused by infection with a group A nephritogenic strain of Streptococcus haemolyticus, which produces antibodies against the antigen and forms an antigen-antibody immune complex that is deposited in the glomerulus, leading to acute nephritis through complement activation and neutrophil involvement. Acute nephritis occurs. Diagnostic points I. Some cases have acute streptococcal or other pathogenic microbial infections, most of which develop 2-4 weeks after infection. Second, edema: often the first symptom of the onset of the disease, the milder cases are morning eyelid swelling, severe cases are widespread and generalized. Concavity is not obvious. Most patients diuretic swelling in 2~4 weeks by themselves. Hematuria Almost every case has hematuria (naked eye or microscopic deformed red blood cell urine), naked eye hematuria occurs about 40%, fresh urine specimens can be seen in the red blood cell tube type, a few days later turned to microscopic hematuria, usually a 5-6 months disappeared, but also can last 1~2 years before recovery. Fourth, most patients have oliguria. Hypertension: 80% of cases have it, mostly moderate [20.0~22.7kpa/12.7~14.7kpa (150~170/95~110mmHg)] often parallel to the degree of edema. VI. Urinary routine: proteinuria is mostly moderate (<3.5g/d). Fresh urine specimens can be seen as erythrocyte tubular pattern, along with granular tubular pattern and a few renal tubular epithelial cells. Seven, blood complement C3 decrease is the prominent feature, and it mostly returns to normal in 6-8 weeks of the disease. About 70~80% of patients have increased anti-O. 65% of patients have elevated blood urea nitrogen and creatinine, which may return to normal after diuresis. B-mode ultrasound: most of them show both kidneys enlarged. Nine, renal pathology: the typical manifestation is glomerular endothelial cell hyperplasia and swelling under light microscopy. Electron microscopy shows the deposition of subepithelial electron dense material forming hump-shaped. Differential diagnosis i. Acute exacerbation of chronic nephritis: symptoms mostly appear 3-5 days after infection, urine specific gravity may decrease, there may be varying degrees of anemia, and long-term hypertension causing cardiac and fundus changes." B" ultrasound shows that the kidneys can be small, and there may be persistent damage to renal function. II. IgA nephropathy: short incubation period, usually 1~3d after infection, or even hours after onset, with a history of recurrent attacks, serum immunoglobulin IgA may be elevated, and a definite diagnosis requires renal biopsy immunofluorescence to see IgA deposited in the glomerular thylakoid area in granular form. Treatment I. General treatment (a) Strict bed rest should be given until the disappearance of carnal hematuria, swelling subsides, and hypertension and azotemia return to normal. If the urine is not completely normalized, the activity can be gradually increased, and the patient should be seen regularly. (2) Diet should be rich in vitamins and low salt diet, if urine protein is not a large amount, there is no special requirement for protein intake. If the edema is heavy and the urine is low, the amount of water should be controlled, not more than the previous day's urine volume plus non-significant water loss (the previous day's urine volume + 500ml or so) per day. Symptomatic treatment (a) Diuretic: If edema is still obvious after controlling the amount of water and salt intake, diuretics should be added. (B) Hypotension: mild hypertension [diastolic blood pressure <12.7kpa (95mmhg)] can be used without hypotensive drugs. If diastolic blood pressure > 13.3kpa (100mmHg), antihypertensive drugs should be taken, generally using diuretics, β-blockers, calcium antagonists. If severe hypertension can be used sodium nitroprusside, intravenous drip (specific antihypertensive drugs and dose, see hypertension renal damage chapter). (C) control of heart failure: the effect of digitalis-type drugs is not certain. The main measures are diuretic, antihypertensive, and if necessary, apply sodium nitroprusside intravenously. (c) Treatment of infected foci (a) If the patient has positive bacterial culture of the foci should be given penicillin treatment, 800,000 units, twice a day, intramuscular injection for about 2 weeks. If the patient is allergic to penicillin, switch to erythromycin, 0.3g, 3~4 times a day, orally. (B) Patients with acute nephritis, such as recurrent disease, and tonsillar lesions are obvious, should be tonsil removal. Indications for surgery: 1, stable nephritis, no obvious symptoms, urine protein <(+), urine sediment erythrocytes <10/HP. 2, no acute inflammation of tonsils. 3. 2 weeks of penicillin each before and after surgery. Chinese herbal medicine: most of the real evidence of this disease. According to the dialectical evidence, it can be divided into wind-cold, wind-heat and damp-heat, which are given to promote the lung and diuresis, cool the blood and detoxify the toxin, etc. Dialysis treatment: The following conditions should be promptly dialysed: 1. oliguric acute renal failure, especially accompanied by hypertension. 2, severe water and sodium retention, causing acute left heart failure, after the diuretic antihypertensive methods are not effective, dialysis therapy should be taken to ultrafiltration dehydration.