Glomerulonephritis is the second most common kidney pathology in children. More often it occurs between the ages of 3 and 7 years and without timely treatment becomes a cause of dangerous complications.

What is glomerulonephritis?

The units of the urinary system of the kidneys, the nephrons, consist of glomeruli and tubules. In the first, urine is filtered, in the second it reaches its final composition and then enters the renal pelvis and then into the bladder.

What is glomerulonephritis? - It is an inflammatory disease caused by infection, a defect in the immune system or allergic causes. And if the disease pyelonephritis in children affects the tissue of the renal pelvis, then glomerulonephritis affects the glomeruli and tubules. This disrupts the normal filtration process of urine, as a result of which its composition and quantity change - proteins and red blood cells penetrate into it, which should not be the case.

As a result, the kidneys cannot cope with the excretory function, because of this, excess water and salts accumulate in the tissues and cells of the body, which leads to the development of edema and an increase in blood pressure.

In advanced cases, the disease leads to anemia, the development of heart failure and other serious complications.

Types of disease

There are three main types of disease:

• chronic;
• spicy;
• subacute.

These types of disease have different severity of symptoms, and in childhood the last two forms are more often detected.

Acute glomerulonephritis in children appears against the background of a previous disease of the upper respiratory tract and lungs (pneumonia, tonsillitis, ARVI). The most common factor is streptococcal infection. There are also cases of the development of this type of nephritis after a child’s vaccination.

Chronic glomerulonephritis in children(latent) is a consequence of an acute form that cannot be treated, or an acquired or hereditary abnormality of the immune system.

Types of disease by reason:

• primary – associated with congenital kidney damage;
• secondary – is the result of a previous infection.

The main provocateurs of this pathology in a child are infections - often bacterial, less often viral. The cause of glomerulonephritis in children can be, in particular, streptoderma and streptococcal dermatitis.

The general mechanism of disease development during infectious damage to the body is as follows:

1. Bacteria or viruses that enter the body actively multiply and release toxins.
2. These harmful substances penetrate through the bloodstream into tissues and organs.
3. If they accumulate in the kidneys, then antigenic complexes are formed and the renal glomeruli become inflamed.
4. As a result, their lumen narrows, in some places the walls become welded together, and the filtering capacity decreases.

Acute and chronic glomerulonephritis in children can have different causes. The aggravated form is provoked by the body’s reaction to foreign objects:

The chronic form of glomerulonephritis in children is often secondary, developing due to the ineffectiveness of acute treatment, or it can be caused by a hereditary disease, congenital or acquired defect of the child’s immune system:

• rheumatism;
• endocarditis;
• Alport syndrome;
• Fabry disease;
• periarteritis nodosa.

The provoking factor for any form of glomerulonephritis is hypothermia, since under the influence of low temperatures the blood supply to the urinary system is disrupted.

In children, the latent course of the disease is extremely rare, and in most cases it is an acute form with a pronounced manifestation. Typical symptoms and signs of glomerulonephritis in children are:

1. A sharp deterioration in health;
2. Pain in the lumbar region;
3. Decrease in the amount of urine and its coloration in a dark rusty color;
4. Increased blood pressure;
5. Swelling, especially noticeable on the eyelids and face;
6. Headache.

Very dangerous a rapidly progressive form of acute glomerulonephritis. In this case, additional signs are always:

• Hematuria (blood in the urine);
• Nephrotic syndrome (presence of a large amount of protein in the urine up to the formation of flakes).

The acute form becomes chronic if recovery cannot be achieved within 3-6 months. In this case, swelling and changes in urine persist for up to a year or more.

With the latent form of glomerulonephritis, most of the above symptoms are not observed. You can recognize this variant of the development of the disease yourself by the appearance of blood in the urine. This is due to an increase in the number of red blood cells in it.

Symptoms of glomerulonephritis in children under one year of age

Children from 0 to 12 months rarely suffer from glomerulonephritis. If the pathology develops, the symptoms can be very painful. The first thing that should alert you is the appearance of edema in the baby, darkening of urine and a decrease in its daily volume (the diuresis rate is presented in the table).

Age, months	1-3	4-6	7-9	10-12
Urine volume per day, ml	170-590	250-670	275-740	340-510

However, there are cases of hidden disease, in which the symptoms of glomerulonephritis in children under one year of age are very difficult to recognize.

The presence of the disease can only be determined by a urine test, which will show the presence of red blood cells and protein in it. Another sign is increased blood pressure.

In addition to glomerulonephritis, there are pathologies similar to it in manifestations. For example, symptoms of pyelonephritis may resemble signs of such inflammation in children under one year of age. Early consultation with a doctor and accurate diagnosis play a decisive role in the success of treatment.

Methods for determining the disease

Diagnosis of glomerulonephritis in children includes:

• examination of the child by a doctor;
• general urinalysis;
• Ultrasound of the kidneys and, if necessary, biopsy;
• immunogram;
• study of renal vessels;
• serological blood test.

Some diseases have symptoms similar to glomerulonephritis, and only a complete examination allows an accurate diagnosis. For example, tests for pyelonephritis in children reveal an increase in the level of leukocytes.

Treatment tactics for glomerulonephritis in children

Therapy for the acute form usually lasts from 10 days to a month and, if started in a timely manner, ends in recovery. For the treatment of glomerulonephritis in children, at the discretion of the doctor, the following are prescribed:

1. Antibiotics from the penicillin series or others, depending on the specifics of the infectious agent;
2. Diuretics;
3. Means for reducing blood pressure;
4. Prednisolone and cytostatics.

A therapeutic diet must be prescribed, and bed rest is indicated throughout the entire period of therapy. Urinalysis is performed periodically to assess the success of therapeutic measures.

In case of high levels of toxins in the blood, itching and icteric coloration of the skin, and the presence of urine odor from the mouth, the attending physician will prescribe a hemodialysis procedure. This is blood purification using an “artificial kidney” device.

After completion of therapy, the child should be under the supervision of a nephrologist for five years after recovery. Children who have had glomerulonephritis are exempt from physical education and also require increased protection against infections. In this regard, preventive measures against ARVI and other infectious diseases and strengthening the immune system are important.

Diet for glomerulonephritis in children

The nature of nutrition is aimed at relieving swelling. At the first stage of treatment, until the daily volume of urine excreted is normalized, salt and proteins are minimized - cottage cheese, eggs, fish and meat are excluded.

Therapeutic diet No. 7a for glomerulonephritis in children involves a sharp limitation of these foods and a moderate reduction in carbohydrates and fats.

Food should be predominantly vegetable, steamed or baked; herbs and spices should not be added to dishes. Only salt-free bread is allowed; products should not contain oxalic acid; you can give your child fruit and sugar.

Preventive measures and prognosis

The first condition for successful prevention of glomerulonephritis in children is correct and timely treatment of infectious diseases of the upper respiratory tract and skin. If your child is sick, you need to take a urine sediment test. This will help identify inflammation in the kidney tissue, if any.

Increasing the child’s body’s resistance to infections is of great importance: hardening, taking vitamins, balanced nutrition and other ways to strengthen the immune system. All this equally applies to the prevention of pyelonephritis in children.

A successful prognosis for glomerulonephritis depends on timely initiation of therapy. Delay can jeopardize the child’s health, causing heart failure, uremia, and nephrotic encephalopathy.

Therefore, at the slightest suspicion of the disease, you should immediately consult a doctor and begin treatment.

Glomerulonephritis is rightfully considered one of the most common and dangerous kidney diseases in children. This disease requires especially careful attention on the part of parents and doctors, because in case of untimely provision of assistance or improper treatment, complications can be fatal for the child. You will learn more about this disease and what the correct actions should be during treatment in this article.

The disease and its varieties

Glomerulonephritis- a disease that affects special kidney cells - glomeruli, which are also called glomeruli. Small cells gave the disease its second name - glomerular nephritis. Because of this, the kidneys cease to fully perform their functions. This paired organ is entrusted by nature with many concerns - the removal of decay products, toxins from the body, the production of substances that control blood pressure and erythropoietin, which is simply necessary for the formation of red blood cells in the blood. Malfunctions of the kidneys lead to the most tragic consequences.

A child with glomerulonephritis has a huge amount of protein in the urine, and red blood cells (blood in the urine) are also released with it. Thus, anemia, arterial hypertension, edema develops, and immunity is reduced due to protein losses that are catastrophic by the body’s standards. Due to the fact that the lesion progresses differently, and the reasons why the glomeruli of the kidneys begin to die are very heterogeneous, the disease in pediatrics is not considered a single disease. This is a whole group of kidney diseases.

Most often, glomerulonephritis affects children aged 3 to 10 years. Children under 2 years of age get sick much less often; only 5% of all cases occur in them. Boys get sick more often than girls.

The classification of glomerulophritis is quite complex and is based on symptoms and clinical picture.

All glomerular nephritis are:

• primary(if kidney pathology manifested itself as a separate independent disease);
• secondary(kidney problems began as a complication after a severe infection).

According to the characteristics of the course, two large groups of the disease are distinguished:

• spicy;
• chronic.

Acute glomerulonephritis is expressed by nephritic (sudden, sharp) and nephrotic (gradually and slowly developing) syndromes; it can be combined and isolated (when there are only changes in the urine, without other symptoms). Chronic can be nephrotic, hematuric (with the appearance of blood in the urine) and mixed.

Diffuse chronic glomerulonephritis develops slowly and gradually, most often the changes in the body are so insignificant that it is very difficult to determine later when the pathological process leading to the death of kidney cells began. Depending on the type of pathogen that caused the underlying disease, complicated by glomerulonephritis, several types of disease are distinguished, the cause of which becomes clear from the name - post-streptococcal, post-infectious, etc.

And based on the severity of the symptoms and the damage that has already been caused to the kidneys, doctors conditionally assign each case 1,2 or 3 degrees with a mandatory indication of the stage of development of the disease (for a chronic illness).

Reasons

The kidneys themselves are not affected by pathogenic microbes and other “outside invaders”. The destructive process is triggered by the child’s own immunity, which reacts to a certain allergen. Most often, streptococci act as “provocateurs”.

Glomerulonephritis is often a secondary complication of primary streptococcal tonsillitis, bacterial pharyngitis, scarlet fever.

Less commonly, the death of renal glomeruli is associated with influenza, ARVI, measles, and hepatitis viruses. Sometimes the allergens that trigger the destruction of glomeruli are snake or bee venom. For reasons that are not yet entirely clear to science, the body, instead of simply bringing these harmful factors out, creates against them a whole “heavy artillery” of the immune complex, which hits its own filters - the kidneys. According to doctors, such an inadequate reaction of the body is influenced by factors that at first glance have little influence - stress, fatigue, climate change, place of residence, hypothermia and even overheating in the sun.

Possible complications

Glomerulonephritis is considered a serious disease. It is quite complex in itself and is rarely completely cured. The most predictable and expected complication of an acute illness is its transition to a chronic diffuse form. By the way, about 50% of all cases are complicated this way.

But there are other complications that pose a danger to life or can cause disability:

• acute renal failure (occurs in approximately 1-2% of patients);
• heart failure, including its acute, deadly forms (3-4% of patients);

• cerebral hemorrhage;
• acute visual impairment;

• kidney dysplasia (when the organ begins to lag behind in growth rates from the size required by age, decreases).

Changes in the kidneys can be so significant that the child will develop chronic renal failure, in which case an organ transplant will be indicated.

With kidney transplantation in Russia, everything is quite deplorable; the child may simply not wait for the donor organ he needs. An alternative (temporary) is an artificial kidney. Since the procedures should be carried out several times a week, the baby becomes dependent on the device, because he simply has no other way to cleanse the body of toxins.

Symptoms and signs

Usually, 1-3 weeks after an illness (scarlet fever or tonsillitis), the first symptoms of glomerulonephritis may appear. The most striking sign is change in urine color. It turns red in a child, and the shade can be either bright or dirty, which is usually called the “color of meat slop.”

The beginning of acute nephritic glomerulonephritis in a child can also be recognized by swelling on the face, which looks like dense, full, changing little during the day. Blood pressure increases, which may result in vomiting and severe headaches. This form of the disease has the most positive prognosis, since more than 90% of children experience a complete recovery with adequate treatment. For others, the disease becomes chronic.

Acute nephrotic disease“attacks” from afar, symptoms appear gradually, due to this the child has no complaints for a long time. If parents do not ignore the morning swelling, which sometimes goes away completely during the day, and go with the child to give urine, then sure signs of the disease will be found in it - proteins.

The first swelling begins to appear on the legs, then gradually spreads further - to the arms, face, lower back, and sometimes to internal organs. The swelling is not dense, it is looser. The child's skin becomes dry, and the hair becomes brittle and lifeless. At the same time, blood pressure rarely rises, and the urine has a normal color, since the protein in it does not color the liquid in any way. For this type of disease, the prognosis is not rosy: according to doctors, only 5-6% of children recover, the rest continue to be treated, but for a chronic form.

If a child’s urine changes color (becomes redder), but there are no other symptoms or complaints, nothing swells or hurts, then we may be talking about isolated acute glomerulonephritis.

About half of all young patients can be cured from it if they go to the hospital in a timely manner. The remaining 50%, even with proper treatment, for logically inexplicable reasons, begin to suffer from a chronic disease.

If a child has all the signs of all three described types of the disease, then we can talk about a mixed form. It almost always ends in transition to a chronic disease and the prognosis is unfavorable. The likelihood of recovery is influenced by the state of the immune system. If it is weak or there is some defect in it, then the onset of the chronic form becomes more obvious.

With chronic glomerulonephritis, the child experiences periods of exacerbation with swelling and changes in urine and periods of remission, when it seems that the disease is left behind. With proper treatment, only half of patients achieve stabilization. About a third of children develop a progressive process, and this ultimately often leads to an artificial kidney.

Hematuric chronic pyelonephritis is considered the most favorable among chronic varieties of the disease. It does not lead to the death of a person, and is noticeable only during periods of exacerbation, when of all the signs the only one appears - blood in the urine.

Diagnostics

If a child has noticeable swelling, even if only in the morning, even if only on the legs or arms, this is already a reason to contact a nephrologist. If the urine has changed color, you need to go to the clinic urgently. Parents should remember that analysis of urine that has been in a jar for more than an hour and a half is less reliable, so you need to use all possible means to deliver the collected urine to the laboratory during this time.

Diagnosis of glomerulonephritis includes a visual examination of the child and laboratory tests, the main of which is the urine test. The number of red blood cells in it will be determined, and the quality - whether they are fresh or leached. An equally important indicator is protein in the urine. The more it is released, the more severe the stage of the disease is usually. In addition, the laboratory assistant will indicate a couple of dozen more different substances, salts, acids, which can tell the nephrologist a lot.

Usually this is enough, but for small children and with very poor tests, doctors “play it safe” by prescribing Ultrasound examination of the kidneys. In doubtful situations, a kidney biopsy may also be prescribed. The doctor recognizes a disease as chronic if the symptoms have lasted for more than six months or if changes in urine formulas have remained at abnormal values ​​for more than a year.

Treatment

In case of acute glomerulonephritis, home treatment is strictly contraindicated.

The doctor will strongly recommend going to the hospital and this is quite justified. After all, the child needs complete rest and strict bed rest. The patient is immediately prescribed diet No. 7, which does not include salt, significantly limits the amount of liquid drunk per day, and cuts the amount of protein food by approximately half of the age norm.

If the disease is caused by streptococci, then a course of penicillin antibiotics is prescribed. In a hospital setting, they will most likely be injected intramuscularly. To reduce edema, diuretics are prescribed in a strict age-specific dosage. If you have high blood pressure, you will be given medications that can lower it.

The modern approach to the treatment of glomerulonephritis involves the use of hormones, in particular “Prednisolone” in combination with cytostatic drugs that can stop and slow down cell growth. Such drugs are usually widely used in the treatment of cancer, but this fact should not frighten parents. When the condition of the kidneys improves, they are entrusted with the function of slowing down the growth of immune colonies, and this will only benefit the suffering kidney cells.

If a child has concomitant chronic infectious diseases, after the acute stage of glomerulonephritis, it is strongly recommended to eliminate foci of infection - cure all teeth, remove adenoids if they hurt, undergo a course of treatment for chronic tonsillitis, etc.

But this should be done no earlier than six months after suffering an acute kidney disease or exacerbation of a chronic one. Recovery, if the treatment schedule is followed, usually occurs after 3-4 weeks. Then the child is recommended to study at home for six months to a year, to be registered with a nephrologist for at least two years, to visit sanatoriums that specialize in kidney diseases, and to follow a strict diet. Such a child cannot receive any vaccinations for a year. And with every sneeze and the slightest sign of ARVI, parents urgently need to take his urine samples to the clinic.

Chronic glomerulonephritis is treated in the same way as acute glomerulonephritis, since it requires treatment only during periods of exacerbation.

In this case, you should also not insist on home treatment; the child must be hospitalized, because in addition to therapy, there he will undergo a full course of examination to find out whether the disease has begun to progress. In severe forms and extensive destruction of kidney structures, artificial kidney procedures and transplantation of a donor organ to replace the affected one are indicated.

A child with a chronic illness will be registered at a dispensary for life. Once a month he will need to have a urine test, visit a doctor, and have an ECG done once a year to prevent pathological changes in the heart.

Prevention

There is no vaccine against this serious disease, and therefore prevention is not specific. However, parents should know that no sore throat or pharyngitis should be treated without permission, because the disease may turn out to be streptococcal, and without antibiotics or if they are taken uncontrolled, the likelihood of such a complication as glomerulonephritis will increase significantly.

After suffering from scarlet fever, you should definitely take a urine test 3 weeks later, even if the doctor forgot to prescribe it for you. 10 days after streptococcal tonsillitis or streptoderma, you must also take urine samples to the laboratory. If there is nothing alarming about them, then you don’t have to worry. Prevention of kidney diseases in general and glomerulonephritis in particular includes proper treatment for ARVI, vaccination against influenza, and measles. It is important to ensure that the child does not sit on the cold floor with his bare bottom and does not overheat in the sun in the summer.

For more information about diagnosing this disease, see the following video.

Due to the immaturity of the immune system, the child’s body is especially susceptible to infectious pathologies. In a group setting, the likelihood of a child developing a disease increases many times over. Immaturity of the immune system provokes the development of complications in sore throat, scarlet fever and others. Acute glomerulonephritis in children is usually caused by these infectious pathologies.

The disease is of an allergic nature, often triggered by microbes. Sometimes one’s own antibodies serve as an allergic agent, in which case the disease is autoimmune in nature.

Causes

The main factor in the development of glomerulonephritis in children is the presence of acute or chronic infection. The most common pathogenic flora is the streptococcal group. But the disease can also develop against the background of viruses, toxoplasma and other microbes. It can also be caused by a reaction to vaccination or poisoning by chemicals.

As a result, immune complexes are formed in the body, which are detected in the kidneys and blood. They accumulate under the basement membrane of the capillaries in the glomeruli, causing organ damage. Nephrotic pathology occurs after exposure to viral diseases. The triggering mechanism can be hypothermia, during which reflex circulatory disorders of organs occur.

Clinical manifestations

In medicine, glomerulonephritis is usually divided into several forms:

• acute;
• subacute;
• chronic.

Acute glomerulonephritis in children is accompanied by three main manifestations - the occurrence of edema, hypertension and changes in urine tests. Swelling appears suddenly mainly on the eyelids and face, the skin becomes pale. Internal edema is especially dangerous, as a result of which fluid accumulates in the abdominal, pleural and pericardial cavities, and the child’s weight increases sharply. The gain in a short time can reach more than 10 kilograms.

With glomerulonephritis, blood pressure rises to high values ​​- 140–160 mm Hg. Art. In case of a sharp increase in systolic pressure, there is a high risk of developing acute heart failure. The child complains of headache, weakness, nausea. Hypertension is accompanied by a convulsive syndrome, which resolves safely and in most cases goes away without leaving a trace.

The most important clinical sign of illness in a child is the appearance of blood and protein in the urine. Urine takes on a rusty hue, and there is a decrease in the amount of discharge or its complete absence (anuria). The development of this condition indicates the progression of acute renal failure.

Subacute form - characterized by a malignant course of the disease, symptoms increase sharply, and within a few weeks the child develops acute renal failure.

The acute form of glomerulonephritis can manifest itself in the following form:

• Cyclic – rapid onset, a sharp increase in the amount of protein in the urine, increased blood pressure, swelling disappears after approximately 3 weeks. Then the disease also resolves sharply. This condition can be observed for six months, if the child is in good health.
• Latent - manifests itself gradually, often there are minor symptoms - legs swell, shortness of breath appears. Chronic glomerulonephritis in children often occurs with a long latent course.
• Nephritic form - develops after infections caused by streptococcus. Characterized by increased blood pressure and edema. Urinalysis revealed hematuria, a slight increase in protein, a decrease in quantity.
• The nephrotic form of glomerulonephritis most often develops in children aged three to seven years. Edema takes on an alarming character. The protein in the urine is much higher than normal.

If the acute form of glomerulonephritis is not diagnosed in a timely manner or the wrong treatment is carried out, there is a high probability of the disease progressing to the chronic stage.

Features of the chronic course

The chronic form of glomerulonephritis in children is divided into 3 stages:

Examination methods

To diagnose glomerulonephritis in a child, use:

1. General urine analysis - an increase several times higher than normal in the level of protein and red blood cells, cylinders. The characteristic color of urine mixed with blood is hematuria.
2. Blood biochemistry - nitrogenous bases, the presence of C-reactive protein, a decrease in the level of total protein and an increase in cholesterol.
3. Urinalysis according to Zimnitsky - decrease or increase in daily urine doses, excessive protein loss.
4. Immunological blood test - increase in the number of globulins M and G.
5. Ultrasound diagnostics - decreased filtration in the renal glomeruli.
6. Biopsy - detection of immune complexes in the kidney tissue, the presence of neutrophils and monocytes in the renal glomeruli.

When treating acute stage glomerulonephritis, strict bed rest and a special salt-free diet are prescribed. Following proper nutrition will help reduce swelling and improve metabolism.

Treatment methods

If the disease occurs against the background of tonsillitis, pneumonia, scarlet fever, then it is more advisable to start treatment with antibiotics. A certain group of drugs is selected based on the susceptibility of the child’s body, individual intolerance and etiological factor. If a clear pathogen cannot be identified, broad-spectrum drugs are prescribed. Infections – tonsillitis, sinusitis, caries treatment – ​​must be sanitized.

For high blood pressure, antihypertensive drugs are used. Diuretics are prescribed, the estimated dose is calculated based on the patient’s weight and the severity of edema. Their use is carried out under strict monitoring of the child’s condition.

Severe edematous syndrome is relieved by forced diuresis (while taking diuretics, droppers with glucose solution or saline are used).

For glomerulonephritis with nephritic syndrome, the child is prescribed blood-thinning drugs, which will prevent the formation of blood clots and restore normal hemodynamics.

Hormonal therapy is used to treat nephrotic syndrome. Steroids are taken with increasing doses over the course of a week, the total course of treatment is 2 months.

If symptoms of uremia and acute renal failure begin, the child is prescribed hemodialysis; if therapy is ineffective, a kidney transplant is performed.

Hemodialysis procedure

Diet

First of all, for glomerulonephritis it is necessary:

1. Reduce the amount of liquid consumed to 1 liter.
2. Limit the consumption of table salt, this will improve water-salt metabolism and swelling will begin to subside.
3. For optimal removal of retained water, it is recommended to consume watermelons, pumpkins, and boiled potatoes in their jackets, which will provide additional sodium removal.
4. Limiting protein foods for glomerulonephritis is not advisable; it is recommended to introduce low-fat cottage cheese and egg whites into the diet.
5. Meat consumption should be limited.
6. To maintain daily caloric intake, carbohydrates are added to the menu.
7. In the first days of an exacerbation, the child is advised to drink very sweet tea or juice.
8. Porridge, vegetable oils, and vegetables should be mandatory in the diet.
9. Canned food, smoked meats, and strong meat broths are completely excluded.

The child needs to follow the diet after the disease has resolved for about another year.

Prognosis and prevention

The acute form of glomerulonephritis most likely ends in the child’s recovery. After a few months, the disease completely recedes. With timely diagnosis, the risk of pathological complications is significantly reduced. In the presence of persistent hypertension, proteinuria and impaired renal function, the prognosis is unfavorable.

Children who have suffered glomerulonephritis are observed in a pediatrician's clinic for five years. If after this time the diagnosis reveals a chronic stage of the disease or nephrotic syndrome, the child is given a disability group. A patient registered with a dispensary is given a medical exemption from preventive vaccinations; preschoolers are not recommended to attend kindergartens. Regular testing is required to diagnose laboratory changes.

The basis for the prevention of glomerulonephritis is the timely detection and rational treatment of infections caused by streptococcus. When treating tonsillitis, scarlet fever, streptoderma, carry out a full course of antibiotic therapy, in doses prescribed by a specialist.

In case of chronic glomerulonephritis, in order to prevent complications, foci of infection are treated in a timely manner, and the child should be protected from hypothermia.

Glomerulonephritis is a group of renal pathologies characterized by a varied course, symptoms and outcome. Glomerulonephritis is always acquired. The specificity of the disease is inflammation of the renal glomeruli, which leads to dysfunction of the organ. The disease is quite common not only in adults, but also in children.

Glomerulonephritis in children

Children's glomerulonephritis is a pathology of the glomerular apparatus of an immunoinflammatory nature. In fact, glomerulonephritis is one of the most common renal pathologies in children. Most often, only urinary infections are detected.

The prevalence of glomerulonephritis among children is as follows:

• The largest number of cases of this disease are diagnosed in preschoolers and primary schoolchildren, i.e. children aged 3-9 years.
• Much less often (up to 5% of cases) the pathology affects babies in the first 2 years of life.
• Boys are affected by this disease twice as often as girls

The formation of the pathology is based on an allergic reaction to infection, when the formation and accumulation of circulating immunological complexes occurs in the kidney structures, or an autoimmune allergy, when active production of autoantibodies occurs. The lesion may affect not only the glomeruli, but also other renal structures such as interstitial tissue or tubules. As a result of the pathology, severe chronic organ failure and early disability of the child may develop.

Glomerulonephritis in children

Causes and pathogenesis

The mechanism of development of childhood glomerulonephritis is quite simple. Inflammation of the glomeruli occurs, which blocks the normal functioning of the organ. As a result, fluid accumulates in the body, swelling occurs, blood pressure remains high, and blood clots and protein fractions are present in the urine in exorbitant quantities.

Acute pathological forms often develop against the background of a recent infectious pathology such as scarlet fever or pneumonia, tonsillitis, and also after vaccination.

Experts identify a number of specific factors that provoke kidney damage due to an abnormal reaction of the body to antigens:

In addition, childhood glomerulonephritis can occur under the influence of systemic inflammatory pathologies, for example, lupus erythematosus or rheumatism, vasculitis or endocarditis. This pathology is also caused by genetic abnormalities.

Factors such as hypothermia or poor heredity, immaturity of nephrons and carriage of streptococci (type A), long stay in conditions of high humidity or in the sun, hypersensitization (increased organic sensitivity), chronic infection in the nasopharynx or in the skin and hypovitaminosis.
In the video about the pathogenesis and causes of glomerulonephritis in children:

Classification

Children's glomerulonephritis has many classifications:
According to the development mechanism, they are divided into:

1. Primary – they develop as a result of pathogenetic influence;
2. Secondary – formed as a result of other pathological processes;

According to the form of the course, glomerulonephritis is divided into:

1. Acute;
2. Subacute;
3. Chronic;

According to etiology, inflammation is divided into:

Depending on the prevalence of the inflammatory process, glomerulonevir syndromes in children are:

1. Diffuse – extensive lesions;
2. Ochagovym;

Morphologically, childhood glomerulonephritis is divided into:

1. Focal segmental - the basis of the disease is damage to epithelial cellular structures, characterized by nephrotic syndrome or persistent proteinuria;
2. Mesangioproliferative - this form meets all immunoinflammatory criteria of the pathological process. The main signs of this morphological type are hematuria and proteinuria, sometimes hypertension and nephrotic syndrome;
3. Membranous or nephrotic form of glomerulonephritis - they are characterized by extensive thickening of the capillary walls in the glomeruli, have a favorable course and are accompanied by pronounced hematuria and proteinuria, nephrotic syndrome and severe depression of renal activity;
4. Mesangiocapillary – a rare variant of glomerulonephritis, characterized by a very progressive course;

Depending on the location of the lesions, glomerulonephritis in children is:

1. Extracapillary - develops in the cavity of the glomerulus;
2. Intracapillary – formed in blood vessels;

Children's glomerulonephritis is also classified according to clinical variants:

1. Hypertensive - high blood pressure is added to the main symptoms;
2. With nephrotic syndrome – it is characterized by hyperedema;
3. Monosymptomatic – occurs with a predominance of urinary syndrome;
4. Combined – when all clinical manifestations are present.

Experts identify acute post-streptococcal glomerulonephritis, which is preceded by a streptococcal infection, as a separate subgroup.

Signs and symptoms

Pathology can occur in various ways, therefore the severity of the clinical picture may also differ. Sometimes the pathology proceeds latently, without manifesting itself, but is discovered during a random medical examination for completely different reasons. But such a course of childhood glomerulonephritis is quite rare. Much more often, the pathology is accompanied by pronounced symptoms. The child’s well-being rapidly deteriorates, to the point of unconsciousness, which requires urgent hospitalization of the patient.

• Most often, with the development of glomerulonephritis, children complain of severe headaches, which often lead to loss of consciousness;
• Patients also experience severe pain in the lumbar area;
• A frequent occurrence of glomerulonephritis is nausea and vomiting syndrome and severe hyperthermia;
• Urine develops due to hematuria, and its amount decreases noticeably;
• There is also an increase in blood pressure, the upper threshold can reach 140-160 mm. rt. Art.;
• Against the background of hyperedema, a noticeable increase in weight occurs, and the swelling is localized mainly on the eyelids and face.

Symptoms of glomerulonephritis in children:


The acute form of the pathology develops, as a rule, a couple of weeks after an infectious disease predominantly of streptococcal origin. With adequate therapeutic measures, renal functions quickly normalize, and the child’s full recovery occurs after 1.5-2 months.

With chronic glomerulonephritis in children, similar symptoms may be present, only in a less pronounced form.

Inflammation of the renal glomeruli can lead to serious consequences such as kidney and myocardial failure, uremia, so the first signs of abnormalities should serve as a signal to consult a doctor.

Diagnostics

The diagnosis is made based on an assessment of the general condition of the small patient.

First, the doctor collects an anamnesis of life and illness, then conducts an examination and prescribes the necessary tests, such as:

• Laboratory tests of blood and urine - immunoassay and blood biochemistry, urine biochemistry, blood test, Rehberg test and. The presence of blood and protein fractions in urine is the most important diagnostic marker. And blood tests can detect anemia, abnormal levels of urea, creatinine and albumin. Immunological diagnostics of blood reveals the presence of antibodies;
• Ultrasound examination of the kidneys - this diagnosis shows increased echogenicity and an increase in kidney parameters;
• Biopsy is usually prescribed to obtain data on the morphology of glomerulonephritis in order to select the most effective treatment regimen.

To diagnose glomerulonephritis in children, additional studies may be needed (renal x-ray with contrast or chest x-ray), as well as consultations with specialists in the field of cardiology, rheumatology, dentistry, ophthalmology, etc. Consultation with a pediatric nephrologist, urologist and infectious disease specialist is possible.

Signs and symptoms of glomerulonephritis in children:

Treatment

Children's glomerulonephritis has one positive feature - it is tolerated much easier by children than by adults:

• The child must be given bed rest for several weeks until the main symptoms disappear.
• Antibiotic therapy is prescribed using macrolides and penicillins.
• To facilitate the removal of accumulated fluid, diuretics are used.
• If a child’s symptoms such as a yellowish-pale tint of the skin, the smell of urine from the mouth, and an increased level of toxins in the blood do not go away over the course of a week, then it is necessary to undergo hemodialysis, which involves the use of an artificial kidney machine.
• Children with glomerulonephritis must be prescribed a diet that includes carbohydrate days. Products such as marinades, meat broths, smoked products, seasonings, fish and meat are strictly prohibited for children during the treatment period. It is recommended to eat more foods rich in potassium - dairy products, natural juices, fruit and vegetable dishes.

Rosehip infusion deserves special attention, because it is a storehouse of ascorbic acid, incredibly beneficial for the immune system. Meals should be 3-5 times. The child’s drinking regime needs to be reviewed so that the amount drunk is no more than half a liter greater than the amount of fluid excreted. The child must eat vegetarian soups and bread, chicken and lean fish.

After completion of treatment, the child is registered with a pediatric nephrologist and pediatrician for another 5 years. If cases of glomerulonephritis are recurrent in nature, then they are registered for life. For such children, a sanatorium stay is especially recommended, but preventive vaccinations will have to be abandoned.
On the video about the treatment of glomerulonephritis in children:

Forecasts

In most clinical cases, childhood glomerulonephritis is successfully cured, but in 1-2% of cases the pathology becomes chronic. Lethal outcome is observed only in isolated cases, when the disease is severe and with many complications.

Among the complications of childhood glomerulonephritis are cerebral hemorrhage, kidney failure, renal encephalopathy, myocardial failure, and uremia. These complications pose a real threat to the child's life.

Prevention of glomerular inflammation consists of timely identification and treatment of streptococcal infectious lesions, allergic reactions, as well as the rehabilitation of chronic pathologies in the mouth and nasopharynx, which consists of timely treatment of carious teeth, inflamed tonsils, etc. It is also necessary to limit the child’s salt intake and avoid overheating or hypothermia, rationally organize the child’s rest and work schedule.

Such a diagnosis is quite serious, but with timely treatment it can be completely cured. If glomerulonephritis has led to the development of chronic kidney failure, then the child is assigned a disability, the group of which is determined by medical and social experts in accordance with the degree of failure and organic disorders.

Illness is always bad, but the worst thing is if it plagues your child. Parents would give everything in the world so that their child would not be in danger. Of course, there are diseases that come and go: colds, flu, and so on. But there are also those who stay with the baby for a long time, and among them glomerulonephritis in children occupies a special place.

What is it

Glomerulonephritis is a bilateral kidney disease. The nature of its occurrence is infectious-allergic. First, the glomeruli of the organ are affected. Over time, all kidney tissue and other systems of the child’s body are affected. Metabolic processes are disrupted.

Most often, this disease manifests itself between the ages of five and twenty years. Almost never occurs in newborns.

The development of the disease is influenced by living and nutritional conditions, the reactivity of the body, and what infections the child has had. Sometimes the disease begins to develop on the second day of the appearance of any infection. The acute form of glomerulonephritis occurs more often in boys.

The disease glomerulonephritis has its own negative features:

According to the clinical course, the following forms occur:

• acute;
• subacute;
• chronic.

According to the extent of the lesion, glomerulonephritis in children is divided into:

• diffuse;
• focal.

By location of the lesion:

• in the glomerulus - intracapillary;
• inside the glomerular capsule - extracapillary.

According to the nature of the inflammatory process:

• exudative;
• proliferative;
• mixed.

As you can see, the forms of glomerulonephritis in children can be different, and they depend on many factors.

Now let's talk about some of them in more detail.

Acute form of the disease

Most often it is caused by streptococci, sometimes staphylococci or pneumococci. It proceeds rapidly, the symptoms are pronounced, and responds well to treatment. True, it should be said that there is also a latent course of the disease. The symptoms are almost invisible and very difficult to detect. It is at this moment that the disease has every chance of developing into a chronic stage.

Acute glomerulonephritis in children is considered rapidly progressive. All pathological processes in the kidneys disappear instantly. This can lead to kidney failure, leading to the need for hemodialysis or a kidney transplant.

Treatment of this form of glomerulonephritis is carried out only in hospital settings. The child is prescribed bed rest until his condition begins to improve. If the treatment process is not started in time, unpleasant consequences may arise, one of which is, as mentioned above, the transition of the disease to a chronic form.

Symptoms of the acute stage of the disease

Usually they begin to be detected within a week or two after an infectious disease. They appear in the following form:

• the child’s general condition worsens;
• weakness appears;
• appetite decreases.

A few days later:

• the lower back begins to hurt;
• the temperature rises;
• the skin becomes pale;
• swelling appears (first in the morning, near the eyes; over time, the limbs also become swollen);
• the amount of urine excreted decreases; if the condition is very severe, the patient may completely stop going to the toilet;
• urine has an unnatural color (from pink to dark red, sometimes there is a green tint);
• your head starts to hurt;
• nausea appears;
• blood pressure rises.

All these signs signal kidney disease. The symptoms of adults and children are almost the same. The only point is that in the latter they are much more pronounced.

Clinical forms of the acute stage of the disease

During an illness, a set of symptoms with the same pathogenesis is always studied. Glomerulonephritis is no exception. Syndromes that can be distinguished by clinical forms are as follows:

• nephritic;
• nephrotic;
• isolated;
• mixed.

The first most often affects children aged five to ten years. The disease begins to develop a week after the child becomes ill with ARVI or another infectious disease. In this case, all processes occur very acutely:

• The face swells. With proper treatment, this symptom goes away within two weeks.
• Blood pressure increases, which is accompanied by nausea, vomiting, and headache. The condition may normalize within a few weeks, if the diagnosis is correct and appropriate treatment is made.
• The composition of urine changes. This situation persists for several months.

Full recovery occurs in two to four months.

The nephrotic form is dangerous and severe. The forecasts are not reassuring. Only five percent of those sick can recover. For the rest, the acute form becomes chronic.

Acute glomerulonephritis symptoms in children have the following:

• Swelling increases slowly.
• The skin becomes pale.
• Hair is brittle.
• The amount of urine decreases sharply.
• The amount of protein increases.
• No red blood cells or white blood cells.

Isolated urinary syndrome is characterized only by changes in the child’s urine. There are no other symptoms. With this form, half of the patients are cured, and in the other half the acute stage becomes chronic.

In the mixed form, children experience all of the above symptoms. Prognosis - the acute form most often becomes chronic.

Chronic form of the disease

Chronic glomerulonephritis in children is a primary chronic disease and can be detected at any age. Sometimes it can be a consequence of untreated acute nephritis.

Pediatric chronic glomerulonephritis is classified as follows:

• Nephrotic.
• Hematuric.
• Mixed.

From a morphological point of view:

• Focal segmental sclerosis.
• Minimal changes in the glomeruli.
• Mesangioproliferative.
• Membranous.
• Fibroplastic.
• Mesangiocapillary.

By pathogenesis:

• Caused by immune processes (immune complex and autoantibody).
• Not caused by immune processes.

Causes of the disease

Treatment of glomerulonephritis in children largely depends on the cause of the disease and its form. What contributes to the development of the disease?

The kidney cannot cope with the function of removing all toxic substances in the urine. It almost does not filter the blood, the glomeruli begin to die, the kidney becomes small and dry. The cause of the pathology is often:

• untreated infectious diseases;
• improper treatment;
• hereditary predisposition.

Kidney disease is not caused by the infection itself, but by the body's response to this infection, its immune reaction. This is why most often the disease begins to progress after:

• tonsillitis;
• scarlet fever;
• measles;
• pneumonia;
• chronic tonsillitis;
• flu

Glomerulonephritis in children can be provoked by:

• consumption of allergens;
• severe hypothermia;
• contact with toxic substances;
• use of certain drugs (mercury, antibiotics, sulfonamides);
• graft;
• long exposure to the sun.

Diagnosis of the disease

The article is about children, but adults can also develop glomerulonephritis: the symptoms and treatment for both are largely similar. But there is one difference - children recover faster.

Before you begin the fight for the recovery of a person, no matter what age he is, it is necessary to make a correct diagnosis.

• A general urine test is given. The presence of: red blood cells, leukocytes, cylinders, protein is determined.
• The specific gravity of urine is determined.
• The blood is checked for an increase in the titer of antibodies to streptococcus.
• Total protein content.

This is about analysis. Second stage of diagnosis:

• Radioisotope angiorenography.
• Fundus examination.
• Kidney biopsy. This procedure allows you to see the activity of the disease and makes it possible to exclude kidney disease, which has similar symptoms to chronic glomerulonephritis.

The medical history begins from the patient’s first visit to a medical institution. Glomerulonephritis is no exception. And how long this story will last depends on the correct diagnosis.

The first step to recovery

Treatment of glomerulonephritis in children involves hospitalization in a specialized department. They are prescribed bed rest and a mandatory diet. Fats and carbohydrates are consumed within the limits of physiological needs, and the amount of proteins must be limited. You will have to adhere to a strictly protein-free diet until azotemia and oliguria disappear. The amount of salt is also reduced. This happens until the swelling subsides.

Excluded: meat, fish, mushroom broths, smoked meats, sausages, cheeses, pickled vegetables, canned foods.

On the second or third day of illness, you can have a sugar-fruit day.

Bed rest must be maintained until signs of disease activity disappear. This period lasts about six weeks. After this time, the child can rise, even if he still has moderate microscopic hematuria.

This is the first step of treatment: diet and bed rest.

Treatment with drugs

As mentioned above, with a disease such as glomerulonephritis, the symptoms and treatment in children and adults are completely the same.

• The fight against infection begins with the use of penicillin drugs.
• Warming the renal area helps in the treatment of anuria.
• For azotemia and hyperkalemia, if this condition lasts more than six days, peritoneal dialysis or hemodialysis is used.
• With exacerbation of chronic glomerulonephritis with minimal changes in the glomeruli, cytostatics and glucocorticoids are used for treatment.
• The drug Prednisolone is prescribed. One milligram per kilogram of weight is administered for six or eight weeks, then the dose is rapidly reduced to five milligrams per week.
• If the activity of CGN is high, Prednisolone is used, but as a drip (three days, once a day). After treatment, it is advisable to carry out such pulse therapy at least once a month.
• Cytostatic agents are prescribed intramuscularly: the medications “Cyclophosphamide” and “Chlorambucil”.
• Alternative drugs used during treatment: drugs "Cyclosporine" and "Azathioprine". They are prescribed in cases where there is a high risk of renal failure.

Multicomponent treatment regimens

When diagnosed with glomerulonephritis in children, a multicomponent treatment regimen is used. The use of cytostatics and glucocorticoids simultaneously is considered much more effective than the use of glucocorticoids alone for treatment.

Immunosuppressive drugs are prescribed in combination with anticoagulants and antiplatelet agents.

• Three-component scheme: two to three months - Prednisolone plus Heparin; then - the drug "Acetylsalicylic acid" plus the drug "Dipyridamole".
• Four-component scheme: the drug “Prednisolone” plus the drug “Cyclofamide” plus the drug “Heparin”; then - the drug "Acetylsalicylic acid" plus the drug "Dipyridamole".
• Ponticelli's regimen: Prednisolone for three days, Chlorambucil for the second month, and then alternating these drugs.
• Stenberg scheme: pulse therapy is used. Over the course of a year, a thousand milligrams of the drug Cyclophosphamide are injected intramuscularly every month. For the next two years, the procedure is carried out once every three months. Another two years - once every six months.

Dispensary observation

In acute forms of the disease, after discharge from the hospital, it is advisable to transfer the child to a sanatorium. During the first three months, a general urine test is taken and blood pressure is measured. The doctor conducts an examination once every two weeks.

For the next nine months, the above procedures are carried out once a month. Then, for two years, you will have to visit the doctor once every three months.

For any infectious disease, for ARVI and others, it is imperative to take a general urine test.

The child is exempt from all physical activity and vaccinations.

It is removed from the register only if there have been no exacerbations or deteriorations for five years, and the tests were within normal limits. In this case, the child is considered to have recovered.

In the chronic form of the disease, the small patient is observed by a pediatrician before transferring to an adult clinic. Once a month, a general urine test is taken and blood pressure is measured.

Electrocardiography is performed every year.

Urine analysis according to Zimnitsky - once every two months. Herbal medicine one month at a time, every other month.

At this time, a diet must be followed, no hypothermia, sudden climate change, no stress. At the first symptoms of an infectious disease, you should immediately consult a doctor.

Conclusion

Prevention of the disease acute glomerulonephritis - diagnosis of any infectious disease, which must be carried out in a timely manner. If you immediately begin treating tonsillitis, scarlet fever and other diseases, you can avoid kidney disease. In addition, the child’s body should be hardened and strengthened.

And you should also teach your baby to eat the “right” food from an early age. After all, nutrition is one of the factors, perhaps even the most important, which is responsible for the health of both children and adults.

By combining all of the above, you can ward off a disease called glomerulonephritis from your child. So, if not everything, then a lot is in your hands, especially the health of your children.