Acute glomerulonephritis in children - causes, symptoms and treatment. Glomerulonephritis in children: classification and etiology Glomerulonephritis in children is often a disease

Glomerulonephritis- a disease of an infectious-allergic nature, which is accompanied by impaired renal function. It develops after a sore throat, scarlet fever, influenza, viral respiratory tract infections, chronic tonsillitis, pharyngitis, laryngitis, after a couple of weeks. Even a small abscess on the skin can cause this disease. In a sick child, streptococci are found on the skin and in the nasopharynx. Very often it is provoked by simple hypothermia of the body.

In medicine, there are two types of disease - chronic and acute glomerulonephritis in children, which differ in their causes and symptoms.

1. Spicy

The reason is a previous infectious disease, the symptoms are pronounced, the child’s condition is deteriorating sharply. If detected early, it can be treated and proceeds in most cases without complications.

2. Chronic

Chronic, so-called diffuse glomerulonephritis is a more severe inflammatory process in the kidneys, which gradually leads to the death of the renal glomeruli. The cause of the disease is most often an undetected and untreated acute form of glomerulonephritis. The main symptom is hypertension with all the ensuing consequences. Requires long-term hospital treatment and recovery period.

Chronic glomerulonephritis occurs much less frequently in children: for every 100 cases of acute development of the disease, only two are chronic.

Symptoms

The symptoms of an acute disease are clearly expressed, while chronic glomerulonephritis can lie low and only make itself felt from time to time, continuing to undermine the small body from the inside. The main signs of the disease begin to appear only 10–21 days after the infection that the child had to endure. These include:

weakness;
thirst;
increased fatigue;
a decrease in the amount of urine excreted per day, the color of which becomes brown, black-coffee, or reminiscent of the shade of meat slop;
the earliest symptom is gradual swelling, which first appears on the face, after a few days - on the lower back and legs;
One of the leading signs of the disease is hypertension: there is a simultaneous increase in both maximum and minimum blood pressure, and this effect is long-lasting, persistent (does not fade for three or more months) and is a kind of indication of the disease becoming chronic;
after this, vision deterioration may begin, the child increasingly complains of headaches, nausea, and drowsiness in the middle of the day.

If the disease is not recognized in time by these symptoms, childhood glomerulonephritis can cause serious complications: acute renal and heart failure, cerebral edema. To make sure that these are signs of this particular pathology, a full diagnosis is carried out in an inpatient setting.

Diagnostics

Diagnosis of glomerulonephritis in children is difficult because the signs of the disease are very similar to the symptoms. Therefore, conclusions are drawn based on laboratory tests:

a lot of protein and traces of blood are found in the urine;
its specific gravity is either normal or increased;
significant changes in the blood detected during analysis, which in some forms of glomerulonephritis remain in the child’s body for life;
a reduced content of total protein is detected in the blood serum;
Ultrasound of the kidneys, ECG, radioisotope angiorenography, Zimnitsky and Reberg tests, ultrasound Dopplerography of the renal vessels are also performed;
The child’s fundus is examined with special equipment, which confirms or refutes the diagnosis;
Kidney biopsy is prescribed for children only if chronic glomerulonephritis is suspected: this way its activity is checked and kidney diseases with similar symptoms are excluded.

Based on the results of these diagnostics, appropriate therapy is prescribed.

Treatment of glomerulonephritis in children

Almost always, treatment of glomerulonephritis is carried out inpatiently using the following methods:

an appropriate drinking regime is prescribed: the amount of liquid consumed by the child is limited to 1 liter or less;
the diet for glomerulonephritis should be protein-free and salt-free;
antibiotic therapy for 2–3 weeks;
diuretics;
in some cases, corticosteroid hormones may be prescribed;
bed rest;
plasmapheresis;
vitamin therapy;
pulse therapy;
surgical intervention: kidney transplantation.

Treatment of glomerulonephritis in children in an inpatient setting lasts from 1.5 to 2 months.

Prevention

A child who has had glomerulonephritis will need to be under constant supervision of a nephrologist for five years. To prevent the disease from returning or worsening, it is recommended:

have your urine analyzed monthly;
It is recommended to protect children from any infections that provoke the disease;
the child is exempt from sports and physical education.

Despite the fact that glomerulonephritis in children is quite severe and requires such serious, long-term treatment, in most cases the prognosis is still favorable: complete recovery with strict adherence to all medical recommendations.

Bed rest is prescribed for 7-10 days only for conditions associated with the risk of complications: heart failure, angiospastic encephalopathy, acute renal failure. Long-term strict bed rest is not indicated, especially with nephrotic syndrome, as the threat of thromboembolism increases. Expansion of the regimen is allowed after normalization of blood pressure, reduction of edema syndrome and reduction of gross hematuria.

Diet for acute glomerulonephritis in children

The prescribed table is kidney No. 7: low-protein, low-sodium, normocaloric.

Protein is limited (up to 1 -1.2 g/kg due to the limitation of animal proteins) for patients with impaired renal function with an increase in the concentration of urea and creatinine. In patients with NS, protein is prescribed according to the age norm. Protein restriction is carried out for 2-4 weeks until urea and creatinine levels normalize. With salt-free diet No. 7, food is prepared without salt. In the products included in the diet, the patient receives about 400 mg of sodium chloride. When hypertension is normalized and edema disappears, the amount of sodium chloride is increased by 1 g per week, gradually bringing it to normal.

Diet No. 7 has a high energy value - at least 2800 kcal/day.

The amount of fluid administered is regulated based on diuresis of the previous day, taking into account extrarenal losses (vomiting, loose stools) and perspiration (500 ml for school-age children). There is no need for special fluid restriction, since there is no thirst on the background of a salt-free diet.

To correct hypokalemia, foods containing potassium are prescribed: raisins, dried apricots, prunes, baked potatoes.

Table No. 7 is prescribed long-term for acute glomerulonephritis - for the entire period of active manifestations with a gradual and slow expansion of the diet.

In acute glomerulonephritis with isolated hematuria and preservation of renal function, dietary restrictions are not applied. Table number 5 is assigned.

Symptomatic treatment of acute glomerulonephritis in children

Antibacterial therapy

Antibacterial therapy is administered to patients from the first days of the disease if a previous streptococcal infection is indicated. Preference is given to penicillin antibiotics (benzylpenicillin, augmentin, amoxiclav); macrolides or cephalosporins are less commonly prescribed. Duration of treatment is 2-4 weeks (amoxicillin orally 30 mg/(kg day) in 2-3 divided doses, amoxiclav orally 20-40 mg/(kg day) in three divided doses).

Antiviral therapy is indicated if its etiological role is proven. Thus, in case of association with the hepatitis B virus, the prescription of acyclovir or valacyclovir (Valtrex) is indicated.

Treatment of edema syndrome

Furosemide (Lasix) is a loop diuretic that blocks potassium-sodium transport at the level of the distal tubule. Prescribed orally or parenterally from 1-2 mg/kg to 3-5 mg/(kg/day). When administered parenterally, the effect occurs within 3-5 minutes, when administered orally - after 30-60 minutes. The duration of action when administered intramuscularly and intravenously is 5-6 hours, when taken orally - up to 8 hours. The course is from 1-2 to 10-14 days.

Hydrochlorothiazide - 1 mg/(kg/day) (usually 25-50 mg/day, starting with minimal doses). Breaks between doses are 3-4 days.

Spironolactone (veroshpiron) is a sodium-sparing diuretic, an aldosterone antagonist. Prescribed at a dose of 1-3 mg/kg per day in 2-3 doses. Diuretic effect - after 2-3 days.

Osmotic diuretics (polyglucin, rheopolyglucin, albumin) are prescribed to patients with refractory edema with nephrotic syndrome and severe hypoalbuminemia. As a rule, combination therapy is used: a 10-20% albumin solution at a dose of 0.5-1 g/kg per dose, which is administered over 30-60 minutes, followed by the administration of furosemide at a dose of 1-2 mg/kg or higher for 60 min in 10% glucose solution4. Instead of albumin, a solution of polyglucin or rheopolyglucin can be administered at a rate of 5-10 ml/kg.

Osmotic diuretics are contraindicated in patients with AGN with nephritic syndrome, since they have severe hypervolemia and possible complications in the form of acute left ventricular failure and eclampsia.

Treatment of arterial hypertension

Hypertension in acute nervous system syndrome is associated with sodium and water retention, with hypervolemia, therefore, in many cases, a decrease in blood pressure is achieved by a salt-free diet, bed rest and the administration of furosemide. The dose of furosemide can reach 10 mg/kg per day for hypertensive encephalopathy.

For CGN and, less commonly, for acute glomerulonephritis in children, antihypertensive drugs are used.

Slow calcium channel blockers (nifedipine sublingually 0.25-0.5 mg/day) in 2-3 doses until blood pressure normalizes, amlodipine 2.5-5 mg orally once a day until blood pressure normalizes).

Angiotensin-converting enzyme inhibitors (ACE inhibitors): enalapril orally 5-10 mg/day in 2 divided doses until blood pressure normalizes, captopril orally 0.5-1 mg/day) in 3 divided doses until blood pressure normalizes. Course - 7-10 days or more.

The simultaneous use of these drugs is undesirable, as myocardial contractility may decrease.

Pathogenetic treatment of acute glomerulonephritis in children

Impact on microthrombotic processes

Heparin sodium has a multifactorial effect:

suppresses intravascular processes, including intraglomerular coagulation;
has a diuretic and natriuretic effect (suppresses the production of aldosterone);
has a hypotensive effect (reduces the production of the vasoconstrictor endothelin by mesangial cells);
has an antiproteinuric effect (restores the negative charge on the BM).

Sodium heparin is prescribed subcutaneously at a dose of 150-250 IU/kg/day) in 3-4 doses. Course - 6-8 weeks. Discontinuation of sodium heparin is carried out gradually by reducing the dose by 500-1000 IU per day.

Dipyridamole (chimes):

has antiplatelet and antithrombotic effects. The mechanism of action of chimes is associated with an increase in the content of cAMP in platelets, which prevents their adhesion and aggregation;
stimulates the production of prostacyclin (a powerful antiplatelet agent and vasodilator);
reduces proteinuria and hematuria, has an antioxidant effect.

Curantil is prescribed at a dose of 3-5 mg/kg/day) for a long time - for 4-8 weeks. Prescribed as monotherapy and in combination with sodium heparin and glucocorticoids.

Impact on immune inflammation processes - immunosuppressive therapy

Glucocorticoids (GC) - non-selective immunosuppressants (prednisolone, methylprednisolone):

have an anti-inflammatory and immunosuppressive effect, reducing the flow of inflammatory (neutrophils) and immune (macrophages) cells into the glomeruli, and thereby inhibit the development of inflammation;
suppress the activation of T-lymphocytes (as a result of decreased production of IL-2);
reduce the formation, proliferation and functional activity of various subpopulations of T-lymphocytes.

Depending on the response to hormonal therapy, hormone-sensitive, hormone-resistant and hormone-dependent variants of glomerulonephritis are distinguished.

Prednisolone is prescribed according to regimens depending on the clinical and morphological variant of glomerulonephritis. For acute glomerulonephritis in children with NS, prednisolone is prescribed orally at the rate of 2 mg/kg/day (no more than 60 mg) continuously for 4-6 weeks, in the absence of remission - up to 6-8 weeks. Then they switch to an alternating course (every other day) at a dose of 1.5 mg/kg/day) or 2/3 of the treatment dose in one dose in the morning for 6-8 weeks, followed by a slow decrease of 5 mg per week.

In case of steroid-sensitive NS, a subsequent relapse is stopped with prednisolone at a dose of 2 mg/kg/day until three normal results of 24-hour urine analysis are obtained, followed by an alternating course for 6-8 weeks.

For frequently relapsing and hormone-dependent NS, therapy with prednisolone in a standard dose or pulse therapy with methylprednisolone at a dose of 30 mg/kg/day) intravenously three times with an interval of one day is started for 1-2 weeks, followed by a transition to prednisolone daily, and then to an alternating course. In case of frequently relapsing NS, cytostatic therapy may be prescribed after the 3-4th relapse.

Cytostatic drugs are used for chronic glomerulonephritis: mixed form and nephrotic form with frequent relapses or in the hormone-dependent version.

Chlorambucil (leukeran) is prescribed at a dose of 0.2 mg Dkgxut) for two months.
Cyclophosphamide: 10-20 mg/kg administered in the form of pulse therapy once every three months or 2 mgDkg/day) for 8-12 weeks.
Cyclosporine: 5-6 mg/kg/day) for 12 months.
Mycophenolate mofetil: 800 mg/m2 for 6-12 months.

Cytotoxic drugs are prescribed in combination with prednisolone. The choice of therapy, combination of drugs and its duration depend on the clinical, morphological variant and characteristics of the course.

Depending on the clinical variant and the acute and morphological variant of chronic glomerulonephritis, appropriate treatment regimens are selected.

Here are possible treatment regimens. In acute glomerulonephritis with nephritic syndrome, antibiotic therapy for 14 days, diuretics, antihypertensive drugs, as well as chimes and sodium heparin are indicated.

For acute glomerulonephritis in children with nephrotic syndrome, the administration of diuretics (furosemide in combination with osmotic diuretics) and prednisolone according to the standard regimen is indicated.

For AGN with isolated urinary syndrome: antibiotics as indicated, chimes and, in some cases, sodium heparin.

For acute glomerulonephritis in children with hypertension and hematuria: diuretic, antihypertensive drugs, prednisolone according to the standard regimen and, if there is no effect, add cytostatics after a kidney biopsy.

For CGN (nephrotic form), pathogenetic therapy includes the prescription of prednisolone, diuretics, chimes, and sodium heparin. However, in cases of frequently relapsing course or hormone resistance, cytostatic drugs should be used. The scheme and duration of their use depends on the morphological variant of glomerulonephritis.

In case of CGN (mixed form), with exacerbation and the presence of edema, diuretics and antihypertensive drugs are prescribed, and prednisolone in the form of pulse therapy with the addition of cyclosporine is prescribed as immunosuppressive therapy.

Treatment of complications of acute glomerulonephritis in children

Hypertensive encephalopathy:

intravenous administration of furosemide in large doses - up to 10 mg/kg/day);
intravenous administration of sodium nitroprusside 0.5-10 mcg/(kgmin) or sublingual nifedipine 0.25-0.5 mg/kg every 4-6 hours;
for convulsive syndrome: 1% solution of diazepam (seduxen) intravenously or intramuscularly.

Acute renal failure:

furosemide up to 10 mg/kg/day);
infusion therapy with a 20-30% glucose solution in small volumes of 300-400 ml/day;
for hyperkalemia - intravenous administration of calcium gluconate at a dose of 10-30 ml/day;
administration of sodium bicarbonate in a dose of 0.12-0.15 g of dry matter orally or in enemas.

When azotemia increases above 20-24 mmol/l, potassium above 7 mmol/l, pH decreases below 7.25 and anuria for 24 hours, hemodialysis is indicated.

Pulmonary edema:

furosemide intravenously up to 5-10 mg/kg;
2.4% aminophylline solution intravenously 5-10 ml;
korglykon intravenously 0.1 ml per year of life.

Reasons for the development of the disease
Treatment of the disease in children
What complications can the disease cause?
Preventive actions

Glomerulonephritis, or simply nephritis, is a common acquired kidney disease. Quite often it occurs in children aged 3 to 12 years, rarely in newborns and breastfed children.

Acute glomerulonephritis in children is characterized by varying intensity and severity of the clinical picture, usually has an infectious-allergic nature and affects the tiny filtering glomeruli of the kidney, called the renal glomeruli.

With the development of nephritis in the kidneys, immune inflammation occurs, which develops as a result of certain reasons that are the main factors in the development of the pathology. In this case, streptococci can be stimulants. They are the most familiar initiators of jade. In addition to kidney diseases, they are the cause of sore throat, many colds, pharyngitis, dermatitis and scarlet fever. As a rule, acute manifestations of glomerulonephritis occur three weeks after the child has suffered one of these diseases.

The disease can also be caused by:

infections, viruses and various bacteria;
vaccines and all kinds of serums;
snake and bee venom.

The child feels unwell immediately after the vaccination. When encountering the above stimulants, the child’s body responds to danger, but instead of neutralizing foreign substances, it forms an immune response that destroys the glomeruli.

Damage to the renal glomeruli can also be caused by:

accidental hypothermia and overheating;
long stay on the road;
extra-long exposure to the sun;
sudden climate change;
emotional shock;

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What happens during the development of glomerulonephritis?

The structure of the renal glomeruli consists of blood vessels and capillary loops (nodes). These nodes help filter the blood and remove excess fluid from it.

If a child develops glomerulonephritis, the glomeruli of the kidneys become inflamed, swollen, and unable to perform their functions. Your child may develop kidney failure or more serious kidney disease.

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What can glomerulonephritis be?

Depending on the severity of the disease, glomerulonephritis can be acute, subacute and chronic or diffuse.

Subacute and acute glomerulonephritis often occurs suddenly, after previous infectious diseases such as tonsillitis, acute respiratory infections, influenza, scarlet fever, laryngitis, systemic lupus erythematosus, amyloidosis or polyarthritis nodosa.

In this case, the causative agent of the disease is streptococcus, in rare cases – streptococcal, viral or any other coccal infection. In a weakened child, the disease can develop from an ordinary abscess present on the skin or mucous membrane.

Streptococcus, entering the child’s body, begins to produce toxins that enter all organs and tissues through the blood. Accumulating in the kidneys, dangerous substances form antigenic complexes. The complexes provoke inflammatory processes in the renal glomeruli.

Chronic diffuse glomerulonephritis, as a rule, develops very slowly and is asymptomatic. This can cause permanent kidney damage and serious illness. In some cases, chronic glomerulonephritis in children may be caused by a genetic disease.

Hereditary diffuse glomerulonephritis often occurs in boys with poor vision and hearing.

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What are the symptoms of glomerulonephritis?

Early symptoms of acute glomerulonephritis in children include:

Bad feeling. The child may be whiny, irritable and lethargic.
Headache and lower back pain. It is impossible to play and talk with the child.
Nausea and vomiting. The child may refuse to eat and drink.
Temperature increase.
Increased blood pressure, sometimes the readings can rise to 140-160 mm Hg. Art.
Swelling of the face and eyelids, often spreading to other parts of the body.
Frequent and sparing urination.
Presence of blood in the urine (urine becomes dark, rusty, or pink).
A cough that occurs because fluid accumulates in the lungs.
Red blood cells and protein appear in the urine, and in the case of an infectious course of the disease, bacteria and leukocytes appear.
Weight gain.

At the slightest suspicion of the development of glomerulonephritis in a child, you should immediately consult a doctor and begin treatment. Neglecting help can cause complications and the development of serious pathologies: nephrotic encephalopathy, uremia and heart failure.

Symptoms of chronic glomerulonephritis in children are most often mild. Therefore, the child is practically no different from healthy children. Chronic glomerulonephritis in children can only be determined by:

persistently elevated blood pressure;
the presence of blood and protein in the urine (determined visually and by laboratory tests);
swelling of the ankles and face;
frequent night urination;
foamy and cloudy urine (a condition caused by excess protein in the urine);
pain in the abdomen and lower back;
frequent nosebleeds.

If the chronic course of the disease begins to cause complications and lead to renal failure, the child may additionally:

feel tired;
experience nausea and vomiting;
lose appetite, and in especially severe cases, completely refuse to eat food;
have trouble sleeping both at night and during the day;
experience muscle cramps at night and during daytime sleep;
feel itchy and dry skin.

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How is the disease diagnosed?

Both acute and chronic glomerulonephritis in children are diagnosed by:

Laboratory urine analysis. The presence of blood and protein in a urine test is an important marker for confirming the diagnosis.
Blood test. A blood test may show anemia (low levels of red blood cells), abnormal albumin and creatinine levels, and abnormal blood urea nitrogen concentrations.
Immunological testing. Testing detects the presence of antibodies. If antibodies are detected, the child may have kidney damage.
Biopsies. The test is performed using a needle. A sample is taken from the kidneys to clarify or confirm the diagnosis.

To find out what is really going on with the child, the doctor may prescribe:

computed tomography (CT);
Ultrasound of the kidneys;
chest x-ray;
internal pyelogram (x-ray of the kidneys with dye).

Glomerulonephritis in children is classified as an immuno-inflammatory lesion of the renal glomeruli, which leads to a decrease in their performance. Now this disease is one of the most common. Glomerulonephritis occurs twice as often in boys than in girls.

Acute glomerulonephritis in children develops as a result of inflammation of the glomeruli, thereby blocking the normal functioning of the organ.

The disease develops due to inflammation of the glomeruli

During this pathological process, fluid accumulates in the child’s body, which leads to edema, increased blood pressure and the appearance of protein fractions and blood clots in the urine.

Basically, the development of acute glomerulonephritis occurs against the background of infectious diseases such as tonsillitis, scarlet fever or pneumonia. In some situations, a banal vaccination can provoke a pathological process in a child’s body.

Among other things, the following factors can lead to the occurrence of a disease such as glomerulonephritis:

tuberculosis;
flu;
chicken pox;
herpes;
hypothermia;
hypovitaminosis;
various types of infections;
previous respiratory diseases;
genetic predisposition.

Also, glomerulonephritis can be a consequence of complications after suffering systemic diseases, such as vasculitis, endocarditis or lupus erythematosus.

The latent course of glomerulonephritis in childhood is quite rare, while in young patients pronounced manifestations are always observed.

The main symptoms of glomerulonephritis in children, indicating its development, are:

constant headaches;
increased body temperature;
the occurrence of attacks of nausea, which usually end in vomiting;
decreased performance, weakness and fatigue;
a sharp deterioration in health;
the appearance of swelling on the eyelids and face;
pain in the lumbar region;
increased blood pressure;
change in the color of urine, which takes on a dark rusty hue;
decreased amount of urine.

The main danger of acute glomerulonephritis is that the disease can develop into a rapidly progressive form, as evidenced by the following symptoms:

the appearance of blood impurities in urine;
the presence of a large amount of protein in the urine, which can be manifested by the appearance of white flakes in it.

The appearance of blood impurities in urine is characteristic

If, when the first symptoms appear, timely treatment of glomerulonephritis in children is started, and also if, despite the prescribed treatment, recovery does not occur within six months, then basically the pathological process becomes chronic. In this case, swelling and changes occurring in urine can be observed for one year or more.

In order to accurately determine the presence of the disease based on the symptoms that appear, you should seek help from a pediatrician, urologist or nephrologist. Before prescribing a number of additional tests for a child, the doctor must first collect an anamnesis and only then decide on the necessary laboratory and instrumental diagnostic methods.

Thanks to these studies, the doctor will be able to identify the presence of signs of a developing inflammatory process, as well as determine the presence, decrease in diuresis and hematuria, increase in ESR, as well as an increase in harmful substances in the blood.

The child needs to undergo a series of examinations to establish an accurate diagnosis.

In addition to laboratory tests, a small patient should undergo an ultrasound examination, an immunogram, and a study of the renal vessels. This is necessary, first of all, in order to determine the increase in kidney volume and find out the full picture of the disease. In some situations, a biopsy is recommended, which allows us to clarify the variant of the pathological process. Based on all the above laboratory and instrumental examinations, the doctor will be able to make an accurate diagnosis. If the assumptions about the diagnosis are confirmed, the child is given consultations with specialized specialists, such as an otolaryngologist, geneticist, dentist and ophthalmologist.

The acute form of glomerulonephritis in childhood is treated exclusively in a hospital setting under the close supervision of the attending physician.

When a child is diagnosed with a disease such as glomerulonephritis, the pathology is treated using the following conservative methods:

taking medications;
performing a set of exercise therapy exercises;
adherence to a strict pastel regime until recovery;
compliance with all rules regarding dietary nutrition.

As for taking medications, in order to cure glomerulonephritis in childhood, the following drugs are prescribed:

antibiotics;
cytostatics;
diuretics;
blood pressure lowering agents;
hormonal drugs;
drugs aimed at reducing viscosity and normalizing blood clotting;
vitamin complexes;
means to enhance immunity.

During treatment it is very important to follow a diet

In the process of treating glomerulonephritis in children, it is also very important to observe. In this case, it is recommended to adhere to the rules and nutrition of dietary table No. 7. Such nutrition is primarily aimed at reducing the amount of protein consumed, completely eliminating salt from the diet and limiting fluid intake.

Note! If acute glomerulonephritis becomes diffuse, the patient must undergo hemodialysis or surgery.

Once treatment is completed, the child should be monitored by a nephrologist for five years. In addition, after an illness, the child is given an exemption from physical education, and ways to increase immunity and preventive measures to prevent infectious and inflammatory diseases are selected.

The child should be monitored by a nephrologist

Also, after treating the acute stage of childhood glomerulonephritis, if there are concomitant pathologies, it is strongly recommended to eliminate all foci of infection, as well as cure teeth, get rid of adenoids and all other diseases and abnormalities. But you shouldn’t do this right away; at least six months must pass after treatment. This applies to both acute and chronic forms of glomerulonephritis.

The basis for the prevention of childhood glomerulonephritis is timely diagnosis and professional treatment of inflammatory and infectious diseases of the skin and upper respiratory tract. Unfortunately, at present, a vaccine against this insidious and dangerous disease has not yet been created, and as for prevention methods, they are considered very specific.

Among other things, it is very important to harden the child’s body from an early age, as well as provide him with a balanced diet, systematic intake of vitamin complexes and means to enhance immunity.

If you suspect the development of a pathological process such as glomerulonephritis in a child’s body, you should immediately consult a doctor. This is very important, since even the slightest delay can lead to aggravation of the situation and the emergence of various kinds of complications. It is strictly forbidden to self-medicate, as this can jeopardize the child’s health and even lead to complications such as uremia, heart or kidney failure, or nephropathic encephalopathy.

To prevent the development of glomerulonephritis, you should follow some simple rules

Also, in order to prevent the development of glomerulonephritis in childhood, you should adhere to the following recommendations:

limit salt intake;
systematically undergo examinations by a pediatrician for preventive purposes;
promptly treat allergic diseases;
Avoid hypothermia and overheating.

As for the prognosis for recovery, if the pathology is diagnosed in a timely manner and all the recommendations of the attending physician are followed, the possibility of getting rid of glomerulonephritis increases significantly and the child can completely get rid of the disease.

With professionally prescribed treatment, the transition of pathology to the chronic stage, as well as the development of other complications, occurs quite rarely, and deaths are recorded in only two percent of cases.

Possible complications

If you ignore the symptoms indicating the development of glomerulonephritis for a long time or self-medicate, then serious and sometimes irreversible changes can occur in the body, such as:

renal eclampsia;
nephrotic encephalopathy;
uremia;
acute or chronic renal failure;
heart failure;
swelling of the lungs;
cerebral hemorrhage;
severe convulsive seizures.

Childhood glomerulonephritis in itself is considered a rather severe and complex disease. Cases of complete relief from this pathological process are recorded quite rarely. One of the most common complications that this disease leads to is its transition to a chronic form.

Glomerulonephritis in children is a kidney disease characterized by autoimmune inflammation in the glomerular apparatus. With its development, there is a disruption in the filtration of blood from decay products that are retained in the body. At the same time, there is excessive excretion of blood elements and proteins in the urine. As a result, kidney failure begins to develop, which can cause disability in the child.

Term autoimmune inflammation means that immune cells damage their own tissues, to which they normally have tolerance.

When viral or bacterial agents enter the body, the immune system produces antibodies - protective proteins that bind to pathogenic particles and remove them from the body, incl. and with the participation of the kidneys (through urine).

With the development of glomerulonephritis, this process is disrupted. The resulting complex of proteins and pathogenic agents sensitizes the immune system. As a result, the antibodies that are supposed to protect the body begin to perceive the kidney tissue as foreign. This is the basis for damage to the renal glomeruli in glomerulonephritis.

The renal glomeruli are the functional unit of this organ, so when they are damaged, kidney failure develops.

When the function of the glomerular apparatus is disrupted, the permeability of the kidney filters increases, through which not only salts and water, but also blood elements begin to be removed from the body. For this reason, when taking urine tests for this disease, elevated levels of proteins, red blood cells and leukocytes in the urinary sediment are detected.

For of glomerulonephritis, the most specific sign in a urine test is hematuria, i.e. increased number of red blood cells (normally there should be no more than 1).

Impaired excretion of water and salts by the kidneys causes the accumulation of these elements in the body, which causes severe swelling. And since the kidneys, in addition to their excretory function, maintain the process of blood formation and normalize blood pressure, when their functionality is impaired, children often develop diseases such as anemia and hypertension.

Since a disease such as glomerulonephritis causes enormous loss of proteins, decreased immunity. Immunoglobulins that perform protective functions are proteins. Therefore, the risk of a bacterial infection against the background of inflammation increases several times.

What factors provoke the development of pathology?

Symptoms and treatment of glomerulonephritis in children primarily depend on the nature of the origin and form of the disease. In most cases, the development of this disease is provoked by various pathogenic agents., which act as an immune provocateur (a kind of allergen). In this case it could be:

Streptococcus. This infectious agent most often provokes kidney dysfunction; it also causes diseases such as tonsillitis, scarlet fever, dermatitis and pharyngitis. In 80% of cases, post-streptococcal glomerulonephritis in children begins to develop immediately after the baby suffers one of these diseases.
Other agents of bacterial origin, atypically activating the immune system.
Viruses. These pathogens can also cause the development of glomerulonephritis. Among them, herpes virus, hepatitis, measles, parainfluenza and others are more often detected.
Vaccines. The development of glomerulonephritis in newborns can occur after preventive vaccinations, for example, against influenza, polio, whooping cough, tetanus, etc. The risk increases if you use low-quality, poorly purified vaccines or immunize against the background of various infections or diseases.
Snake or bee venom, entered the body.

When such pathogenic agents appear in the body, instead of eliminating them, it begins to form immune complexes (agents and antibodies) that indirectly affect the glomerular apparatus. This process can be triggered by a variety of factors affecting the body. For example:

hypothermia;
stress;
prolonged exposure to the sun;
change in climatic conditions;
excessive physical activity.

As a result of exposure to all these unfavorable factors, the functionality of the kidneys is impaired, and the child’s condition begins to deteriorate sharply.

Since harmful substances remain in the body, the functioning of other organs and systems is disrupted, and the development of inflammatory diseases is also provoked. And due to the fact that the immune system also suffers from all these processes, the body becomes vulnerable to bacteria and infections, which further aggravates the situation.

Clinical picture

The following symptoms are characteristic of this disease:

swelling (most often appears on the face, but can also affect the lower and upper limbs);
changes in blood pressure;
change in the composition of urine (during laboratory testing, a high concentration of proteins and red blood cells is observed).

But it must be said that the clinical manifestations of the disease largely depend on its form. In medicine, glomerulonephritis is divided into acute and chronic. This is not a complete classification of this disease, since it also has its own subtypes.

Acute course

Acute glomerulonephritis in children manifests itself in the form of nephritic and nephrotic syndrome. Nephritic syndrome is most often observed in children aged 5-10 years after suffering viral diseases. The pathology progresses very quickly and is accompanied by the following unpleasant symptoms:

Swelling of soft tissues. If the causative disease is adequately treated, swelling will disappear within 1-2 weeks.
Hypertension. Accompanied by a significant increase in blood pressure, which can also lead to dizziness, nausea and vomiting.
Changes in the composition of urine. When examining it, a high concentration of proteins and red blood cells is detected. In some cases, the amount of the latter is so high that the color of the urine changes - it becomes dark red. In addition, an increase in the level of leukocytes is observed in the urine, but not as significant as with pyelonephritis. Such changes usually persist for a long time.

Acute glomerulonephritis in children with nephritic syndrome is relatively easy to treat. The prognosis in this case is the most favorable, since complete recovery is observed in 90% of children without any complications.

Nephrotic syndrome is the most severe form of the disease. Only in isolated cases do small patients manage to overcome the disease. But most often it takes a chronic form and provokes the development of renal failure.

The nephrotic form manifests itself as follows: swelling and increased levels of protein compounds in the urine. Swelling in this disease has its own characteristics. They first appear in the area of the legs and on the face. Further, swelling begins to spread to the lumbar region and can even form in the cavities of the body. And if in the nephritic form the edema has a dense texture, then in the nephrotic form it is soft.

In the nephrotic form, only an increase in the level of proteins is observed in the urine. Red blood cells and white blood cells are found in small quantities. Blood pressure in children is normal, but pale skin, dullness and severe brittleness of hair are observed.

Also, acute glomerulonephritis can be observed in the form of an isolated urinary syndrome, which is characterized by changes only in the composition of urine. The child's condition with this form remains unchanged.

In some cases, this pathology may be mixed. In this case, all the above-described symptoms of the disease are observed at once. This form is typical for school-age children and almost always develops into chronic glomerulonephritis.

Chronic form

When changes in urine during glomerulonephritis are observed for one year or the main symptoms (swelling and increased blood pressure) persist for six months, then we are talking about a chronic course of the disease.

The chronic form of glomerulonephritis occurs in different ways. It is characterized by the following manifestations:

Nephrotic syndrome. This form of the disease most often occurs in young children and is accompanied by prolonged swelling and increased protein levels in the urine. These symptoms appear during periods of exacerbation of the disease. The prognosis for the nephrotic form of chronic glomerulonephritis is most favorable. In 70% of cases, it is possible to achieve stable periods of remission. However, in 30% of children, as a result of this disease, renal failure begins to develop, which requires constant use of devices that replace the functionality of the kidney.
Mixed form. It is characterized by the appearance of all the symptoms that occur during an exacerbation at once. These include long-term edema, hypertension, changes in the composition of urine, etc. In this case, the prognosis is not the most favorable. Only 10% of sick children achieve stable remission. In 90% of cases, the disease occurs in frequently alternating phases of remission and exacerbation. Unfortunately, the mortality rate associated with this form of the disease is very high. More than half of sick children do not survive 15-20 years after developing glomerulonephritis.
Hematuric form. As it develops, the level of red blood cells in the urine increases. During an exacerbation, proteins may appear in it. Other clinical manifestations of glomerulonephritis are not typical for this form. The hematuric form is the most favorable, since in only 7% of cases it provokes the development of chronic renal failure.

Pyelonephritis and glomerulonephritis in children are different diseases. The first is associated with infectious inflammation (there is a clear connection with the microbe), and the second with autoimmune inflammation.

Establishing diagnosis

The diagnosis is made on the basis of the patient’s medical history, complaints and the presence of congenital or hereditary renal pathologies in him or his relatives. But in addition, the diagnosis of glomerulonephritis includes:

Rehberg test (determines the functional reserves of the kidneys);
biochemical analysis of blood and urine;
urine test according to Nechiporenko;
Zimnitsky's test;
ultrasound examination of the kidney;
puncture kidney biopsy.

The child will also need to undergo a fundus examination to rule out the development of angiopathy and be tested to detect genetic pathologies. In addition, you will need to consult a dentist and otolaryngologist to identify foci of chronic infection in the body.

Treatment of glomerulonephritis

Treatment of glomerulonephritis in children is carried out with medication. The following drugs are used for this:

hormonal or cytostatic drugs that suppress the pathological activity of the immune system (basic therapy);
diuretics (necessary to remove excess fluid from the body and eliminate swelling);
medications that normalize blood pressure levels (as soon as blood pressure returns to normal, the child’s condition will improve significantly, as symptoms such as nausea, dizziness and vomiting will disappear);
antibacterial agents (they are prescribed only if the development of glomerulonephritis is provoked by agents of a bacterial nature);
medicines that improve blood composition and properties;
elimination of foci of infection (treatment of carious teeth, tonsillitis, etc.).

Thus, therapy for glomerulonephritis includes taking basic and symptomatic medications. Additionally, possible provoking factors are eliminated.

If a child nevertheless develops renal failure due to glomerulonephritis, hemosorption or a kidney transplant is used. The last method is drastic and has great risks. Therefore, it is used extremely rarely.

In case of exacerbation of the disease, treatment is carried out only in a hospital setting!

During treatment, the child should avoid hypothermia, overheating, severe physical exertion and emotional shock. Therefore, doctors often send sick children to medical and preventive sanatoriums for 2-3 months.

Nutrition for glomerulonephritis

A diet for glomerulonephritis is prescribed to absolutely all children. As a rule, for such a disease, treatment table No. 7 is recommended. It means:

fractional meals;
drinking liquid in a volume of 0.6-0.8 liters per day (this includes not only water, compotes, juices, etc., but also liquid dishes);
reducing the consumption of protein foods;
exclusion of table salt and various pickles.