Acute Glomerulonephritis in Children

Introduction

Acute glomerulonephritis is defined as inflammation and subsequent damage of the glomeruli leading to hematuria, proteinuria, and azotemia; it may be caused by primary renal disease or systemic conditions
It  is a disorder of structure and or a functional anomaly of an abrupt onset with a tendency to spontaneous recovery
It may be acute or chronic.
Chronic type is a common cause of end-stage renal disease in children.

Causes

It could be caused by post streptococcal
glomerulonephritis, diffuse proliferative
glomerulonephritis, mesangial proliferative glomerulonephritis, focal
segmental glomerulosclerosis, membranous glomerulopathy, rapidly progressive glomerulonephritis, systemic illness, SLE, Henoch Schonlein Purpura, HBV, poly arteritis nodosa
The commonest cause in this environment is post streptococcal

Clinical features

History of passage of dark smoky urine,
preceding sore throat, skin infection, facial or pedal oedema, seizure, oliguria, anorexia.

Physical examination

Hypertension, oedema, respiratory distress in presence of severe fluid accumulation, seizures, hypertensive encaphalopathy

Diagnostic Criteria

  • Gross hematuria, hypertension, oliguria are the hall mark of diagnosis

Complication

  • Hypertensive encephalopathy, acute kidney injury, hyperkalemia, fluid overload, congestive cardiac failure

Investigation:

Urinalysis:

  • pH-acid
  • colour- dark smoky urine.
  • Red cell casts commonly may be absent and repeated urinalysis of fresh urine may be needed

Leucocyte (pyuria)

  • waxy-suggest pre existing nephritis
  • pr-+,2+ not massive <500mg/dl
  • non selective pr (>0.2 IgG/alb)
  • Na’, Ca2′ reduced
  • FeNa <0.5%
  • Electrolyte, urea creatinine.

Throat Swab

  • grp A strept organism
  • ASO>200 todds unit. Streptozyme:
  • Complement: -C3
  • FBC – anaemia

Treatment

Goal:

  • Treatment of hypertension,
  • Eradication of organism

Hypertension:

  • Tabs aldomet at a dose of 10mg/kg/dose in divided doses

ACE inhibitors like lisinopril
Diuretics e.g. thiazides at 1-2 mg/kg/day in 2 divided doses

  • Salt restriction
  • Diet: normal protein with 60-70% high biologic value but reduced to 0.6-1gm/kg in renal failure

Organism Eradication:

  • Oral penicillin
    • at a dose of 100mg/kg/day in divided doses
  • Cephalosporins
  • Erythromycin
    • at a dose of 40- 50mg/kg/day in divided doses when there is penicillin allergy