Acute glomerulonephritis in children

Acute glomerulonephritis is a common disease in children and it is one of the diseases that are presented commonly with hematuria which means red urine (blood in urine).

Hematuria is the commonest presentation but not the only one. There are many other causes for hematuria in children that has to be differentiated from the topic of this article which is : Acute Post Streptococcal Glomerulonephritis in children which occurs after a streptococcal throat infection (sore throat with exudates or pus,congested throat, enlarged lymph nodes in the neck and may be a membrane on the tonsills).

Characters of post streptococcal glomerulonephritis : (the typical presentation):

• History of strptococcal throat infection within the past 5 days to weeks (a latent period as immune reaction takes time to occur) or laboratory evidence of the infection if history is not available.
• No history of previous renal disease.
• No family history of renal diseases.
• Red urine described as smoky coca-cola like colour (hematuria). This is also associated with oliguria (reduced amount of urine)
• Hypertension occurs in 70% of cases and it rises all of a sudden and may also suddenly drop back to normal and so on. Hypertension needs early managment and proper treatment and it's the cause of most the complications associated with the disease.
• Edema. It starts in the eyes as puffy eye lids in the morning (puffy eyes) and it may progress to edema of the limbs but most of the time edema is not marked.
• Complications include hypertensive encephalopathy, heart failure and elecvtrolyte disturbances.

95% of the cases recover completely and the disease never recurs in the same child. Only a little proportion of the cases develope renal failure or chronicity.

Investigations:
-Urine examination shows:

• RBCs casts.
• Distorted shape of RBCs in urine (more than 5/HPF).

-Blood examination shows the following:

• Elevated ESR and CRP.
• Low levels of C3 and C4.
• Normocytic normochromic anemia.

-Impaired glomerular function of the kidney.

Biopsy is insicated in resistant cases or in cases with atypical presentation (absence of the laboratory signs or clinical manifestations e.g.(normal C3 levels, history of renal disease, severe proteinuria in the nephrotic range)
Also, investigations should be done to exclude other causes of hematuria such as:

• ANA to exclude SLE.
• Ultrasound to exclude renal stones.
• Urine analysis and hearing tests with family history taking to exclude Alport syndrome.

Treatment of Acute Glomerulonephritis in children :

• Hospital admission to monitor blood pressure changes.
• Salt and fluid restriction if needed (in marked edema, oliguria and H.F.)
• Antibiotic therapy to eradicate infection (long acting Penicillin, one dose intramuscular, dose is calculated according to the age).
• Treatment of hypertension using diuretics, ACE inhibitors and calcium channel blockers. Other complications such as renal failure, heart failure and electrolytes disturbances should be treated immediately.
• Follow up according to the doctor's instructions.

image source:
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