Acute Glomerulonephritis in Children
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ℹ️ About
- Causes ⚠️: Haematuria 🩸 and oliguria 🚱 with low BP ⬇️ caused by an immune-mediated response in the kidneys.
- Presentation 🩺: Commonly presents with kidney inflammation.
- Peak Age 👶: Around 7 years old.
Uncomplicated Presentation
- Haematuria 🩸, Oliguria 🚱, Low blood pressure (50% of cases) ⬇️
- Periorbital oedema 👁️, Fever 🌡️
- Gastrointestinal disturbances 🤢, Loin pain ⚡
- Hypertensive Encephalopathy 🧠: Restlessness 😟, Drowsiness 😴, Severe headache 🤯, Seizures ⚡, Vision loss 👀❌, Vomiting 🤮, Coma 🛌
- Uraemia 🧪: Acidosis, Muscle twitching 💢, Stupor, Coma
- Cardiac failure ❤️❌ with fluid overload 💧
Causes of Nephritis
- Group A β-hemolytic streptococcus 🦠, often following a sore throat 😷
- Henoch–Schönlein purpura (HSP) ✨
- Toxins or heavy metals ☠️
- Berger's disease (IgA nephropathy) 🧬
- Malignancies 🎗️
- Viruses 🦠
- Bacteria 🧫 (e.g., infective endocarditis, syphilis)
- Renal vein thrombosis 🩸
Blood Tests 🧪
- Full blood count (FBC) 🧾
- Urea and electrolytes (U&E) 💧, including creatinine, potassium, bicarbonate, calcium, phosphate, and albumin
- Complement levels 🧬 (low C3, normal C4)
- ASOT/anti-DNase B 🦠 (post-streptococcal infection)
- Antinuclear factor (ANA) 🧪, anti-DNA antibodies (if lupus suspected)
- ANCA 🔬 (if vasculitis suspected)
- Syphilis serology 🧫
- Blood cultures 💉
- Virology testing 🧾
Urine Tests 💧
- Microscopic urinalysis 🔬: RBCs, WBCs, hyaline/granular casts; red cell casts 👉 glomerular bleeding
- Urine culture and specific gravity ⚖️ (infants ~1.002–1.006; child/adult ~1.001–1.035)
Other Tests 🩻
- Throat swabs 🧫
- Urgent renal ultrasound (US) 🖼️
- Chest X-ray (CXR) 📸 if fluid overload suspected
Treatment 💊
Supportive treatment is essential 🏥
- Fluid balance 💧
- Treat hypertension 💊
- Manage infections 🦠
- Restrict dietary sodium 🧂 and fluids 💧 to prevent overload
- Diuretics 💊 for oedema
- Antihypertensives 💉 (e.g., ACE inhibitors, ARBs)
- Monitor renal function 📊 regularly
- Renal replacement therapy 🩸 (dialysis) in severe cases
