Glomerulonephritis in children: how to identify and treat the disease in time. Acute glomerulonephritis with nephrotic syndrome Secondary glomerulonephritis in children

Glomerulonephritis is sometimes called nephritis for short. Nephritis (inflammation of the kidneys) is a more general concept (for example, there may be nephritis with a kidney injury or toxic nephritis), but it also includes glomerulonephritis.

The functions of the kidneys. The kidneys play a very important role in humans.

The main function of the kidneys is excretion. Through the kidneys with urine, the end products of protein breakdown (urea, uric acid, etc.), foreign and toxic compounds, and excess organic and inorganic substances are excreted from the body.

The kidneys maintain the constancy of the composition of the internal environment of the body, the acid-base balance, removing excess water and salts from the body.

The kidneys are involved in the metabolism of carbohydrates and proteins.

The kidneys are a source of various biologically active substances. They produce renin, a substance involved in the regulation of blood pressure, and also produce erythropoietin, which promotes the formation of red blood cells - erythrocytes.

In this way:

• The kidneys are responsible for the level of blood pressure.
• The kidneys are involved in blood formation.

How the kidney works. The structural unit of the kidney is the nephron. Roughly, it can be divided into two components: the glomerulus and the renal tubules. The removal of excess substances from the body and the formation of urine in the kidney occurs when two important processes are combined: filtration (occurs in the glomerulus) and reabsorption (occurs in the tubules).
Filtration. Human blood is driven through the kidney, as if through a filter. This process occurs automatically and around the clock, as the blood must be constantly cleansed. Blood flows through the blood vessels into the glomerulus of the kidney and is filtered into the tubules, urine is formed. From the blood, water, salt ions (potassium, sodium, chlorine) and substances that must be removed from the body enter the tubules. The filter in the glomerulus has very small pores, so large molecules and structures (proteins and blood cells) cannot pass through it, they remain in the blood vessel.

Reverse suction. Much more water and salts are filtered out in the tubules than it should be. Therefore, some of the water and salts from the renal tubules are absorbed back into the blood. At the same time, all harmful and excess substances dissolved in water remain in the urine. And if an adult person filters about 100 liters of fluid per day, then only 1.5 liters of urine is formed as a result.

What happens when the kidneys are damaged. If the glomeruli are damaged, the permeability of the renal filter increases, and protein and red blood cells pass through it into the urine along with water and salts (erythrocytes and protein will appear in the urine).

If inflammation joins, in which bacteria and protective leukocyte cells participate, then they will also enter the urine.

Violation of the absorption of water and salts will lead to their excessive accumulation in the body, edema will appear.

Since the kidneys are responsible for blood pressure and blood formation, as a result of the insufficiency of these functions, the patient will develop anemia (see) and arterial hypertension (see).

The body loses blood proteins in the urine, and these are immunoglobulins responsible for immunity, important carrier proteins that transport various substances in the bloodstream, proteins for building tissues, etc. With glomerulonephritis, protein losses are huge, and leaving red blood cells with urine leads to anemia .

Reasons for the development of glomerulonephritis

With glomerulonephritis in the kidneys, there is an immune inflammation caused by the appearance of immune complexes, which are formed under the influence of a certain agent that acts as an allergen.

These agents can be:

• Streptococcus. This is the most common provocateur of glomerulonephritis. In addition to kidney damage, streptococcus is the cause of tonsillitis, pharyngitis, streptococcal dermatitis and scarlet fever. As a rule, acute glomerulonephritis occurs 3 weeks after the child has had these diseases.
• other bacteria.
• Viruses (influenza and other pathogens of acute respiratory viral infections, hepatitis virus, measles viruses, etc.)
• Vaccines and serums (after inoculations).
• Snake and bee venom.

Meeting with these agents, the body reacts to them perversely. Instead of neutralizing and removing them, it forms immune complexes that damage the kidney glomerulus. The starting points for the formation of immune complexes are sometimes the simplest effects on the body:

• Hypothermia or overheating.
• Long stay in the sun. Abrupt climate change.
• Physical or emotional stress.

The filtration process is disturbed, kidney function is reduced. The child's condition worsens significantly, as excess water, protein breakdown products and various harmful substances remain in the body. Glomerulonephritis is a very severe, prognostically unfavorable disease, often resulting in disability.

Clinical forms of glomerulonephritis

In the clinic of glomerulonephritis, there are 3 main components:

• Edema.
• Increase in blood pressure.
• Change in urinalysis.

Depending on the combination of these symptoms, the patient has several forms, pathological syndromes that occur with glomerulonephritis. There are acute and chronic glomerulonephritis.

Clinical forms of glomerulonephritis:

Acute glomerulonephritis.

• nephritic syndrome.
• nephrotic syndrome.
• Isolated urinary syndrome.
• combined form.

Chronic glomerulonephritis.

• nephrotic form.
• mixed form.
• hematuric form.

Acute glomerulonephritis

The disease can begin either acutely, in the case of nephritic syndrome, or gradually, gradually, in nephrotic syndrome. The gradual onset of the disease is prognostically less favorable.

nephritic syndrome. This form of the disease, as a rule, affects children 5-10 years old. Usually the disease develops 1-3 weeks after suffering a sore throat, scarlet fever, SARS and other infections. The onset of the disease is acute.

Characteristic:

• Edema. They are located mainly on the face. These are dense, difficult-to-pass edemas, with adequate treatment, they persist for up to 5-14 days.
• Increased blood pressure, accompanied by headache, vomiting, dizziness. With proper treatment, it is possible to lower blood pressure in 1-2 weeks.
• Changes in urine: decreased amount of urine; the appearance of protein in the urine in moderate amounts; erythrocytes in the urine. The number of erythrocytes in the urine in all patients is different: from a slight increase to a significant one. Sometimes there are so many erythrocytes that the urine turns red (urine is “the color of meat slops”); an increase in the number of leukocytes in the urine.

Changes in the urine persist for a very long time, for several months. The prognosis of this form of acute glomerulonephritis is favorable: recovery occurs in 95% of patients after 2-4 months.

nephrotic syndrome. This form of glomerulonephritis is very severe and prognostically unfavorable. Only 5% of children recover, the rest of the disease becomes chronic.

• The leading symptoms of nephrotic syndrome are edema and protein in the urine.
• The onset of the disease is gradual, consisting in a slow increase in edema. First, it is the shins, the face, after the swelling spreads to the lower back and can be very pronounced, up to fluid retention in the body cavities (the cavity of the heart bag, in the lungs, and the abdominal cavity). Unlike edema in nephritic syndrome, they are soft and easily displaced.
• The skin is pale, dry. Hair is brittle and dull.
• Changes in the urine: a decrease in the amount of urine with an increase in its concentration; protein in the urine in large quantities; there are no erythrocytes or leukocytes in the urine with nephrotic syndrome.

• Arterial pressure is normal.

Isolation urinary syndrome. With this form, there are changes only in the urine (the protein content is moderately increased and the number of erythrocytes is increased to varying degrees). The patient does not present other complaints. Diseases in half of the cases ends in recovery, or becomes chronic. There is no way to influence this process, since even with good competent treatment, the disease passes into a chronic form in 50% of children.

mixed form. There are signs of all three of the above syndromes. The patient has everything: pronounced edema, high blood pressure, and a large amount of protein and red blood cells in the urine. Mostly older children get sick. The course of the disease is unfavorable, usually it ends with a transition to a chronic form.

Chronic glomerulonephritis

They say about the chronic course of glomerulonephritis when changes in the urine persist for more than a year or it is not possible to cope with high pressure and edema for 6 months.

The transition of the acute form of glomerulonephritis to chronic occurs in 5-20% of cases. Why does glomerulonephritis end in recovery in some patients, while in others it becomes chronic? It is believed that patients with chronic glomerulonephritis have some kind of immunity defect, either congenital or formed during life. The body is not able to cope with the disease that attacked it and constantly maintains a sluggish inflammation, leading to the gradual death of the glomeruli of the kidneys and their sclerosis (replacement of the working tissue of the glomeruli with connective tissue, see).

The transition to the chronic form is also facilitated by:

• The patient has foci of chronic infection (chronic sinusitis, caries, chronic tonsillitis, etc.).
• Frequent SARS and other viral infections (measles, chickenpox, mumps, herpes, rubella, etc.).
• Allergic diseases.

The course of chronic glomerulonephritis, like any other chronic disease, is accompanied by periods of exacerbations and temporary well-being (remission). Chronic glomerulonephritis is a serious disease, often leading to the development of chronic renal failure. At the same time, the patient's kidneys stop working, and they have to be replaced with artificial ones, since a person cannot live without constant blood purification, he dies from poisoning with toxic products. The patient becomes dependent on the artificial kidney apparatus - the blood purification procedure has to be carried out several times a week. There is another option - a kidney transplant, which in modern conditions is also very problematic.

Nephrotic form. Usually occurs in young children. It is characterized by persistent prolonged edema, the appearance of a significant amount of protein in the urine during an exacerbation of the disease. Approximately half of patients with this form of the disease can achieve a stable long-term remission (actual recovery). In 30% of children, the disease progresses and leads to chronic renal failure, and as a result of it - to the transition to an artificial kidney apparatus.

mixed form. In the mixed form, all possible manifestations of glomerulonephritis occur in various combinations: pronounced edema, significant loss of protein and red blood cells in the urine, and a persistent increase in blood pressure. Changes occur during an exacerbation of the disease. This is the most severe form. Only 11% of patients go into long-term stable remission (actual recovery). For 50%, the disease ends with chronic renal failure and an artificial kidney apparatus. After 15 years of the course of a mixed form of chronic glomerulonephritis, only half of the patients remain alive.

hematuric form. The patient has only changes in the urine: during an exacerbation of the disease, erythrocytes appear. There may also be a small amount of protein in the urine. This form of chronic glomerulonephritis is prognostically the most favorable, rarely complicated by chronic renal failure (only in 7% of cases) and does not lead to the death of the patient.

Treatment of glomerulonephritis in children

I. Mode. A child with acute glomerulonephritis and an exacerbation of a chronic one is treated only in a hospital. He is prescribed bed rest until the disappearance of all symptoms. After being discharged from the hospital, the child is homeschooled for a year and is exempted from physical education lessons.

II. Diet. Traditionally, table number 7 according to Pevzner is assigned. In acute glomerulonephritis or exacerbation of chronic - table number 7a, when the process subsides, the diet expands, during the period of remission, if there is no renal failure, they switch to table number 7.

Table number 7a.

Indications: acute renal diseases (acute nephritis or its exacerbations).

• The food is fractional.
• Liquids up to 600-800 ml per day.
• Table salt is completely excluded.
• Significant restriction of protein foods (up to 50% of the amount prescribed by age).

III. Medical treatment(main directions):

• Diuretic drugs.
• Drugs that lower blood pressure.
• Antibiotics if it is confirmed that the cause of glomerulonephritis is a bacterial infection.
• Hormones (prednisolone), cytostatics (stop cell growth).
• Drugs that improve the properties of blood (reducing viscosity and clotting, etc.).
• Treatment of foci of chronic infection (removal of tonsils in chronic tonsillitis, treatment of caries, etc.) 6-12 months after the exacerbation of the disease.
• With the development of renal failure, hemosorption or kidney transplantation is used.

Dispensary observation

For acute glomerulonephritis:

• After discharge from the hospital, the child is transferred to a local sanatorium.
• For the first 3 months, a general urinalysis, blood pressure measurement and a doctor's examination every 10-14 days. The next 9 months - 1 time per month. Further within 2 years - 1 time in 3 months.
• For any disease (ARVI, childhood infections, etc.), it is necessary to take a general urine test.
• Exemption from physical education.
• Medical exemption from vaccinations for 1 year.

The child is removed from the dispensary and is considered recovered if there have been no exacerbations and worsening of tests within 5 years.

For chronic course:

• The child is observed until the transition to an adult clinic.
• Urinalysis followed by examination by a pediatrician and measurement of blood pressure once a month.
• Electrocardiography (ECG) - once a year.
• Urinalysis according to Zimnitsky (for details, see "Pyelonephritis") - 1 time in 2-3 months.
• Phytotherapy courses for 1-2 months with monthly intervals.

Very important:

• dieting;
• protection from hypothermia, a sharp change in climate, excessive loads (both physical and emotional);
• timely identify and treat infectious diseases and SARS in a child.

Prevention of glomerulonephritis

Prevention of acute glomerulonephritis is timely detection and competent treatment of streptococcal infections. Scarlet fever, tonsillitis, streptoderma must be treated with antibiotics in the dose and course prescribed by the doctor, without amateur performance.

After suffering a streptococcal infection (on the 10th day after a sore throat or on the 21st day after scarlet fever), it is necessary to take urine and blood tests.
Prevention of chronic glomerulonephritis does not exist, it's just as lucky.

In conclusion, I would like to dwell on the main points:

• Glomerulonephritis is a severe, serious kidney disease and should not be taken lightly. Treatment of glomerulonephritis is mandatory, carried out in a hospital.
• The disease does not always begin acutely, obviously. Signs of it sometimes come gradually, gradually.
• Suspicions of glomerulonephritis in a child are caused by: the appearance of edema: the child woke up in the morning - his face was swollen, his eyes, like slits, or pronounced traces of gum socks remain on the legs; red, “color of meat slops” urine; decrease in the amount of urine; in the analysis of urine, especially if it is taken after an illness, the amount of protein and red blood cells is increased; increase in blood pressure.
• With an acute, manifest, onset with nephritic syndrome (erythrocytes in the urine, a slight increase in protein in the urine, edema, increased pressure), in 95% of cases the disease ends with a complete recovery.
• In the chronic form goes mainly glomerulonephritis with nephrotic syndrome (gradual onset, slowly increasing pronounced edema and a large amount of protein in the urine).
• Chronic glomerulonephritis often ends in kidney failure, resulting in the use of an artificial kidney machine or a kidney transplant.
• To protect the child from the progression of the disease in chronic glomerulonephritis, it is necessary to strictly observe the regimen, diet and treat infectious and colds in time.

Glomerulonephritis is a rather serious disease of an allergic-infectious nature, in which the function of the kidneys and the excretory system as a whole is noticeably impaired. This disease almost always affects people under 40 years old, but it is especially common in children of different ages.

This pathology in boys and girls in most cases occurs in an acute form, however, if it is not treated in a timely manner, it can go into a chronic stage.

Forms of glomerulonephritis in children

Doctors distinguish two varieties of this disease - chronic and acute glomerulonephritis in children.

They differ not only in the nature of the flow, but also in other ways, namely:

Causes of acute glomerulonephritis in children

The main cause of acute glomerulonephritis is an infection that has entered the child's body, mainly streptococcal. As a rule, this disease develops in a child approximately 2-3 weeks after the flu, tonsillitis, scarlet fever, pharyngitis, laryngitis, tonsillitis, and some viral infections of the respiratory tract. In rare cases, glomerulonephritis is a complication after measles or chickenpox.

Meanwhile, this reason is the main one, but not the only one. In fact, even the formation of a small abscess on the skin of a child or banal hypothermia can cause the development of this disease.

The main symptoms and methods of treatment of acute glomerulonephritis

The symptoms of this disease almost always appear very brightly, so it is incredibly difficult to miss this disease.

As a rule, in the acute phase, the disease is accompanied by the following symptoms:

Acute glomerulonephritis can provoke other complications, namely:

• acute renal or heart failure;
• intracerebral hemorrhage;
• preeclampsia or eclampsia;
• swelling of the brain.

That is why, in order to prevent the development of such complications, the treatment of this disease should begin immediately after the first signs of the disease are detected. As a rule, if the child himself does not complain to his parents about changes in his condition, mom and dad begin to suspect that something is wrong with the change in the color of the urine of the crumbs.

So what color is urine in acute glomerulonephritis?

In fact, there is no exact answer to this question, since the shades that a child's discharge acquires with this disease can be different. Most often, the urine of a sick baby has a brown or black-coffee color. Also, its shade in some cases may resemble meat slops.

Often, the symptoms of this disease can resemble signs of pyelonephritis, in which case the diagnosis of the disease can be difficult.

To establish an accurate diagnosis, you must consult a doctor without delay and conduct the following examinations for your child:

In the treatment of acute glomerulonephritis, especially in young children, bed rest is most often prescribed, which is almost always maintained and controlled in a hospital setting of a medical institution.

In this case, the following methods are used:

• antibiotic therapy lasting approximately 2-3 weeks;
• strict restriction of the amount of fluid consumed by the baby. The child can drink no more than one liter of water and any other liquid per day;
• plasmapheresis;
• the use of diuretic drugs as prescribed by a doctor;
• diet for acute glomerulonephritis, as a rule, excludes the intake of protein and salt;
• Be sure to use various vitamins and minerals. At the same time, in a hospital, a child can be prescribed vitamin droppers or taking multivitamin complexes and immunomodulators;
• pulse therapy is often also used;
• in rare cases, corticosteroid hormones are additionally prescribed;
• finally, in the most severe situations, surgery is indicated, which is a kidney transplant.

It can be quite difficult to cure acute glomerulonephritis, and this disease tends to recur. To prevent this from happening, after the illness, the baby must be constantly monitored by a nephrologist, take urine tests monthly, carefully monitor their health and prevent colds, hypothermia, and so on.

Glomerulonephritis is the second most common kidney disease in children. More often it occurs at the age of 3 to 7 years and without timely treatment becomes the cause of dangerous complications.

What is glomerulonephritis?

The units of the urinary system of the kidneys - nephrons - consist of glomeruli and tubules. In the first, urine is filtered, in the second it reaches the 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 tissues of the renal pelvis, then glomerulonephritis affects the glomeruli and tubules. This disrupts the normal process of urine filtration, as a result, its composition and quantity change - proteins and red blood cells penetrate into it, which should not be.

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 the disease:

• chronic;
• spicy;
• subacute.

These types of the 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 disease of the upper respiratory tract and lungs (pneumonia, tonsillitis, SARS). In this case, streptococcal infection is the most common factor. There are also cases of the development of this type of nephritis after the vaccination of the child.

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

Types of disease by reason:

• primary - associated with congenital kidney damage;
• secondary - is the result of an infection.

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

The general mechanism of the development of the disease in case of an infectious lesion of the body is as follows:

1. Bacteria or viruses that enter the body actively multiply and release toxins.
2. These harmful substances penetrate 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 are soldered, 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 this can be a hereditary disease, a congenital or acquired defect in the child's immune system:

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

Hypothermia is a provocative factor for any form of glomerulonephritis, since under the influence of low temperatures the blood supply to the urinary system is disturbed.

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

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

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

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

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

With a latent form of glomerulonephritis, most of the above signs are not observed. You can recognize this variant of the development of the disease on your own 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 old

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

However, there are cases of a latent course of the disease, in which the symptoms of glomerulonephritis in children under one year old are very difficult to recognize.

In this case, only a urine test can determine the presence of the disease, which will show the presence of red blood cells and protein in it. Another sign is high 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 old. Early contact 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 urine analysis;
• Ultrasound of the kidneys and, if necessary, a biopsy;
• immunogram;
• study of the 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.

Tactics of treatment of glomerulonephritis in children

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

1. Antibiotics from a number of penicillins or others, depending on the specifics of the infectious agent;
2. Diuretic drugs;
3. Means for reducing pressure;
4. Prednisolone and cytostatics.

A therapeutic diet is mandatory, and bed rest is indicated throughout the entire period of therapy. Urinalysis is performed periodically to evaluate the success of therapeutic measures.

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

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 exempted from physical education, and also require increased protection against infections. In this regard, preventive measures against SARS and other infectious diseases, strengthening immunity are important.

Diet for glomerulonephritis in children

The nature of nutrition is aimed at removing edema. 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.

The therapeutic diet No. 7a for glomerulonephritis in children provides for a sharp restriction of these products and a moderate decrease in carbohydrates and fats.

Food should be predominantly vegetable, steamed or baked, spices and spices should not be added to dishes. Bread is allowed only salt-free, products should not contain oxalic acid, fruits and sugar can be given to the child.

Preventive measures and prognosis

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

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

A successful prognosis for glomerulonephritis depends on timely therapy. Delay can endanger the health of the child, causing heart failure, uremia, nephrotic encephalopathy.

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

- acute or chronic inflammation of the renal glomeruli of an infectious-allergic nature. Acute glomerulonephritis in children is characterized by a triad of syndromes: urinary (oliguria, anuria, hematuria, proteinuria), edematous and hypertensive; in chronic forms, one of them or a latent course predominates. The diagnosis of glomerulonephritis in children is based on the history, characteristic clinical picture, laboratory parameters, ultrasound and kidney biopsy. In the acute period of glomerulonephritis in children, bed rest, diet, antibiotic therapy, corticosteroids, anticoagulants, diuretics, antihypertensive and immunosuppressive drugs are prescribed.

General information

Glomerulonephritis in children is an immuno-inflammatory lesion of the glomerular apparatus of the kidneys, leading to a decrease in their function. In pediatrics, glomerulonephritis is one of the most common acquired kidney pathologies in children, ranking second only to urinary tract infections. Most cases of glomerulonephritis are recorded in children of preschool and primary school age (3-9 years), rare episodes (less than 5%) - in children of the first 2 years of life. In boys, glomerulonephritis occurs 2 times more often than in girls.

The development of glomerulonephritis in children is based on infectious allergy (formation and fixation in the kidneys of circulating immune complexes) or autoallergy (production of autoantibodies), as well as non-immune damage to the organ due to developing hemodynamic and metabolic disorders. In addition to the renal glomeruli, tubules and interstitial (interstitial) tissue may be involved in the pathological process. Glomerulonephritis in children is dangerous with the risk of developing chronic renal failure and early disability.

Causes of glomerulonephritis in children

The course of glomerulonephritis in young children is influenced by the features of age-related physiology (functional immaturity of the kidneys), the peculiarity of the reactivity of the child's body (sensitization with the development of immunopathological reactions).

Classification of glomerulonephritis in children

According to the prevalence of the lesion, diffuse and focal glomerulonephritis in children is distinguished; according to the localization of the pathological process - intracapillary (in the vascular glomerulus) and extracapillary (in the cavity of the glomerular capsule); by the nature of inflammation - exudative, proliferative and mixed.

Chronic glomerulonephritis in children includes several morphological forms: minor glomerular disorders; focal segmental, membranous, mesangioproliferative and mesangiocapillary glomerulonephritis; IgA nephritis (Berger's disease). According to the leading manifestations, latent, hematuric, nephrotic, hypertensive and mixed clinical forms of glomerulonephritis in children are distinguished.

Symptoms of glomerulonephritis in children

Acute glomerulonephritis in children usually develops 2-3 weeks after the infection, more often streptococcal origin. In a typical variant, glomerulonephritis in children is cyclical, characterized by a rapid onset and pronounced manifestations: fever, chills, feeling unwell, headache, nausea, vomiting, back pain.

In the first days, the volume of urine excreted noticeably decreases, significant proteinuria, micro- and macrohematuria develop. Urine acquires a rusty color (the color of "meat slops"). Edema is characteristic, especially noticeable on the face and eyelids. Due to edema, the weight of the child may be several kilograms higher than the norm. There is an increase in blood pressure up to 140-160 mm Hg. Art, in severe cases, acquiring a long character. With adequate treatment of acute glomerulonephritis in children, kidney function is quickly restored; full recovery occurs after 4-6 weeks (on average after 2-3 months). Rarely (in 1-2% of cases), glomerulonephritis in children becomes chronic, which has a very diverse clinical picture.

Hematuric chronic glomerulonephritis is the most common in childhood. Has a relapsing or persistent course with slow progression; characterized by moderate hematuria, with exacerbations - gross hematuria. Hypertension is not noted, edema is absent or mild.

Children often show a tendency to a latent course of glomerulonephritis with poor urinary symptoms, without arterial hypertension and edema; in this case, the disease can be detected only with a thorough examination of the child.

For nephrotic glomerulonephritis in children, a typically undulating, constantly relapsing course is typical. Urinary symptoms predominate: oliguria, significant edema, ascites, hydrothorax. Blood pressure is normal or slightly elevated. There is massive proteinuria, slight erythrocyturia. Hyperazotemia and a decrease in glomerular filtration are manifested with the development of chronic renal failure or exacerbation of the disease.

Hypertensive chronic glomerulonephritis in children is rare. The child is worried about weakness, headache, dizziness. Persistent, progressive hypertension is characteristic; urinary syndrome is mild, edema is insignificant or absent.

Diagnosis of glomerulonephritis in children

The diagnosis of acute glomerulonephritis in a child is verified on the basis of anamnesis data on a recent infection, the presence of hereditary and congenital renal pathology in blood relatives, and a characteristic clinical picture, confirmed by laboratory and instrumental studies. A child with suspected glomerulonephritis is examined by a pediatrician and a pediatric nephrologist (pediatric urologist).

As part of the diagnosis, a general and biochemical analysis of blood and urine, a Reberg test, a urine test according to Nechiporenko, and a Zimnitsky test are examined. With glomerulonephritis in children, a decrease in diuresis, glomerular filtration rate, nocturia, micro- and macrohematuria, proteinuria, cylindruria are detected. In the blood, there is a slight leukocytosis and an increase in ESR; decrease in complement fractions C3 and C5; increase in the level of the CEC, urea, creatinine; hyperazotemia, increased titer of streptococcal antibodies (ASH and ASL-O).

Ultrasound of the kidneys in acute glomerulonephritis in children shows a slight increase in their volume and an increase in echogenicity. Needle biopsy of the kidneys is performed to determine the morphological variant of glomerulonephritis in children, prescribe adequate therapy and assess the prognosis of the disease.

With glomerulonephritis in children, a consultation of a pediatric ophthalmologist (with an examination of the fundus to exclude retinal angiopathy), genetics (to exclude hereditary pathology), a pediatric otolaryngologist and dentist (to identify and sanitize foci of chronic infection) is indicated.

Treatment of glomerulonephritis in children

With pronounced manifestations of glomerulonephritis in children (gross hematuria, proteinuria, edema, arterial hypertension), inpatient treatment is indicated with the appointment of bed rest and a special diet (with salt and protein restriction), etiotropic, symptomatic and pathogenetic therapy. A strict salt-free diet is necessary until the edema disappears, and a strict protein-free diet is necessary until the normal volume of excreted fluid is restored.

In the acute period of glomerulonephritis in children, antibiotic therapy (penicillin, ampicillin, erythromycin) is prescribed. Correction of edematous syndrome is carried out with the help of furosemide, spironolactone. Of the antihypertensive drugs in children, long-acting ACE inhibitors (enalapril), slow calcium channel blockers (nifedipine), and angiotensin II receptor blockers (losartan, valsartan) are used in adolescence. Glucocorticosteroids (prednisolone) are used, in severe forms of chronic glomerulonephritis - immunosuppressive drugs (chlorbutin, cyclophosphamide, levamisole). For the prevention of thrombosis in severe nephrotic syndrome, anticoagulants (heparin) and antiplatelet agents are prescribed. With a significant increase in the levels of uric acid, urea and creatinine in the blood, accompanied by severe itching and icterus of the skin, hemodialysis can be used.

After discharge from the hospital, children should be registered with a pediatrician and a pediatric nephrologist for 5 years, and in case of recurrence of glomerulonephritis - for life. Recommended sanatorium treatment; prophylactic vaccination is contraindicated.

Forecast and prevention of glomerulonephritis in children

With adequate treatment, acute glomerulonephritis in children in most cases ends in recovery. In 1-2% of cases, glomerulonephritis in children becomes chronic, in rare cases, death is possible.

With acute glomerulonephritis in children, serious complications may develop: acute renal failure, cerebral hemorrhage, nephrotic encephalopathy, uremia, and heart failure, which are life-threatening. Chronic glomerulonephritis in children is accompanied by wrinkling of the kidneys and a decrease in renal function with the development of CRF.

Prevention of glomerulonephritis in children consists in the timely diagnosis and treatment of streptococcal infections, allergic diseases, rehabilitation of chronic foci in the nasopharynx and oral cavity.

Illness is always bad, but it's worst when it torments your child. Parents would give anything in the world to keep their child safe. Of course, there are diseases that come and go: colds, flu, and so on. But there are those who stay with the baby for a long time, and among them a special place is occupied by glomerulonephritis in children.

What it is

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

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

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

The disease glomerulonephritis has its negative features:

According to the clinical course, the following forms are encountered:

• acute;
• subacute;
• chronic.

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

• diffuse;
• focal.

Location of damage:

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

By 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 by staphylococci or pneumococci. It proceeds rapidly, the symptoms are pronounced, the treatment responds well. True, it should be said that there is also a latent course of the disease. Symptoms are almost invisible, it is very difficult to detect them. It is at this moment that the disease has all the chances to develop into a chronic stage.

Acute glomerulonephritis in children is considered to be rapidly progressive. All pathological processes in the kidneys pass instantly. This can lead to kidney failure, necessitating hemodialysis or a kidney transplant.

Treatment of this form of glomerulonephritis is carried out only in stationary conditions. The child is prescribed bed rest until his condition begins to improve. If the treatment process is not started in time, unpleasant consequences may occur, 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 come to light in a week or two after the transferred infectious disease. They appear in the following form:

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

A few days later:

• the lower back begins to hurt;
• the temperature rises;
• the skin becomes pale;
• edema appears (first in the morning, near the eyes, with time the extremities 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);
• the 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 between the ages of five and ten years. The disease begins to develop a week after the child fell ill with SARS or another infectious disease. In this case, all processes occur very sharply:

• The face swells. With proper treatment, this symptom resolves in two weeks.
• The pressure rises, which is accompanied by nausea, vomiting, headache. The condition can normalize within a few weeks, in case of correct diagnosis and appropriate treatment.
• The composition of urine changes. This situation persisted 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 who get sick can recover. In the rest, the acute form becomes chronic.

Acute glomerulonephritis in children has the following symptoms:

• The swelling builds up slowly.
• The skin becomes pale.
• Hair is brittle.
• The amount of urine decreases sharply.
• The amount of protein is growing.
• There are no erythrocytes and leukocytes.

For isolated urinary syndrome, only changes in the urine of the child are characteristic. There are no other symptoms. With this form, half of the patients are cured, and in the other half, the acute stage becomes chronic.

With a mixed form in children, all of the above symptoms are observed. 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 undertreated acute nephritis.

Children's chronic glomerulonephritis is classified as follows:

• Nephrotic.
• Hematuric.
• Mixed.

From a morphological point of view:

• Focal segmental sclerosis.
• Minimal glomerular changes.
• Mesangioproliferative.
• Membrane.
• Fibroplastic.
• Mesangiocapillary.

By pathogenesis:

• Caused by immune processes (immunocomplex and autoantibody).
• Not due to 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.

It is not the infection itself that causes kidney disease, but the body's response to this infection, its immune response. That is why most often the disease begins to progress after:

• sore throats;
• scarlet fever;
• measles;
• pneumonia;
• chronic tonsillitis;
• flu.

Provoke glomerulonephritis in children can:

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

Diagnosis of the disease

The article focuses on 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 start the fight for the recovery of a person, no matter how old he is, it is necessary to make a correct diagnosis.

• A general urinalysis is given. The presence is determined: erythrocytes, leukocytes, cylinders, protein.
• 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. The second stage of diagnosis:

• Angiorenography radioisotope.
• Checking the fundus.
• Kidney biopsy. This procedure allows you to see the activity of the disease, makes it possible to exclude kidney disease, which has similar symptoms to chronic glomerulonephritis.

From the first visit of a patient to a medical institution, the history of the disease begins. Glomerulonephritis is no exception. And how long this story will last depends on the correct diagnosis.

First step to recovery

Treatment of glomerulonephritis in children involves their hospitalization in a specialized department. They are assigned 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 continues 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 spend a sugar-fruit day.

It is necessary to observe bed rest until the 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.

Drug treatment

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 kidney area helps in the treatment of anuria.
• With azotemia and hyperkalemia, if this condition lasts more than six days, peritoneal dialysis or hemodialysis is used.
• With an exacerbation of chronic glomerulonephritis with a minimal change in the glomeruli, cytostatics and glucocorticoids are used for treatment.
• The drug "Prednisolone" is prescribed. For six or eight weeks, one milligram per kilogram of body weight is administered, then there is a rapid decrease in the dose to five milligrams per week.
• If CGN activity is high, Prednisolone is used, but already drip (for three days, once a day). After treatment, it is desirable to carry out such pulse therapy at least once a month.
• Cytostatics are prescribed intramuscularly: medicines "Cyclophosphamide" and "Chlorambucil".
• Alternative drugs used during treatment: drugs "Cyclosporine" and "Azathioprine". They are prescribed in cases where there is a high risk of kidney failure.

Multicomponent treatment regimens

In the diagnosis of "glomerulonephritis" in children, a multicomponent treatment regimen is also used. The use of both cytostatics and glucocorticoids 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 - the drug "Prednisolone" plus the drug "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".
• The Ponticelli scheme: three days of the drug "Prednisolone", the second month - the drug "Chlorambucil" and further alternation of these drugs.
• Stenberg scheme: pulse therapy is used. Throughout the year, every month, a thousand milligrams of the drug "Cyclophosphamide" is injected intramuscularly. The next two years, the procedure is carried out once every three months. Two more years - once every six months.

Dispensary observation

In the acute form of the disease, after discharge from the hospital, the child should be transferred to a sanatorium. The first three months, a general urine test is given, pressure is measured. Once every two weeks, the doctor conducts an examination.

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

It is imperative for any infectious disease, with ARVI and others, a general urine test should be taken.

The child is exempted from all physical activities and vaccinations.

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

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

An electrocardiogram is performed every year.

Urinalysis according to Zimnitsky - once every two months. Phytotherapy for a month, in a month.

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

Conclusion

Prevention of the disease acute glomerulonephritis is the diagnosis of any infectious disease, which should be carried out in a timely manner. If you immediately begin to treat 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 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 take away from your child an ailment called glomerulonephritis. So, if not everything, then a lot is in your hands, especially the health of your children.