Acute and chronic glomerulonephritis in children: symptoms, diagnosis, treatment. Glomerulonephritis in children: how to identify and treat the disease in time How to treat kidney glomerulonephritis in a child 2 years old

Glomerulonephritis in children is an inflammation of the kidney glomeruli. The disease proceeds in an acute or chronic form, develops under the influence of an infection or an allergy. The disease is diagnosed by characteristic features, on the basis of laboratory and instrumental studies. In severe cases of the disease, a sparing regimen, a special diet and medication are indicated.

The work of the paired organ

The kidneys perform the most important functions. The main purpose is filtration and removal of metabolic products. The paired organ is responsible for the normal content of protein and carbohydrates, the generation of blood components, and maintains blood pressure at an optimal level. The kidneys are also responsible for the concentration of electrolytes and acid-base balance. The body promotes the release of active substances and enzymes, regulates blood circulation.

Clinical picture

The inflammatory process in the glomeruli of the paired organ leads to a decrease in their performance. Glomerulonephritis occurs in children quite often, takes second place after infectious pathologies of the urinary system.

The disease affects children from 3 to 9 years old, cases of the disease in babies under two years of age are less common. Boys are most often affected.

The cause of the development of glomerulonephritis in children is an allergy of an infectious nature, in which immune complexes are formed that circulate in the kidneys. The provoking factor may be the production of autoantibodies, which contributes to the development of autoallergy. Sometimes the disease becomes a consequence of metabolic disorders and hemodynamic changes, which leads to damage to the organ of a non-immune nature.

Inflammation affects the tubules and interstitial tissues. Glomerulonephritis is quite dangerous, it can provoke kidney failure, which leads to disability at an early age.

The reasons

The causative agent of glomerulonephritis are bacteria:

• group A streptococci;
• enterococci;
• pneumococci;
• staphylococci.

Among viral infections, a negative effect on a paired organ is exerted by:

• chickenpox;
• rubella;
• Hepatitis B;
• measles.

A provoking factor in the development of pathology can be the presence of harmful microorganisms:

• candida;
• toxoplasma.

Among non-infectious causes, allergens that can cause glomerulonephritis are distinguished:

• medicinal preparations;
• vaccines;
• plants;
• toxic substances.

The most common factor in the development of pathology is the transferred infection of a streptococcal nature, tonsillitis, streptoderma, pharyngitis, scarlet fever.

The transition to a chronic form is the result of an uncured disease at an acute stage. A decisive role in the development of glomerulonephritis in children is played by the immune response to the presence of antigens. The individual reaction of the body forms immune complexes that have a negative effect on blood circulation in the kidneys and cause dystrophic changes.

The disease can develop in children prone to such pathologies:

• endocarditis;
• rheumatism;
• lupus erythematosus (systemic);
• hemorrhagic vasculitis.

The disorder is formed in children with hereditary anomalies:

• deficiency of C6 and C7;
• T cell dysfunction.

Predisposed to the disease are children with severe heredity, susceptibility to streptococci, suffering from chronic skin infections. Glomerulonephritis develops in children and after ARVI or hypothermia. Such a disease occurs due to immunopathological reactions and immaturity of the kidneys.

Types of pathology

Glomerulonephritis happens:

• primary;
• secondary (due to the development of other pathologies).

According to the clinical course, the disease is divided into:

• acute;
• subacute;
• chronic.

Given the nature of inflammation, the following classification is carried out:

• proliferative;
• exudative;
• mixed.

According to the degree of spread of pathology:

• focal;
• diffuse.

By localization:

• extracapillary;
• intracapillary.

Taking into account the most pronounced manifestations, the following forms of glomerulonephritis are distinguished:

• latent;
• nephrotic;
• hematuric;
• hypertonic;
• mixed.

Symptoms and treatment of glomerulonephritis depend on the form and severity of the disease.

acute form

This pathology is characterized by the following symptoms:

• malaise;
• increased body temperature;
• headache;
• feverish state;
• pain in the kidney area;
• nausea, urge to vomit.

With the disease, the excretion of urine decreases, with the development of hematuria, while the urine turns reddish. With glomerulonephritis, edema is formed, which is pronounced on the front, especially in the eyelids. Body weight may increase by several kilograms, due to insufficient removal of fluid from the body. The child's blood pressure rises sharply, which can last long enough.

With proper treatment, it is possible to restore kidney function after glomerulonephritis in three months. With ineffective therapy or the absence of such, the disease passes into a latent form.

Chronic form

Glomerulonephritis in children can occur in a latent form, with relapses or progressive progression. There is microhematuria, which increases with exacerbation of the disease. Puffiness is weak or absent at all, blood pressure is normal. In view of the scarce symptoms, latent glomerulonephritis can be detected when examining a child. Chronic pathology is diagnosed while maintaining signs of the disease for 6 months, and edema and high blood pressure do not go away with treatment for a year.

The nephrotic syndrome is characterized by relapses. Symptoms of glomerulonephritis in children with a similar course of the disease are as follows:

• decrease in urine volume;
• pronounced edema;
• accumulation of fluid in the pleural or abdominal cavity.

At the same time, blood pressure remains normal, an elevated protein concentration is observed in the urine, and erythrocytes are present in a small amount. The content of nitrogen derivatives increases in the blood and the filtration function of the kidneys decreases with the development of chronic renal failure.

Diagnostics

The data of the child's history are of great importance in establishing the diagnosis and determining the etiology. A thorough survey is conducted on the subject of hereditary pathologies, congenital anomalies, past infections. With glomerulonephritis, it is necessary to undergo such studies:

• analysis of urine and blood (general and biochemical);
• according to Nechiporenko;
• samples of Zimnitsky and Rehberg.

With ultrasound, an increase in the kidneys is noticeable, echogenicity is increased. As an additional diagnostic method, a biopsy of a paired organ is prescribed, which allows assessing the prognosis and determining the method of treatment.

Therapy

With acute symptoms of the disease, the treatment of glomerulonephritis in children requires a hospital stay. It is important to observe bed rest and adhere to a special menu. It is necessary to completely eliminate the intake of salt-containing foods, to minimize food containing protein until the final restoration of kidney function.

At the acute stage of glomerulonephritis, antibiotic treatment is prescribed:

• ampicillin;
• penicillin;
• erythromycin.

To reduce swelling apply:

• furosemide;
• spironolactone.

Of the antihypertensive drugs prescribed:

• volsartan;
• losartan;
• nifedipine;
• enalapril

It is possible to treat chronic glomerulonephritis:

• prednisolone;
• levamisole;
• chlorbutin;
• cyclophosphamide.

To exclude the formation of blood clots in children, Heparin is prescribed. With a strong increase in urea, uric acid, creatinine with a pronounced reaction on the skin, the child may need hemodialysis.

Medical examination after illness

After completing the full course of therapy, the child is observed for five years. If glomerulonephritis recurs, the patient is placed on a lifelong dispensary record.

In the acute form of glomerulonephritis in children, after inpatient treatment, a transfer to a sanatorium for recovery is required. In the first three months, it is necessary to control blood pressure, you should regularly take a urine test, visit a doctor at least 1 time in 14 days. After the expiration of this period, visits to the doctor are carried out with a frequency of once a month throughout the year.

Children who have recovered from glomerulonephritis are exempted from physical education, and vaccination is prohibited for a period of 12 months. You should refrain from swimming in open water.

Prevention and prognosis

About 98% of children with acute glomerulonephritis fully recover. Quite rarely, the pathology is transformed into a chronic stage. In medical practice, there are cases of death due to this disease.

Glomerulonephritis is dangerous in children with such consequences:

• heart failure and chronic renal failure;
• uremia;
• hemorrhage in the brain;
• encephalopathy (neurotic).

With a latent form of the disease, deterioration of kidney function, wrinkling of the organ, and development of chronic renal failure are possible.

Preventive measures of glomerulonephritis in children are the correct diagnosis and adequate treatment of diseases of the nasopharynx, streptococcal infections, and allergic manifestations.

Glomerulonephritis in children is a kidney disease characterized by autoimmune inflammation in the glomerular apparatus. With its development, there is a violation of blood filtration from decay products that linger in the body. Along with this, there is an 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 there is normally 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, antibodies that are supposed to protect the body begin to perceive kidney tissue as foreign. This is the basis of damage to the renal glomeruli in glomerulonephritis.

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

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

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

Violation of the excretion of water and salts by the kidneys causes the accumulation of these elements in the body, against which severe edema occurs. And since the kidneys, in addition to the excretory function, ensure the maintenance of the process of blood formation and the normalization of blood pressure with their impaired functionality, children often develop diseases such as anemia and hypertension.

Since a disease such as glomerulonephritis causes a huge loss of proteins, there is decreased immunity. Immunoglobulins that perform protective functions are proteins. Therefore, the risk of joining 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, these could be:

1. Streptococcus. This infectious agent most often provokes a violation of the kidneys, 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.
2. Other agents of bacterial origin, atypically activating the immune system.
3. Viruses. These pathogens can also cause the development of glomerulonephritis. Among them, the herpes virus, hepatitis, measles, parainfluenza and others are more often detected.
4. 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 low-quality poorly purified vaccines are used or immunization is carried out against the background of various infections or diseases.
5. Snake or bee venom that has 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. A variety of factors affecting the body can start this process. For example:

• hypothermia;
• stress;
• long stay in the open rays of the sun;
• change in climatic conditions;
• excessive physical activity.

As a result of exposure to all these adverse 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 work 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

This disease is characterized by the following symptoms:

• swelling (most often appears on the face, but can also affect the lower and upper limbs);
• changes in blood pressure;
• a change in the composition of urine (in its laboratory study, 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 subspecies.

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. Pathology progresses very quickly and is accompanied by the following unpleasant symptoms:

1. Swelling of soft tissues. If adequate treatment of the causative disease is carried out, edema is eliminated after 1-2 weeks.
2. Hypertension. It is accompanied by a significant increase in blood pressure, which can also lead to dizziness, nausea and vomiting.
3. Change in the composition of urine. When examining it, a high concentration of proteins and erythrocytes is found. In some cases, the amount of the latter is so high that a change in the color of the urine occurs - it becomes dark red. In addition, there is an increase in the level of leukocytes 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, small patients manage to defeat the disease. But most often it takes a chronic form and provokes the development of renal failure.

The nephrotic form is manifested as follows - swelling and an increase in the level of protein compounds in the urine. Puffiness in this disease has its own characteristics. First they appear in the area of ​​​​the legs and on the face. Further, puffiness begins to spread to the lumbar region and can form even in the body cavities. And if in the nephritic form the edema has a dense texture, then in the nephrotic form they are soft.

In the nephrotic form, only an increase in the level of proteins is observed in the urine. Erythrocytes and leukocytes in it are found in small quantities. Blood pressure in children is normal, but there is pallor of the skin, tarnishing and severe fragility of the hair.

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

In some cases, this pathology can be mixed. In this case, all the above symptoms of the disease are observed immediately. This form is typical for schoolchildren and almost always flows into chronic glomerulonephritis.

Chronic form

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

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

1. nephrotic syndrome. This form of the disease is most common in young children and is accompanied by prolonged swelling and increased levels of protein in the urine. These symptoms appear during periods of exacerbation of the disease. The prognosis for nephrotic form of chronic glomerulonephritis is the most favorable. In 70% of cases, stable periods of remission can be achieved. However, in 30% of children against the background of this disease, kidney failure begins to develop, which requires constant use of devices that replace the functionality of the kidney.
2. mixed form. It is characterized by the appearance at once of all the symptoms that occur during the period of exacerbation. These are prolonged edema, and hypertension, and a change in the composition of urine, etc. In this case, the prognosis is not the most favorable. Only 10% of sick children manage to achieve stable remission. In 90%, the disease proceeds with frequently alternating phases of remission and exacerbation. Unfortunately, the mortality associated with this form of the disease is very high. More than half of sick children do not live 15-20 years after the development of glomerulonephritis.
3. hematuric form. With its development, there is an increase in the level of red blood cells in the urine. 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 it provokes the development of chronic renal failure only in 7% of cases.

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.

Establishing diagnosis

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

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

Also, the child will need to undergo an examination of the fundus to exclude the development of angiopathy and pass tests to identify genetic pathologies. In addition, you will need to consult a dentist and an otolaryngologist to identify foci of chronic infection in the body.

Treatment of glomerulonephritis

Treatment of glomerulonephritis in children is carried out by medication. For this, the following drugs are used:

• 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 edema);
• medications that normalize the level of blood pressure (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 was provoked by agents of a bacterial nature);
• medicines that improve the composition of the blood and its properties;
• elimination of foci of infection (treatment of carious teeth, tonsillitis, etc.).

Thus, the therapy of glomerulonephritis includes the intake of basic and symptomatic agents. Additionally, possible provocation factors are eliminated.

If a child still develops renal failure against the background of glomerulonephritis, hemosorption or kidney transplantation is used. The last method is cardinal, has big risks. Therefore, it is used extremely rarely.

With an exacerbation of the disease, treatment is carried out only in a hospital!

During treatment, the child should avoid hypothermia, overheating, strong physical exertion and emotional upheaval. Therefore, doctors often send sick children to treatment-and-prophylactic sanatoriums for 2-3 months.

Nutrition for glomerulonephritis

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

• fractional nutrition;
• fluid intake in the amount of 0.6-0.8 liters per day (this includes not only water, compotes, juices, etc., but also liquid dishes);
• reduced consumption of protein foods;
• the exclusion of table salt and various pickles.

In the practice of pediatrics, glomerulonephritis - which is quite common in. It can be of both infectious and allergic origin, and manifests itself in disruption of the kidneys due to their inflammation. Even elementary hypothermia can provoke, not to mention more serious diseases - infections of the upper respiratory tract, influenza, tonsillitis, scarlet fever and others.

What happens when the disease develops

Glomerulonephritis is one of the most common kidney diseases in children. As a result of a combination of pathological autoimmune and external, infectious influences, the renal glomeruli, adjacent tubules and interstitial tissue become inflamed. With the development of the disease in patients, the volume of urine excreted during the day decreases, edema appears throughout the body, and blood pressure rises significantly. Children from 4 to 12 years old are prone to the appearance of the disease..

What can be glomerulonephritis?

The disease occurs in three forms: acute, subacute and chronic. Each of them differs in course and manifestation.

Acute and subacute course

Initial appearance, onset progresses rapidly. Usually, the pathogenesis of acute glomerulonephritis in children suggests that one or three weeks before the onset of the first symptoms, he had some infectious disease. If the disease is detected on time, and adequate medical care is provided, then there are no complications, and the prognosis is good.

If the treatment was not provided in a timely manner, it can become chronic. The subacute form is the most dangerous. It is difficult to treat, progresses rapidly and is often malignant, accompanied in most cases by various complications, sometimes it can lead to death.

Chronic form

This type of glomerulonephritis appears if there was no treatment for the initial acute form, and if the symptoms continue for more than six months.

Important! The chronic form of glomerulonephritis is the most dangerous for a child, as it often ends in renal failure.

In almost 20% of children, inflammation of the glomeruli of the kidneys turns into a chronic course of the disease. This is due to a number of reasons:

• permanent immunodeficiency, when the body cannot cope with the disease, and it is constantly in a state of slight inflammation;
• if there is any chronic disease (caries, sinusitis, tonsillitis);
• if the baby is often sick with various viral infections, ranging from ordinary to chickenpox and;
• if the child is suffering from

What are the symptoms?

The infectious nature of the disease has a long incubation period, but when the pathogenesis is unknown, the incubation period may be indeterminate. General symptoms:

• constant weakness and lethargy of the child;
• slight increase;
• headache can be of different strength;
• bouts of nausea and;
• occurrence of back pain.

• the appearance of edema of varying intensity - from swelling of the face and to the abdominal organs;
• changes in the color of urine to dark, coffee, a decrease in its amount with frequent urination;
• hypertension.

Important! The acute form of the disease, which began very quickly and is characterized by nephritic syndrome (the presence of red blood cells in urine), in most cases has a good prognosis and complete recovery over time.

• swelling is insignificant, sometimes absent altogether;
• gradual increase in blood pressure over time;
• urinary syndrome is mild;
• headache;
• general weakness;
• constantly thirsty;
• drowsiness at any time of the day;
• weakening of vision.

Symptoms of glomerulonephritis in children under one year old

In children in the first year of life, only a chronic form of glomerulonephritis with nephrotic syndrome occurs. This syndrome is characterized by the appearance of persistent massive edema. The course is usually cyclical: from exacerbations to remission. During an exacerbation, the amount of protein in urine increases critically.

How is the disease diagnosed?

Already at the first visit to a pediatrician or pediatric nephrologist, a specialist, based on the clinical picture and complaints, will be able to make a diagnosis. However, a narrow-profile diagnosis is still required in order to determine how badly the kidneys are damaged. Diagnostics includes the following steps:

• collection of a complete anamnesis not only of the most ill peanut, but also of all his closest relatives;
• measurement of blood pressure;
• determination of the degree of swelling during examination;
• complete blood count and blood biochemistry;
• immune analysis of blood serum;
• urinalysis according to Zimnitsky or Nechiporenko;
• ultrasound examination of the kidneys;
• kidney biopsy.

Did you know? During the day, the kidneys produce about 180 liters of primary urine. However, the amount of urine that a person excretes per day is no more than one and a half liters.

Tactics of treatment of the disease in children

Treatment of glomerulonephritis in children includes dispensary observation, taking medications (antibiotics, diuretics, vitamins, hormones, and others), following a strict diet (table No. 7 according to Pevzner), purely bed rest and individual exercise therapy.

Mode

With this disease, treatment is indicated only in a hospital with strict bed rest until the very recovery. This is especially true of acute glomerulonephritis in children and its exacerbation in chronic course. Further, after discharge, the baby cannot attend school for a year and must be educated at home. He is also completely exempt from physical education.

Diet

With such a disease, it should be fractional. Liquid intake is limited to 600-800 ml during the day, no more. Food should be absolutely unsalted - salt is excluded from the diet completely. The amount of protein consumed is also limited: they should be half as much as it should be for age. All these requirements are met by Pevzner's diet No. 7, which is prescribed for glomerulonephritis in children. In the acute form of the disease or during exacerbation of the chronic course, they are transferred to diet No. 7a - this is a low-protein diet.

Important! Black and white bread of ordinary baking, salt, broths from fish, meat or mushrooms, fatty foods, canned food, sausages, legumes, garlic, onions, sorrel, mushrooms in any form, cocoa, chocolate and coffee, as well as sodium mineral water.

Medical treatment

Treatment of acute and chronic glomerulonephritis in children involves taking diuretics and drugs that lower blood pressure. If the cause of the disease was a bacterial infection, the patient is prescribed antibiotics. Mandatory hormonal treatment with cytostatics and prednisone stopping cell growth.

Six months to a year after the onset of the disease, organs prone to chronic infections are treated (for example, tonsils are removed). They are also prescribed, which affect the state of the blood - reduce its viscous properties and improve clotting. If the disease is complicated by renal failure, the patient is prescribed hemosorption or kidney transplantation.

Dispensary observation

If the crumbs were diagnosed with an acute form of the disease, then after discharge from the hospital, he is transferred for observation at the nearest sanatorium. During the first three months, it is necessary to take a urinalysis, measure blood pressure and visit a doctor almost every two weeks. And until the expiration of one year after discharge, all this is carried out monthly. For the next two years, examinations and tests are given once every three months.

It is imperative to take urine for analysis if any disease of a bacterial or viral nature occurs - whether it is a common cold or any childhood infection. A sick baby receives a withdrawal from vaccinations during the year and is completely exempted from physical education.

In chronic glomerulonephritis in children, clinical recommendations imply dispensary observation for up to its transition to registration in an adult hospital. A doctor's examination, blood pressure measurement and urinalysis are required every month. Once a year, an ECG (electrocardiography) should be done.

Every three months it is worth taking a urine test according to Zimnitsky. Phytotherapy is also carried out in two-month courses with a monthly interval between them. Common to both forms of glomerulonephritis is strict adherence to a diet, avoidance of any overload - both physical and emotional, and the treatment of colds and any infections should occur immediately.

Did you know? Each kidney contains a million elements that are responsible for the filtering function.

What complications can the transferred disease give?

If the diagnosis of acute glomerulonephritis in children was not carried out on time, then the disease becomes chronic, which is fraught with serious consequences and complications. In the future, may suffer from renal eclampsia, uremia, nephrotic encephalopathy, renal and heart failure. Also, he may experience a hemorrhage in the brain, there may be severe convulsions and seizures, and the lungs may swell.

Prevention of inflammation of the glomeruli in children

The chronic form of the disease cannot be prevented. It occurs spontaneously and does not depend on the actions of the parents. But the acute form can be prevented. To do this, it is necessary to regularly examine the child by the local pediatrician, to immediately treat any diseases and allergic reactions in the baby.

Also, parents need to provide conditions in which they will not overcool and overheat. It is advisable not to eat a lot of salt in food and take vitamins in courses. Infections caused by streptococcus should be detected immediately, properly treated, and after 14-20 days it is necessary to take blood and urine tests in order to know if its composition has changed due to the development of glomerulonephritis.

Glomerulonephritis is a serious and dangerous disease. It affects the kidneys, causes severe swelling, increased pressure and changes in the urine. The disease is fraught with the occurrence of kidney failure, as a result of which a kidney transplant or life on an artificial kidney apparatus may be necessary. Therefore, the disease must be warned in advance, not allowing its occurrence at all.

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 infections of the respiratory tract, 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 provokes its simple hypothermia of the body.

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

• 1. Sharp

The reason is a transferred infectious disease, the symptoms are pronounced, the child's condition is deteriorating sharply. With timely detection, it is treatable 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 unnoticed, untreated acute form of glomerulonephritis. The main symptom is hypertension with all the ensuing consequences. Requires long-term inpatient treatment and recovery period.

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

Symptoms

The symptoms of an acute disease are pronounced, while chronic glomerulonephritis can hide and only occasionally make itself felt, 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 slops;
• the earliest symptom is gradual swelling, which first appears on the face, after a few days - on the lower back and legs;
• hypertension is considered one of the leading signs of the disease: there is a simultaneous increase in both maximum and minimum blood pressure, and this effect has a long, persistent character (it does not go astray for three or more months) and is a kind of indication of the transition of the disease to a chronic form;
• after that, visual impairment may already begin, the child increasingly complains of headaches, nausea, and drowsiness in the middle of the day.

If the disease is not recognized in time according to 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-fledged diagnosis is carried out in stationary conditions.

Diagnostics

Diagnosis of glomerulonephritis in children is difficult because the signs of the disease are very similar to the symptoms. Therefore, conclusions are drawn on the basis of 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 the analysis, which, in some forms of glomerulonephritis, remain in the child's body for life;
• in the blood serum, a reduced content of total protein is found;
• ultrasound of the kidneys, ECG, radioisotope angiorenography, Zimnitsky and Reberg tests, ultrasound (doppler ultrasound) of the renal vessels are also carried out;
• special equipment in a child examines the fundus, which confirms or refutes the diagnosis;
• a kidney biopsy is prescribed to children only if chronic glomerulonephritis is suspected: this is how its activity is checked, kidney diseases with similar symptoms are excluded.

According to the results of these diagnostics, appropriate therapy is prescribed.

Treatment of glomerulonephritis in children

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

• an appropriate drinking regimen is assigned: the amount of fluid 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;
• surgery: kidney transplant.

Treatment of glomerulonephritis in children in stationary conditions lasts from 1.5 to 2 months.

Prevention

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

• give urine for analysis monthly;
• children are recommended to be protected from any infections that provoke the disease;
• the child is exempted from sports and physical education.

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

As you know, in the first years of life, the child is characterized by unstable immunity. Even a small ailment can provoke many serious complications. In the autumn-winter period and early spring, the incidence of kidney pathologies increases sharply. The most common among them is glomerulonephritis. This disease occurs annually in more than six hundred thousand children around the world and often ends unfavorably. That is why it is so important to know the first signs of the development of glomerulonephritis in children, as well as ways to provide assistance and various treatment options for the disease.

What is an ailment

Glomerulonephritis is a disease in which the inflammatory process damages the renal glomeruli involved in filtering and purifying the blood. Often the disease is called nephritis in an abbreviated form. Pathology is often found in children in all age periods, but newborns and adolescents 12–17 years old are most affected by it.

The renal glomerulus filters and purifies the blood, when it becomes inflamed, the function of the kidneys is impaired

With glomerulonephritis, the renal tissue becomes edematous, the vessels are squeezed. Often this leads to the necrosis of small areas and the development of a connective substance in their place, which cannot perform the functions of filtering and purifying the blood.

Varieties of pathology

Nephrologists classify the disease according to its features. So, depending on the causes of occurrence, glomerulonephritis is distinguished:

• Primary (develops in a healthy body):
  • caused by the damaging action of immune complexes:
    • acute post-streptococcal - after suffering a sore throat, characterized by a sudden increase in temperature and the rapid development of the clinic in a couple of days;
    • chronic - exists for several years;
  • rapidly progressive - a symptomatic picture occurs in a matter of hours, is an extremely unfavorable pathology.
• Secondary (formed against the background of already existing diseases of the liver, kidneys, heart).

Varieties of acute glomerulonephritis depending on clinical manifestations:

• with nephrotic syndrome (fluid accumulation in soft tissues, blood in the urine);
• with nephritic symptoms (a large amount of protein in the tests and pain in the lumbar region);
• with urinary syndrome (urine changes: the predominance of inflammatory cells and salts);
• combined form (combines the features of all of the above pathologies).

Types of chronic glomerulonephritis depending on the symptoms:

• nephrotic (accompanied by swelling, the presence of red blood cells in the urine);
• hypertensive (characterized by an increase in blood pressure);
• mixed.

Video: what happens to the kidneys with glomerulonephritis

Why does glomerulonephritis develop in children

The main reason for the formation of kidney disease in babies is the penetration of microbes. Most often, the role of the causative agent is:

But the mere presence of microorganisms is not enough. In order for the development of glomerulonephritis to occur, the influence of the following factors is also necessary:

• hypothermia;
• frequent change of climatic zones;
• weakened immunity;
• malnutrition;
• recent surgery or injury.

Clinical picture and the first signs of pathology

The course of glomerulonephritis in children is characterized by a combination of general and local manifestations. The body of a baby differs in many ways from the body of an adult: inflammatory processes in them are much more intense and with greater intoxication. That is why it is so important to start treatment of the disease in a timely manner and prevent the development of complications.

General manifestations:

• an increase in body temperature up to 38-40 degrees;
• nausea and vomiting after eating;
• swelling of the face and upper body;
• headache;
• tearfulness, refusal of food;
• weight loss;
• blood pressure indicators are 20–40 mm Hg higher than normal;
• sleep disturbances (insomnia, waking up during the night).

An increase in body temperature often indicates an inflammatory process.

Local symptoms include:

• pain in the lumbar region of a aching nature, which can radiate to the perineum, abdomen or thigh;
• changes in urine tests (turbidity, the appearance of protein, blood and pathological impurities);
• swelling of the lower back;
• cramps, burning when urinating.

Methods for diagnosing glomerulonephritis in children

Since all kidney diseases have a similar clinical picture, it is often necessary to differentiate them from each other. Glomerulonephritis should be distinguished from:

• pyelonephritis;
• urolithiasis;
• malignant and benign neoplasms;
• cystitis;
• urethritis.

Often there is a combination of several diseases at once, which significantly complicates the work of the doctor.

The author happened to participate in the treatment of a 7-year-old boy who developed glomerulonephritis against the background of urolithiasis. Since the clinical picture was rather blurred, an ultrasound examination had to be performed. So the doctors found that in addition to the stone in the ureter, the child had changes in the structure of the kidneys, characteristic of glomerulonephritis.

Diagnosis methods:

How to get rid of the problem in childhood

As soon as the diagnosis of glomerulonephritis has been suspected and confirmed by a doctor, parents receive a referral for hospitalization in a hospital. Treatment is carried out in the Department of Nephrology or Urology by pediatric doctors.

The tactics of treating glomerulonephritis is largely determined by the form of the disease (acute or chronic process), the age and condition of the child:

• When the disease is at an early stage of development, the symptoms are mild, and doctors begin with the use of a sparing diet and the use of pharmaceuticals.
• If the disease progresses steadily, and complications appear, one has to resort to surgical intervention.
• At the stage of restoration of renal functions and rehabilitation, physiotherapy procedures are widely used.
• To reduce symptoms, you can use some folk remedies (after consulting a doctor).

The main goals of the treatment of glomerulonephritis in children:

• improvement of blood supply to soft tissues;
• increased outflow of lymph from the affected kidneys;
• normalization of urine output;
• decrease in the severity of pain syndrome and inflammatory edema;
• preventing the development of bacterial complications;
• strengthening the immunity of the baby;
• stabilization of water-salt and electrolyte balance;
• prevention of acute and chronic renal failure.

Medical treatment of glomerulonephritis

To restore the function of the urinary system, doctors resort to the use of pharmaceuticals. All medicines prescribed by doctors can be divided into two groups:

• means that affect the causative agent of the disease (etiotropic);
• drugs to get rid of clinical manifestations (symptomatic).

The combination of these methods helps the body to fight glomerulonephritis more actively.

Dosages of drugs for children are selected based on their weight and age. That is why pediatricians forbid parents to engage in therapy on their own.

The etiotropic treatment of pathology includes the use of antibiotics. These drugs allow you to disrupt the life cycle of the microbe that caused glomerulonephritis, and also contribute to its death and excretion from the body. The most common in pediatric practice are:

• Augmentin;
• Azithromycin;
• Zinacef;
• Sumamed.

For symptomatic therapy, the following groups of drugs are used:

1. Anti-inflammatory drugs - relieve swelling of soft tissues and reduce the severity of pain, as well as lower body temperature. The preparations can be used both in tablet form and in the form of rectal suppositories. Most commonly used:
   • Paracetamol;
   • ibuprofen;
   • Nurofen;
   • Nise.
2. Detoxification and infusion solutions - help to remove toxic substances from the body and protect the cerebral cortex from damage, as well as restore the water-salt balance. Their introduction is carried out using a dropper. Used in Pediatrics:
   • Disol;
   • Trisol;
   • Regidron;
   • Reopoliglyukin;
   • glucose.
3. Immunostimulants - increase the formation of cells that are responsible for the destruction of bacteria by the body itself. They can be taken in the form of tablets, rectal suppositories, or intramuscular injections. Popular drugs:
   • Cycloferon;
   • Thymogen;
   • Timalin;
   • Taktivin.
4. Antispasmodics - help to relax the smooth muscles of the urinary system and facilitate the discharge of urine. In pediatrics, No-shpu is used, as well as herbal medicines (given to the baby at bedtime to alleviate his condition):
   • peppermint;
   • Dill seeds;
   • valerian;
   • lemon balm.

Photo gallery: drugs for the treatment of illness in children

Ibuklin - anti-inflammatory drug with antipyretic effect
Acesol - a solution for normalizing the water-salt balance in the body
Flemoxin Solutab is a broad-spectrum antibiotic that kills many pathogenic microbes.
Viferon rectal suppositories help the body to activate its own forces to fight the disease
No-shpa has an antispasmodic effect, reduces pain during urination

Features of the diet and drinking regimen for children with glomerulonephritis

To fight the disease, the baby's body spends a huge amount of energy: that is why a serious loss of body weight is characteristic. To make up for nutritional deficiencies, it is necessary to normalize the diet of the child.

Particular attention should be paid to the drinking regimen: in order to remove toxins and toxins from the body, doctors recommend drinking more pure non-carbonated water (up to one and a half to two liters per day). Carbonated drinks, packaged juices and mineral water can only aggravate the situation and provoke the development of urolithiasis. It is necessary to cook food by boiling, stewing and baking: fried foods are prohibited with glomerulonephritis.

The largest number of calories should be absorbed by the child for lunch, breakfast and dinner make up a much smaller part. Do not forget about snacks: healthy bread and muesli will help not to kill your appetite before the main meal.

Children with glomerulonephritis need to eat the following foods:

• kefir, yogurt, cottage cheese, milk, sour cream, cheese;
• hard pasta;
• legumes;
• lean meat and fish;
• vegetables (in the form of purees, soups, cuts, salads);
• berries and fruits (in the form of fruit drinks, juices, compotes);
• nuts;
• cereals (buckwheat, oatmeal, rice, millet, barley).

Photo gallery: healthy food for illness

Nuts are a great option for an afternoon snack
Cottage cheese contains a lot of calcium and protein necessary for the children's body Vegetables and fruits - a storehouse of vitamins and minerals Cereals are a good source of essential vitamins and minerals for children.

Table: the role of physiotherapy in the treatment of the disease

Photo gallery: physiotherapy for illness

Massage movements are widely used to improve metabolic processes in tissues. Electrophoresis is absolutely painless for a child, but it has a good therapeutic effect. Due to the directed action of laser beams, there is no proliferation of connective tissue

Surgical treatment of glomerulonephritis in children

The indications for surgery are:

• lack of effect from conservative therapy for six months;
• the formation of acute or chronic kidney failure;
• development of nephrosclerosis - proliferation of connective tissue;
• severe condition of the patient;
• death of one kidney;
• the occurrence of a secondary infection and the occurrence of an abscess, phlegmon, carbuncle.

In newborns and children of the first year of life, surgical treatment is carried out in extremely rare cases, as they respond well to the use of pharmaceuticals.

The duration of the operation is two to five hours.

The operation is performed under general or spinal anesthesia. The sequence of actions is as follows:

1. After immersing a small patient into a dream, the doctor, using an incision in the lumbar region (if an endoscopic technique is used, the size of the wound does not exceed a few centimeters), separates the soft tissues: skin, fatty tissue, muscles, and also brings the kidney to the surface.
2. Next, surgeons carefully study the state of the organ: the presence of wrinkling, hemorrhage, purulent processes and cicatricial adhesions is an indication for the removal of a site or all affected tissues.
3. Clamps are applied to the neurovascular bundles, after which the foreign bodies are excised.
4. At the end of the operation, doctors wash the wound area with saline or an antibacterial agent, carefully and consistently sew up the tissues, installing small drains - tubes through which lymph and blood flow.
5. A small patient is transferred for several days to the intensive care unit, where he is monitored by doctors and nurses.

As soon as the child becomes stable, he is returned to nephrology to continue conservative treatment and subsequent rehabilitation measures.

Folk therapy of the disease as an additional remedy

It was previously believed that the use of various herbs, plants and berries allows you to partially restore kidney function and minimally affects the health of the child. However, at present, doctors are confident that alternative medicine helps only slightly alleviate the symptomatic manifestations of the disease, but is not able to cure its cause. By combining natural remedies with pharmaceutical products, truly tremendous results can be achieved in the treatment of glomerulonephritis in children.

Do not forget that many plants, fruits and herbs are quite strong allergens for a child.

Once, while working in a children's hospital department, the author was involved in the treatment of a boy who was admitted urgently with anaphylactic shock and severe suffocation. As it turned out, the parents decided to use the herbal collection in the treatment of the disease without consulting a doctor. They brewed several spoons at once, without calculating the weight and age of the child. As a result, the baby had an acute allergic reaction to one of the components of the collection, which led to suffocation. The little patient was resuscitated, but the child experienced severe stress, which contributed to the emergence of a lag in neuropsychic development. That is why doctors recommend starting with a small dosage (one teaspoon), after which monitor the body's reaction.

Here are some folk remedies that can be used to treat glomerulonephritis in children:

1. Mix one hundred grams of freshly frozen cranberries with the same amount of blueberries and place in a saucepan with two liters of water. Simmer for half an hour and then add a few tablespoons of honey to improve the taste. Once the liquid has cooled, give your child half a glass a day before and after meals. Cranberries and blueberries are not only universal sources of vitamin components, but also the best folk remedies that relieve inflammation. It is recommended to use this treatment at least twice a week for six months.
2. Cook fifty grams of rose hips over low heat in a saucepan with a liter of water for fifteen minutes. Use a sieve to remove the fruits and cool the liquid. It is necessary to give the baby one glass before breakfast, lunch and dinner. Rosehip stimulates the activity of the immune system and has an antimicrobial effect. It is necessary to take a course of twenty procedures, after which you can use the decoction for preventive purposes at least twice a week.
3. Steep one tablespoon of chamomile in a glass of boiling water. After cooling, let the baby drink in small sips (preferably before bedtime). Chamomile gently relieves spasms and reduces the severity of pain, which makes it an indispensable remedy for glomerulonephritis. It is recommended to be treated in this way for up to three months in order to achieve the expected result.

Photo gallery: folk remedies used for illness

Cranberries are rich in vitamins B and C, and also have antimicrobial properties. Rosehip - the best way to strengthen the immune system Chamomile has a sedative and antispasmodic effect and will help your baby sleep through the night.

Treatment prognosis and possible negative consequences

Such a pathology in childhood is quite easy to treat with timely access to a doctor. On average, the terms of treatment of pathology range from two weeks to six months. If the parents visited the doctor too late, the duration of therapy can reach several years. In this case, factors such as:

• the presence of other acute or chronic diseases;
• recent infections, trauma, surgery, radiation and chemotherapy;
• hereditary pathologies;
• body weight of the baby;
• child's age.

If glomerulonephritis was detected in the period from one to three years, the prognosis is extremely favorable. About 97% of renal functions are fully restored. In the case when the pathology was diagnosed in adolescence and it is combined with other ailments, disability may develop.

The success of treatment and rehabilitation is largely influenced by the patient's lifestyle and compliance by his parents with all medical recommendations. In his clinical practice, the author came across a teenager who had been suffering from exacerbations of chronic pyelonephritis for two years. At the same time, he refused to take medications, did not attend physiotherapy and ate mostly fast food and fried foods, which led to the development of obesity. Parents could not influence the child in any way, which ultimately led to extremely adverse consequences. The boy was hospitalized in the intensive care unit with acute renal failure. Due to complications, he developed necrosis and death of one kidney, and it had to be removed. The patient now has to attend hemodialysis procedures for life - artificial filtration of blood through a system of membranes.

What complications can occur in children with glomerulonephritis:

How to protect your baby from the development of the disease

From an early age, parents take care of their child in every possible way and protect his health. In this they are also helped by children's doctors - pediatricians, who monitor the baby from the very moment of his birth. Currently, regular patronage examinations for infants are carried out, during which the doctor examines the state of health and determines the existing pathologies.

Medical sciences have gone far ahead compared to the last century: if earlier it was believed that it was easier to choose an individual treatment regimen for everyone, now doctors are mainly engaged in the prevention of various diseases. This tactic did not bypass the problem of glomerulonephritis - every year in cities and large towns events are organized dedicated to the therapy and diagnosis of pathology.

As you know, many people know little about the children's body and its features. In order to help parents, the author, together with his colleagues, organized special seminars on the basis of various hospitals, hospitals and outpatient clinics, which were devoted to the problem of glomerulonephritis in babies. Everyone could attend such an event: someone came just to listen and write down new information, while others brought the child to donate urine and blood, as well as for a comprehensive examination. After analyzing the results obtained, it was found that about 20% of all children suffered from acute or chronic glomerulonephritis, while only 5% had active complaints. In 3% of babies, parents preferred to deal with the problem on their own or ignore it, which led to adverse consequences in the form of kidney failure. A hereditary pattern was also revealed: if mom or dad had problems with the kidneys, then in 90% of cases the child suffered from such a disease. Parents were given special advice on the prevention of glomerulonephritis, and children were offered hospitalization and various treatment options.

How to protect the baby from the development of such a pathology:

1. Give your child all mandatory vaccinations by age in the absence of medical contraindications. Vaccination is one of the most important methods of formation and stimulation of the human immune system. Many weakened bacteria, viruses and their toxins are introduced into the body in small amounts. This helps, upon contact with a real pathogen, to activate the baby's immunity and contribute to an easier and safer course of the disease. It is known that about 70% of children suffering from glomerulonephritis did not receive preventive vaccination.
   

   Vaccines help build a child's immune system

2. Limit your child's intake of unhealthy foods. Junk food slows down metabolic processes in the body and makes it less resistant to adverse environmental factors.
3. Visit your pediatrician regularly and get all the necessary medical examinations. This will allow timely diagnosis of the development of pathological changes in urine and blood tests. About 30% of all cases of glomerulonephritis in childhood occur with minimal clinical symptoms, and they can only be detected by examining biological fluids. That is why it is necessary to show the baby to a specialist at least once every six months.
4. Try to dress your child appropriately for the weather. Too light jacket and lack of a hat can lead to the development of colds and tonsillitis, which is often complicated by glomerulonephritis. However, warm clothes in hot weather can also play a cruel joke on the health of the baby, causing serious sweating and impaired thermoregulation. Pediatricians advise choosing a few optimal suits for walking, which will protect from strong winds and will not allow you to freeze in winter and overheat in summer.
5. Teach your kids to be active. To keep the growing body in good shape, it is necessary to provide for its motor needs: give the baby to the sports section or regularly do light gymnastics and exercises with him in a playful way. Physical activity will help strengthen the immune system and protect the body of the child from the action of harmful microbes.

   Sports strengthen the body, allow you to better fight germs.

Glomerulonephritis in children is a complex problem that has not lost its relevance for several decades. That is why doctors strongly recommend monitoring the health of your baby and paying attention to the slightest fluctuations in his well-being. Even minor whims and tearfulness can be symptoms of the development of the disease. You should immediately go to the hospital, not trying to treat the disease with folk methods or taking medication without a doctor's prescription. Often this ends in an unfavorable outcome and even disability.