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About
- Causes: Haematuria and oliguria with low BP caused by an immune-mediated response in the kidneys.
- Presentation: Commonly presents with kidney inflammation.
- Peak Age: Around 7 years old.
Uncomplicated Presentation
- Haematuria, Oliguria, Low blood pressure (50% of cases)
- Periorbital oedema, Fever
- Gastrointestinal disturbances, Loin pain
- Hypertensive Encephalopathy: Restlessness, Drowsiness, Severe headache, Seizures, Vision loss, Vomiting, Coma
- Uraemia: Acidosis, Muscle twitching, Stupor, Coma
- Cardiac failure with fluid overload
Causes of Nephritis
- Group A β-hemolytic streptococcus, often following a sore throat
- Henoch-Schönlein purpura
- Toxins or heavy metals
- Berger's disease (IgA nephropathy)
- Malignancies
- Viruses
- Bacteria (e.g., infective endocarditis, syphilis)
- Renal vein thrombosis
Blood Tests
- Full blood count (FBC)
- Urea and electrolytes (U&E), including creatinine, potassium, bicarbonate, calcium, phosphate, and albumin
- Complement levels (low C3, normal C4)
- ASOT/anti-DNase B levels
- Antinuclear factor (ANA), anti-DNA antibodies (if systemic lupus erythematosus is suspected)
- Anti-neutrophil cytoplasmic antibodies (ANCA) (if vasculitis is suspected)
- Syphilis serology
- Blood cultures
- Virology testing
Urine Tests
- Microscopic urinalysis to count red blood cells (RBCs), white blood cells (WBCs), hyaline and granular casts; red cell casts are indicative of glomerular bleeding
- Urine culture and specific gravity (normal range: infants ~1.002–1.006; child/adult ~1.001–1.035)
Other Tests
- Throat swabs
- Urgent renal ultrasound (US)
- Chest X-ray (CXR) if fluid overload is suspected
Treatment: Supportive treatment is essential
- Fluid balance
- Treatment of hypertension
- Management of any infection
- Restricting dietary sodium and fluid intake to prevent fluid overload
- Administering diuretics to manage oedema
- Providing antihypertensive medications (e.g., ACE inhibitors, ARBs) to control blood pressure
- Monitoring renal function regularly to assess the progression of the disease
- In severe cases, considering renal replacement therapy, such as dialysis, may be necessary