Acute Glomerulonephritis in Children ✅
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ℹ️ About
- Causes ⚠️: Haematuria 🩸 and oliguria 🚱 with low BP ⬇️ caused by an immune-mediated response in the kidneys.
- Presentation 🩺: Kidney inflammation with varying severity.
- 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 🦠 (post-streptococcal)
- Henoch–Schönlein purpura (HSP) ✨
- Toxins or heavy metals ☠️
- Berger's disease (IgA nephropathy) 🧬
- Malignancies 🎗️
- Viruses 🦠
- Bacteria 🧫 (e.g., infective endocarditis, syphilis)
- Renal vein thrombosis 🩸
Investigations 🧾
- Blood Tests 🧪
- Full blood count (FBC) 🧾 – infection/anaemia
- Urea & electrolytes (U&E) 💧 – monitor renal function
- Complement levels 🧬 – low C3, normal C4 suggests post-streptococcal GN
- ASOT / anti-DNase B 🦠 – recent streptococcal infection
- ANA / anti-DNA 🧪 – if lupus suspected
- ANCA 🔬 – if vasculitis suspected
- Blood cultures 💉 – systemic infection
- Virology testing 🧾
- Urine Tests 💧
- Microscopic urinalysis 🔬 – RBCs, WBCs, casts; red cell casts = glomerular bleeding
- Urine culture & specific gravity ⚖️ – detect infection, assess concentration
- Other Tests 🩻
- Throat swabs 🧫 – detect streptococcal colonisation
- Renal ultrasound 🖼️ – kidney size, obstruction, scarring
- Chest X-ray (CXR) 📸 – if fluid overload suspected
Management 💊
- Supportive care 🏥
- Monitor fluid balance 💧 and urine output
- Vital signs, especially blood pressure ⬇️
- Manage hypertension 💊
- ACE inhibitors or ARBs
- Other antihypertensives if needed
- Fluid & sodium restriction 💧🧂 – prevent fluid overload, pulmonary oedema
- Diuretics 💊 – for oedema or fluid overload
- Treat underlying infection 🦠 – antibiotics if post-streptococcal or bacterial
- Renal replacement therapy 🩸 – dialysis if severe uraemia, fluid overload, or refractory hypertension
- Ongoing monitoring 📊 – FBC, U&E, urine output, electrolytes, complement levels
Key Clinical Pearls 💡
- Most children present with haematuria 🩸 and periorbital oedema 👁️ after a sore throat or skin infection.
- Low BP ⬇️ and oliguria 🚱 suggest severe disease; hypertensive encephalopathy 🧠 is an emergency.
- Supportive care + monitoring is often sufficient; complications require timely intervention 💊🏥.
📚 References
