Acute Glomerulonephritis in

Children
What is glomerulonephritis?
Glomerulonephritis is a type of kidney disease that involves the glomeruli.
These are very small, important structures in the kidneys that supply
blood flow to the small units in the kidneys that filter urine called the
nephrons. During glomerulonephritis, the glomeruli become inflamed and
impair the kidney's ability to filter urine.

AGN is a complex of findings which is marked histologically by a

generalized glomerular inflammation. Frequently, renal biopsy is not
available, but AGN can usually be recognized by the clinical picture
of hematuria, fluid overload (edema and hypertension), and some
evidence of renal insufficiency (elevation of BUN and creatinine).
In most circumstances, glomerular inflammation begins with an
antigen-antibody reaction, either direct antibody binding to an
antigen expressed or trapped in the glomerulus, or the localization
of a circulating complex in the kidney. This incites injury by
activating one or more systems of inflammatory mediators: the
complement cascade, coagulation factors, cytokines, growth factors,
and others. The inflammation is marked by proliferation of resident
glomerular cells and infiltration by lymphocytes or neutrophils.
The glomerular inflammation and expansion impairs the
microcirculation, reducing the glomerular filtration rate (GFR) and
usually resulting in an increase in BUN and creatinine. This reduction
in GFR, in turn, leads to the retention of salt and water, causing fluid
overload. The degree of fluid overload in AGN can vary considerably.
In severe situations, it can be manifest by life-threatening
hypertension and pulmonary edema. Indeed, hypertensive
encephalopathy may be the presenting complaint in some children
with AGN [1].
In some situations, AGN is a primary process, and virtually, all of the
clinical findings are a consequence of the renal lesion.
Poststreptococcal AGN is the best example of this . In other cases,
the AGN is but one manifestation of a systemic illness which has
targeted multiple organs, each of which may be independently
injured. In children, the AGN associated with Henoch Schoenlein
purpura is the prototype for this .

Fortunately, most cases of AGN in children are either self-limited or

amenable to therapy although there may be devastating
complications of the illness during the acute phase. Less commonly,
what begins as an apparent AGN may presage the development of a
chronic process, which ultimately may progress into irreversible endstage renal disease (ESRD).

What causes glomerulonephritis?

Glomerulonephritis is caused by several different disease states, including
the following:
Systemic immune disease, such as systemic lupus erythematosus (SLE or
lupus)

Other systemic diseases may include:

Polyarteritis nodosa group. An inflammatory disease of the arteries.

Wegener vasculitis. A progressive disease that leads to widespread

inflammation of all of the organs in the body.

Henoch-Schnlein purpura. A disease usually seen in children that is

associated with purpura (small or large purple lesions on the skin and
internally on the organs) and involves multiple organ systems.

A form of inherited glomerulonephritis called Alport syndrome, which

affects both men and women; men are more likely to have kidney
problems. Treatment focuses on preventing and treating high blood
pressure and preventing kidney damage.

In children, a common cause of glomerulonephritis is from a streptococcal

infection, such as strep throat or upper respiratory infection.
Glomerulonephritis usually occurs more than one week after an infection.
This is often referred to as acute poststreptococcal glomerulonephritis or
APSGN.

What are the symptoms of glomerulonephritis?

The following are the most common symptoms of glomerulonephritis:
> Dark brown-colored urine (from blood and protein)
> Sore throat
> Diminished urine output
> Fatigue
> Lethargy
> Increased breathing effort
> Headache
> High blood pressure
> Seizures (may occur as a result of high blood pressure)
> Rash, especially over the buttocks and legs
> Weight loss
> Joint pain
> Pale skin color
> Fluid build up in the tissues (edema)
The symptoms of glomerulonephritis may look like other conditions and
medical problems. Always consult your child's doctor for a diagnosis.

How is glomerulonephritis diagnosed?

In addition to a thorough physical exam and complete medical history,
your child's doctor may recommend the following tests:
> Throat culture
> Urine tests
> Blood tests

> Electrocardiogram (ECG or EKG). A test that records the electrical

activity of the heart, shows abnormal rhythms (arrhythmias or
dysrhythmias), and detects heart muscle damage
> Renal ultrasound (also called sonography). A noninvasive test in which
a transducer is passed over the kidney producing sound waves which
bounce off of the kidney, transmitting a picture of the organ on a video
screen. The test is used to determine the size and shape of the kidney
and to detect a mass, kidney stone, cyst, or other obstruction or
abnormalities.
> Chest X-ray. A diagnostic test that uses invisible electromagnetic
energy beams to produce images of internal tissues, bones, and organs
onto film.
> Renal biopsy. A procedure during which a small sample of tissue is
taken from the kidney through a needle. The tissue is sent for special
testing to determine the specific disease.

If glomerulonephritis is caused by a streptococcal infection, then

treatment will be focused on curing the infection and treating the
symptoms associated with the infection. Treatment will depend on the
underlying cause. Therefore, treatments focus on slowing the progression
of the disease and preventing complications.
Treatment for glomerulonephritis may include:
> Fluid restriction
> Decreased protein diet
> Decreased salt and potassium diet
Medication, such as:

> Diuretics
> Blood pressure medications
> Phosphate binders. Medications to decrease the amount of the mineral
phosphorus in the blood.
> Immunosuppressive agents
> Dialysis. A medical treatment to remove wastes and additional fluid
from the blood after the kidneys have stopped functioning. Dialysis may
be required for short-term or long-term therapy.