Glomerulonephritis in children

Glomerulonephritis is rightfully considered one of the most common and dangerous kidney diseases in children. This ailment requires especially careful attention from parents and doctors, because in the event of untimely assistance or improper treatment, complications can be fatal for the child. You will learn more about this disease and what the correct actions should be during treatment in this article.

Disease and its varieties

Glomerulonephritis - a disease in which special kidney cells are affected - glomeruli, also called glomeruli. Small cells gave the disease and the second name - glomerular nephritis. Because of this, the kidneys cease to fully perform their functions. This paired organ has been entrusted by nature with many concerns - the removal of decay products, toxins from the body, the production of substances that control blood pressure and erythropoietin, which is simply necessary for the formation of red blood cells in the blood. Failures in the work of the kidneys lead to the most sad consequences.

In a child with glomerulonephritis, a huge amount of protein is found in the urine, and erythrocytes (blood in the urine) come out with it. Thus, anemia, arterial hypertension, edema develop, due to catastrophic protein losses by the standards of the body, immunity decreases. Due to the fact that the lesion proceeds in different ways, and the reasons why the glomeruli of the kidneys begin to die are very heterogeneous, the disease in pediatrics is not considered a solitary one. This is a whole group of kidney ailments.

Most often, glomerulonephritis affects children aged 3 to 10 years. Babies under 2 years old get sick much less often, only 5% of all cases occur in them. Boys get sick more often than girls.

The classification of glomerulophritis is quite complex and is based on symptoms and clinical presentation.

All glomerular nephritis are:

primary (if kidney pathology manifested itself as a separate independent disease);
secondary (kidney problems started as a complication after a severe infection).

According to the characteristics of the course, two large groups of the disease are distinguished:

acute;
chronic.

Glomerulonephritis of the acute form is expressed by nephritic (sudden, sharp) and nephrotic (developing gradually and slowly) syndromes, it can be combined and isolated (when there are only changes in the urine, without other symptoms). Chronic can be nephrotic, hematuric (with the appearance of blood in the urine) and mixed.

Diffuse chronic glomerulonephritis develops slowly and gradually, most often the changes in the body are so insignificant that it is very difficult to determine later when the pathological process began, leading to the death of kidney cells. Depending on the type of pathogen that caused the underlying disease, complicated by glomerulonephritis, there are several types of disease, the cause of which becomes clear from the name - post-streptococcal, post-infectious, etc.

And according to the severity of the symptoms and the damage that has already been delivered to the kidneys, doctors conditionally award each case to 1.2 or 3 degrees with a mandatory indication of the stage of development of the disease (in case of a chronic illness).

Causes

The kidneys themselves are not affected by pathogenic microbes and other "outsiders". The destructive process is triggered by the child's own immunity, which reacts to a certain allergen. Most often streptococci act as "provocateurs".

Glomerulonephritis is often a secondary complication of primary streptococcal sore throat, bacterial pharyngitis, scarlet fever.

Less often, the death of the renal glomeruli is associated with influenza, ARVI, measles, hepatitis viruses. Sometimes snake or bee venom acts as allergens that trigger the destruction of glomeruli. For reasons not entirely clear to science, the body, instead of simply bringing these harmful factors out, creates a whole "heavy artillery" of the immune complex against them, which hits its own filters - the kidneys. According to the assumptions of doctors, such an inadequate reaction of the body is influenced by, at first glance, little influencing factors - stress, fatigue, climate change, place of residence, hypothermia and even overheating in the sun.

Possible complications

Glomerulonephritis is considered a severe disease. It is quite complex on its own and rarely heals completely. The most predictable and expected complication of an acute illness is its transition to a chronic diffuse form. By the way, about 50% of all cases are complicated this way.

But there are other complications that are life threatening or can cause disability:

acute renal failure (occurs in about 1-2% of patients);
heart failure, including its acute, deadly forms (3-4% of patients);

cerebral hemorrhage;
acute visual impairment;

dysplasia of the kidney (when the organ begins to lag behind in growth rates from the size set for age, it decreases).

Changes in the kidneys can be so significant that the child will develop chronic renal failure, in which he will be indicated for an organ transplant.

With kidney transplantation in Russia, everything is quite deplorable, the child may simply not wait for the donor organ he needs. An alternative (temporary) is an artificial kidney. Since the procedures should be carried out several times a week, the baby is made dependent on the apparatus, because he simply has no other way to cleanse the body of toxins.

Symptoms and Signs

Usually, 1-3 weeks after the illness (scarlet fever or sore throat), the first symptoms of glomerulonephritis may appear. The most striking feature is discoloration of urine... It becomes red in a child, and the shade can be either bright or dirty, which is commonly called the "color of meat slops."

The onset of acute nephritic glomerulonephritis in a child can also be recognized by edema on the face, which looks like dense, poured, little changing during the day. Blood pressure rises, as a result of which vomiting and severe headaches may appear. This form of the disease has the most positive prognosis, since more than 90% of children experience a full recovery with adequate treatment. For the rest, the disease becomes chronic.

Acute nephrotic disease "Comes" from afar, the symptoms appear gradually, due to this, the child has no complaints for a long time. If the parents do not ignore the morning edema, which sometimes disappear completely during the day, and go with the child to donate urine, then the correct signs of the disease will be found in it - proteins.

The first edema begins to appear on the legs, then gradually spreads further - to the arms, face, lower back, and sometimes to internal organs. The swellings are not dense, they are looser. The baby's skin becomes dry and the hair becomes brittle and lifeless. In this case, blood pressure rarely rises, and the urine has a normal color, since the protein in it does not color the liquid in any way. With regard to this type of disease, the forecasts are not rosy: according to doctors, only 5-6% of children recover, the rest continue to be treated, but from the chronic form.

If the child's urine changes in color (becomes more red), but there are no other symptoms or complaints, nothing swells or hurts, then we can talk about isolated acute glomerulonephritis.

About half of all young patients can be cured of it with timely admission to the hospital. The remaining 50%, even with proper treatment, for inexplicable logical reasons, begin to suffer from a chronic disease.

If a child has all the signs of all three described types of the disease, then we can talk about a mixed form. It almost always ends with a transition to a chronic illness and the prognosis is unfavorable. The likelihood of recovery is influenced by the state of immunity. If it is weak or there is some kind of defect in it, then the onset of the chronic form becomes more obvious.

In chronic glomerulonephritis, the child experiences periods of exacerbation with edema and changes in urine and periods of remission, when it seems that the disease is behind. With the right treatment, only half of the patients are able to stabilize. About a third of children develop a progressive process, and this ultimately often leads to an artificial kidney apparatus.

Hematuric chronic pyelonephritis is considered the most favorable among the chronic varieties of the disease. It does not lead to the death of a person, and is noticeable only during periods of exacerbation, when of all the signs, the only one appears - blood in the urine.

Diagnostics

If the child has noticeable swelling, even if only in the morning, even if only on the legs or arms, this is already a reason for contacting a nephrologist. If the urine has changed color, you need to run to the clinic urgently. Parents should remember that the analysis of urine that has been in the jar for more than an hour and a half is less reliable, therefore, it is necessary to have time to deliver the collected urine to the laboratory by all possible means during this time.

Diagnosis of glomerulonephritis includes a visual examination of the child and laboratory tests, the main of which is the same urinalysis. The number of red blood cells in it will be determined, from the quality - whether they are fresh or leached. An equally important indicator is protein in the urine. The more it is released, the usually more severe the stage of the disease. In addition, the laboratory assistant will indicate a couple of dozen different substances, salts, acids, which can tell a lot to the nephrologist.

Usually this is enough, but with regard to small children and with very poor analyzes, doctors are "reinsured" by prescribing ultrasound examination of the kidneys. In doubtful situations, a kidney biopsy may also be prescribed. Chronic doctor recognizes such an ailment, the symptoms of which have lasted for more than six months or if changes in urine formulas have been kept at abnormal values for more than a year.

Treatment

In acute glomerulonephritis, home treatment is categorically contraindicated.

The doctor will strongly recommend going to the hospital and this is quite justified. After all, the child needs complete rest and the strictest bed rest. The patient is immediately prescribed diet number 7, which does not imply salt, significantly limits the amount of liquid drunk per day, and cuts the amount of protein foods by about half of the age norm.

If the disease is provoked by streptococci, then a course of antibiotics of the penicillin group is prescribed. In a hospital setting, they will most likely be injected intramuscularly. To reduce edema, diuretics are prescribed in a strict age-specific dosage. With increased pressure, they will give funds that can reduce it.

The modern approach to the treatment of glomerulonephritis involves the use of hormones, in particular, "Prednisolone" in combination with drugs - cytostatics, which can stop and slow down the growth of cells. These drugs are commonly used extensively in cancer therapy, but this fact should not scare parents. When the condition of the kidneys improves, they are entrusted with the function of slowing down the growth of immune colonies, and this will only benefit the suffering kidney cells.

If the child has concomitant chronic infectious diseases, after the acute stage of glomerulonephritis, it is strongly recommended to eliminate foci of infection - to cure all the teeth, remove the adenoids if they hurt, undergo treatment for chronic tonsillitis, etc.

But you need to do this no earlier than six months after suffering an acute renal disease or exacerbation of a chronic one. Convalescence with adherence to the treatment schedule usually occurs after 3-4 weeks. Then the child is recommended to study at home for six months or a year, to be registered with a nephrologist for at least two years, to visit sanatoriums that specialize in kidney diseases, and to follow a strict diet. During the year, such a child should not be given any vaccinations. And with every sneeze and the slightest sign of ARVI, parents need to urgently take his urine tests to the clinic.

Chronic glomerulonephritis is treated in the same way as acute, since it needs treatment only during periods of exacerbation.

With him, you should also not insist on home treatment, the child must necessarily be hospitalized, because in addition to therapy, he will be given a full course of examination there to find out if the disease has begun to progress. In severe forms and extensive destruction of the structures of the kidneys, procedures for an artificial kidney and transplantation of a donor organ to replace the damaged one are shown.

With a chronic illness, the child will be on the dispensary for life. Once a month, he will need to give urine, visit a doctor, and once a year do an ECG to prevent pathological changes in the heart.

Prevention

There is no vaccination against this serious ailment, and therefore prevention is not specific. However, parents should know that no sore throat and pharyngitis should be treated without permission, because the disease may turn out to be streptococcal, and without antibiotics or with uncontrolled intake of them, the likelihood of such a complication as glomerulonephritis will increase significantly.

After suffering scarlet fever, after 3 weeks, it is absolutely necessary to pass a urine test, even if the doctor forgot to prescribe it for you. 10 days after streptococcal sore throat or streptoderma, urine samples must also be taken to the laboratory. If there is nothing alarming in them, then you can not worry. Prevention of renal disease in general and glomerulonephritis in particular includes proper treatment for ARVI, influenza and measles vaccination. It is important to ensure that the child does not sit on the cold floor with his bare bottom and does not overheat in the summer in the sun.