Acute Glomerulonephritis in Children (nephritic Syndrome)

Clinical Description

Acute glomerular injury, defined by:

• Hematuria (may be macroscopic) and RBC casts in urine
• Hypertension
• Oliguria and increasing creatinine
• Mild Proteinuria (not nephrotic range)
• Oedema

Signs and Symptoms

• Preceding symptoms or illnesses (Infections, bloody diarrhea, joint pains, rash):
• Oliguria or anuria
• haematuria
• Abdominal pain
• Breathlessness, cough
• Headache, convulsions (hypertension) hypertension
• Past medical history of similar problem
• Family history of kidney diseases
• Oedema and pulmonary oedema
• Ascites

Causes

• Mostly post-infectious glomerulonephritis Membranoproliferative glomerulonephritis (MPGN)
• Lupus nephritis
• Haemolytic uraemic syndrome
• Vasculitides, such as Henoch Schonlein Purpura (IgA nephropathy)
• Sickle cell disease

Investigations

• Blood pressure
• Urine dipstick and microscopy – Haematuria with red cell casts on microscopy,
• proteinuria and leucocyturia can be present
• FBC
• Creatinine,urea and electrolytes
• Albumin
• HIV- test, Hepatitis B and C
• Sickle cell test
• Renal ultrasound
• chest X-ray and Cardiac echo

Treatment

• Salt restriction
• Furosemide 1-2mg/kg IV, if moderate/ severe fluid overload and hypertension
• Treat blood pressure Start Nifedipine 0.25-0.3mg/kg 6-8 hourly, if hypertensive Give

Praziquantel 40mg/kg PO STAT. When poststreptococcal glomerulonephritis is suspected, give Amoxicillin 15mg/kg PO 8 hourly for 10 days

• Follow up in pediatric or renal clinic

Complications

• Hypertensive emergency
• Acute kidney injury
• Chronic kidney disease

Complications and Referral Criteria

• Hypertensive emergency
• Persistent uncontrolled hypertension
• Acute kidney injury