Acute glomerulonephritis in children - causes, course and possibilities of prevention

Causes of pathology

• bacteria;
• viral diseases;
• fungal infection;
• parasites;
• allergens;
• scarlet fever, tonsillitis, pneumonia, pharyngitis and other streptococcal infections;
• connective tissue diseases;
• heredity;
• overheating or hypothermia;
• stress;
• excessive physical stress;
• cystitis and other infectious pathologies of the urinary system;
• change of living climate;
• childhood rheumatism;
• systemic lupus erythematosus;
• hemorrhagic vasculitis;
• toxins;
• poison of snakes, bees;
• and etc.

Reasons for the development of glomerulonephritis

With glomerulonephritis, kidney damage is of the immune-inflammatory type. That is, the glomeruli are affected by the human immune system. The cause is the appearance in the blood of antigen-antibody complexes, which are formed after a respiratory infection (most often streptococcal, but can also be after measles, influenza, chickenpox or ARVI).

After suffering from a sore throat, about 15% of children develop glomerulonephritis, and immune complexes are found in 50%, which indicates a predominantly asymptomatic course. This is due to the high reactivity of the immune system. In adults, the disease develops in 5-7% of cases.

Types of disease

The main forms of glomerulonephritis:

• Spicy. It is characterized by severe symptoms and occurs abruptly against the background of an infection the child has suffered. Source: Z.M. Enikeeva, E.N. Akhmadeeva, A.R. Imaeva, R.F. Agzamova Acute glomerulonephritis in children: risk factors, course, outcomes // Pediatrics, 2012, v. 91, no. 6, pp. 17-21
• Chronic (2% of cases). It is characterized by a severe course. Inflammation in the kidneys gradually leads to the death of the glomeruli. The main symptom is hypertension, and the cause is an advanced acute process. Source: O.N. Gerasimenko Chronic glomerulonephritis (hematuric form) in childhood: clinical and morphological features and prognostic factors // Clinical Pediatrics, 2011, No. 4(31)

There are also types:

• primary (occurs on its own);
• secondary (complication of chronic).

By localization:

• focal (only some part of the kidney is affected);
• diffuse (almost the entire kidney is affected).

Due to the occurrence:

• viral;
• bacterial;
• parasitic.

Herbs for glomerulonephritis

Herbs are powerful medicines. In an individually selected combination, herbal infusions can provide a full range of “services” necessary in the treatment of glomerulonephritis: reduce blood pressure, eliminate swelling and inflammation, restore tissue, harmonize metabolism, remove toxins and reduce their formation, etc. Can herbal infusion completely replace drug therapy? The answer to this question is very individual. In any case, only a herbalist can select it after examining the patient and familiarizing himself with the results of laboratory and instrumental studies. A herbalist can carry out his own diagnostics, for example, using the method of determining the state of various body systems using the iris of the eye (iridology).

In the treatment of patients suffering from glomerulonephritis, other holistic methods of traditional medicine can be used - classical and resonant homeopathy, osteopathy, acupuncture, qigong therapy. An individually selected diet and exercise regimen play a big role.

Are the methods of classical medicine combined with traditional ones? Yes. The “proportion” is determined by the duration and severity of the disease, the individual characteristics of the body and the course of the disease, and the choice of the person himself.

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Diagnosis of the disease

The most difficult thing to diagnose is an infant. During diagnosis, only an acute process can be identified, which in the vast majority of cases subsequently becomes chronic. In addition, the manifestations of the disease are similar to pyelonephritis. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305788/ Mamiko Hosoya, Yukihiko Kawasaki, Ryo Maeda, Masatoki Sato, Kazuhide Suyama, Koichi Hashimoto, and Mitsuaki Hosoya Predictive factors for poor outcome in pediatric C3 glomerulonephritis // Fukushima J Med Sci. 2018; 64(3): 142–150

Laboratory research:

• Analysis of urine;
• general blood analysis.

A number of examinations are also carried out:

• ECG;
• Ultrasound;
• Doppler ultrasound of renal vessels;
• fundus examination;
• if a chronic form is suspected, a kidney biopsy is performed.

Recommendations for the prevention of glomerulonephritis

To prevent the development of glomerulonephritis, you must adhere to the following principles:

• avoid hypothermia;
• treat respiratory infections promptly;
• when a doctor prescribes antibiotics, drink the entire course to the end, following the doctor’s instructions;
• after suffering from a sore throat or acute respiratory viral infection, take a general urine test to exclude the asymptomatic (latent) form.

The treatment tactics for the disease and its complications are highly individual and depend on many factors that must be taken into account.

Self-medication using the Internet or on the advice of pharmacists at a pharmacy is fraught with dangerous complications.

How to treat glomerulonephritis?

In most cases, patients require inpatient therapy for 1.5-2 months. A salt-free diet is prescribed and proteins are excluded from the diet. Drinking regime is important - strictly up to 1 liter of liquid per day. The doctor prescribes antibiotics for a period of two or three weeks. Diuretics, vitamins, and sometimes corticosteroids are prescribed. Rest and bed rest are important. Plasmapheresis is performed.

If the disease progresses severely and the kidney stops functioning, a kidney transplant is prescribed.

Drug therapy may also include:

• cytostatics;
• blood pressure lowering agents;
• drugs to reduce blood clotting and viscosity.

After discharge, dispensary observation is required: lifelong (for a chronic disease) or for 5 years (for an acute disease).

Possible complications

The disease is primarily dangerous because it can be complicated by renal failure. You may also experience:

• cerebral edema;
• heart failure;
• visual impairment (transient);
• eclampsia and preeclampsia;
• cerebral hemorrhage.

Sources:

1. HE. Gerasimenko. Chronic glomerulonephritis (hematuric form) in childhood: clinical and morphological features and prognostic factors // Clinical Pediatrics, 2011, No. 4(31).
2. Z.M. Enikeeva, E.N. Akhmadeeva, A.R. Imaeva, R.F. Agzamova. Acute glomerulonephritis in children: risk factors, course, outcomes // Pediatrics, 2012, v. 91, no. 6, pp. 17-21.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305788/ Mamiko Hosoya, Yukihiko Kawasaki, Ryo Maeda, Masatoki Sato, Kazuhide Suyama, Koichi Hashimoto, and Mitsuaki Hosoya. Predictive factors for poor outcome in pediatric C3 glomerulonephritis // Fukushima J Med Sci. 2018; 64(3): 142–150.

Lavrishcheva Yulia Vladimirovna Clinic

Author of the article

Lavrishcheva Yulia Vladimirovna

Doctor of the first qualification category

Specialty: nephrologist

Experience: 13 years

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Treatment methods for glomerulonephritis

If the process is active, treatment is carried out in a specialized hospital. Bed rest and a special diet are prescribed. Determining the daily volume of fluid that a child should consume is carried out individually for each patient, taking into account many parameters.

Drug treatment is complex and includes glucocorticoids, and it is also possible to prescribe cytostatics. In addition, the treatment uses drugs that lower blood pressure, antibacterial, antihistamines, and, if indicated, diuretics, vitamin therapy, and cardiometabolites. If renal failure develops, hemodialysis is necessary.

Self-medication of glomerulonephritis at home is unacceptable and extremely dangerous for the health and life of the child.

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Classification

Acute glomerulonephritis can develop according to one of the following scenarios:

• Typical GN is an active onset with characteristic, pronounced symptoms.
• Latent GN is a slowly developing form with mild symptoms, making it more dangerous. The patient does not immediately consult a doctor, diagnosis is difficult. There is a high risk of glomerular nephritis becoming chronic.

As a result of untimely or incomplete treatment, acute glomerulonephritis can become chronic. In this case, there may also be several development options:

• The latent form is the most common, characterized by moderate proteinuria, i.e. increased glomerular permeability. Plasma proteins can be found in small amounts in the urine. Other symptoms are mild.
• Nephrotic, in which urinary symptoms predominate. Occurs in 20% of cases.
• Hypertensive - typically increased, more than 95 mm Hg. Art., blood pressure. Diagnosed in 20% of patients.
• Hematuric form or Berger's disease - there are red blood cells in the urine, swelling, arterial hypertension, other symptoms are mild or completely absent.
• Mixed glomerulonephritis is a combination of symptoms of hypertensive and nephrotic forms.

A chronic disease is characterized by a long course. Kidney function remains on average for 10 to 25 years. The disease develops cyclically with periods of exacerbation, similar in symptoms to acute glomerulonephritis, and periods of remission (imaginary recovery). However, a urine test can always determine changes occurring, even if there are no symptoms.

Exacerbation can be caused by alcohol consumption, hypothermia or infection. But, more often than not, unnoticed, as a result of pathological processes, the kidney tissue is replaced by scar tissue. Slowly progressing, glomerulonephritis leads to the final stage - chronic renal failure.

Acute post-streptococcal glomerulonephritis

TONSILLITIS (STRESS) AND WHAT IS IT DANGEROUS FOR THE KIDNEYS?!

Acute tonsillitis (in everyday life, tonsillitis) is an infectious disease with local manifestations in the form of acute inflammation of the palatine tonsils, most often caused by streptococci or staphylococci, less often by other microorganisms. Sore throat is also called an exacerbation of chronic tonsillitis.

WHAT IS STREPTOCOCCUS?

Beta-hemolytic streptococcus from group A (lat. Streptococcus pyogenes) is a very common microbe (bacterium) that can be detected in the body of many healthy people, but under unfavorable conditions it can provoke sore throat, sore throat (acute tonsillitis), scarlet fever, skin infections, abscess formation, blood poisoning and complications in the form of acute rheumatism and ACUTE GLOMERULONEPHRITIS.

HOW DOES STREPTOCOCCI INFECTION OCCUR?

Epidemiological studies have found that beta-hemolytic streptococcus infects up to 20% of healthy children who are carriers of this microbe.

Most often, beta-hemolytic streptococcus is transmitted through particles of mucus that are released from the throat and nose of a sick person (or carrier) during coughing or sneezing.

STREPTOCOCCUS CAUSES MANY DISEASES:

Nowadays, streptococci are of interest mainly because of the rare cases of rapidly progressing disease, as well as the risk of serious complications from untreated infections.

Acute streptococcal infection may manifest as pharyngitis (strep throat), scarlet fever (rash), impetigo (infection of the superficial layers of the skin), or cellulitis (infection of the deeper layers of the skin). Aggressive, toxigenic infection can lead to necrotizing fasciitis, myositis, and streptococcal toxin shock syndrome. Patients following an acute streptococcal infection may also develop immune-mediated post-streptococcal complications such as acute rheumatism and acute glomerulonephritis.

LATE COMPLICATIONS OF STREPTOCOCOCCAL INFECTION (IMMUNE-RELATED)

Specifically, in nearly 1% of children ages 3 to 15 who are recently infected with beta-hemolytic streptococcus, the immune system begins to produce antibodies (defense immune cells) that attack not only the infection itself, but also normal body tissue, including joint tissue , KIDNEY and heart. Because some proteins of streptococcus are very similar in structure to the proteins of the cells of the heart, kidneys and joints, i.e. The immune system cannot recognize a foreign protein from its own and thus the body begins to attack itself. For this reason, 1-2 weeks after the onset of sore throat (or scarlet fever) caused by beta-hemolytic streptococcus, such children may develop the so-called “acute rheumatic fever”, in which inflammation of the joints and heart occurs and/or “ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS”.

LET'S CONSIDER HOW YOU CAN SUSPECT ACUTE GLOMERULONEPHRITIS:

If you notice that a few weeks after suffering from a sore throat (scarlet fever, pharyngitis), he has the following symptoms:

• Swelling of the face, pastiness in the eyelids or in another area of ​​the body has appeared, or the child rarely urinates.
• The urine has acquired a dark red (burgundy) color (the color of meat slop urine)

Other symptoms may include fever, weakness, chills, and severe headache.

IF YOU NOTICE THESE SYMPTOMS, CONSULT A DOCTOR IMMEDIATELY!

In any case, all children and adults who have a sore throat, pharyngitis or scarlet fever in whom tests have revealed beta-hemolytic streptococcus from group A should be treated with antibiotics.

Treatment should be started as soon as possible (this is necessary to prevent the formation of abscesses in the throat or the spread of infection to neighboring organs), as well as the development of late complications in the heart, kidneys and joints.

If you have any questions about this topic, we will try to answer them.

Damage to the palatine tonsils in acute tonsillitis (hypertrophy (increase in size) of the palatine tonsils, plaque)

Beta-hemolytic streptococcus from group A (lat. Streptococcus pyogenes) is a very common microbe (bacterium) that can be detected in the body of many healthy people

Scarlet fever is an acute infectious disease characterized by fever, intoxication, sore throat and profuse pinpoint rash. Children aged 2-10 years are most often affected. The causative agent of scarlet fever is group A streptococcus.

Macrohematuria (hematuria visible to the eye, urine in the form of “meat slop”)

Symptoms

The primary disease (acute course) is characterized by the following symptoms:

• Oliguria is a decrease in the volume of daily urine.
• Micro- or macrohematuria is the presence of blood in the urine; in the first case, the volume is small and can only be detected by laboratory analysis; in the second case, it is determined visually.
• Swelling causes deterioration in kidney function.
• Hypertensive symptoms occur in the form of increased blood pressure.

Symptoms of acute glomerulonephritis appear a couple of weeks after suffering from an infectious streptococcal disease. This fact should also be attributed to characteristic symptoms. In children, the disease develops quickly, has a clear clinical picture, and ends with recovery. In adults, erased forms and the absence of general symptoms of glomerulonephritis are common. As a result, the disease becomes chronic.

Chronic glomerulonephritis develops cyclically. The patient either feels well or suffers from symptoms. This can continue for years, with periods of regression becoming longer and becoming more acute each time. At this time it is noted:

• changes in urine, presence of blood;
• fever, chills;
• nausea accompanies loss of appetite;
• pain occurs in the head and lumbar region;
• the swelling is so significant that even the eyelids swell.

In 15% of patients, gross hematuria develops to such an extent that the urine becomes dark brown and sometimes black. It has a specific smell that is compared to “meat slop.”