Acute glomerulonephritis in childrenAcute glomerulonephritis is one of the common kidney problems in children. In this condition there is swelling of small blood vessels inside the kidney leading to decreased blood flow and decreased urine output. Cause: The disease usually follows skin infection caused by a type of bacteria called streptococci but may occur following other infections also. Hence it is also called post-infectious glomerulonephritis. Whenever there is an infection, the human body produces certain proteins called antibodies to fight the invading organism. In some children these antibodies also cause damage to the small blood vessels of kidneys resulting is swelling. It is not clear why the antibodies attack the kidney in some children. Whenever blood flow to the kidneys is decreased an inbuilt defense mechanism is activated to increase the blood flow. This is done by increasing the blood pressure. Symptoms and signs: Due to decreased urine output more water accumulates is the body causing some swelling which is more marked over the face. There may be fever and abdominal pain. The damage to the blood vessels of kidneys causes some bleeding inside the kidneys resulting in passage of blood in the urine. As the blood undergoes some chemical change inside the kidneys the urine looks brown and not bright red. In the initial stage the urine may appear normal but laboratory examination may reveal the abnormality. The increased blood pressure can cause headache. If hypertension is severe child can develop convulsions and lapse into coma due to increased pressure inside the head affecting the function of the brain. Some children are brought to the hospital at this stage as some parents are not aware of the significance of early manifestation- swelling of face. Facial swelling that is more obvious as soon as the child gets up from bed should not be neglected. After some time the swelling decreases as the fluid gravitates down to the lower limbs. Management: It is necessary to hospitalize the child to monitor blood pressure. The blood pressure is unstable and can shoot up anytime. Urine output has to be monitored continuously. . Accurate checking of the child’s weight daily gives an idea of abnormal fluid retention. Renal function has to be assessed by testing the blood for urea, creatinine, sodium and potassium. Occasionally a child with severe kidney dysfunctions may require dialysis a procedure which removes the waste products from the blood. Anti-hypertensive drugs have to be given to reduce blood pressure. It may be necessary to restrict fluid intake till urine output improves. The intake of salt needs to be restricted as there is abnormal sodium retention. It is better to avoid intake of substances containing high potassium like fruits and tender coconut. A course of appropriate antibiotic is needed to eradicate infection. Prognosis: The outcome is generally good. Urine output increases and blood pressure comes down usually within a week. Once the blood pressure is normal without medication child can go home. Abnormalities of urine may persist for several months. Urine is examined at regular intervals till it is normal. Usually there will be no long term problem. Prevention: Prompt treatment of streptococcal skin infection can prevent acute glomerulonephritis in many children.
Page last reviewed on 19th November 2009
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