Glomerulonephritis nephrotic syndrome in children, the prognosis of recovery. Glomerulonephritis in children: causes, symptoms, diagnosis and treatment. Prevention of inflammation of glomeruli in children

Glomerulonephritis is sometimes abbreviated as nephritis. Nephritis (inflammation of the kidneys) is a more general concept (for example, it can be nephritis with kidney injury or toxic nephritis), but it also includes glomerulonephritis.

Kidney function. The kidneys play a very important role in humans.

The main function of the kidneys is excretion. End products of protein breakdown (urea, uric acid, etc.), foreign and toxic compounds, excess of organic and inorganic substances are excreted from the body through the kidneys with urine.

The kidneys maintain the constancy of the composition of the internal environment of the body, the acid-base balance, removing excess water and salts from the body.

The kidneys are involved in the metabolism of carbohydrates and proteins.

The kidneys are a source of various biologically active substances. They produce renin, a substance involved in the regulation of blood pressure, and erythropoietin is produced, which contributes to the formation of red blood cells - erythrocytes.

Thus:

The kidneys are responsible for blood pressure levels.
The kidneys are involved in blood formation.

How the kidney works. The structural unit of the kidney is the nephron. It can be roughly divided into two components: the glomerulus and the renal tubules. The elimination of excess substances from the body and the formation of urine in the kidney occurs when two important processes are combined: filtration (occurs in the glomerulus) and reabsorption (occurs in the tubules).
Filtration. Human blood is driven through the kidney like a filter. This process takes place automatically and around the clock, as the blood must be constantly purified. Blood flows through the blood vessels into the glomerulus of the kidney and is filtered into the tubules, urine is formed. Water, salt ions (potassium, sodium, chlorine) and substances that must be removed from the body enter the tubules from the blood. The filter in the glomeruli has very small pores, so large molecules and structures (proteins and blood cells) cannot pass through it, they remain in the blood vessel.

Reverse suction. Much more water and salt is filtered out in the tubules than it should be. Therefore, part of the water and salts from the renal tubules is absorbed back into the blood. At the same time, all harmful and excess substances dissolved in water remain in the urine. And if about 100 liters of liquid is filtered out in an adult per day, then only 1.5 liters of urine is formed as a result.

What happens when the kidneys are damaged. If the glomeruli are damaged, the permeability of the renal filter increases, and protein and erythrocytes pass through it into the urine along with water and salts (erythrocytes and protein will appear in the urine).

If inflammation joins, in which bacteria and protective cells of leukocytes are involved, then they will also enter the urine.

Impaired absorption of water and salts will lead to their excessive accumulation in the body, and edema will appear.

Since the kidneys are responsible for blood pressure and blood formation, as a result of insufficiency of these functions, the patient will develop anemia (see) and arterial hypertension (see).

The body loses blood proteins with urine, and these are immunoglobulins, which are responsible for immunity, important proteins - carriers that transport various substances in the bloodstream, proteins for building tissues, etc. ...

The reasons for the development of glomerulonephritis

With glomerulonephritis, an immune inflammation occurs in the kidneys, caused by the appearance of immune complexes that are formed under the influence of an agent acting as an allergen.

Such agents can be:

Streptococcus. It is the most common provocateur of glomerulonephritis. In addition to kidney damage, streptococcus is the cause of sore throat, pharyngitis, streptococcal dermatitis and scarlet fever. As a rule, acute glomerulonephritis occurs 3 weeks after the child undergoes these diseases.
Other bacteria.
Viruses (influenza and other causative agents of ARVI, hepatitis virus, measles viruses, etc.)
Vaccines and serums (after vaccinations).
Snake and bee venom.

When meeting with these agents, the body reacts to them in a perverse way. Instead of neutralizing and removing them, it forms immune complexes that damage the glomerulus of the kidney. Sometimes the simplest effects on the body become the starting points for the formation of immune complexes:

Hypothermia or overheating.
Long exposure to the sun. Abrupt climate change.
Physical or emotional stress.

The filtration process is impaired, kidney function decreases. The child's condition worsens significantly, since excess water, protein breakdown products and various harmful substances remain in the body. Glomerulonephritis is a very severe, prognostically unfavorable disease, often resulting in disability.

Clinical forms of glomerulonephritis

In the clinic of glomerulonephritis, there are 3 main components:

Swelling.
Increased blood pressure.
Change in urinalysis.

Depending on the combination of these symptoms, the patient has several forms, pathological syndromes that occur in glomerulonephritis. Distinguish between acute and chronic glomerulonephritis.

Clinical forms of glomerulonephritis:

Acute glomerulonephritis.

Nephritic Syndrome.
Nephrotic syndrome.
Isolated urinary syndrome.
Combined form.

Chronic glomerulonephritis.

Nephrotic form.
Mixed form.
Hematuric form.

Acute glomerulonephritis

The disease can begin either acutely, in the case of nephritic syndrome, or gradually, gradually, with nephrotic syndrome. Gradual onset of the disease is prognostically less favorable.

Nephritic Syndrome. This form of the disease usually affects children 5-10 years old. Usually, the disease develops within 1-3 weeks after the transferred sore throat, scarlet fever, ARVI and other infections. The onset of the disease is acute.

Characteristic:

Swelling. They are located mainly on the face. These are dense, difficult-to-pass edemas, with adequate treatment, they persist for up to 5-14 days.
Increased blood pressure, accompanied by headache, vomiting, dizziness. With proper treatment, it is possible to lower blood pressure in 1-2 weeks.
Changes in urine: decreased amount of urine; the appearance of protein in the urine in moderation; red blood cells in the urine. The number of erythrocytes in the urine is different for all patients: from a slight increase to a significant one. Sometimes there are so many erythrocytes that the urine turns red (urine is "the color of meat slops"); an increase in the number of leukocytes in the urine.

Changes in urine persist for a very long time, for several months. The prognosis of this form of acute glomerulonephritis is favorable: recovery occurs in 95% of patients after 2-4 months.

Nephrotic syndrome. This form of glomerulonephritis is very severe and prognostically unfavorable. Only 5% of children recover, the rest of the disease becomes chronic.

The leading symptoms of nephrotic syndrome are edema and protein in the urine.
The onset of the disease is gradual, consisting in a slow increase in edema. First, these are the legs, face, after the edema spreads to the lower back and can be very pronounced, up to fluid retention in the body cavities (the cavity of the heart bag, in the lungs, abdominal cavity). Unlike edema in nephritic syndrome, they are soft and easily displaceable.
The skin is pale, dry. Hair is brittle, dull.
Changes in urine: a decrease in the amount of urine with an increase in its concentration; protein in urine in large quantities; there are no erythrocytes or leukocytes in the urine with nephrotic syndrome.

Blood pressure is normal.

Isolation urinary syndrome. With this form, there are changes only in the urine (the protein content is moderately increased and the number of erythrocytes is increased to varying degrees). The patient has no other complaints. Diseases in half of the cases end with recovery, or become chronic. It is in no way possible to influence this process, since even with good competent treatment, the disease turns into a chronic form in 50% of children.

Mixed form. There are signs of all three of the above syndromes. The patient has everything: severe edema, high blood pressure, and a large amount of protein and red blood cells in the urine. Mostly older children get sick. The course of the disease is unfavorable, it usually ends with a transition to a chronic form.

Chronic glomerulonephritis

The chronic course of glomerulonephritis is said to be when changes in the urine persist for more than a year or if it is not possible to cope with high blood pressure and edema for 6 months.

The transition of an acute form of glomerulonephritis to a chronic one occurs in 5-20% of cases. Why does glomerulonephritis end in recovery in some patients, while in others it becomes chronic? It is believed that patients with chronic glomerulonephritis have some kind of immune defect, either congenital or formed during life. The body is not able to cope with the disease that attacked it and constantly maintains a sluggish inflammation, leading to the gradual death of the glomeruli of the kidneys and their sclerosis (replacement of the working tissue of the glomeruli with connective tissue, see).

The transition to a chronic form is also facilitated by:

The presence of foci of chronic infection in the patient (chronic sinusitis, caries, chronic tonsillitis, etc.).
Frequent SARS and other viral infections (measles, chickenpox, mumps, herpes, rubella, etc.).
Allergic diseases.

The course of chronic glomerulonephritis, like any other chronic disease, is accompanied by periods of exacerbation and temporary well-being (remission). Chronic glomerulonephritis is a serious illness that often leads to the development of chronic renal failure. At the same time, the patient's kidneys stop working, and they have to be replaced with artificial ones, since a person cannot live without constant blood purification, he dies from poisoning with toxic products. The patient becomes dependent on the artificial kidney apparatus - the blood purification procedure has to go through several times a week. There is another option - a kidney transplant, which in modern conditions is also very problematic.

Nephrotic form... Usually occurs in young children. It is characterized by persistent long-term edema, the appearance of a significant amount of protein in the urine during an exacerbation of the disease. In about half of patients with this form of the disease, persistent long-term remission (actual recovery) can be achieved. In 30% of children, the disease progresses and leads to chronic renal failure, and as a result, to the transition to an artificial kidney apparatus.

Mixed form. In the mixed form, all possible manifestations of glomerulonephritis are found in various combinations: both pronounced edema, and a significant loss of protein and red blood cells in the urine, and a persistent increase in blood pressure. Changes occur during an exacerbation of the disease. This is the most severe form. Only 11% of patients go into long-term stable remission (actual recovery). For 50%, the disease ends with chronic renal failure and an artificial kidney apparatus. After 15 years of the course of the mixed form of chronic glomerulonephritis, only half of the patients remain alive.

Hematuric form. The patient has only changes in the urine: during an exacerbation of the disease, erythrocytes appear. Small amounts of protein may also appear in the urine. This form of chronic glomerulonephritis is prognostically the most favorable, is rarely complicated by chronic renal failure (only in 7% of cases) and does not lead to the death of the patient.

Treatment of glomerulonephritis in children

I. Mode. A child with acute glomerulonephritis and exacerbation of a chronic one is treated only in a hospital. He is prescribed bed rest until all symptoms disappear. After being discharged from the hospital, the child is homeschooled for a year and is exempted from physical education lessons.

II. Diet. Traditionally, table number 7 is assigned according to Pevzner. In acute glomerulonephritis or exacerbation of chronic - table number 7a, when the process subsides, the diet expands, during remission, if there is no renal failure, go to table number 7.

Table 7a.

Indications: acute renal disease (acute nephritis or its exacerbation).

The food is fractional.
Liquids up to 600-800 ml per day.
Table salt is completely excluded.
Significant restriction of protein foods (up to 50% of the amount prescribed by age).

III. Drug treatment(main directions):

Diuretic drugs.
Blood pressure lowering drugs.
Antibiotics, if it is confirmed that the cause of glomerulonephritis is a bacterial infection.
Hormones (prednisone), cytostatics (stop cell growth).
Drugs that improve the properties of blood (reduce viscosity and clotting, etc.).
Treatment of foci of chronic infection (removal of tonsils in chronic tonsillitis, treatment of caries, etc.) 6-12 months after exacerbation of the disease.
With the development of renal failure, hemosorption or kidney transplantation is used.

Dispensary observation

For acute glomerulonephritis:

After being discharged from the hospital, the child is transferred to a local sanatorium.
For the first 3 months, a general urine test, blood pressure measurement and a doctor's examination every 10-14 days. The next 9 months - once a month. Further within 2 years - 1 time in 3 months.
For any disease (ARVI, childhood infections, etc.), it is necessary to take a general urine test.
Exemption from physical education.
Medical withdrawal from vaccinations for 1 year.

The child is removed from the dispensary and is considered recovered if there have been no exacerbations and deterioration of analyzes for 5 years.

With chronic course:

The child is observed before moving to an adult clinic.
Urine analysis followed by a pediatrician examination and blood pressure measurement once a month.
Electrocardiography (ECG) - once a year.
Analysis of urine according to Zimnitsky (for details, see "Pyelonephritis") - 1 time in 2-3 months.
Phytotherapy courses for 1-2 months at monthly intervals.

Very important:

adherence to a diet;
protection from hypothermia, abrupt climate change, unnecessary stress (both physical and emotional);
timely identify and treat infectious diseases and acute respiratory viral infections in a child.

Prevention of glomerulonephritis

Prevention of acute glomerulonephritis consists of. timely detection and competent treatment of streptococcal infection. Scarlet fever, tonsillitis, streptoderma must necessarily be treated with antibiotics in the dose and the course prescribed by the doctor, without initiative.

After a streptococcal infection (on the 10th day after a sore throat or on the 21st day after scarlet fever), it is necessary to pass urine and blood tests.
Prevention of chronic glomerulonephritis does not exist, so how lucky.

In conclusion, I would like to dwell on the main points:

Glomerulonephritis is a severe, serious kidney disease and should not be taken lightly. Treatment of glomerulonephritis is mandatory, carried out in a hospital.
The disease does not always start acutely, obviously. Her signs sometimes come gradually, gradually.
Suspicions of glomerulonephritis in a child are caused by: the appearance of edema: the child woke up in the morning - the face is swollen, the eyes, like cracks or on the legs, there are pronounced traces from the elastic of socks; red, "meat-slop-colored" urine; decrease in the amount of urine; in the analysis of urine, especially if it is submitted after an illness, the amount of protein and erythrocytes is increased; increased blood pressure.
In acute, manifest, onset with nephritic syndrome (erythrocytes in the urine, a slight increase in protein in the urine, edema, increased pressure) in 95% of cases, the disease ends with complete recovery.
Glomerulonephritis with nephrotic syndrome (a gradual onset, slowly increasing pronounced edema and a large amount of protein in the urine) becomes a chronic form.
Chronic glomerulonephritis often results in renal failure, which results in the use of an artificial kidney machine or kidney transplant.
To protect the child from the progression of the disease in chronic glomerulonephritis, it is necessary to strictly observe the regimen, diet and treat infectious and colds on time.

Glomerulonephritis is an immune-inflammatory disease in which a structural element of the kidneys called the renal glomerulus is predominantly affected. Glomerulonephritis in children is more common between the ages of 5 and 12 years. In the practice of childhood diseases, glomerulonephritis is found in second place among infectious diseases of the urinary tract.

The etiology of glomerulonephritis includes a combination of three factors - an infectious agent, provoking factors and a perverted immune response of the body (allergic component). In pediatrics, the epidemiology of acute glomerulonephritis can be detected in 80% of children, most often it is post-streptococcal.

The following infections can lead to the development of the disease:

The disease can occur under the influence of provoking factors. They are stress, hypothermia, physical strain, long exposure to the sun, climate change.

Between the influence of external factors and the development of the disease, it takes from one to three weeks.

The pathogenesis of glomerulonephritis is based on an allergic immune response. It consists in the fact that immunoglobulins and complement fractions, instead of infectious agents, attack their own tissues - the membranes of the renal glomeruli.

The defeat of the membrane leads to an increase in its permeability, penetration into the urine of blood cells of erythrocytes and protein molecules. Also, the filtration process of salt and water is disrupted, and therefore they are retained in the body. The regulatory effect of the kidneys on blood pressure also suffers.

The classification of the disease glomerulonephritis in children is based on its etiology, morphology and course:

Allocate primary glomerulonephritis and secondary developing against the background of another systemic pathology. It can be with an established etiology, when the connection with a previous infection is clearly visible, and with an unknown ethology.
Also glomerulonephritis can be with an established immunological component and immunologically unconditioned.
In the clinical course of the disease, glomerulonephritis in children is isolated acute, subacute and chronic forms.
It can also be diffuse or focal, and by the nature of the inflammation proliferative, exudative or mixed.

The main syndromes in glomerulonephritis are distinguished in connection with the groups of clinical manifestations:

Nephrotic syndrome- characterized mainly by edema, which is located on the face and appears or increases in the morning. In this case, an increased amount of protein is noted in the urine.
Hypertensive syndrome characterized by high numbers of blood pressure, in most cases, the increase in pressure is persistent. Mostly diastolic pressure rises, it can reach 120 mm Hg.
Hematuric syndrome characterized by the presence of red blood cells in the urine, sometimes urine takes on a characteristic color, described in the medical literature as "the color of meat slops."

Etiology of glomerulonephritis in children

The disease begins acutely, with an increase in temperature. The child complains of weakness, thirst, increased fatigue and headaches. After edema, high blood pressure join, a special place is occupied by changes in urine and blood.

The clinic of the disease can be presented with a predominance of one of the syndromes, as well as in a mixed version, when all three are manifested. Sometimes there is a latent variant, when the clinical manifestations of the disease are small.

The chronic form is characterized by a long-term manifestation of clinical syndromes in varying degrees of severity and in different combinations. Chronic is a form in which the disease lasts more than several months.

The diagnosis of this disease in a child is made on the basis of anamnesis, clinic. Of particular importance in determining glomerulonephritis is the diagnosis of laboratory tests.

To establish the diagnosis, the following activities are carried out - general urine analysis, urine analysis according to Zimnitsky, Reberg's test.

Revealed protein and erythrocytes in the urine, the density of urine is increased. The total amount of urine is reduced. In the analysis of blood, there may be anemia, moderate leukocytosis, with a shift in the formula to the left, increased ESR.
A biochemical blood test shows a decrease in total protein, due to a decrease in albumin and an increase in globulins.
Immunological analysis reveals antibodies to streptococcus, in the case of streptococcal etiology of the disease. Fractions of the complement system are also detected.

Ultrasound examination of the kidneys does not provide information on glomerulonephritis in the absence of morphological changes. It is indicated in chronic glomerulonephritis to determine the degree of renal wrinkling, in severe edema to identify fluids in the cavities and for differential diagnosis with other kidney diseases.

In cases of chronic course and with a decrease in the severity of the process, excretory urography, computed tomography can be performed. Percutaneous biopsy to identify the histological form of the disease in children, in contrast to adults, is indicated only if a malignant course is suspected.

Treatment of acute glomerulonephritis in children is carried out strictly in a hospital, under medical supervision. Severe forms require nursing care. Initial measures should be strict bed rest, restriction of salt and water, control of urine output and an appropriate diet for glomerulonephritis:

The amount of fluid consumed should be planned taking into account the allocated the day before. Salt is completely eliminated. Meals are carried out according to diet number 7 according to Pevzner.
Also shown are dairy-plant diets, potato, rice, rice-vegetable and rice-fruit, recipes and photos of which can be found on any forum. The calorie content of food due to bed rest may be low.
All extractives are excluded - broths, teas, coffee, juices, spices. Any mineral water is prohibited.

Drug therapy acute glomerulonephritis in children suggests etiotropic treatment, with a proven streptococcal agent - penicillin and its derivatives.

Pathogenetic treatment consists in influencing the pathological immune response, this is achieved with the help of glucocorticoids, in particular prednisolone.

The appointment of cytostatics to children should be made only if the benefits of their use will significantly exceed their side effects and complications.

Symptomatic treatment is to eliminate the manifestations or symptoms of the disease.

Arterial hypertension is subject to drug correction with diuretics, antihypertensive drugs from the group of angiotensin converting factor inhibitors. Also, drugs from the group of angiotensin 2 receptor blockers affect the mechanism of regulation of pressure in the kidneys.

Its useful to note

With edematous syndrome, the problem of fluid and sodium retention can be solved through the use of diuretics, and those drugs that do not have a toxic effect on the kidneys should be chosen.

These are loop diuretics and thiazide diuretics. Since edema in glomerulonephritis is accompanied by sodium retention and potassium excretion, it is advisable to use potassium-sparing diuretics as well. It is possible to use some drugs that affect blood clotting.

The form and route of administration of drugs can be different - these are intramuscular and intravenous injections in the acute period and in severe cases, and tablet forms in convalescence and in chronic course.

In severe cases and with renal failure, modern methods are used - plasmapheresis and hemodialysis.

Folk remedies in the treatment of glomerulonephritis in children, complications and prevention

From the means of traditional medicine, diuretic and anti-inflammatory, as well as fortifying fees are recommended. They are taken in different ways, both in the form of infusions and in the form of baths and applications.

Herbal medicine, as well as homeopathy and other gifts of nature, is recommended to be taken only for chronic glomerulonephritis without exacerbations.

Treatment of acute glomerulonephritis takes about a month, and with timely diagnosis and after adequate therapy, the prognosis is favorable.

The most common outcome of the disease is recovery, sometimes the disease becomes chronic.

There is a malignant current variant, which is associated with the peculiarities of pathogenesis - proliferation and sclerosis in the renal glomeruli. This option can lead to the development of complications - to disability and the formation of renal failure.

There is no specific prophylaxis for glomerulonephritis. Nonspecific prevention of acute glomerulonephritis in children, as well as exacerbations of chronic glomerulonephritis, is the observance of the temperature regime, avoidance of overheating and hypothermia, prolonged insolation, physical and emotional overload.

In order to increase the resistance of the child's body to infections, hardening is recommended, a lot of useful information is contained in the lectures of Dr. Komarovsky.

A child who has had glomerulonephritis requires dispensary observation for several years; if possible, spa treatment is indicated in a dry and warm climate.

Bed rest is prescribed for 7-10 days only in conditions associated with the risk of complications: heart failure, angiospastic encephalopathy, acute renal failure. Prolonged strict bed rest is not indicated, especially in nephrotic syndrome, as the threat of thromboembolism increases. Expansion of the regimen is allowed after normalization of blood pressure, reduction of edema syndrome and reduction of gross hematuria.

Diet for acute glomerulonephritis in children

The assigned table is renal No. 7: low-protein, low-sodium, normal-calorie.

Protein is limited (up to 1-1.2 g / kg due to the limitation of animal proteins) in patients with impaired renal function with an increase in the concentration of urea and creatinine. In patients with NS, protein is prescribed according to the age norm. Protein restriction is carried out for 2-4 weeks until the normalization of urea and creatinine. With the salt-free diet number 7, food is prepared without salt. In the products included in the diet, the patient receives about 400 mg of sodium chloride. With the normalization of hypertension and the disappearance of edema, the amount of sodium chloride is increased by 1 g per week, gradually bringing it to normal.

Diet No. 7 has a great energy value - not less than 2800 kcal / day.

The amount of injected fluid is regulated, focusing on the diuresis of the previous day, taking into account extrarenal losses (vomiting, loose stools) and perspiration (500 ml for school-age children). There is no need for special fluid restriction, since there is no thirst against the background of a salt-free diet.

To correct hypokalemia, products containing potassium are prescribed: raisins, dried apricots, prunes, baked potatoes.

Table number 7 is prescribed for a long time in acute glomerulonephritis - for the entire period of active manifestations with a gradual and slow expansion of the diet.

In acute glomerulonephritis with isolated hematuria and preservation of renal function, dietary restrictions are not applied. Assign a table number 5.

Symptomatic treatment of acute glomerulonephritis in children

Antibacterial therapy

Antibiotic therapy is carried out to patients from the first days of the disease when indicating a previous streptococcal infection. Preference is given to antibiotics of the penicillin series (benzylpenicillin, augmentin, amoxiclav), less often macrolides or cephalosporins are prescribed. The duration of treatment is 2-4 weeks (amoxicillin inside 30 mg / (kghsut) in 2-3 doses, amoxiclav inside 20-40 mg / (kghsut) in three doses).

Antiviral therapy is indicated if its etiological role is proven. So, in association with the hepatitis B virus, the appointment of acyclovir or valacyclovir (valtrex) is indicated.

Edema Syndrome Treatment

Furosemide (lasix) is a loop diuretic that blocks sodium-potassium transport at the level of the distal tubule. Assign orally or parenterally from 1-2 mg / kg to 3-5 mg / (kghsut). With parenteral administration, the effect occurs after 3-5 minutes, with oral administration - after 30-60 minutes. The duration of action for intramuscular and intravenous administration is 5-6 hours, for oral administration - up to 8 hours. The course is from 1-2 to 10-14 days.

Hydrochlorothiazide - 1 mg / (kghsut) (usually 25-50 mg / day, starting with the lowest doses). The breaks between doses are 3-4 days.

Spironolactone (veroshpiron) is a sodium-sparing diuretic, aldosterone antagonist. Assign in a dose of 1-3 mg / kg per day in 2-3 doses. Diuretic effect - after 2-3 days.

Osmotic diuretics (polyglucin, rheopolyglucin, albumin) are prescribed to patients with refractory edema with nephrotic syndrome, with severe hypoalbuminemia. As a rule, combination therapy is used: 10-20% albumin solution at a dose of 0.5-1 g / kg per dose, which is administered within 30-60 minutes, followed by the appointment of furosemide at a dose of 1-2 mg / kg and higher for 60 min in 10% glucose solution 4. Instead of albumin, a solution of polyglucin or rheopolyglucin can be introduced at the rate of 5-10 ml / kg.

Osmotic diuretics are contraindicated in patients with AHN with nephritic syndrome, since they have expressed hypervolemia and complications in the form of acute left ventricular failure and eclampsia are possible.

Arterial hypertension treatment

Hypertension in ONS is associated with sodium and water retention, with hypervolemia, therefore, in many cases, a decrease in blood pressure is achieved with a salt-free diet, bed rest and the appointment of furosemide. The dose of furosemide can reach 10 mg / kg per day in hypertensive encephalopathy.

With chronic hepatitis and, less often, with acute glomerulonephritis in children, antihypertensive drugs are used.

Slow calcium channel blockers (nifedipine under the tongue 0.25-0.5 mg Dkhsut) in 2-3 doses until blood pressure normalizes, amlodipine inside 2.5-5 mg once a day until blood pressure normalizes).

Angiotensin-converting enzyme (ACE inhibitors) inhibitors: enalapril by mouth 5-10 mg / day in 2 doses, until blood pressure is normalized, captopril inside 0.5-1 mg Dkghsut) in 3 doses, until blood pressure is normalized. The course is 7-10 days or more.

The simultaneous use of these drugs is undesirable, since the contractility of the myocardium may decrease.

Pathogenetic treatment of acute glomerulonephritis in children

Impact on the processes of microthrombus formation

Heparin sodium has a multifactorial effect:

suppresses intravascular processes, including intraglomerular coagulation;
has a diuretic and natriuretic effect (suppresses the production of aldosterone);
has a hypotensive effect (reduces the production of endothelin vasoconstrictor by mesangial cells);
has an antiproteinuric effect (restores a negative charge on BM).

Heparin sodium is prescribed subcutaneously at a dose of 150-250 IU / kg day) in 3-4 doses. The course is 6-8 weeks. Cancellation of sodium heparin is carried out gradually by reducing the dose by 500-1000 IU per day.

Dipyridamole (Curantil):

has antiplatelet and antithrombotic effects. The mechanism of action of curantil is associated with an increase in the content of cAMP in platelets, which prevents their adhesion and aggregation;
stimulates the production of prostacyclin (a powerful antiplatelet and vasodilator);
reduces proteinuria and hematuria, has an antioxidant effect.

Curantil is prescribed at a dose of 3-5 mg / kg day) for a long time - for 4-8 weeks. Prescribed as monotherapy and in combination with sodium heparin, glucocorticoids.

Impact on the processes of immune inflammation - immunosuppressive therapy

Glycocorticoids (GC) - non-selective immunosuppressants (prednisolone, methylprednisolone):

have anti-inflammatory and immunosuppressive effects, reducing the flow of inflammatory (neutrophils) and immune (macrophages) cells into the glomeruli, and thereby inhibit the development of inflammation;
suppress the activation of T-lymphocytes (as a result of a decrease in the production of IL-2);
reduce the formation, proliferation and functional activity of various subpopulations of T-lymphocytes.

Depending on the response to hormonal therapy, hormone-sensitive, hormone-resistant and hormone-dependent variants of glomerulonephritis are distinguished.

Prednisolone is prescribed according to the schemes depending on the clinical and morphological variant of glomerulonephritis. In acute glomerulonephritis in children with NS, prednisolone is prescribed orally at the rate of 2 mg / kg x day) (no more than 60 mg) continuously for 4-6 weeks, in the absence of remission - up to 6-8 weeks. Then they switch to an alternating course (every other day) at a dose of 1.5 mg / kg day) or 2/3 of the therapeutic dose in one dose in the morning for 6-8 weeks, followed by a slow decrease of 5 mg per week.

With steroid-sensitive NS, the subsequent relapse is stopped with prednisolone at a dose of 2 mg / kg day) until three normal daily urine analysis results are obtained, followed by an alternating course for 6-8 weeks.

In case of frequently relapsing and hormone-dependent NS, therapy with prednisolone at a standard dose or pulse therapy with methylprednisolone at a dose of 30 mg / kg day) is started intravenously three times with an interval of one day for 1-2 weeks, followed by switching to prednisolone daily, and then to an alternating course. With frequently recurrent NS after 3-4th relapse, cytostatic therapy may be prescribed.

Cytostatic drugs are used for chronic glomerulonephritis: mixed form and nephrotic form with frequent relapses or with a hormone-dependent variant.

Chlorambucil (leukeran) is prescribed at a dose of 0.2 mg (Dkhsut) for two months.
Cyclophosphamide: 10-20 mg / kg for the introduction in the form of pulse therapy 1 time in three months or 2 mg Dkghsut) for 8-12 weeks.
Cyclosporin: 5-6 mg / kg day) for 12 months.
Mycophenolate mofetil: 800 mg / m2 for 6-12 months.

Cytostatic drugs are prescribed in combination with prednisolone. The choice of therapy, the combination of drugs and its duration depend on the clinical, morphological variant and characteristics of the course.

Depending on the clinical variant and the acute and morphological variant of chronic glomerulonephritis, appropriate treatment regimens are selected.

Here are the possible treatment regimens. In acute glomerulonephritis with nephritic syndrome, antibiotic therapy is indicated for 14 days, diuretics, antihypertensive drugs, as well as curantil and sodium heparin.

In acute glomerulonephritis in children with nephrotic syndrome, diuretic drugs (furosemide in combination with osmotic diuretics) and prednisolone are indicated according to the standard regimen.

For OHN with isolated urinary syndrome: antibiotics if indicated, courantil and, in some cases, sodium heparin.

In acute glomerulonephritis in children with hypertension and hematuria: diuretic, antihypertensive drugs, prednisone according to the standard scheme and, in the absence of effect, the connection of cytostatics after a kidney biopsy.

With CGN (nephrotic form), pathogenetic therapy includes the appointment of prednisolone, diuretic drugs, curantil, sodium heparin. However, with a frequently recurrent course or hormone resistance, cytostatic drugs should be used. The scheme and duration of their use depends on the morphological variant of glomerulonephritis.

With CGN (mixed form), with exacerbation and the presence of edema, diuretics and antihypertensive drugs are prescribed, as immunosuppressive therapy, prednisolone is prescribed in the form of pulse therapy with cyclosporine.

Treatment of complications of acute glomerulonephritis in children

Hypertensive encephalopathy:

intravenous administration of furosemide in large doses - up to 10 mg / kg day);
intravenous administration of sodium nitroprusside 0.5-10 μg / (kgmin) or nifedipine under the tongue 0.25-0.5 mg / kg every 4-6 hours;
with convulsive syndrome: 1% solution of diazepam (seduxen) intravenously or intramuscularly.

Acute renal failure:

furosemide up to 10 mg / kghsut);
infusion therapy with 20-30% glucose solution in small volumes of 300-400 ml / day;
with hyperkalemia - intravenous administration of calcium gluconate at a dose of 10-30 ml / day;
the introduction of sodium bicarbonate at a dose of 0.12-0.15 g of dry matter inside or in enemas.

With an increase in azotemia above 20-24 mmol / l, potassium above 7 mmol / l, a decrease in pH below 7.25 and anuria for 24 hours, hemodialysis is indicated.

Pulmonary edema:

intravenous furosemide up to 5-10 mg / kg;
2.4% solution of aminophylline intravenously 5-10 ml;
korglikon intravenously 0.1 ml per year of life.

Glomerulonephritis in children is an inflammation of the renal glomeruli. The disease proceeds in an acute or chronic form, develops under the influence of infection or allergies. The disease is diagnosed by its characteristic features, based on laboratory and instrumental studies. In severe cases of the disease, a sparing regimen, a special diet and taking medications are indicated.

The work of a paired organ

The kidneys perform essential functions. The main purpose is filtration and removal of metabolic products. The paired organ is responsible for the normal content of protein and carbohydrates, the generation of blood components, and blood pressure is maintained at an optimal level. Also, the kidneys are responsible for the concentration of electrolytes and acid-base balance. The organ promotes the release of active substances and enzymes, regulates blood circulation.

Clinical picture

The inflammatory process in the glomeruli of the paired organ leads to a decrease in their performance. Glomerulonephritis occurs in children quite often, takes second place after infectious pathologies of the urinary system.

The disease affects children from 3 to 9 years old, less often there are cases of the disease in babies up to two years old. Most often, boys are exposed to pathology.

The cause of the development of glomerulonephritis in children is an allergy of an infectious nature, in which immune complexes are formed that circulate in the kidneys. The provoking factor can be the production of autoantibodies, which contributes to the development of autoallergies. Sometimes the disease becomes a consequence of metabolic disorders and hemodynamic changes, which leads to damage to an organ of a non-immune nature.

With inflammation, the tubules and interstitial tissues are affected. Glomerulonephritis is quite dangerous, it can provoke renal failure, which leads to disability at an early age.

Causes

Glomerulonephritis is caused by bacteria:

group A streptococci;
enterococci;
pneumococci;
staphylococci.

Among viral infections, a negative effect on the paired organ is exerted by:

chickenpox;
rubella;
Hepatitis B;
measles.

The provoking factor in the development of pathology can be the presence of harmful microorganisms:

candida;
toxoplasma.

Among the non-infectious causes, allergens are distinguished that can cause glomerulonephritis:

medications;
vaccines;
plants;
toxic substances.

The most common factor in the development of pathology is a transferred streptococcal infection, tonsillitis, streptoderma, pharyngitis, scarlet fever.

The transition to the chronic form is the result of an untreated disease in the acute stage. The decisive role in the development of glomerulonephritis in children is played by the immune response to the presence of antigens. The individual reaction of the body forms immune complexes that have a negative effect on blood circulation in the kidneys and cause dystrophic changes.

The disease can develop in children prone to such pathologies:

endocarditis;
rheumatism;
lupus erythematosus (systemic);
hemorrhagic vasculitis.

The disorder is formed in children with hereditary anomalies:

deficiency of C6 and C7;
dysfunction of T cells.

Children with severe heredity, susceptibility to streptococci, and chronic skin infections are prone to the disease. Glomerulonephritis develops in children and after suffering from acute respiratory viral infections or hypothermia. Such a disease occurs due to immunopathological reactions and immaturity of the kidneys.

Types of pathology

Glomerulonephritis happens:

primary;
secondary (due to the development of other pathologies).

According to the clinical course, the disease is divided into:

spicy;
subacute;
chronic.

Given the nature of the inflammation, the following classification is carried out:

proliferative;
exudative;
mixed.

According to the extent of the spread of pathology:

focal;
diffuse.

By localization:

extracapillary;
intracapillary.

Taking into account the most pronounced manifestations, such forms of glomerulonephritis are distinguished:

latent;
nephrotic;
hematuric;
hypertensive;
mixed.

Symptoms and treatment of glomerulonephritis depend on the form and severity of the disease.

Acute form

This pathology is characterized by the following symptoms:

malaise;
increased body temperature;
headache;
feverish condition;
soreness in the kidney area;
nausea, urge to vomit.

With the disease, the excretion of urine decreases, with the development of hematuria, while the urine turns reddish. With glomerulonephritis, edema is formed, which is pronounced on the face, especially in the eyelids. Body weight can increase by several kilograms due to insufficient excretion of fluid from the body. The child's blood pressure rises sharply, which can be kept for a long time.

With proper treatment, it is possible to restore kidney function after glomerulonephritis in three months. With ineffective therapy or the absence of such, the disease becomes latent.

Chronic form

Glomerulonephritis in children can be latent, with relapses or progressive progression. Microhematuria is present, which increases with exacerbation of the disease. Edema is weak or absent altogether, blood pressure is normal. In view of the meager symptoms, it is possible to identify glomerulonephritis in a latent form when examining a child. Chronic pathology is diagnosed while the symptoms of the disease persist for 6 months, and edema and high blood pressure do not disappear during treatment for a year.

Nephrotic syndrome is characterized by relapses. Symptoms of glomerulonephritis in children with a similar course of the disease are as follows:

decreased urine volume;
severe edema;
accumulation of fluid in the pleural or abdominal cavity.

At the same time, blood pressure remains normal, an increased concentration of protein is observed in the urine, and erythrocytes are present in a small amount. In the blood, the content of nitrogen derivatives increases and the filtration function of the kidneys decreases with the development of chronic renal failure.

Diagnostics

The data of the child's anamnesis are of great importance in establishing the diagnosis and determining the etiology. A thorough survey is conducted on the subject of hereditary pathologies, congenital anomalies, and previous infections. With glomerulonephritis, it is necessary to undergo such studies:

analysis of urine and blood (general and biochemical);
according to Nechiporenko;
samples of Zimnitsky and Reberg.

With ultrasound, an increase in the kidneys is noticeable, echogenicity is increased. As an additional diagnostic method, a biopsy of the paired organ is prescribed, which makes it possible to assess the prognosis and determine the method of treatment.

Therapy

With acutely expressed symptoms of the disease, the treatment of glomerulonephritis in children requires a hospital stay. It is important to stay in bed and stick to a special menu. It is necessary to completely eliminate the consumption of salt-containing foods, reduce to a minimum protein-containing food until the final restoration of kidney function.

In the acute stage of glomerulonephritis, antibiotic treatment is prescribed:

ampicillin;
penicillin;
erythromycin.

To reduce puffiness, apply:

furosemide;
spironolactone.

From antihypertensive drugs are prescribed:

volsartan;
losartan;
nifedipine;
enalapril.

It is possible to treat chronic glomerulonephritis:

prednisone;
levamisole;
chlorobutin;
cyclophosphamide.

To exclude the formation of blood clots in children, Heparin is prescribed. With a strong increase in urea, uric acid, creatinine with a pronounced reaction on the skin, the child may need hemodialysis.

Clinical examination after illness

After completing the full course of therapy, the child is monitored for five years. If glomerulonephritis recurs, the patient is put on a lifelong dispensary.

With the acute form of glomerulonephritis in children, after inpatient treatment, transfer to a sanatorium is required for recovery. In the first three months, blood pressure control is necessary, a urine test should be taken regularly, a visit to a doctor at least 1 time in 14 days. After the expiration of this period, visits to the doctor are carried out with a frequency of once a month throughout the year.

Children who have had glomerulonephritis are exempted from physical education, vaccination is prohibited for a period of 12 months. You should refrain from swimming in open bodies of water.

Prevention and prognosis

About 98% of children with acute glomerunephritis recover completely. Quite rarely, the pathology transforms into a chronic stage. In medical practice, there are cases of death due to this disease.

Glomerulonephritis in children is dangerous with the following consequences:

heart failure and chronic renal failure;
uremia;
cerebral hemorrhage;
encephalopathy (neurotic).

With a latent form of the disease, deterioration of renal function, organ shrinkage, and the development of chronic renal failure are possible.

Preventive measures of glomerulonephritis in children consist in the correct diagnosis and adequate treatment of diseases of the nasopharynx, streptococcal infections, and allergic manifestations.

Glomerulonephritis is a group of renal pathologies characterized by a varied course, symptomatology and outcome. Glomerulonephritis is always acquired in nature. The specificity of the disease is inflammation of the renal glomeruli, which leads to dysfunction of the organ. The disease is quite common not only in adults, but also in the child population.

Glomerulonephritis in children

Children's glomerulonephritis is a pathology of the glomerular apparatus of an immune-inflammatory nature. In fact, glomerulonephritis is one of the most common renal pathologies in children. Most often, only urinary infections are detected.

The prevalence of glomerulonephritis among children is as follows:

The largest number of cases of such a disease is diagnosed in preschoolers and primary schoolchildren, that is, children aged 3-9 years.
Much less often (up to 5% of cases), pathology affects babies in the first 2 years of life.
Boys are affected by this disease twice as often as girls

The formation of pathology is based on an allergic reaction to an infection, when the formation and accumulation of circulating immunological complexes occurs in the renal structures, or an autoimmune allergy, when there is an active production of autoantibodies. The defeat can affect not only the glomeruli, but also other renal structures such as interstitial tissue or tubules. As a result of the pathology, severe organ failure of a chronic form and early disability of the child can develop.

Glomerulonephritis in children

Causes and pathogenesis

The mechanism of development of childhood glomerulonephritis is quite simple. Inflammation of the glomeruli occurs, which blocks the normal activity of the organ. As a result, fluid accumulates in the body, edema occurs, pressure remains at high levels, and blood clots and protein fractions are present in the urine in exorbitant quantities.

Acute pathological forms often develop against the background of a recent infectious pathology such as scarlet fever or pneumonia, tonsillitis, and also after vaccination.

Experts identify a number of specific factors that provoke kidney damage due to the body's abnormal response to antigens:

In addition, childhood glomerulonephritis can occur under the influence of inflammatory pathologies of a systemic scale, for example, lupus erythematosus or rheumatism, vasculitis or endocarditis. This pathology is also due to genetic abnormalities.

Factors such as hypothermia or poor heredity, immature nephrons and carriage of streptococci (type A), prolonged exposure to high humidity or the sun, hypersensitization (increased organic sensitivity), chronic infection in the nasopharynx or on skin and hypovitaminosis.
In the video about the pathogenesis and causes of glomerulonephritis in children:

Classification

Children's glomerulonephritis has quite a few classifications:
According to the mechanism of development, they are divided into:

Primary - they develop as a result of pathogenetic effects;
Secondary - are formed as a result of other pathological processes;

According to the form of the course, glomerulonephritis are divided into:

Sharp;
Subacute;
Chronic;

According to etiology, inflammations are subdivided into:

Depending on the prevalence of the inflammatory process, glomerulonephir syndromes in children are:

Diffuse - extensive lesions;
Focal;

Morphologically, children's glomerulonephritis are divided into:

Focal segmental - the basis of the disease is damage to epithelial cell structures, characterized by nephrotic syndrome or persistent proteinuria;
Mesangioproliferative - this form meets all the immune-inflammatory criteria of the pathological process. The main signs of this morphological type are hematuria and proteinuria, sometimes hypertension and nephrotic syndrome;
Membranous or nephrotic form of glomerulonephritis - they are characterized by extensive thickening of the capillary walls in the glomeruli, characterized by a favorable course and accompanied by pronounced hematuria and proteinuria, nephrotic syndrome and strong suppression of renal activity;
Mesangiocapillary - a rare variant of glomerulonephritis, characterized by a very progressive course;

In accordance with the localization of lesions, glomerulonephritis in children is:

Extracapillary - develops in the glomerular cavity;
Intracapillary - formed in the vessels;

Children's glomerulonephritis is also classified according to clinical options:

Hypertensive - high blood pressure is added to the main signs;
With nephrotic syndrome - it is characterized by hyper-edema;
Monosymptomatic - occurs with a predominance of urinary syndrome;
Combined - when all clinical manifestations are present.

In a separate subgroup, experts distinguish acute post-streptococcal glomerulonephritis, which is preceded by streptococcal infection.

Signs and symptoms

Pathology can occur in different ways, therefore, the severity of the clinical picture may also differ. Sometimes the pathology proceeds latently, without manifesting itself in any way, but is detected during an accidental medical examination for completely different reasons. But such a course of childhood glomerulonephritis is quite rare. Much more often, pathology is accompanied by pronounced symptoms. Children's health is rapidly deteriorating, up to unconsciousness, which requires urgent hospitalization of the patient.

Most often, with the development of glomerulonephritis, children complain of severe headaches, which often lead to loss of consciousness;
Also, patients are worried about severe pain in the lumbar region;
A frequent phenomenon in glomerulonephritis is nausea-vomiting syndrome and severe hyperthermia;
Urine acquires due to hematuria, and its amount decreases markedly;
There is also an increase in blood pressure, the upper threshold can reach 140-160 mm. rt. Art .;
Against the background of hyper edema, a noticeable increase in weight occurs, and the edema is localized mainly on the eyelids and face.

Symptoms of glomerulonephritis in children:

The acute form of pathology develops, as a rule, a couple of weeks after an infectious disease, predominantly of streptococcal origin. With adequate therapeutic measures, renal functions normalize rather quickly, and the child's full recovery occurs after 1.5-2 months.

With chronic glomerulonephritis in children, similar symptoms may be present, only in a less pronounced version.

Inflammation of the renal glomeruli can lead to serious consequences such as failure of the kidneys and myocardium, uremia, so the first signs of abnormalities should serve as a signal to see a doctor.

Diagnostics

The diagnosis is made on the basis of an assessment of the general condition of the little patient.

First, the doctor collects a history of life and illness, then conducts an examination and prescribes the necessary studies like:

Laboratory analyzes of blood and urine - immune research and blood biochemistry, urine biochemistry, analysis by software, Reberg's test, etc. The presence of blood impurities and protein fractions in urine is the most important diagnostic marker. And blood tests can detect anemia, abnormal values of urea, creatinine and albumin. Immunological diagnostics of blood reveals the presence of antibodies;
Ultrasound examination of the kidneys - this diagnosis shows increased echogenicity and an increase in kidney parameters;
Biopsy - usually prescribed to obtain data on the morphology of glomerulonephritis in order to choose the most effective therapy regimen.

To diagnose glomerulonephritis in children, additional studies may be needed (renal x-ray with contrast or chest x-ray), as well as consultations of specialists in the field of cardiology, rheumatology, dentistry, ophthalmology, etc. Consultation of a pediatric nephrologist, urologist and infectious disease specialist is possible.

Signs and symptoms of glomerulonephritis in children:

Treatment

Children's glomerulonephritis has one positive feature - it is much easier for children to tolerate than adults:

The child must be shown bed rest for several weeks before the disappearance of the main symptoms.
Antibiotic therapy with macrolides and penicillins is prescribed.
To facilitate the withdrawal of accumulated fluid, diuretic drugs are used.
If the child does not have symptoms such as a yellowish-pale skin tone, odor of urine from the mouth, an increased content of toxins in the blood for a week, then hemodialysis should be performed, which involves the use of an artificial kidney apparatus.
Children with glomerulonephritis must be assigned a diet that assumes the presence of carbohydrate days. Products such as marinades, meat broths, smoked products, spices, fish and meat are strictly prohibited for children during the treatment period. It is recommended to eat more potassium-rich dishes - dairy products, natural juices, fruit and vegetable dishes.

Rosehip infusion deserves special attention, because it is a storehouse of ascorbic acid, incredibly useful for immunity. Meals should be 3-5 times. The child's drinking regime needs to be revised so that the amount drunk is no more than half a liter higher than the amount of fluid released. Your child should definitely eat vegetarian soups and breads, chicken and lean fish.

After the end of the treatment, the child is registered with a pediatric nephrologist and pediatrician for another 5 years. If cases of glomerulonephritis are recurrent, then they are registered for life. Sanatorium rest is especially recommended for such children, but preventive vaccinations will have to be abandoned.
In the video about the treatment of glomerulonephritis in children:

Forecasts

In most clinical cases, children's glomerulonephritis is safely cured, but in 1-2% of cases, the pathology is chronic. Fatal outcome is observed only in isolated cases, when the disease is severe and with many complications.

Among the complications of childhood glomerulonephritis are cerebral hemorrhage, kidney failure, renal encephalopathy, myocardial insufficiency, uremia. These complications pose a real threat to the child's life.

Prevention of glomerular inflammation consists in the timely detection and treatment of streptococcal infectious lesions, allergic reactions, as well as the rehabilitation of chronic pathologies in the mouth and nasopharynx, which consists in the timely treatment of carious teeth, inflamed tonsils, etc. It is also necessary to limit the child's salt intake, to exclude overheating or hypothermia, rationally organize the child's rest and work regime.

Such a diagnosis is quite serious, but with timely therapy, it is quite possible to recover from it. If glomerulonephritis has led to the development of chronic kidney failure, then the child is assigned a disability, the group of which is determined by medical and social experts in accordance with the degree of failure and organic disorders.