Glomerulonephritis is a group of renal pathologies characterized by a diverse course, symptomatology and outcome. Glomerulonephritis is always of an acquired nature. Specificity of the disease is inflammation of the kidney glomeruli, which leads to a violation of the functions of the organ. The disease is quite often found not only in the adult, but also in the children's 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. More often than not only urinary infections are detected.
The prevalence of glomerulonephritis among children is as follows:
- The greatest number of cases of such a disease is diagnosed in preschool and primary school children, i.e., children of 3-9 years of age.
- Much less frequently( up to 5% of cases), pathology affects children in the first 2 years of life.
- Boys are affected by this disease twice as often as girls
Allergic reaction to infection is based on the formation of pathology, when in the kidney structures there is the formation and accumulation of circulating immunological complexes, or autoimmune allergy when there is an active production of autoantibodies. The lesion can affect not only the glomeruli, but also other kidney structures like interstitial tissue or tubules. As a result of pathology, severe chronic organ failure and early disability of the child can develop. Glomerulonephritis in children
Causes and pathogenesis of
The mechanism of development of children's glomerulonephritis is quite simple. There is an inflammation of the glomeruli, because of which the normal activity of the organ is blocked. As a result, the body accumulates fluid, there is swelling, the pressure is held at high levels, and in the urine in excess quantities there are blood clots and protein fractions.
Acute pathological forms often develop against a background of recent infectious diseases such as scarlet fever or pneumonia, sore throats, and after vaccination.
Specialists identify a number of specific factors that cause renal damage due to an abnormal reaction of the body to antigens:
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- Allergens like vaccinations, pollen, food or household allergies, insects, etc.;
- Bacterial agents - streptococci and enterococci, staphylococci or pneumococci;
- Toxic substances contained in nephrotoxic drugs or obtained by the body in various kinds of poisoning;
- Parasites of the type of malaria or toxoplasmosis;
- Viral agents of hepatitis or rubella, influenza or measles, chickenpox, etc.
Serious increases in the likelihood of glomerular inflammation in children may be factors such as hypothermia or bad heredity, immaturity of nephrons and carriage of streptococci( type A), long stay in high humidityor in the sun, hypersensitivity( increased organic sensitivity), a chronic infection in the nasopharynx or on the skin and hypovitaminosis.
On the video about the pathogenesis and causes of glomerulonephritis in children:
Children's glomerulonephritis has many classifications:
According to the development mechanism, they are divided into:
- Primary - they develop due to pathogenetic effects;
- Secondary - are formed due to other pathological processes;
According to the current form, glomerulonephritis is divided into:
According to the etiology, inflammations are divided into:
- Infectious - this includes parasitic, viral and bacterial;
- Idiopathic - when the etiology can not be established;
- Non-infectious forms - they are represented by allergic glomerulonephritis;
Depending on the prevalence of the inflammatory process, the syndromes of glomerulonephira in children are:
- Diffuse - extensive lesions;
Morphologically children's glomerulonephritis is divided into:
- Focal-segmental - the basis of the disease is the defeat of epithelial cell structures, characterized by nephrotic syndrome or persistent-type proteinuria;
- Mesangioproliferative - this form meets all immuno-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 - 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 severe oppression of renal activity;
- Mesangiocapillary is 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 vessels;
Children's glomerulonephritis is also classified according to clinical variants:
- Hypertensive - additional pressure is added to the main signs;
- With nephrotic syndrome - it is characterized by hypertension;
- Monosymptomic - proceeds with a predominance of urinary syndrome;
- Combined - when all clinical manifestations are present.
In a separate subgroup, specialists distinguish acute poststreptococcal glomerulonephritis, which is preceded by streptococcal infection.
Symptoms and Symptoms
Pathology can occur in a variety of ways, so the severity of the clinical picture may also differ. Sometimes the pathology proceeds latently, without manifesting itself in any way, but is detected with random medical examination for entirely different reasons. But such a course of children's glomerulonephritis is rare. Much more often, pathology is accompanied by a pronounced symptomatology. Children's state of health is rapidly deteriorating, down to an unconscious state, which requires urgent hospitalization of the patient.
Symptoms of glomerulonephritis in children:
- Most often, with the development of glomerulonephritis, children complain of severe headaches, which often lead to loss of consciousness;
- Patients are also concerned about severe pain in the lumbar region;
- A common phenomenon in glomerulonephritis is a nausea-vomiting syndrome and severe hyperthermia;
- Urine acquires a rusty-red color due to hematuria, and its amount is noticeably reduced;
- There is also an increase in blood pressure, the upper threshold can reach 140-160 mm.gt;p.
- Against the backdrop of hypertension, there is a noticeable increase in weight, and edema is localized primarily to the eyelids and face.
The acute form of the pathology develops, usually within a couple of weeks after an infectious disease of predominantly streptococcal origin. With adequate therapeutic measures, kidney functions quickly enough normalize, and full recovery of the child occurs after a lapse of 1.5-2 months.
In chronic glomerulonephritis, children may have similar symptoms, only in a less pronounced version.
The diagnosis is made on the basis of an assessment of the general condition of a small patient.
First, the doctor collects an anamnesis of life and disease, then conducts an examination and assigns the necessary examinations such as:
- Laboratory tests of blood and urine - immune research and blood biochemistry, urine biochemistry, Nechiporenko analysis, Rebberg and Zimnitsky test. The presence in the urine of impurities of blood and protein fractions is an important diagnostic marker. And blood tests can detect anemia, abnormal urea, creatinine and albumin. Immunological diagnosis of blood reveals the presence of antibodies;
- Ultrasonic kidney examination - this diagnosis shows increased echogenicity and increased kidney parameters;
- Biopsy - Usually assigned to obtain data on the morphology of glomerulonephritis in order to select the most effective therapy regimen.
For the diagnosis of glomerulonephritis, children may need additional studies( MRI, CT, renal radiograph with contrast or a chest radiograph), as well as consultations of specialists in the field of cardiology, rheumatology, dentistry, ophthalmology, etc. A pediatric nephrologist, urologist and infectious disease specialist is available.
Symptoms and symptoms of glomerulonephritis in children:
Children's glomerulonephritis has one positive feature - it is carried by children much more easily than adults:
- A child is necessarily shown a bed rest several weeks before the disappearance of the main symptomatology.
- Antibiotic therapy with macrolides and penicillins is prescribed.
- To facilitate the withdrawal of accumulated fluid, diuretic drugs are used.
- If the child does not go through a week of symptoms such as a yellowish-pale skin tone, the smell of urine from the mouth, an increased content of toxins in the blood, then it is necessary to conduct hemodialysis, involving the use of an artificial kidney apparatus.
- Children with glomerulonephritis must be prescribed a diet that presupposes the presence of carbohydrate days. Products like marinades, meat broths, smoked products, spices, fish and meat to children during the treatment period are strictly prohibited. It is recommended to eat more dishes rich in potassium - dairy products, natural juices, fruit and vegetable dishes.
Separate attention deserves the shipovnikovy infusion, because it is a storehouse of ascorbic acid, incredibly useful for immunity. The food should be 3-5 times. The drinking regime of the child needs to be revised so that the amount drunk no more than half a liter exceeds the amount of the allocated liquid. The child must necessarily eat vegetarian soups and bread, chicken and lean fish.
After the termination of treatment of the child for 5 more years put on the dispensary account at the children's nephrologist and the pediatrist. If the cases of glomerulonephritis are of a recurring nature, then they are put on record for life. Such children are especially recommended for sanatorium rest, but from preventive vaccinations will have to be abandoned.
On the video about the treatment of glomerulonephritis in children:
In most clinical cases, children's glomerulonephritis is safely cured, but in 1-2% of cases, the pathology is chronic. The lethal outcome is observed only in isolated cases, when the disease proceeds in severe form and with a number of complications.
Prevention of glomerular inflammations consists in the timely detection and treatment of streptococcal infectious lesions, allergic reactions, and the sanitation of chronic pathologies in the mouth and nasopharyngeal areas, which consists in the timely treatment of carious teeth, inflamed tonsils, etc. It is also necessary to limit the child's intake of salt, excludeoverheating or hypothermia, rationally organize the rest and labor of the child.
A similar diagnosis is serious enough, but with timely therapy from it it is quite possible to be cured. If glomerulonephritis led to the development of chronic kidney failure, the child is assigned a disability, the group of which is determined by experts in medical and social expertise in accordance with the degree of insufficiency and organic disorders.