Glomerulonephritis in Children

Key Points About Glomerulonephritis

Each kidney contains millions of capillaries. Glomeruli are small clusters of capillaries that carry blood and act as filtering units. Glomerulonephritis is a kidney disease caused by inflammation of these capillaries, that is, the glomeruli. As a result, the kidneys' ability to filter the blood is impaired.

This disease can be caused by autoimmune diseases, infections or other diseases.

Symptoms may include dark urine, decreased urination, low energy and weakness.

Treatment includes dietary changes, medications or dialysis.

If glomerulonephritis does not heal, it can lead to kidney failure.

What Is Glomerulonephritis?

The kidney contains a large number of small tufts of blood vessels. Each of these is called a glomerulus. The glomeruli filter various substances from the blood, and the remainder is separated to be excreted in the urine. If these structures become inflamed, as in glomerulonephritis, this filtration process is disrupted.

Glomerulonephritis Can Occur for the Following Reasons:

• Systemic Autoimmune Diseases

In these diseases, the immune system perceives healthy cells in the body as foreign and attacks them. These are called autoimmune diseases. Kidney involvement can occur in diseases such as systemic lupus erythematosus (SLE).

• Polyarteritis Nodosa

This is an inflammatory disease of the arteries.

• Wegener's Vasculitis

It is a progressive disease that leads to increasing inflammation in all organs.

• Henoch–Schönlein Purpura (HSP)

In this disease, small or large purpura-like lesions appear on the skin and in the internal organs. Other serious symptoms also occur in various organ systems.

• Alport Syndrome

This is a hereditary form of glomerulonephritis.

• Streptococcal Infections

In children, glomerulonephritis often follows a throat infection or an upper respiratory tract infection. The disease appears one or several weeks after these infections.

Symptoms May Vary Somewhat from Child to Child

• Dark, tea-colored urine (due to blood and protein)
• Sore throat
• Decreased urine output
• Tiring easily and weakness
• Difficulty breathing
• Headache
• Increased blood pressure
• Seizures due to high blood pressure
• A rash, especially on the hips and legs
• Weight loss
• Joint pain
• Pale skin
• Edema

These symptoms can also be caused by diseases other than glomerulonephritis. You should see your pediatrician for a diagnosis.

Some Tests May Be Needed for Diagnosis

• Throat culture
• Blood test
• Urine test
• Electrocardiogram (ECG)
• Renal ultrasound
• Chest X-ray
• Renal biopsy

Treatment of Glomerulonephritis

Treatment varies depending on your child's symptoms, age, general health, the severity of the disease and the underlying cause. Treatment aims to slow the progression of the disease and prevent complications.

Your child's diet will also need to be restricted in protein, potassium, phosphorus and sodium, because when kidney function is insufficient, excessive intake of these can cause serious problems for the patient. Your diet will be planned by your pediatrician and a dietitian.

Medications aim to achieve:

• Increased urine output (diuretics)
• Lower blood pressure
• Reduced phosphorus levels in the blood (phosphate binders)
• A reduced immune system response (immunosuppressive treatments).

Serious electrolyte problems may occur in some cases. Sometimes there may also be excessive fluid overload in the body. In such cases, dialysis may be necessary. Dialysis removes from the body the waste products and excess fluid that the kidneys cannot remove from the blood. Normally, the kidneys do this job. There are two types of dialysis:

Peritoneal Dialysis

Its advantage is that it can be done at home. After receiving adequate training, the family can perform it themselves. The abdominal cavity is used to filter the blood. Inside the abdomen there is a space called the peritoneum, which contains the internal organs (such as the stomach, intestines and liver). A thin, flexible catheter is placed in the abdomen by a surgeon. Dialysis fluid is sent through this catheter and left inside for a while. This fluid absorbs waste products from the peritoneum. The fluid is then drawn back out. In this way, filtration is achieved.

Hemodialysis

This can only be done in hospitals or dialysis centers. With a minor surgical procedure, a structure called a fistula is created, where an artery and a vein are joined. This is usually done in your child's arm. Your child is then connected to the hemodialysis machine with the help of a catheter. Your child's blood is pumped into this machine, and waste products and excess fluid are filtered out by the machine. The filtered blood is then returned to your child's body. Each session lasts 4–5 hours. It may need to be done several times a week. It is a good idea to bring things to keep your child occupied during this time, such as games or reading materials.

The type of dialysis to be performed depends on your child's condition.