Glomerulonephritis in children: classification and etiology. How is acute glomerulonephritis treated in children?

The main function of the kidneys is to cleanse the blood and remove metabolic products from the body.

The glomeruli are responsible for this process. Through their filters, liquid with dissolved toxins seeps into the nephron tubules and is transported out in the form of urine.

Inflammation of the kidneys, affecting the filtering apparatus, leads to an increase in its permeability. With glomerular nephritis, valuable protein and red substances enter the exit along with harmful substances. blood cells. This condition can lead to serious complications, and glomerulonephritis in children often causes disability.

Causes

Glomerular nephritis is an immuno-inflammatory disease with a strong connection with infectious and allergic factors.

This is common in children renal diagnosis, which is due to the functional immaturity of the structure of nephrons and hypersensitivity body to histamines.

The greatest risk of developing glomerulonephritis is observed in children from 3 to 9–10 years of age, more often in boys.

The pathogenesis of inflammation is based on the immune response to exposure infectious agents or allergens. As a result of the reaction between the antigens circulating in the blood when the disease occurs and the antibodies produced to neutralize them, large protein formations are formed. These immune complexes settle on the walls of the renal capillaries, disrupting the filtering ability of the glomeruli.

The structure of the renal glomeruli

Acute glomerulonephritis in children often begins against the background of a recent infection (sore throat, pneumonia, scarlet fever and others) and after vaccination. Eat whole line factors that can provoke kidney damage due to an inadequate response of the body to foreign antigens:

Another reason is not associated with the penetration of provocateurs from the outside, but with pathological autoimmune processes in the body.

These are systemic inflammatory diseases that affect connective tissues: endocarditis, rheumatism, hemorrhagic vasculitis, systemic lupus erythematosus. Glomerulonephritis in children can be caused by genetic abnormalities: dysfunction of T-lymphocytes, congenital deficiency of certain complement fractions (C6, C7).

Systemic lupus erythematosus is one of the possible reasons kidney damage

Factors that increase the risk of developing glomerular nephritis in a child:

• hypothermia;
• prolonged exposure to a humid environment;
• excessive insolation;
• the presence of chronic foci of infection on the skin and in the nasopharynx;
• latent carriage of streptococcus A;
• increased sensitization of the body;
• unfavorable heredity;
• functional immaturity of nephrons.

Classification

Glomerulonephritis has a broad classification and is divided into types according to various signs:

If glomerulonephritis is not treated promptly, a person has an increased risk of acquiring other kidney diseases, among which . Read about external manifestations diseases, diagnosis and treatment.

The appearance of blood in the urine may indicate the most various diseases. Read about the types and causes of hematuria.

Video on the topic

One of the most common and dangerous diseases kidney disease in children is rightfully considered glomerulonephritis. This disease requires especially careful attention on the part of parents and doctors, because in case of untimely provision of assistance or improper treatment complications can be fatal for the child. Learn more about this disease and what you should be correct actions during treatment, you will learn from this article.

The disease and its varieties

Glomerulonephritis- a disease that affects special kidney cells - glomeruli, which are also called glomeruli. Small cells gave the disease its second name - glomerular nephritis. Because of this, the kidneys cease to fully perform their functions. This paired organ is entrusted by nature with many concerns - the removal of decay products, toxins from the body, the production of substances that control blood pressure and erythropoietin, which is simply necessary for the formation of red blood cells in the blood. Malfunctions of the kidneys lead to the most tragic consequences.

A child with glomerulonephritis has a huge amount of protein in the urine, and red blood cells (blood in the urine) are also released with it. Thus, anemia, arterial hypertension, edema develops, and immunity is reduced due to protein losses that are catastrophic by the body’s standards. Due to the fact that the lesion progresses differently, and the reasons why the glomeruli of the kidneys begin to die are very heterogeneous, the disease in pediatrics is not considered a single disease. This is a whole group of kidney diseases.

Most often, glomerulonephritis affects children aged 3 to 10 years. Children under 2 years of age get sick much less often; only 5% of all cases occur in them. Boys get sick more often than girls.

The classification of glomerulophritis is quite complex and is based on symptoms and clinical picture.

All glomerular nephritis are:

• primary(if kidney pathology manifested itself as a separate independent disease);
• secondary(kidney problems began as a complication after a severe infection).

According to the characteristics of the course, there are two large groups illness:

• spicy;
• chronic.

Glomerulonephritis acute form It is expressed by nephritic (sudden, sharp) and nephrotic (gradually and slowly developing) syndromes; it can be combined and isolated (when there are only changes in the urine, without other symptoms). Chronic can be nephrotic, hematuric (with the appearance of blood in the urine) and mixed.

Diffuse chronic glomerulonephritis develops slowly and gradually, most often the changes in the body are so insignificant that it is only possible to determine later when it began pathological process, leading to the death of kidney cells, is very difficult. Depending on the type of pathogen that caused the underlying disease, complicated by glomerulonephritis, several types of disease are distinguished, the cause of which becomes clear from the name - post-streptococcal, post-infectious, etc.

And based on the severity of the symptoms and the damage that has already been caused to the kidneys, doctors conditionally assign each case 1,2 or 3 degrees, with an obligatory indication of the stage of development of the disease (for a chronic illness).

Causes

The kidneys themselves pathogenic microbes and other “outsiders” are not affected. The destructive process is triggered by the child’s own immunity, which reacts to a certain allergen. Most often, streptococci act as “provocateurs”.

Glomerulonephritis is often a secondary complication of primary streptococcal sore throat, bacterial pharyngitis, scarlet fever.

Less commonly, the death of renal glomeruli is associated with influenza, ARVI, measles, and hepatitis viruses. Sometimes the allergens that trigger the destruction of glomeruli are snake or bee venom. For reasons not yet entirely clear to science, the body, instead of simply removing these harmful factors outward, creates a whole “heavy artillery” against them immune complex, which hits its own filters - the kidneys. According to doctors, such an inadequate reaction of the body is influenced by factors that at first glance have little influence - stress, fatigue, climate change, place of residence, hypothermia and even overheating in the sun.

Possible complications

Glomerulonephritis is considered a serious disease. It is quite complex in itself and is rarely completely cured. The most predictable and expected complication of an acute illness is its transition to chronic diffuse form. By the way, about 50% of all cases are complicated this way.

But there are other complications that pose a danger to life or can cause disability:

• acute renal failure (occurs in approximately 1-2% of patients);
• heart failure, including its acute, fatal dangerous forms(3-4% of patients);

• cerebral hemorrhage;
• acute visual impairment;

• kidney dysplasia (when the organ begins to lag behind in growth rates from the size required by age, decreases).

Changes in the kidneys can be so significant that the child will develop chronic renal failure, in which case an organ transplant will be indicated.

With kidney transplantation in Russia, everything is quite deplorable; the child may simply not wait for the donor organ he needs. An alternative (temporary) is an artificial kidney. Since the procedures should be carried out several times a week, the baby becomes dependent on the device, because he simply has no other way to cleanse the body of toxins.

Symptoms and signs

Usually, 1-3 weeks after an illness (scarlet fever or tonsillitis), the first symptoms of glomerulonephritis may appear. Most a clear sign - change in urine color. It turns red in a child, and the shade can be either bright or dirty, which is usually called the “color of meat slop.”

The beginning of acute nephritic glomerulonephritis in a child can also be recognized by swelling on the face, which looks like dense, full, changing little during the day. Blood pressure increases, which may result in vomiting and severe headaches. This form of the disease has the most positive prognosis, since more than 90% of children experience full recovery with adequate treatment. For others, the disease progresses to chronic form

Acute nephrotic disease“attacks” from afar, symptoms appear gradually, due to this the child has no complaints for a long time. If parents do not ignore the morning swelling, which sometimes disappears completely during the day, and go with the child to give urine, then it will be found sure signs diseases - proteins.

The first swelling begins to appear on the legs, then gradually spreads further - to the arms, face, lower back, and sometimes to internal organs. The swelling is not dense, it is looser. The child's skin becomes dry, and the hair becomes brittle and lifeless. At the same time, blood pressure rarely rises, and the urine has a normal color, since the protein in it does not color the liquid in any way. For this type of disease, the prognosis is not rosy: according to doctors, only 5-6% of children recover, the rest continue to be treated, but for a chronic form.

If a child’s urine changes color (becomes redder), but there are no other symptoms or complaints, nothing swells or hurts, then we may be talking about isolated acute glomerulonephritis.

About half of all patients can be cured from it if they go to the hospital in a timely manner. young patients. The remaining 50%, even with proper treatment, for logically inexplicable reasons, begin to suffer from a chronic disease.

If a child has all the signs of all three described types of the disease, then we can talk about a mixed form. It almost always ends with a transition to chronic illness and the prognosis is unfavorable. The likelihood of recovery is influenced by the state of the immune system. If it is weak or there is some defect in it, then the onset of the chronic form becomes more obvious.

At chronic glomerulonephritis the child experiences periods of exacerbation with swelling and changes in urine and periods of remission when it seems that the disease is left behind. With proper treatment, only half of patients achieve stabilization. About a third of children develop a progressive process, and this ultimately often leads to an artificial kidney.

Hematuric chronic pyelonephritis considered the most favorable among chronic varieties diseases. It does not lead to the death of a person, and is noticeable only during periods of exacerbation, when of all the signs the only one appears - blood in the urine.

Diagnostics

If a child has noticeable swelling, even if only in the morning, even if only on the legs or arms, this is already a reason to contact a nephrologist. If the urine has changed color, you need to go to the clinic urgently. Parents should remember that an analysis of urine that has been in a jar for more than an hour and a half is less reliable, so everyone should possible ways have time to deliver the collected urine to the laboratory during this time.

Diagnosis of glomerulonephritis includes a visual examination of the child and laboratory research, the main one of which is the same urine test. The number of red blood cells in it will be determined, and the quality - whether they are fresh or leached. No less important indicator-protein in urine. The more it is released, the more severe the stage of the disease is usually. In addition, the laboratory assistant will indicate a couple more dozen various substances, salts, acids, which can tell a nephrologist a lot.

Usually this is sufficient, but for small children and very bad tests doctors “play it safe” by prescribing ultrasonography kidney In doubtful situations, a kidney biopsy may also be prescribed. The doctor recognizes a disease as chronic if the symptoms have lasted for more than six months or if changes in urine formulas have remained at abnormal values ​​for more than a year.

Treatment

In case of acute glomerulonephritis, home treatment is strictly contraindicated.

The doctor will strongly recommend going to the hospital and this is quite justified. After all, the child needs complete rest and the strictest bed rest. The patient is immediately prescribed diet No. 7, which does not include salt, significantly limits the amount of liquid drunk per day, and cuts the amount of protein food by approximately half of the age norm.

If the disease is caused by streptococci, then a course of penicillin antibiotics is prescribed. In a hospital setting, they will most likely be injected intramuscularly. To reduce edema, diuretics are prescribed in a strict age-specific dosage. At high blood pressure will be given means that can reduce it.

The modern approach to the treatment of glomerulonephritis involves the use of hormones, in particular “Prednisolone” in combination with cytostatic drugs that can stop and slow down cell growth. Such medicines usually widely used in therapy cancerous tumors, but this fact should not scare parents. When the condition of the kidneys improves, they are entrusted with the function of slowing down the growth of immune colonies, and this will only benefit the suffering kidney cells.

If the child has concomitant chronic infectious diseases, after acute stage glomerulonephritis, it is strongly recommended to eliminate foci of infection - cure all teeth, remove adenoids if they hurt, undergo a course of treatment for chronic tonsillitis, etc.

But this should be done no earlier than six months after suffering an acute kidney disease or exacerbation of a chronic one. Recovery, if the treatment schedule is followed, usually occurs after 3-4 weeks. Then the child is recommended to study at home for six months to a year, to be registered with a nephrologist for at least two years, to visit sanatoriums that specialize in kidney diseases, to observe strict diet. Such a child cannot receive any vaccinations for a year. And with every sneeze and the slightest sign ARVI, the parents urgently need to take his urine samples to the clinic.

Chronic glomerulonephritis is treated in the same way as acute glomerulonephritis, since it requires treatment only during periods of exacerbation.

With him, you should also not insist on home treatment, the child must be hospitalized, because in addition to therapy, he will be given full course examinations to find out whether the disease has begun to progress. At severe forms and extensive destruction of kidney structures, artificial kidney procedures and transplantation of a donor organ to replace the affected one are indicated.

A child with a chronic illness will be registered at a dispensary for life. Once a month he will need to take a urine test, visit a doctor, and once a year have an ECG to prevent pathological changes from the side of the heart.

Prevention

There is no vaccine against this serious disease, and therefore prevention is not specific. However, parents should know that no sore throat or pharyngitis should be treated without permission, because the disease may turn out to be streptococcal, and without antibiotics or if they are taken uncontrolled, the likelihood of such a complication as glomerulonephritis will increase significantly.

After suffering from scarlet fever, you should definitely take a urine test 3 weeks later, even if the doctor forgot to prescribe it for you. 10 days after streptococcal tonsillitis or streptoderma, you must also take urine samples to the laboratory. If there is nothing alarming about them, then you don’t have to worry. Prevention of kidney diseases in general and glomerulonephritis in particular includes correct treatment against ARVI, vaccination against influenza, measles. It is important to ensure that the child does not sit on the cold floor with his bare bottom and does not overheat in the sun in the summer.

More about diagnostics of this disease watch in the next video.

Kidney disease, unfortunately, is a very common occurrence in preschool and younger children. school age. Adaptation of children to kindergarten or school, it is not always possible to do without troubles and illnesses.

The child’s immunity finds itself in a new environment and becomes a field for the development of infections still unknown to the immune system, some of which can cause glomerulonephritis.

What kind of disease is this and why does it occur in children?

Glomerulonephritis – severe childhood disease kidneys, which is one of the most common among children. This disease occurs in both infants and older children. Children whose age ranges from three to eight years are often affected.

Mechanism of occurrence the disease is extremely simple. The kidney glomeruli (glomeruli) become inflamed, thereby blocking the ability of the kidneys to work normally. The fluid that accumulates in the body does not have the opportunity to be eliminated from the body in time, and therefore provokes the appearance of edema. Blood pressure also increases, and urine contains high level protein and blood clots.

Glomerulonephritis causes inflammation of an immune nature in the kidneys, as a result of which immune compounds are formed in the body, the cause of which is a certain allergen. Often such allergens are: streptococci (the most common provocateur of this disease); viruses that cause hepatitis, chickenpox or influenza; vaccines (after the vaccination procedure), snake or bee venoms. The body is unable to fight these allergens: instead of neutralizing them, it resists, forming these lumps.

The disease process starts thanks to such influences: if there was overheating of the body or hypothermia, if the climate changes sharply or the sun exposure is too great for the body. Another impetus is nervous stress or physical strain.

Glomerulonephritis often results in disability in children.

Symptoms of glomerulonephritis in children

Sometimes a disease can be almost invisible, and pure chance helps to detect its presence. Glomerulonephritis is mainly accompanied by serious symptoms. The children's well-being deteriorates at the moment. There are even cases urgent hospitalization a child who suddenly loses consciousness due to these symptoms.

The main complaints in children are frequent headache, which practically makes it impossible to remain conscious. Possible pain in the lower back, accompanied by a sharp change in the amplitude of the pain wave. Phenomena such as vomiting and fever are frequent accompaniments of glomerulonephritis. The color of urination takes on a rusty-reddish hue, and its quantity decreases or sharply disappears.

The pressure can rise to as much as one hundred and forty to one hundred and sixty millimeters of mercury. Body weight increases, as kilograms are added due to the edema that accompanies glomerulonephritis. The most common parts of the body where swelling appears in children are the eyelids (both upper and lower) and the entire face.

After a child suffers such an illness, serious complications may occur, such as uremia, heart failure. Because when the slightest symptoms glomerulonephritis, the child must be urgently shown to a doctor who will prescribe treatment and prescribe the necessary medications.

Features of acute and chronic glomerulonephritis in children

Acute glomerulonephritis usually does not go unnoticed from its onset. The disease is accompanied by serious symptoms that worsen general health and the condition of the child, as a result of which children, as a rule, end up in medical department on an ambulance.

First you need to diagnose the disease. There are different ways to do this:

The disease may begin unexpectedly and in a sharp way, or maybe gradual. It is better, of course, when the disease has an acute onset, since in this case it passes faster. The sluggish form can be more serious in the sense that it is not noticed immediately and, accordingly, it will be much more difficult to treat.

The acute form is also called “nephritic syndrome”. This syndrome is typical for children of five to ten years of age, because it is easy to catch such a disease in kindergarten or school. It is usually accompanied by tonsillitis or scarlet fever, as well as other infections, the period of which ranges from one to three weeks, and after recovery from infectious disease, the time of glomerulonephritis comes.

The child develops swelling that is difficult to subside. They remain on the skin, mainly on the face, for five to fourteen days. Blood pressure rises. Its increase is accompanied by the release of vomit, frequent dizziness and pain.

If you act correctly, the pressure should drop and return to normal position after one and a half to two weeks. A huge amount of protein appears in the urination, and sometimes red blood cells, which is why the urine acquires a red-rusty color. Leukocytes are also present in the urine, multiplying your quantity.

With nephrotic syndrome, which is a sluggish form of glomerulonephritis, the chances of recovery are negligible. This is, as a rule, five percent of a hundred cases. Basically, the outcome is the same: glomerulonephritis becomes chronic in the baby.

With this form, swelling also appears mainly on the face, but it will not occur quickly, but rather slowly. Although such swelling appears throughout the body, it goes away more easily than with nephritic syndrome. Hair breaks and falls out easily hair follicles and fade. The skin becomes rough and takes on a pale tint. Protein in the urine increases, but the concentration of leukocytes and red blood cells remains the same and does not increase.

If the doctor who treats this form of the disease in children is truly qualified and experienced, and the parents turn to him in time, then the likelihood of recovery will naturally be higher than for those children who are unlucky for all these reasons.

A competent doctor manages to cure fifty percent of cases of children, and in the remaining fifty the disease becomes chronic.

The nephrotic form is typical for children over ten years of age. As a rule, these are already middle school or even high school students.

Effective treatment of disease in children

The good thing about the childhood form of glomerulonephritis is that the child’s body tolerates it much easier than an adult. Treatment of glomerulonephritis in children takes about ten days, after this period the disease should completely recede.

The doctor prescribes penicillin. In order to start processes in the urinary organs, doctors prescribe diuretics to drink, depending on the dosage they indicate.

At the very acute period illness, when the body is completely weakened, a sick child needs bed rest.

Signs such as an increase in the amount of toxic substances in the blood and a yellowish-pale color cannot be excluded. skin, the smell of urine that comes from the mouth. If such symptoms are present in children for more than six days, then urgent blood purification is necessary.

A method used for this is hemodialysis, which involves the use of a machine called an “artificial kidney.”

Doctors also prescribe a mandatory diet.

Diet for childhood glomerulonephritis

The diet for glomerulonephritis in children is specific, since it consists of the so-called carbohydrate days, worn for unloading purposes. Smoked products, meat, fish, meat broths and seasonings are strictly prohibited during a therapeutic diet.

To mobilize the function of the urinary system, it is necessary to take more potassium. Because dairy products, vegetables, fruits, natural juices should be permanent components of the patient’s diet.

It is important to use rosehip infusion, as it has a huge charge of vitamin C, which is necessary to restore immunity.

Doctors recommend eating three to five times a day, depending on individual characteristics body. The diet should be about three thousand kilocalories. The liquid that the patient drinks must also be of a certain amount - this is a volume exceeding daily norm discharge of no more than five hundred milliliters.

Bread, regardless of grinding and flour, soups (strictly vegetarian!), meat (low-fat, rabbit, chicken are suitable) are mandatory for consumption. The meat is boiled and then stewed or fried. But the cooking process is a mandatory stage of preparation!

Fish is also allowed, but not fatty. Vegetables and cereals should be consumed regularly, but eggs should not be too boiled, they will fit “in a bag”.

Sweets are allowed, but their quantity is usually reduced, and tea can only be drunk not strong. Juices are welcome. Canned food and products containing alcohol are strictly prohibited!

Preventive measures

In order to protect your child from such serious illness, you must adhere to some recommendations and rules. It is necessary to do a urine test frequently, especially if the child often experiences purulent inflammations.

Such analysis can help prevent further development inflammatory processes in the body. It is also necessary to strengthen the body, move more and strengthen the immune system with vitamins.

Kidney diseases in children arise for the most seemingly insignificant reasons. A complication of another ARVI or hypothermia in the autumn-winter off-season, or such a banality as urinary retention can trigger inflammatory process in the baby's kidneys.

For example, very often first-graders are embarrassed to raise their hand and go to the toilet during class. Such an insignificant and understandable episode can start inflammation, which can be catalyzed by another untreated runny nose or hypothermia.

Children's health is more fragile than that of an adult. It needs constant monitoring, since many diseases that prevent life in adolescence, or even adulthood, can be avoided in childhood. Therefore, it is very important for parents not to forget about the prevention of various diseases and their timely treatment.

Acute glomerulonephritis in children is a cyclical infectious-allergic kidney disease that often develops 1 to 3 weeks after an infectious disease (usually of streptococcal etiology). The disease can develop at any age, but most patients are under 40 years of age.

Symptoms of the development of acute glomerulonephritis in a child

Clinical syndromes of the disease:

extrarenal

• neurovegetative syndrome (malaise, anorexia, lethargy, nausea, vomiting, poor appetite, headache);
• cardiovascular syndrome (hypertension, muffled heart sounds, murmurs and accents of heart sounds, enlarged liver);
• edematous syndrome, manifested by pastosity, limited or generalized edema;

renal manifestations:

• urinary syndrome(oliguria, proteinuria, hematuria, cylindruria, transient lymphocytic-mononuclear leukocyturia);
• pain syndrome. Manifested by pain in the lumbar region or undifferentiated abdominal pain;
• syndrome renal failure(azotemia is manifested by three main symptoms - edematous, hypertensive and urinary).

Diagnosis of acute childhood glomerulonephritis

Protein and red blood cells are found in the urine. The amount of protein in the urine usually ranges from 1 to 10 g/l, but often reaches 20 g/l or more. Slight proteinuria may be present from the very beginning of the disease, and in some periods it may even be absent. Small amounts of protein in the urine of patients who have suffered acute nephritis are observed for a long time and disappear only after 3–6, and in some cases even 9–12 months from the onset of the disease. Hematuria is a mandatory sign of acute hepomerulonephritis. There are macrohematuria and microhematuria, sometimes the number of red blood cells may not exceed 10–15 in the field of view.

Cylindruria is not a mandatory symptom of gpomerulonephritis. Leukocyturia can be insignificant, but sometimes 20–30 or more leukocytes are found in the field of view. At the same time, there is always a quantitative predominance of erythrocytes over leukocytes, which is better revealed by counting shaped elements urine sediment using the Addis-Kakovsky and Nechiporenko methods. Oliguria (400 – 700 ml of urine per day) is the first symptom acute nephritis. In a blood test, the hemoglobin content and the number of red blood cells decrease, determined increase in ESR, there is slight leukocytosis. Rehberg and McClure-Aldrich tests are performed. Examine the function of the proximal convoluted tubules, prescribe excretory urography, ultrasound examination of the kidneys, radioisotope renography.

Differential diagnosis is made between acute glomerulonephritis and exacerbation of chronic glomerulonephritis. What is important here is to clarify the period from the onset of an infectious disease to acute manifestations jade. In acute cases, this period is 1 - 3 weeks, and in case of exacerbation of the chronic process - only a few days (1 - 2 days). Urinary syndrome may be the same in severity, but a persistent decrease in the relative density of urine (below 1.015) and a decrease in the filtration function of the kidneys are more typical for exacerbation of the chronic process.

Forms of glomerulonephritis and their signs in a child

There are two forms of acute glomerulonephritis.

Cyclic form It starts off stormy. Swelling, shortness of breath, headache, pain in the lumbar region appear, and the amount of urine decreases. Urine tests show high levels of proteinuria and hematuria. Blood pressure rises. The swelling lasts for 2–3 weeks, during the course of the disease a turning point occurs: polyuria develops and blood pressure decreases. The recovery period may be accompanied by hyposthenuria. However, often when feeling good sick and practically full recovery performance may last for a long time, for months, a slight proteinuria (0.03 - 0.1 g/l) and residual hematuria may be observed.

Latent form is rare, and its diagnosis has great importance, since often with this form the disease becomes chronic. This form of glomerulonephritis is characterized by a gradual onset, without any significant subjective symptoms, and is manifested only by slight shortness of breath or swelling in the legs. In such cases, it is possible to diagnose glomerulonephritis only with a systematic examination of urine. The duration of the relatively active period in the latent form of the disease can be significant (2–6 months or more).

How to treat acute glomerulonephritis in a child?

Hospitalization in a hospital, bed rest and diet are prescribed. Sharp limitation table salt in food (no more than 1.5 - 2 g per day) in itself can lead to increased release of water and the elimination of edematous and hypertensive syndromes. In the future, watermelons, pumpkins, oranges, and potatoes are given, which provide almost completely sodium-free nutrition. Liquids can be consumed up to 600 – 1000 ml per day. Long-term restriction of protein intake is not sufficiently justified, since retention of nitrogenous wastes, as a rule, is not observed, and the sometimes supposed increase in blood pressure under the influence of protein nutrition has not been proven. Among protein products, it is better to eat cottage cheese, as well as egg white. Fats are allowed in the amount of 50–80 g per day. Carbohydrates are added to provide daily caloric intake. Antibacterial therapy is indicated when there is a clear connection between glomerulonephritis and an existing infection, for example when chronic tonsillitis.

For chronic tonsillitis, tonsillectomy is indicated 2 to 3 months after the acute symptoms of the disease have subsided. The use of steroid hormones - prednisone, dexamethasone is possible no earlier than 3 - 4 weeks from the onset of the disease, when general symptoms(in particular, arterial hypertension) are less pronounced. Corticosteroid hormones are also indicated for the nephrotic form or prolonged course of acute glomerulonephritis. Corticosteroid therapy affects both edema and urinary syndrome. Moderate arterial hypertension is not a contraindication for use corticosteroid drugs. Vitamin therapy.

Stages of treatment for acute glomerulonephritis in children

Early rehabilitation- This successful treatment acute process in a hospital. In order to improve kidney function, bed rest, diet, drugs that improve renal blood flow (chimes, aminophylline), electrophoresis with a 1% solution are prescribed nicotinic acid or heparin.

Late rehabilitation includes a sanatorium stage, which is carried out in a clinic or at a local sanatorium. Previously prescribed therapy, diet within table No. 7, physiotherapeutic procedures, exercise therapy, sanitation of foci of chronic infection and treatment continue concomitant diseases.

A therapeutic-motor regimen with restriction is indicated physical activity and the inclusion of morning exercises according to an individual plan, exercise therapy, games, and music classes. Recommended day rest.

When suffering from acute glomerulonephritis in children, diet is of great importance. It must be complete, taking into account the age of the patient. Appointed physiological norms protein, fats and carbohydrates with the inclusion of complete proteins, unsaturated fatty acids, vitamins. Extractive substances are excluded from the diet, essential oils, smoked meats, hot seasonings, spices.

Physiotherapy occupies a large place in sanatorium treatment. Apply paraffin applications to the lumbar region. To eliminate renal ischemia, novocaine electrophoresis is used in the lumbar region.

Expanding blood vessels By increasing diuresis, magnesium has a positive effect on the course of the disease and the patient’s well-being. Irradiation of the lumbar region with Sollux lamps or infrared rays. In order to desensitize the body and reduce inflammation in the kidneys, calcium electrophoresis is used. At the stage sanatorium treatment important role devoted to therapeutic pedagogy and psychotherapy.

Rehabilitation treatment , or secondary prevention, produced in a clinic using factors spa treatment or at a resort. However, treatment of acute glomerulonephritis in children at the resort is indicated for children with no signs of exacerbation of the process in the kidneys during the year.

At the stage of spa treatment, children are hardened using all methods of spa treatment:

• balneotherapy,
• mud applications,
• as well as climatotherapy;
• rehabilitation of chronic foci of infection.

Dynamic observation carried out within 5 years after suffering an acute process. The child is observed by a pediatrician and nephrologist. Inspections are carried out once a quarter in the 1st year, thereafter - 2 times a year.

Full examination carried out 2 times a year at the time of hospitalization for rehabilitation and includes urine and blood tests, biochemical analysis blood.

Causes of acute form of glomerulonephritis in a child and prevention of the disease

Acute glomerulonephritis – inflammatory disease kidneys of an immunopathological nature with predominant defeat renal glomeruli and involvement of renal tubules, interstitial tissue, and blood vessels in the process.

Possibly caused by viral infection, after administration of vaccines and serums (serum, vaccine nephritis). Cooling causes reflex disorders of the blood supply to the kidneys and affects the course of immunological reactions. The generally accepted idea is that glomerulonephritis is an immune complex pathology. The onset of symptoms after an infection is preceded by a long latent period, during which the body’s reactivity changes, antibodies to microbes or viruses are formed.

Antigen-antibody complexes, interacting with complement, are deposited on the surface of the basement membrane of capillaries, mainly glomeruli.

Prevention of acute glomerulonephritis in children

Prevention comes down to prevention and early intensive treatment of acute infectious diseases, elimination of focal infection, especially in the tonsils. Prevention of sudden hypothermia of the body is also of preventive importance.

Among childhood kidney diseases, the leading place is occupied by glomerulonephritis in children. Glomerulonephritis is usually called a whole group of diseases that manifest themselves as bilateral kidney damage in children and damage to the renal glomeruli (glomeruli). Glomerulonephritis is often called simply “nephritis”, this is not entirely correct, since nephritis is general inflammation kidneys, and not just the glomerulus. In general terms, this is very serious illness, which requires long and proper qualified treatment.

General information

Before you get acquainted with the causes of glomerulonephritis, you should familiarize yourself with the functions of the kidneys and the mechanism of their work. The main functions of the kidneys are to remove protein breakdown products, toxic foreign compounds, and excess organic and inorganic particles from the body. Kidneys also participate in the formation of blood and are responsible for the level blood pressure.

A nephron is a structural unit of the kidney, which consists of tubules and glomeruli in the kidneys. When these same glomeruli are damaged, the process of purifying the blood from harmful substances is disrupted. Red blood cells, as well as protein, begin to leak into the urine along with salts. When diagnosing glomerulonephritis in children, large protein losses are observed and in a situation where red blood cells are reduced, there is a risk of anemia.

Glomerulonephritis occurs quite often, moreover, it occupies the second “prize” position among kidney pathologies, sacrificing only diseases urinary system. It most often affects children aged 2−12 years. In young children under 2 years of age, this disease is rarely diagnosed. Among girls, the diagnosis is confirmed two times less often than among boys. Glomerulonephritis is especially dangerous for children, as there is a risk of kidney failure and a chance of disability at an early age.

Causes

The causes of the above disease in children are:

No less dangerous reason- connective tissue diseases (rheumatism, endocarditis, hemorrhagic vasculitis).

It should be noted that when the body encounters pathogens, it does not neutralize foreign bodies, but forms immune protection, which then destroys the renal glomeruli. Triggering factors The occurrence of glomerulonephritis in children are:

• prolonged overheating or hypothermia;
• significant physical or emotional stress;
• sudden climate change;
• prolonged exposure to the sun;
• long trips;
• hereditary predisposition.

Classification of glomerulonephritis

Glomerulonephritis is usually divided into: acute and chronic, primary and secondary, with established and unidentified etiology, immunologically caused and unconditioned, diffuse and focal. In acute glomerulonephritis, emphasis is placed on following forms: nephritic, urinary, mixed, nephrotic form. Chronic glomerulonephritis is represented by the following types: hematuric, nephrotic, mixed forms.

Acute glomerulonephritis

As a rule, acute glomerulonephritis begins to appear 2-3 weeks after the illness. The symptoms of its development are clear. Children develop a fever, chills, headache, nausea (sometimes vomiting), and discomfort in the lower back. Already in the first days, urine acquires a reddish color, its amount decreases significantly, and the child recovers due to swelling of the entire body. Blood pressure also increases. With proper treatment, swelling disappears after 5-14 days, normalization of blood pressure also takes 1-2 weeks, and changes in urine disappear only after 2-4 weeks.

The most dangerous is nephrotic syndrome, because only 5% of patients fully recover. Acute glomerulonephritis becomes chronic if: the consistency of urine has not stabilized for 1 year; For six months the swelling has not gone away. It is misleading that with chronic glomerulonephritis, children feel no worse than their healthy peers. But, nevertheless, this disease provokes kidney failure. Then the child loses his appetite, may be bothered by nausea and vomiting, feels tired, his sleep worsens, and convulsions and itchy skin may occur. Glomerulonephritis causes kidney failure, which can lead to death.

Symptoms of the disease in children

The symptoms of acute glomerulonephritis in children differ significantly from the symptoms of chronic glomerulonephritis. In the first case, they are pronounced: the child complains about bad feeling, thirst, headache, increased fatigue. Also, very often the disease provokes hypertension (there is an increase in the maximum along with a decrease in the minimum blood pressure), which torments the child for at least 3 months. and speaks of the possible rapid transition of the disease to a chronic form. Glomerulonephritis with nephrotic syndrome is characterized primarily by severe swelling, which sometimes covers a third child's body. If the symptoms are not quickly taken into account, the treatment of glomerulonephritis will become protracted, and the child will develop complications such as cerebral edema and renal failure. For get well soon and the absence of consequences, a timely and thorough diagnosis should be carried out.