Glomerulonephritis
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Acute inflammation of the renal glomeruli (small blood vessels in the kidney)
Cause
- Immune reactions often following an infection - usually 1-5 weeks after a streptococcal skin or throat infection
Clinical features
- Common in children >3 years and adolescents
- Haematuria (red, or tea-coloured urine)
- Oedema: Puffiness of the face/around the eyes, less commonly generalised body swelling
- Discomfort in the kidney area (abdominal or back pain)
- Anorexia
- General weakness (malaise)
- High blood pressure for age, commonly presenting as headaches, visual disturbances, vomiting, and occasionally pulmonary oedema with dyspnoea
- Convulsions (in hypertensive crisis)
- Oliguria (passing little urine) as renal failure sets in
- Evidence of primary streptococcal infection:
- Usually as acute tonsillitis with cervical adenitis
- Less often as skin sepsis
Differential diagnosis
- Kidney infections e.g. TB, pyelonephritis
- Kidney tumours
- Heart failure
- Malnutrition
- Allergic reactions
Investigations
- Urine: Protein, microscopy for RBCs and casts, WBCs
- Blood: Urea (uraemia) and creatinine levels, ASOT, electrolytes
- Ultrasound: Kidneys
ManagementTreatment
- Monitor urine output, BP, daily weight
- Restrict fluid input (in oliguria)
- Restrict salt and regulate protein in the diet (in oliguria)
- Avoid or use with caution any drugs excreted by the kidney
- Treat any continuing hypertension
If post-streptococcal
- Treat primary streptococcal infection (10-day course): phenoxymethylpenicillin 500 mg every 6 hours
- Child: 10-20 mg/kg per dose
- Or Amoxicillin 500 mg every 8 hours for 10 days
- Child: 20 mg/kg per dose
If allergic to penicillin
- Erythromycin 500 mg every 6 hours for 10 days
- Child: 15 mg/kg per dose
For fluid overload (oedema)
- Furosemide 80 mg IV (slow bolus)
- Child:1 mg/kg every 8-12 hours
For high blood pressure
- Nifedipine 20 mg every 12 hours
- Children: refer to specialist
Caution
- Ciprofloxacin, tetracycline, doxycyline, and cotrimoxazole are unsuitable and should not be used for treating primary streptococcal infection
Prevention
- Treat throat and skin infections promptly and effectively
- Avoid overcrowding
- Adequate ventilation in dwellings