Glomerulonephritis according to the ICD code refers to glomerular infectious and allergic diseases that affect the glomeruli of the kidneys. Glomerulonephritis in children most often begins to develop after angina, scarlet fever, influenza, laryngitis, tonsillitis. The nasopharynx and skin are affected by streptococci. Boys from 3 to 9 years old suffer more often. The prevalence among girls of this age group and children under 2 years of age is much lower.
Doctors identify 3 forms of this disease:
Acute glomerulonephritis is characterized by vivid symptoms and a sharp deterioration in the patient’s condition. If the diagnosis is carried out in a timely manner, most patients are cured and do not cause complications. Only in 1-2% of children this type becomes chronic. The main reason for the development is the low resistance of the body to harmful microorganisms. If streptococci became the cause of the development of the disease, we are talking about an acute post-streptococcal form, characteristic of preschool children.
The subacute form is considered special. It is characterized by very severe clinical manifestations and rapidly growing (in 2, 3 weeks) renal failure. Until 1914, it was considered a variant of the other two types. In the medical literature, the subacute type of the disease is called transient, hyperacute, violent, anuric, malignant. A.P. Peleschuk in 1983 called it autoimmune. Subacute glomerulonephritis is poorly treated, the prognosis is poor.
Chronic glomerulonephritis is most often the result of an unnoticed and untreated acute form. The patient needs long-term hospital treatment. If the acute form is not treated, the body’s water-mineral metabolism gets lost, nephrotic syndrome comes to the fore, often leading to a fatal outcome.
The pathogenesis of this disease is most often associated with an acute infection of a streptococcal nature. The cause of the development of the disease can also be vaccination or poisoning.
Symptoms are pronounced in acute and subacute form. The main signs include hypertension with a simultaneous increase in the minimum and maximum pressure.
The patient may also complain about:
- increased thirst
- weakness and increased fatigue,
- decreased urine volume
- brown or black-coffee-colored urine,
- swelling of the legs, arms and face,
- drowsiness, headaches, nausea.
This disease occurs in 0,1-0,2% of pregnant women. Pregnancy makes diagnosis difficult, especially if the disease is chronic. The only sign is changes in the composition of urine, so it is important to get tested regularly.
Treatment methods for children
Any kind of glomerulonephritis in children is treated in a hospital for 1,5-2 months. Bed rest is prescribed, fluid consumption is reduced (to one liter or less per day).
In the process of conservative treatment, the following are prescribed:
- antibiotics (for 2-3 weeks),
- corticosteroid hormones (only for selected patients),
- pulse therapy.
In severe cases, surgical intervention is used – kidney transplantation.
If, due to the severe course of the disease, the child develops heart or renal failure, urinary syndrome, uremia, cerebral hemorrhage, treatment of concomitant diseases is required. Sometimes the chronic form is accompanied by wrinkling of the kidneys. A similar clinical picture indicates the need for hemodialysis or transplantation.
Treatment in pregnant women
With a chronic disease, it is possible to develop quite serious complications for both the mother and the child. Often there is exfoliation of the placenta, cessation of development or death of the fetus. Treatment should be started early and in the hospital.
The acute form is characterized by a significant increase in blood pressure, therefore, bed rest is required until it normalizes. The diet is prescribed without salt and with a limited volume of fluids and proteins. During pregnancy, it is pathogenetic therapy that is considered the main means of combating this disease. Diuretics and drugs that lower blood pressure are prescribed less frequently than in pediatrics.
If the treatment is completed successfully, physiological childbirth is not prohibited. Recommendations for a cesarean section are given when complications develop.
Clinical examination since 2017 for this group of patients is provided 2 times a year (in the presence of nephrotic syndrome – 4 times a year). An examination by a urologist, ENT, dentist, gynecologist, blood and urine tests, ECG is prescribed.
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