GLOMERULONEPHRITIS IN CHILDREN

What is glomerulonephritis in children?

Inflammation of the glomeruli (part of the kidneys’ filtering network), a
kidney disease affecting the capillaries of the glomeruli, characterized by
albuminuria, edema, and hypertension.

What causes glomerulonephritis in a child?

Glomerulonephritis can be caused by diseases such as:
 Systemic autoimmune diseases. With these types of diseases, the body’s
immune system attacks healthy cells by mistake. Systemic means that many
parts of the body are affected. An example of this is systemic lupus
erythematosus (SLE or lupus).
 Polyarteritis nodosa. This is an inflammatory disease of the arteries.
 Wegener vasculitis. This is a progressive disease that leads to widespread
inflammation of all of the body's organs.
 Henoch-Schönlein purpura. This disease causes small or large purple
lesions (purpura) on the skin and internal organs. It causes other symptoms
in several organ systems.
 Alport syndrome. This is a form of inherited glomerulonephritis that affects
both boys and girls. But boys are more likely to have kidney problems.
Treatment focuses on preventing and treating high blood pressure and
preventing kidney damage.
 Streptococcal infection. In children, glomerulonephritis is often caused by
strep throat or an upper respiratory infection. The disease usually occurs 1
week or more after an infection.

Which children are at risk for glomerulonephritis?

A child is more at risk for glomerulonephritis if he or she has:
 A systemic autoimmune disease such as lupus
 Polyarteritis nodosa
 Wegener vasculitis
 Henoch-Schönlein purpura
 Alport syndrome
 Streptococcal infection

What are the symptoms of glomerulonephritis in a child?

 Symptoms can occur a bit differently in each child. They can include:
 Urine that is dark brown, from blood and protein
 Sore throat
 Less urine
 Lack of energy or tiring easily (fatigue)
 Trouble breathing
 Headache
 High blood pressure
 Seizures from high blood pressure
 Rash, especially over the buttocks and legs
 Weight loss
 Joint pain
 Pale skin color
 Fluid buildup in the tissues (edema)
The symptoms of glomerulonephritis can be like other health conditions.
Make sure your child sees his or her healthcare provider for a diagnosis.

How is glomerulonephritis diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health
history. He or she may also ask about your family’s health history. He or she
will give your child a physical exam. Your child may also have tests, such
as:
 Throat culture. This may be done to check for strep throat. A swab is gently
wiped in your child’s throat to collect bacteria.
 Blood tests. These look at blood cell counts, electrolyte levels, and kidney
function.
 Urine test. This test looks for protein in urine and other problems.
 Electrocardiogram (ECG). This is a test that records the electrical activity
of the heart, shows abnormal heart rhythms, and detects heart muscle
damage.
 Renal ultrasound (sonography). This is a painless test that uses sound
waves and a computer to create images of body tissues. During the test, a
healthcare provider moves a device called a transducer over the belly in the
kidney area. This sends a picture of the kidney to a video screen. The
healthcare provider can see the size and shape of the kidney. He or she can
also see a growth, kidney stone, cyst, or other problems.
 Chest X-ray. This test uses a small amount of radiation to make images of
tissues, bones, and organs on film.
 Renal biopsy. The healthcare provider takes a small sample of kidney tissue.
This is done through the skin with a needle or during surgery. The sample is
looked at under a microscope.

How is glomerulonephritis treated in a child?

Treatment for glomerulonephritis may include:
 Fluid restriction
 Decreased protein diet- Protein is vital for proper growth and nutrition.
But the kidneys may not be able to get rid of the waste products that come
from eating too much protein.
 Decreased salt and potassium diet- Potassium is an important nutrient.
But when the kidneys don’t work well, too much potassium can build up
in the blood.
 Medication, such as blood pressure medicines, corticosteroids or
immunosuppressive
 Diuretics
 Blood pressure medications
 Phosphate binders - The kidneys help remove excess phosphorus from
the body. If the kidneys are not working well, too much phosphorus builds
up in the blood and can cause calcium to leave the bones. - medications to
decrease the amount of the mineral phosphorus in the blood
 Immunosuppressive agents
 Dialysis - a medical treatment that removes waste and additional fluid
from the blood after the kidneys have stopped functioning
 Dietary restrictions on salt, fluids, protein and other substances
 Sodium. A low-sodium diet can help prevent or reduce fluid retention in
your child's body. The healthcare provider will talk with you about the
amount of sodium allowed in your child's diet.
Possible complications of glomerulonephritis in a child
If glomerulonephritis does not go away, it may lead to kidney failure.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:
 Symptoms that don’t get better, or get worse
 New symptoms
 Key points about glomerulonephritis in children
 The kidneys contain many tiny coils of blood vessels called glomeruli.
Glomerulonephritis is a type of kidney disease where these become inflamed.
The disease makes it hard for the kidneys to filter the blood.
 The condition has many possible causes, such as autoimmune disease, or
other diseases or an infection.
 Symptoms can include dark brown urine, less urine, and low energy.
 Treatment may include changes in diet, medicines, or dialysis.
 If glomerulonephritis does not go away, it may lead to kidney failure.

Nursing Management
Nursing Assessment
Physical examination. Obtain complete physical assessment
Assess weight. Monitor daily weight to have a measurable account on the
fluid elimination.
Monitor intake and output. Monitor fluid intake and output every 4 hours to
know progressing condition via glomerular filtration.
Assess vital signs. Monitor BP and PR every hour to know progression of
hypertension and basis for further nursing intervention or referral.
Assess breath sounds. Assess for adventitious breath sounds to know for
possible progression in the lungs.

Nursing Diagnoses
Ineffective breathing pattern related to the inflammatory process.
Altered urinary elimination related to decreased bladder capacity or irritation
secondary to infection.
Excess fluid volume related to a decrease in regulatory mechanisms (renal
failure) with the potential of water.
Risk for infection related to a decrease in the immunological defense.
Imbalanced nutrition less than body requirements related to anorexia, nausea,
vomiting.
Risk for impaired skin integrity related to edema and pruritus.
Hyperthermia related to the ineffectiveness of thermoregulation secondary to
infection.
Nursing Care Planning and Goals
Excretion of excessive fluid through urination.
Demonstration of behaviors that would help in excreting excessive fluids in
the body.
Improvement of distended abdominal girth.
Improvement of respiratory rate.
Participation and demonstration of various ways to achieve effective tissue
perfusion.

Nursing Interventions
Activity. Bed rest should be maintained until acute symptoms and gross
hematuria disappear.
Prevent infection. The child must be protected from chilling and contact with
people with infections.
Monitor intake and output. Fluid intake and urinary output should be
carefully monitored and recorded; special attention is needed to keep the
intake within prescribed limits.
Monitor BP. Blood pressure should be monitored regularly using the same
arm and a properly fitting cuff.
Monitor urine characteristics. The urine must be tested regularly for protein
and hematuria using dipstick tests.

Evaluation
Excretion of excessive fluid through urination.
Demonstration of behaviors that would help in excreting excessive fluids in
the body.
Improvement of distended abdominal girth.
Improvement of respiratory rate.
Participation and demonstration of various ways to achieve effective tissue
perfusion.