Which clinical findings would the nurse expect of a child with a diagnosis of acute Poststreptococcal glomerulonephritis?

Glomerulonephritis is a type of kidney disease that involves the glomeruli. The glomeruli are very small, important structures in the kidneys that supply blood flow to the small units in the kidneys that filter urine called the nephrons. During glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine.

Glomerulonephritis is caused by several different disease states, including the following:

• Systemic immune disease, such as systemic lupus erythematosus (SLE or lupus)

• Other systemic diseases may include:

  • Polyarteritis nodosa group. An inflammatory disease of the arteries.

  • Wegener vasculitis. A progressive disease that leads to widespread inflammation of all of the organs in the body.

  • Henoch-Schönlein purpura. A disease usually seen in children that is associated with purpura (small or large purple lesions on the skin and internally on the organs) and involves multiple organ systems.

• A form of inherited glomerulonephritis called Alport syndrome, which affects both men and women; men are more likely to have kidney problems. Treatment focuses on preventing and treating high blood pressure and preventing kidney damage. 

• In children, a common cause of glomerulonephritis is from a streptococcal infection, such as strep throat or upper respiratory infection. Glomerulonephritis usually occurs more than one week after an infection. This is often referred to as acute poststreptococcal glomerulonephritis or APSGN.

The following are the most common symptoms of glomerulonephritis. However, each child may experience symptoms differently. Symptoms may include:

• Dark brown-colored urine (from blood and protein)

• Sore throat

• Diminished urine output

• Fatigue

• Lethargy

• Increased breathing effort

• Headache

• High blood pressure

• Seizures (may occur as a result of high blood pressure)

• Rash, especially over the buttocks and legs

• Weight loss

• Joint pain

• Pale skin color

• Fluid accumulation in the tissues (edema)

The symptoms of glomerulonephritis may resemble other conditions and medical problems. Always consult your child's doctor for a diagnosis.

In addition to a thorough physical examination and complete medical history, your child's doctor may recommend the following diagnostic tests:

• Throat culture

• Urine tests

• Blood tests

• Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

• Renal ultrasound (also called sonography). A noninvasive test in which a transducer is passed over the kidney producing sound waves which bounce off of the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities. 

• Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• Renal biopsy. A procedure during which a small sample of tissue is taken from the kidney through a needle. The tissue is sent for special testing to determine the specific disease. 

Specific treatment for glomerulonephritis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• The extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

If glomerulonephritis is caused by a streptococcal infection, then treatment will be focused on curing the infection and treating the symptoms associated with the infection. Treatment will depend on the underlying cause. Therefore, treatments focus on slowing the progression of the disease preventing complications.

Treatment for glomerulonephritis may include:

• Fluid restriction

• Decreased protein diet

• Decreased salt and potassium diet

• Medication, such as:

  • Diuretics

  • Blood pressure medications

  • Phosphate binders. Medications to decrease the amount of the mineral phosphorus in the blood.

  • Immunosuppressive agents

• Dialysis. A medical treatment to remove wastes and additional fluid from the blood after the kidneys have stopped functioning. Dialysis may be required for short-term or long-term therapy.

If glomerulonephritis does not resolve, long-term kidney failure may need to be addressed.

Which are common clinical manifestations of acute Poststreptococcal glomerulonephritis?

What are some laboratory results you may find in a child who has acute Poststreptococcal glomerulonephritis?

Which are signs and symptoms that indicate cerebral involvement of acute glomerulonephritis in a child?

How is acute Poststreptococcal glomerulonephritis diagnosed?