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Glomerulonephritis

Summary

Glomerulonephritis (GN) is a condition that causes inflammation in the glomeruli (the tiny filtering units in the kidneys). GN can be part of a multisystem disorder where other parts of the body are affected. It often leads to oedema (swelling) and hypertension (high blood pressure), which are signs of more severe or chronic disease.

A kidney biopsy is typically used to confirm the diagnosis, although not all patients require this procedure. Treatment focuses on managing the underlying disorder, as well as hypertension and proteinuria (protein in the urine), which are common in GN.

In some cases, patients may eventually require dialysis or a kidney transplant. Frequent monitoring of kidney function is essential to prevent complications and ensure effective treatment.

Diagnosis and When to Seek Help

Consult a healthcare provider if your child experiences:

  • Swelling in the face, legs, or abdomen
  • High blood pressure or signs of hypertension
  • Changes in urine (e.g., foamy or dark urine, or blood in the urine)
  • Fatigue or decreased appetite

A kidney biopsy may be recommended if there is suspicion of GN, although urine tests and blood tests can also help in identifying kidney problems.

Management

  • The main goals in managing GN are:

    • Treat the underlying disorder causing the GN (e.g., infections, autoimmune diseases, or other conditions)
    • Control hypertension: Medications may be prescribed to help reduce blood pressure.
    • Manage proteinuria: Medicines like ACE inhibitors or angiotensin receptor blockers (ARBs) are commonly used.
    • Monitor kidney function: Regular urine and blood tests will track the kidneys’ ability to filter and manage waste.
    • Supportive care: Depending on the severity, your child may need additional treatments to manage swelling or kidney function.

Follow-Up and Monitoring

    • Kidney function tests: Frequent blood and urine tests to monitor the progression of GN and assess kidney function.
    • Blood pressure monitoring: Regular checks to ensure hypertension is managed effectively.
    • Possible dialysis or transplant: If the kidney function deteriorates significantly, your child may need dialysis or a kidney transplant.

    In cases of GN, timely and consistent treatment is essential to prevent kidney damage and complications. Working closely with a healthcare team can help ensure the best outcomes for your child’s kidney health.

History and Exam

Key diagnostic factor

  • presence of risk factors
  • haematuria
  • oedema
  • hypertension

Other diagnostic factors

  • oliguria
  • anorexia
  • nausea
  • malaise

Risk factors

  • group A beta-haemolytic Streptococcus
  • respiratory infections
  • gastrointestinal infections
  • hepatitis B

Diagnostic Investigations

1st investigations to order

  • urinalysis and microscopy of urine sediment
  • comprehensive metabolic profile
  • estimated glomerular filtration rate (eGFR)
  • full blood count

Investigations to consider

  • spot urine protein:creatinine ratio (PCR)
  • spot urine albumin:creatinine ratio (ACR)
  • erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
  • complement levels

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