GLOMERULONEPHRITIS

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

Management

Inflammatory kidney disease with oedema, hypertension and oliguria should be referred to regional hospital for
specialised management.

  • 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 (see section 7.1.3)
  • 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