Paediatric Acute Glomerulonephritis
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define acute glomerulonephritis (AGN) and recognize its diagnostic criteria.
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Identify post-infectious, systemic, and drug-induced causes of AGN in children.
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Recognize typical signs and symptoms including oedema, hematuria, hypertension, and renal dysfunction.
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Interpret essential laboratory and imaging investigations for AGN.
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Outline supportive care, pharmacologic therapy, and fluid/electrolyte management.
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Understand indications for early nephrology consultation.
Description
Acute glomerulonephritis is a clinical syndrome resulting from inflammation of the glomeruli, characterized by the constellation of oedema, hypertension, hematuria, and renal dysfunction.
Common causes include:
| Category | Causes |
|---|---|
| Post-infectious | Bacterial: Group A β-haemolytic Streptococcus (most common), syphilis, TB, Salmonella, E. coliViral: Hepatitis B & C, HIVParasitic: Malaria |
| Systemic | Collagen vascular diseases (e.g., SLE), Vasculitis (IgA nephropathy, HSP, ANCA-associated), HUS, TTP, ventriculo-atrial shunts |
| Drug-induced | Gold, penicillamine |
Clinical Features
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Sudden puffiness of eyelids and facial oedema, often post-streptococcal infection
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Dark urine (hematuria)
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Reduced urine output
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Fever, malaise, abdominal pain
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Hypertension
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Dipstick urinalysis showing hematuria
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Other features depend on underlying cause (e.g., malar rash in SLE, vasculitic rashes)
Investigations
| Category | Tests / Findings |
|---|---|
| Urine | Microscopy: RBCs, RBC casts (dysmorphic), proteinuria, leukocytes |
| Blood | FBC, U&E, creatinine, ESR, complement levels (C3, C4), ANA, anti-DNA, ANCA |
| Microbiology | Throat swab, blood cultures as indicated |
| Imaging | Renal ultrasound, CXR, echocardiography |
| Other | Renal biopsy if diagnosis uncertain or rapidly progressive disease suspected |
Treatment
Supportive Care:
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Sodium restriction
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Adjust all drug doses according to estimated GFR
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Fluid restriction if significant renal dysfunction
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Early nephrology consultation if rapid progression
Pharmacologic Therapy:
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Treat underlying cause:
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Post-streptococcal infection: Penicillin
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Antihypertensives:
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Diuretics, calcium channel blockers, beta-blockers
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Avoid ACE inhibitors initially until creatinine and potassium are checked
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Monitoring:
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Blood pressure, fluid balance, renal function, electrolytes
Key Summary
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AGN = inflammation of glomeruli → oedema, hematuria, hypertension, renal dysfunction
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Most common cause: post-streptococcal infection
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Systemic and drug-induced causes must be considered
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Investigations: urine microscopy, blood work (FBC, renal function, complement), imaging
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Supportive care is critical: sodium and fluid management, renal dose adjustment of medications
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Early nephrology input is crucial in rapidly progressive cases