Glomerulonephritis refers to kidney diseases that involve inflammation of the glomeruli. There are two main clinical manifestations - the nephritic syndrome characterized by hematuria, edema, hypertension, and reduced kidney function; and the nephrotic syndrome defined by heavy proteinuria, edema, low serum albumin, and hyperlipidemia. Causes include post-infectious glomerulonephritis, IgA disease, and Henoch-Schonlein purpura. Management involves treating symptoms, monitoring fluid balance and output, and administering steroids or immunosuppressants depending on the underlying disease. Complications can arise if the syndromes are not properly managed.

1. Department of pediatricsDepartment of pediatrics
GLOMERULONEPHRITIS INGLOMERULONEPHRITIS IN
CHIDRENCHIDREN

2. DEFINITION OFDEFINITION OF
GLOMERULONEPHRITISGLOMERULONEPHRITIS
Most important group of
generalized parenchimal
diseases of mainly autoimmune
origin which has similar:
Etiology and pathogenesisEtiology and pathogenesis
Clinical featuresClinical features
Morphology (various histologyMorphology (various histology
patterns)patterns)

3. MAJOR CLINICAL MANIFESTATIONS OFMAJOR CLINICAL MANIFESTATIONS OF
GLOMERULONEPHRITISGLOMERULONEPHRITIS
Acute nephritic syndrome
Nephrotic syndrome
Persistent urinary abnormalities with few or no
symptoms
Chronic glomerulonephritis

4. Pathogenesis of glomerulonephritis

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6. ETIOLOGY OF NEPHRITIC SYNDROMEETIOLOGY OF NEPHRITIC SYNDROME
• Post infectious glomerunephritis
• Ig A-disease
• Henoch-Schon
lein purpura

7. Characteristics of acute nephriticCharacteristics of acute nephritic
syndromesyndrome
HaematuriaHaematuria
OliguriaOliguria
OedemaOedema
 HypertensionHypertension
Reduced glomerularReduced glomerular
filtration rate (GFR)filtration rate (GFR)
 ProteinuriaProteinuria
Fluid overloadFluid overload

8. Features of acute nephritic syndromeFeatures of acute nephritic syndrome
Haematuria is usually macroscopic with pink or
brown urine (like coca-cola)
Oliguria may be overlooked or absent in milder
cases
Oedema is usually mild or is often just peri-orbital-
weight gain may be detected
Hypertension common and associated with raised
urea and creatinine
Proteinuria is variable but usually less than in the
nephrotic syndrome

9. MANAGEMENT ISSUES IN THE NEPHRITICMANAGEMENT ISSUES IN THE NEPHRITIC
SYNDROMESYNDROME
Skin and throat swab
Strep serology
Evaluation of complement
Urea, creatinine, electrolytes, urinalysis
BP
Urine output and daily weight loss
 Fluid and diet management
Treatment of infections

10. COMLICATIONS OF NEPHRITIC SYNDROMECOMLICATIONS OF NEPHRITIC SYNDROME
Hypertensive encephalopathy
(seizures, coma)
Heart failures (pulmonary oedema)
Uraemia requiring hemodialysis

11. NEPHROTIC SYNDROMENEPHROTIC SYNDROME
This is a group of signs and symptoms
seen in patients with heavy proteinuria
Clinical features:Clinical features:
Oedema
Proteinuria >3,5 g/24 hrs (> 0,05 g/kg/24
hrs)
Serum albumen <30 g/l
Hyperlipidemia and hypercoagulable
state

12. Primary glomerular diseases causingPrimary glomerular diseases causing
the nephrotic syndromethe nephrotic syndrome
o Minimal change diseaseMinimal change disease
o Focal and segmental glomerulosclerosisFocal and segmental glomerulosclerosis
o Membranous glomerulonephritisMembranous glomerulonephritis
o Proliferative nephritis:Proliferative nephritis:
o Membrano-proliferativeMembrano-proliferative
 Focal proliferativeFocal proliferative
 Diffuse proliferativeDiffuse proliferative
 Mesangial proliferativeMesangial proliferative

13. Primary glomerular diseases causingPrimary glomerular diseases causing
the nephrotic syndrome (cont.)the nephrotic syndrome (cont.)
Systemic diseases:
Diabetes mellitus
HIV/AIDS
SLE and other connective tissue disorders
Amyloidosis
Nephrotoxic states: NSAIDS, poisoning
Allergic diseases: bee sting, pollens
Circulatory effects: CHF, constrictive
pericarditis
Neoplastic: leukemia, solid tumors

14. MembranoproliferativeMembranoproliferative
glomerulonephritis Type Iglomerulonephritis Type I
MembranousMembranous
glomerulonephritisglomerulonephritis
MembranoproliferativeMembranoproliferative
glomerulonephritis Type IIglomerulonephritis Type II

15. Electron microscopyElectron microscopy
of kidneys inof kidneys in
glomerulonephritisglomerulonephritis
X-ray of healthy kidneys,
ureters, bladder

16. MANAGEMENT OF PATIENTS WITHMANAGEMENT OF PATIENTS WITH
NEPHROTIC SYNDROMENEPHROTIC SYNDROME
Na+ <60 mmol/24 hrs
Water restriction
Diuretics (if no volume depleted)
Reduced protein diet (controversial!!!)
Treatment of infections
Prevention of thrombosis
Specific therapy: corticosteroids,
immunosupression
For minimal change disease: prednisone forprednisone for
16 weeks or prednisone+cyclophosphamide!!!16 weeks or prednisone+cyclophosphamide!!!

17. INDICATIONS FOR HEMODIALYSISINDICATIONS FOR HEMODIALYSIS
• Pericarditis or pleuritis (urgent indication)
• Progressive uremic encephalopathy or neuropathy,
with signs such as confusion, asterixis, myoclonus,
wrist or foot drop, or, in severe cases, seizures
(urgent indication)
• A clinically significant bleeding diathesis attributable
to uremia (urgent indication)
• Fluid overload refractory to diuretics
• Hypertension poorly responsive to antihypertensive
medications
• Persistent metabolic disturbances that are refractory
to medical therapy; these include hyperkalemia,
metabolic acidosis, hypercalcemia, hypocalcemia,
and hyperphosphatemia
• Persistent nausea and vomiting
• Evidence of malnutrition

18. Peritoneal dialysisPeritoneal dialysis HemodialysisHemodialysis