Kaneswaran, L. Pediatric Glomerulonephritis: A rapid review, First10EM, May 22, 2023. Available at:
This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a first-year Family Medicine resident at the University of Toronto. He has a background in medical health informatics and machine learning. His areas of interest include artificial intelligence and machine learning in medicine, and health equity through advocacy and technology.
What is glomerulonephritis?
- Spectrum of inflammatory disorders characterized by hematuria and proteinuria
- Seen as typically asymptomatic proteinuria and hematuria, nephrotic syndrome, hypertension, or impaired renal functioning
What is the pathophysiology?
- Inflammatory process affecting glomerulus. Usually deposition of immune complexes within glomeruli.
- Causes: typically immune-mediated disorders, inherited disorders, post-infectious sequelae
When are we most likely to see pediatric glomerulonephritis?
- Post-streptococcal glomerulonephritis: prior infection with strains of group A B-hemolytic streptococci
- Usually occurs about 7-15 days after pharyngitis and 3-5 weeks after skin infection
How does it present?
- The most common features on history will be bloody or foamy urine, edema, or oliguria. It may also present with headaches, nausea, and fatigue. A recent URTI or skin infection may be a clue.
- The physical exam is often normal. You might identify edema or hypertension.
- Specific causes will have specific findings, such as the palpable purpura, arthritis/arthralgias, abdominal pain of Henoch-Schonlein purpura/IgA vasculitis
What is the work up?
- The key first step is urine testing. A urinalysis might identify hematuria, RBC casts, proteinuria. Urine microscopy may identify dysmorphic RBCs or RBC casts
- Most patients will also have blood work for CBC, creatinine, electrolytes
- It won’t happen in the emergency department, but definitive diagnosis often requires renal biopsy.
- If post-streptococcal glomerulonephritis is being considered, send anti–streptolysin O or anti–DNAse B titers (typically elevated). A serum C3 level (typically decreased) may also help.
What is the treatment?
- Treatment is primarily symptomatic management, with a focus on hypertension, fluid balance, potassium, and phosphate levels.
- Start the patient on a low sodium/phosphate/potassium diet and limit fluid intake.
- Avoid nephrotoxic medications, like NSAIDs
- Therapies considered on a case by case basis include steroids to treat the underlying inflammatory disease, and an ACEi or ARB for hypertension.
What is the prognosis?
- Streptococcal disease or Henoch-Schonlein purpura usually resolves completely and without sequelae, but other causes can progress to renal damage and ultimately end-stage renal failure
- IgA nephropathy can either completely resolve or progress to end-stage renal disease
What is the disposition?
- If asymptomatic with probable streptococcal disease and normal vitals: eligible for discharge after consulting nephrology and outpatient nephrology referral
- If rapid disease progression, consider admission
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