Pediatric chronic glomerulonephritis

　　1. Etiology

　　The etiology of pediatric chronic glomerulonephritis is complex, mostly caused by recurrent infections with bacteria, viruses, etc., leading to immune complex nephritis.

　　2. Pathogenesis

　　Most renal pathological changes are mild, presenting as focal nephritis or mesangial proliferative nephritis without crescent formation. Only a few cases show severe pathological changes such as membranous or membranous proliferative nephritis.

　　A small number of cases may develop into chronic nephritis. Chronic glomerulonephritis can occur at any age, but it is mainly seen in young and middle-aged males. The onset and clinical manifestations are diverse. Most cases present with insidious and gradual onset, with hematuria, proteinuria, hypertension, and edema as their basic clinical manifestations. Generally speaking, those with abnormal urinalysis (hematuria, proteinuria, cylinder urine), edema, and a history of hypertension should consider this disease, regardless of whether there is renal function damage. Renal biopsy pathological examination can confirm the diagnosis and is beneficial for guiding treatment and judging the prognosis. Early chronic nephritis should be treated according to its pathological type, inhibiting immune-mediated inflammation, inhibiting cell proliferation, and reducing kidney sclerosis.

　　It often manifests as persistent proteinuria without significant clinical symptoms accompanied by microscopic hematuria. Most patients complain of slight edema of the eyelids upon waking up, and symptoms may temporarily worsen when tired or infected. Some patients are asymptomatic and only detected microscopic hematuria and proteinuria during urine screening, with occasional edema, no hypertension, normal renal function. Some cases have a relatively clear history of acute nephritis, but urinary abnormalities persist for more than 1 year; in addition, there are some patients with concealed onset, sometimes discovered incidentally, the course of the disease is often difficult to estimate, but after follow-up observation for more than half a year, the pathological changes of persistent glomerulonephritis are generally non-specific focal nephritis or simple mesangial proliferative nephritis; a very few cases are more severe pathological types, such as membranous or membranoproliferative nephritis.

　　Prevent and control infections, arrange time reasonably, avoid overexertion, and take preventive measures similar to acute nephritis, such as actively preventing and treating streptococcal infection. Daily exercise should be strengthened, and attention should be paid to skin cleanliness and hygiene to reduce respiratory and skin infections. In case of infection, it should be treated promptly and thoroughly. Urinalysis, blood routine, and ultrasound monitoring should be conducted 2 to 3 weeks after infection to detect any abnormalities in a timely manner.

　　Urine routine examination shows red blood cells (+～++), protein (+～++), and a few granular casts can be seen. Renal function is generally normal, complement and urinary fibrinogen are normal. Ultrasound, electrocardiogram, and X-ray examination generally show no special findings.

　　1. Limit protein intake

　　Acute glomerulonephritis develops within 3 to 6 days, with a decrease in glomerular filtration rate, which may produce transient azotemia. Therefore, protein intake should be limited, and efforts should be made to choose high-quality protein foods within the limited range, such as milk, eggs, lean meat, and fish. When the condition improves and urine output increases, with daily urine output greater than 1000 milliliters, protein intake can be gradually increased, but not more than 0.8 grams per kilogram of body weight per day. A low-protein diet requires that daily protein intake be between 30 and 40 grams, and less than 0.5 grams per kilogram of body weight. Recovery to normal protein intake can be gradually achieved after 2 to 3 months of stable condition.

　　2. Low-salt and low-sodium diet

　　Patients with edema and hypertension should adopt a low-salt, salt-free, or low-sodium diet. A low-salt diet generally uses less than 3 grams of salt or 10 to 15 milliliters of soy sauce per day. Foods high in salt should be avoided, such as pickled vegetables, sauerkraut, salted eggs, preserved eggs, cured meat, seafood, salted skin, and dried noodles, etc. Salt-free diet is cooking without adding salt or soy sauce. In addition to avoiding the above foods high in salt, sugar, vinegar, sesame paste, and ketchup can be used for seasoning. A low-sodium diet is to limit foods and vegetables high in sodium, in addition to not adding salt or soy sauce during cooking. Foods high in sodium should also be restricted, such as steamed buns, cakes, cookies, and dried noodles made with baking powder or alkali. Vegetables containing more than 100 milligrams of sodium per 100 grams should be avoided. The daily intake of sodium should not exceed 500 milligrams in the whole-day diet.

　　3. Limiting High-Potassium Foods

　　When oliguria, anuria, or elevated blood potassium levels occur, the intake of vegetables and fruits rich in potassium should be limited, such as soybean sprouts, scallion, green garlic, celery, cauliflower, toon, spinach, bamboo shoots, bamboo shoots, lily, dried red dates, fresh mushrooms, seaweed, sauerkraut, Sichuan winter vegetables,玉兰片, winter mushrooms, apricot, lotus root, sorghum, corn, lima beans, tomato, luffa, bitter melon, etc.

　　4. Limiting Fluid Intake

　　The intake of fluids should be controlled according to the amount of urine excreted each day. The general method of supplementation is to intake an additional 500 to 1000 milliliters of fluid, in addition to supplementing the urine volume excreted the previous day. If the urine volume is low or accompanied by edema, the daily fluid intake should not exceed 1000 milliliters.

　　5. Supplying Appropriate Energy and Fat

　　Patients with acute glomerulonephritis should rest in bed, but the heat energy should not be too high, and the fat content should not be too much, with an adult daily intake of about 105 kilojoules to 126 kilojoules (25 kcal to 30 kcal) per kilogram of body weight. The main source of energy is starch and fat, accounting for more than 90% of the total energy. It is recommended to consume more oils rich in polyunsaturated fatty acids, that is, to use vegetable oils mainly.

　　6. Supplying Sufficient Vitamins

　　Due to the restriction of foods containing a lot of potassium, the intake of vegetables and fruits should be reduced, and the intake of vitamins is significantly reduced, which is easy to cause vitamin deficiency. Various vitamin preparations should be supplemented, especially vitamin C is beneficial to allergic reactions, and should not be less than 300 milligrams per day.

　　1. Treatment

　　The key is to avoid fatigue and prevent infection. Injection prevention should also be avoided. If there are recurrent infection foci (such as dental caries, chronic tonsillitis, etc.), they should be cleared, and general medication is not required. Some people believe that traditional Chinese medicine treatment can help improve microscopic hematuria and proteinuria, and can try to use tripterygium wilfordii, dipyridamole (Panangin), hormones, immunosuppressants, and other drugs. At the same time, regular follow-up should be conducted to prevent the development of chronic nephritis.

　　2. Prognosis

　　Most chronic nephritis has a good prognosis; if it develops into chronic nephritis, the prognosis is poor.