Chronic glomerulonephritis in children

　　The etiology of chronic glomerulonephritis in children is divided into primary, secondary, and genetic categories.

　　1. Primary

　　Chronic glomerulonephritis can develop from acute nephritis that does not heal, with the progression of inflammation, finally entering the stage of chronic nephritis. Some patients have no obvious symptoms of acute nephritis, the symptoms are hidden, but the inflammation progresses slowly, and some become chronic nephritis after several years.

　　2. Secondary

　　Chronic glomerulonephritis in children can be secondary to systemic diseases such as allergic purpura, systemic lupus erythematosus, diabetes, and others.

　　3. Genetic

　　Genetic nephritis, polycystic kidney disease, and other diseases can induce chronic glomerulonephritis in children.

　　In the later stage, due to renal parenchymal damage, decreased erythropoiesis, and malnutrition, it can develop into renal insufficiency, with symptoms such as hypertension, anemia, and eventually renal failure, and develop into uremia, heart failure, and other complications.

　　Chronic glomerulonephritis in children is divided into nephrotic, hypertensive, and common types. The nephrotic type is mainly manifested by large amounts of proteinuria; the hypertensive type is mainly characterized by severe hypertension. The common type presents with non-specific symptoms. Patients may have symptoms such as pallor, fatigue, and delayed growth and development. At the time of medical consultation, varying degrees of renal function failure have already occurred. A large number of children have an acute onset. Some children with an acute onset progress rapidly, showing symptoms such as edema, hypertension, and oliguria. Renal function continues to deteriorate, and some may die within 1-2 years. Some children may experience a regression of edema, but abnormal urine persists, and they often have recurrent acute attacks after infection or fatigue. Renal function continues to deteriorate, and they may enter chronic renal insufficiency after several years or several decades. Once obvious chronic renal failure occurs, death often occurs within several months to 1-2 years without dialysis and transplantation.

　　The fundamental prevention of primary chronic glomerulonephritis in children is the prevention and treatment of streptococcal infection. In daily life, exercise should be strengthened and skin cleanliness and hygiene should be paid attention to in order to reduce respiratory and skin infections. Once infected, timely and thorough treatment should be given. For chronic glomerulonephritis secondary to systemic diseases such as allergic purpura, active treatment should be carried out.

　　Children with chronic glomerulonephritis present with non-specific symptoms, so chemical examination is particularly important for the diagnosis of the disease. The main examination methods are as follows:

　　First, urine examination

　　Abnormal urine is a common phenomenon in chronic nephritis. The changes in urine volume are related to edema and renal function. Granular casts can be seen in the urine sediment, accompanied by mild to moderate hematuria.

　　Second, renal function examination

　　Most patients with glomerulonephritis have a slightly reduced creatinine clearance rate (Ccr) at the time of consultation, but it does not fall below 50% of the normal value.

　　III. Blood Tests

　　In chronic glomerulonephritis, there is mild anemia when edema is obvious. Renal小球diseases all exist varying degrees of hypercoagulability, which often parallels the severity and activity of the lesions. The reduced activity of antithrombin III (ATIII), the increased thromboxane B2 (TXB2), and the abnormal thromboelastography all indicate the presence of hypercoagulability. Hypercoagulability in glomerulonephritis can be used as an indication for anticoagulation therapy.

　　IV. Renal Biopsy

　　Renal biopsy can determine the pathological type and the severity of the lesions, which is of great significance for treatment and prognosis.

　　V. Kidney Ultrasound

　　Ultrasound can understand the size and cortex thickness of the kidneys.

　　Children with chronic glomerulonephritis should limit protein, salt, and water intake according to changes in renal function. Those with oliguria should also limit high-potassium diet. For cases with anemia, foods rich in protein and iron, such as animal liver, beef, egg yolks, and green leafy vegetables, should be selected. When renal function declines and serum creatinine increases, residual renal function should be preserved, and a low-protein diet should be given. It is necessary to choose high-biological-value protein foods such as eggs, milk, and meat to supplement the loss of excretion. The diet should be moderate in temperature, and it is best to choose slightly warm or cool foods.

　　Chronic glomerulonephritis in children not only severely affects the daily life of children, but also may develop other diseases after long-term illness. Therefore, once the disease is diagnosed, it should be treated in a timely manner. The main treatment methods are as follows:

　　1. General Treatment

　　Children should avoid infection and overexertion, pay attention to rest. A low-salt, low-protein diet should be adopted in daily life. Avoid using nephrotoxic drugs.

　　2. Symptomatic Treatment

　　For infections, choose effective antibiotics with low nephrotoxicity and rationally select antihypertensive drugs and diuretics.

　　3. Application of Hormones and Immunosuppressants

　　Long-term oral prednisone can improve clinical symptoms and delay the progression of the disease. For patients resistant to hormones, cyclosporine combined with a small amount of hormones (30mg/m2 every other day) can achieve certain efficacy.

　　4. Anticoagulation Therapy

　　Anticoagulant drugs include heparin anticoagulants, fibrinolytic drugs, and dipyridamole (Persantin) and others.