Glomerular hematuria in children.
Obvious sign of glomerular hematuria in children is a brown color of urine, proteinuria, dysmorphia erythrocytes or erythrocyte cylinders. For the final confirmation of the diagnosis of glomerular hematuria appoint kidney biopsy. The initial assessment includes determining the concentrations of complement in serum titer anti-streptolysin 0, fluorescent titer antinuclear antibodies, serological markers of hepatitis B and anti-neutrophil cytoplasmic antibody.
Glomerular pathology with low complement in the plasma is acute postinfectious glomerulonephritis (post-streptococcal acute glomerulonephritis, chronic infections such as subacute bacterial endocarditis, hepatitis B with infected ventriculo-atrial or ventriculo-peritoneal shunt, infectious mononucleosis and malaria), systemic lupus erythematosus (SLE ) and membrane-proliferative glomerulonephritis. Post-streptococcal acute glomerulonephritis is the most common form of glomerulonephritis in a subgroup of children with a low concentration of complement.
This type of disease is usually spend short time for a full resumption of kidney function. It occurs within 7-30 days after have treatment the throat or skin infections provoked by beta-hemolytic streptococcus group A. Titers antistreptolysin 0 or streptozim are elevated in most children for about six weeks, whereas decreased levels of complement normalized eight weeks. Hematuria can be kept for several months. In the absence of clearly defined clinical acute phase of post-streptococcal acute glomerulonephritis, the disease is difficult to diagnose without a kidney biopsy. A small percentage of children with post-streptococcal acute glomerulonephritis has a rapid progressive course, which can become chronic renal failure (CRF), hypertension, proteinuria, or azotemia. However, children with secondary progressive glomerulonephritis after acute post-streptococcal kidney injury often recover when used a good maintenance therapy.
Children with membranoproliferative glomerulonephritis sometimes have microscopic hematuria, but most of them have nephrotic syndrome. Approximately 75% of children with membranoproliferative glomerulonephritis constantly have low concentration complement in serum. Despite the use of prednisolone, within 5-10 years renal failure can occur.
SLE in children can manifest itself only hematuria or acute glomerulonephritis, nephrotic syndrome, but sometimes it is not accompanied by renal failure. Test results confirm that the low concentrations of complement in the serum and an increase in titer of antinuclear antibodies can be. In children with significant proteinuria and azotemia – renal biopsy is performed to determine the severity of the disease and treatment planning. The use of prednisone or intravenous cyclophosphamide is indicated for the most severe histological forms of SLE.
lgA nephropathy is the most A common form of chronic glomerulonephritis in children of European and Asian descent. Approximately 15% of children with isolated hematuria persistence of more than 12 months have lgA-nephropathy. Usually during viral respiratory disease or gastrointestinal disease occurs episode of severe hematuria, which is the cause of in-depth examination and a kidney biopsy. Immunofluorescence microscopy is reveal a dense mesangial deposits, which are mainly lgA. Recent long-term monitoring of children with lgA nephropathy is found that about 25% of patients with an established diagnosis of childhood have a stable disease progression with the development of chronic renal failure.