ACUTE GLOMERULONEPHRITIS

Acute glomerulonephritis occurs frequently in children as a result of the delayed hypersensitivity reaction initiated by infectious agents like streptococci, often identified as causing tonsillitis or scarlet fever 1-2 weeks before the disease develops.

The manifestations of the disease may vary from mild to severe and the intensity of the manifestations usually parallel the degree of renal structural and functional involvement. The disease may be characterized by hematuria and albuminuria (due to the damage of the renal filtering mechanism) resulting in a cloudy urine; edema and hypertension (as a result of circulatory congestion because of damaged blood vessels in the kidney) and anemia (as a result of hemodilution caused by the edema) and a diminished output of urine or oliguria causing retention of waste products (as a result of reduced glomerular filtration rate). Nausea and vomiting are also observed.

A great majority of the patients recover completely; 5-10% progress to nephritic syndrome and chronic nephritis.

Treatment

The treatment of acute glomerulonephritis consists of management based on physiologic or biologic principles of individual symptoms and manifestations.

Medical Treatment

1. Short periods of hospitalization or bed rest are recommended during the early phase.

2. If infection is present, penicillin administration is recommended.

3. Digitalis is of value only if renal function is greatly reduced and if excess fluid and salt cannot be excreted.

4. Anti-hypertensive drugs may be used if hypertension is severe.

5. In some cases, where hyperkalemia is a problem, artificial kidney dialysis may have to be used as a life-saving device.

Dietary Management

If nausea and vomiting are present, a diet adequate in all nutrients will be difficult to provide. Calories in the form of sweetened fruit juices, sweetened tea and hard candies should be supplied to minimize tissue catabolism. As the condition improves, the following are suggested:

ENERGY. The caloric needs of the patient should be provided by carbohydrate and fat to spare

the tissues from being used up as a source of energy.

PROTEIN. Many clinicians are still a disagreement whether to restrict or not to restrict protein. If

there is nitrogen retention, since the waste products of protein breakdown cannot be

excreted, protein is restricted to 0.5 gm protein per kilogram body weight or about 30

grams per day for adults. If a need for protein restriction arises in children, an amount of

50% of the recommended dietary allowances (RDA) is suggested. When there is marked

proteinuria, protein intake should be increased to compensate for protein lost in the

urine. In which case, protein sources in the diet should come chiefly from sources of

high biologic value.

SODIUM. About 1 gram sodium per day is recommended. This is necessary when edema is present

as a result of the adrenal stimulation and also to prevent dangers of hypertension,

congestive heart failure and pulmonary edema.

POTASSIUM. One gram per day restriction is necessary if there is potassium retention the degree of

which is roughly proportional to the urine output.

FLUID. When the water excretory function of the kidney becomes limited, excess intake of fluid

will result in more edema. In mild cases, fluid restriction is not necessary. In severe

cases, the amount given in 500cc (insensible fuid loss) plus the amount of urine passed

in the previous 24 hours. Larger amounts may be necessary if there is vomiting, diarrhea

or excessive perspiration.

As soon as the edema is reduced, the blood pressure lowered, and the urine output increased, a normal diet may be provided.

A daily food plain for a nine year old child weighing 24 kg is presented below. The sample menu contains 1900 calories, 37 gm protein, 1 gm sodium and 1.1 gm potassium.

FOOD EXCHANGE LIST

CHO PRO FAT CALORIES

(gm) (gm) (gm)

Whole milk – 1 cup 12 8 10

Meat, fish, poultry – 1 each - 8 4

(egg, 2-3 x a week)

Rice – 10 exch – 7 exch, grp I 161 14 -

(unsalted)

-3 exch, grp II 69 6 -

(ordinary)

Fat – 10 tsp – 5 exch unsalted - - 25

- 5 exch ordinary - - 25

Vegetables – 2 exch, grp I 3 1 -

Fruits – 2 exch, grp I 20 - -

Sweets – 7 tsp 35 - -

MEAL PLAN

No salt in the preparation and on the table.

Breakfast

Fruit cocktail – ½ cup (no syrup)

Omelet w/ potato – 1 tbsp egg

Bread, ordinary – 3 slices

butter – 2 tsp

jam – 1 tsp

Milk – ½ cup

Sugar – 1 tsp

Lunch

Lean pork tinola – 1” cube

w/ sayote – ½ cup

fat – 1 tsp

Rice – 1 cup

Kaimito – 1 pc

Cornstarch pudding using

cornstarch – 2 tbsp

coconut milk – 1 tbsp

sugar – 1 tsp

Dinner

Upo picadillo

pork – 1 tbsp

upo – ½ cup

fat – 2 tsp

Rice – 1 cup

Cream pudding

milk – 4 oz evap

sugar – 2 tsp

cornstarch – 2 tbsp