How to Effectively Treat Glomerulonephritis in Children: A Comprehensive, Evidence-Based Approach

Glomerulonephritis in children is not a single disease—but rather a group of immune-mediated kidney disorders affecting the glomeruli, the tiny filtering units of the kidneys. Accurate diagnosis and timely, individualized treatment are essential to prevent long-term complications such as chronic kidney disease or hypertension. Understanding the underlying cause—whether post-infectious, autoimmune, or systemic—is the cornerstone of effective management.

Understanding the Most Common Type: Post-Infectious Acute Glomerulonephritis

The majority of pediatric cases fall under acute post-streptococcal glomerulonephritis (APSGN), typically triggered 1–3 weeks after a streptococcal throat or skin infection. Fortunately, this form is usually self-limiting, meaning it resolves spontaneously in most children without permanent kidney damage. However, close clinical monitoring remains critical during the acute phase.

First-Line Supportive Care Strategies

Rest and fluid balance form the foundation of initial therapy. Children are advised to limit physical exertion until hematuria and edema improve. Dietary sodium restriction helps reduce fluid retention, while careful fluid intake management supports natural diuresis. In cases of significant edema or hypertension, short-term use of loop diuretics (e.g., furosemide) may be prescribed to promote urine output and relieve swelling.

Managing Complications: Hypertension and Acute Kidney Injury

Approximately 60–70% of children with acute glomerulonephritis develop transient hypertension—often due to fluid overload and renin release. First-line antihypertensives include calcium channel blockers (e.g., amlodipine) or ACE inhibitors, chosen for their renal-protective properties and safety profile in pediatrics. If serum creatinine rises significantly or urine output drops sharply—signaling acute kidney injury (AKI)—urgent nephrology consultation is warranted. While dialysis is rarely needed (<5% of cases), it becomes life-saving in severe anuria, refractory hyperkalemia, or symptomatic uremia.

When Glomerulonephritis Is Secondary: Recognizing Systemic Causes

A smaller but clinically important subset of pediatric glomerulonephritis arises from systemic conditions—most notably IgA vasculitis (formerly Henoch-Schönlein purpura) and systemic lupus erythematosus (SLE). These require dual-targeted treatment: controlling both the underlying disease and its renal manifestations.

Tailored Therapy for IgA Vasculitis–Associated Nephritis

In children with purpuric rash, abdominal pain, and arthralgia alongside hematuria or proteinuria, renal biopsy often reveals IgA-dominant immune deposits. Mild cases may only need supportive care. But those with nephrotic-range proteinuria, rising creatinine, or crescentic changes on biopsy benefit from oral corticosteroids—and sometimes adjunctive immunosuppressants like mycophenolate mofetil or cyclophosphamide in severe or steroid-resistant forms.

Addressing Lupus Nephritis in Young Patients

Lupus nephritis in children demands early, aggressive intervention. Treatment follows evidence-based protocols—starting with high-dose corticosteroids combined with either mycophenolate mofetil or low-dose intravenous cyclophosphamide, followed by long-term maintenance therapy. Regular monitoring of complement levels (C3/C4), anti-dsDNA antibodies, and urinary biomarkers helps guide treatment adjustments and predict flares.

Why Early Referral to Pediatric Nephrology Makes a Difference

While many cases resolve spontaneously, subtle signs—like persistent microscopic hematuria beyond 6 months, unexplained proteinuria, or abnormal growth patterns—warrant specialist evaluation. A pediatric nephrologist can determine whether a kidney biopsy is indicated, interpret complex serologic results, and design a personalized follow-up plan that includes blood pressure tracking, urine albumin-to-creatinine ratio monitoring, and age-appropriate patient education.

With prompt recognition, targeted interventions, and multidisciplinary support, the vast majority of children with glomerulonephritis achieve full recovery and maintain normal kidney function into adulthood. Parents play a vital role—not just in adherence, but in advocating for timely care and understanding the importance of long-term surveillance—even after symptoms subside.