Chronic Glomerulonephritis

The most common chronic glomerulonephritis in children include:
 * IgA nephropathy (Berger's glomerulonephritis) - most common;
 * Mesangioproliferative glomerulonephritis without IgA deposits;
 * Membranoproliferative glomerulonephritis;
 * Glomerulonephritis in systemic diseases accompanied by nephrotic syndrome.

IgA nephropathy

 * IgA-mesangioproliferative glomerulonephritis, IgA nephropathy
 * immunocomplex nephritis - IgA globulin deposits (demonstrated by immunofluorescence assay of renal biopsy);
 * in school children and adolescents, more often in boys;
 * pathogenesis: impaired immunoregulation with increased IgA production → mesangial deposits of IgA immunocomplexes;
 * clinical picture: incidental findings of microscopic haematuria or episodes of macroscopic haematuria in upper respiratory tract infections;
 * mild proteinuria (0.5-1 g/day), nephrotic syndrome is not typical; about half of cases have elevated serum IgA;
 * diagnosis: biopsy - mesangioproliferative glomerulonephritis, immunofluorescence testing for IgA deposits (+IgG and C3C); focal and segmental glomerular involvement;
 * therapy: no causal treatment; eradication of sources of bacterial infection, in proteinuria ACE inhibitors or angiotensin receptor blockers;
 * prognosis: some have a benign course, some are at risk of progression to chronic kidney disease - dispensary required.

Membranoproliferative glomerulonephritis

 * mesangiocapillary GN, persistent hypocomplementary GN
 * chronic mesangioproliferative glomerulonephritis with dense deposits within the basement membrane;
 * uncommon in children, pathogenesis is unclear;
 * clinical picture: development of hematuria and proteinuria, nephrotic syndrome; decreased complement levels;
 * diagnosis: biopsy - intramembranous deposits on electron microscopy;
 * therapy: no causal treatment; corticosteroids for rapid progression;
 * prognosis: poor - progression to terminal chronic renal failure within 5-8 years.

Membranous nephropathy

 * in adults the most common cause of nephrotic syndrome; rare in children;
 * pathogenesis: immunocomplex disease - diffusely thickened glomerular membrane, inclusions from immune complexes (IgG and C3);
 * clinical picture: nephrotic syndrome (manifestation mostly in the 2nd decade); microhematuria, proteinuria, hypoalbuminemia;
 * diagnosis: biopsy (histology and immunofluorescence);
 * therapy: salt restriction, diuretics, possibly immunosuppressants.

Glomerulonephritis in Henoch-Schonlein purpura

 * Henoch-Schönlein purpura is a vasculitis that affects small blood vessels of the skin and gastrointestinal tract; in 25-50%, the kidneys and, rarely, the CNS are also affected;
 * renal involvement is focally segmental and resembles IgA nephropathy;
 * clinical picture: 1-2 weeks after seeding of petechiae, microscopic haematuria and proteinuria, rarely nephrotic; rarely in the form of rapidly progressive glomerulonephritis;
 * therapy: corticosteroids - controversial;
 * prognosis: good, microscopic haematuria often persists.

Glomerulonephritis in SLE

 * severe and frequent complication of SLE;
 * systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease caused by B-cell hyperactivity, autoantibody production against components of the cell nucleus, and immune complex deposition;
 * clinical picture: hematuria and proteinuria, nephrotic syndrome, early glomerular filtration disorder, rapidly progressive severe glomerulonephritis;
 * diagnosis: biopsy (histology, immunofluorescence - positive Ig, complement, fibrinogen)
 * therapy: corticosteroids, cyclophosphamide, possibly immunosuppressants.

Goodpasture syndrome

 * a combination of pulmonary hemorrhage and glomerulonephritis due to the production of antibodies against the pulmonary alveoli and glomerular basement membrane;
 * very rare in children;
 * biopsy picture of rapidly progressive glomerulonephritis; evidence of anti-GBM antibodies in serum; poor prognosis.

Related articles

 * Glomerulonephritis: Acute Glomerulonephritis - Rapidly progressive glomerulonephritis (RPGN)
 * Light chain deposition disease
 * Glomerulopathy
 * Acute renal failure - Acute renal failure (paediatrics) - Chronic kidney disease - Chronic kidney disease (paediatrics)