What is the management of a child with acute glomerulonephritis?

  1. Refer the child to hospital if possible.
  2. Oral phenoxymethyl penicillin (penicillin V) 12.5 mg/kg 6 hourly or oral amoxycillin for 10 days to treat the Streptococcal infection.
  3. Restrict the daily fluid intake to 20 ml/kg plus the volume of the previous day’s urine output. It is important to keep a careful check on the fluid intake and output.
  4. Weigh daily to assess fluid status.
  5. Low sodium and low protein diet until the urine output increases (diuresis). Bread, jam, rice, fruit and vegetables with no added salt is a practical diet.
  6. Furosemide (Lasix) 1 mg/kg orally to help increase urine output
  7. Observe the blood pressure every 6 hours.
  8. Check serum urea, creatinine and electrolytes to monitor any renal failure.

Severe hypertension can be treated as an emergency with nifedipine (Adalat)
0.25 mg/kg sublingually (under the tongue). Convulsions can be stopped with rectal diazepam.

Respiratory distress due to pulmonary oedema should be managed with oxygen, furosemide 1 mg/kg intravenously, sitting the patient up and referring to hospital urgently.

Serum C3 complement is classically markedly reduced. The chest X-ray often shows an enlarged heart plus features of pulmonary oedema due to fluid retention. Serum Streptococcal antibodies are usually raised.

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