Evaluation of a child with glomerular disease
- Patrick Niaudet, MD
Patrick Niaudet, MD
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Hôpital Necker-Enfants Malades, Paris, France
There are numerous causes of glomerular diseases in children. Many of these conditions vary in their presentation with mild or no symptoms, to serious renal disease with life-threatening complications. As a result, the diagnosis of a specific glomerular disease is challenging in children but important so that therapy, if helpful and needed, can be initiated.
The diagnostic evaluation of children with glomerular disease will be reviewed here. The evaluation of children with nonglomerular causes of isolated hematuria or proteinuria is discussed separately. (See "Evaluation of microscopic hematuria in children" and "Evaluation of gross hematuria in children" and "Evaluation of proteinuria in children".)
Numerous primary (renal disease alone) and secondary (due to systemic autoimmune disorders, vasculitis, or infection) disorders produce glomerular disease (table 1).
Findings suggestive of a glomerular disease include proteinuria, hematuria (which may be microscopic or macroscopic), nephrotic syndrome, arterial hypertension, and renal insufficiency. The presence of these manifestations and their severity can be used to describe several different clinical patterns that often correspond to different underlying etiologies.
●An acute nephritic syndrome pattern is associated with active urine sediment with red cells, white cells, granular and often red cell and other cellular casts, and a variable degree of proteinuria including nephrotic range proteinuria, and often elevated blood pressure. Histologic examination demonstrates inflammation. This pattern is most often seen in children with poststreptococcal glomerulonephritis, but may also be secondary to a membranoproliferative glomerulonephritis. (See "Overview of the pathogenesis and causes of glomerulonephritis in children" and "Poststreptococcal glomerulonephritis".)
- Srivastava T, Alon US, Althahabi R, Garg U. Impact of standardization of creatinine methodology on the assessment of glomerular filtration rate in children. Pediatr Res 2009; 65:113.
- Schwartz GJ, Muñoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20:629.
- Madaio MP, Harrington JT. The diagnosis of glomerular diseases: acute glomerulonephritis and the nephrotic syndrome. Arch Intern Med 2001; 161:25.