About treatment
Many children with glomerulonephritis do not need any treatment, but will be monitored by a healthcare team. Some children need to make changes to what they eat or drink, or take medicines – for example, to control their blood pressure, reduce swelling in their body or treat infections.
Some types of glomerulonephritis are caused by problems with the immune system. These children may need to take medicines that suppress the immune system, or make it less active.
A small number of children will need further treatment if their kidney function gets worse, such as medicines or dialysis, which uses special equipment to remove waste from the body.
If another condition is causing glomerulonephritis, this will be treated.
It is important that your child follows any treatment plan outlined by your doctor.
Where will my child be treated?
Your child will be looked after by a paediatrician, a doctor who treats babies, children and young people. Your child may be referred to a paediatric renal unit, a specialised unit that treats babies, children and young people with kidney conditions and may be in a different hospital to your own. He or she will be looked after by a team, including a paediatric nephrologist, a doctor who treats children with kidney problems.
Visiting the hospital during the day
Most children with glomerulonephritis have care as outpatients. This means that they visit the hospital during the day and can go home.
Staying in hospital
Children with serious glomerulonephritis or complications may need to be treated in hospital. This is usually needed if:
- your child has severe oedema, especially if there is a lot of fluid around their lungs that makes them breathless
- your child has very high blood pressure (hypertension)
- your child’s kidneys have stopped working properly – this is called acute kidney injury
- your child needs to take medicines, but is not able to take them.
Read more about what happens in hospital stay and the healthcare team
A team of healthcare professionals will:
- check your child’s kidney function (how well his or her kidneys are working)
- measure how much your child is drinking and how much urine he or she is passing
- test your child’s urine with a dipstick
- check your child’s blood pressure
- weigh your child to help find out if he or she has too much or too little fluid in their body.
Your child’s healthcare team may include:
- paediatric nephrologist – a doctor who treats children with kidney problems
- radiologist – a healthcare professional who uses imaging tests to help identify a condition
- renal nurse – a nurse who cares for children with kidney problems
- paediatric dietitian – a professional who advises what your child should eat and drink during different stages of a kidney condition
- renal social worker – a professional who supports you and your family, especially with any concerns about money, travel and housing related to looking after your child with kidney disease
- renal psychologist – a healthcare professional who supports your child and family, especially with emotional stresses and strains from having or look after a child with kidney disease
- play specialist – a professional who uses dolls and other toys to help your child prepare for procedures, such as blood tests
Changes to eating and drinking
Your child may need to make temporary changes to what they eat – for example, less salt and less of certain foods. He or she may also need to drink less fluid, such as water, squash and soft drinks.
Your doctor, nurse or a paediatric dietitian will help you and your child make these changes.
Treating complications
Controlling blood pressure
Children with glomerulonephritis may have high blood pressure (hypertension). Their blood pressure will need to be controlled so it is in a healthy range.
If your child has hypertension, he or she may need to change what they eat and drink. Some children need to take medicines.
Reducing oedema
Very occasionally, children with glomerulonephritis need to take diuretics, medicines that help reduce oedema.
Diuretics work on the kidneys to increase the amount of water and salt they remove from the body in urine. If your child is taking diuretics, he or she will need to go to follow-up appointments. Your doctor will examine your child for oedema and measure his or her weight. This helps find out how well the medicine is working.
Common diuretics are: furosemide, spironolactone and metolazone. Some of the other diuretics that may be used are: amiloride, bendroflumethiazide and chlorothiazide.
Suppressing the immune system
Some types of glomerulonephritis are caused by a problem with the immune system, which normally protects the body against disease and infection. Medicines may be used that suppress the immune system – they make it less active so it does not harm the kidneys. These medicines are called steroids and immunosuppressants. They are usually taken by mouth – as tablets, capsules or liquid medicine.
Your doctor will work out the amount of medicine (the dose) that is right for your child. The dose will be shown on the medicine label.
It is important that you follow your doctor’s instructions about when and how much to give. Continue to give the medicine to your child as your doctor has told you, even if he or she is getting better.
Read more about about giving steroids and immunosuppressants
Vaccines
It is important that your child has the vaccines (immunisations) that he or she needs to reduce the risk of some diseases. Speak with your doctor about these – some vaccines are not safe to give while a child is taking steroids or immunosuppressants.
Your child should have the flu vaccine each year.
Infections
Children taking these medicines are more likely to get infections. Speak with your doctor or nurse, and your child’s teacher or daycare manager, about how you can help prevent infection. Contact your doctor straight away if your child:
- has been in contact with someone who has chicken pox (if they have not had this illness before) or measles (if they have not had the MMR vaccine, which protects against measles, mumps and rubella); or
- is unwell and you are worried about an infection.
If your child does get an infection, he or she may need to take an antibiotic medicine, which kills the germs that cause infection. Your child must take the medicine for the number of days that the doctor has told you, or until all of the medicine has been taken.
Side-effects you need to something about
We use medicines to help children get better, but sometimes they have side-effects.
Contact your doctor straight away if your child has:
- a fever (temperature above 38°C), with a sore throat or a cough
- a rash or severe bruising
- bad stomach pain or repeated vomiting sometimes steroids can cause ulcers in the stomach
Other side-effects
Other side-effects that affect some children are below – speak with your doctor or nurse if you are concerned or need more support:
- nausea, vomiting, stomach pain and/or indigestion (heartburn) due to irritation to the lining of the stomach – your doctor may give your child some medicine to treat this
- behavioural problems – you may find that your child is more likely to have tantrums, be moody, feel depressed, have difficulty sleeping or have nightmares
- weight gain and larger appetite – you can help by making sure your child has lots of physical activity and eats fruits, vegetables and low-calorie food, rather than food that is high in calories (such as cakes, biscuits, sweets and crisps), and by reducing the portion size
- high blood pressure (hypertension) – your child’s blood pressure will be regularly checked, and if it is too high, will need to be controlled by eating a no-added salt diet or taking medicines.
There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor.
Side-effects if steroids taken over a long time or in high doses
- Steroids can slow growth and affect puberty. They can also cause growth of body hair and irregular periods in girls. Your doctor will check your child’s growth and development. If you have any concerns, talk to your doctor.
- All steroid medicines, including prednisolone, may affect the adrenal glands so that they produce less of a hormone called cortisol when the body is stressed (e.g. during illness or injury). This means that your child may have more difficulty fighting off an infection, or may recover less quickly from injury or after surgery. If your child is unwell and you are worried about an infection, contact your doctor straight away.
- Your child’s skin may become thinner, and heal more slowly than usual. Acne (spots) may become worse, or your child may develop mouth ulcers or thrush (candidiasis). If you are concerned, contact your doctor.
- Your child may develop problems with their hip bones, or their bones may become weaker (osteoporosis). The muscles around their hips and shoulders may also become weaker. If your child has any difficulty walking or moving around, contact your doctor.
- Occasionally, steroids cause diabetes. If your child seems more thirsty than normal, needs to pass urine (wee) often, or starts wetting the bed at night, contact your doctor
Plasma exchange
Antibodies are proteins that are part of the immune system and, in some types of glomerulonephritis, they harm the kidneys. Plasma exchange, which is also called plasmapheresis, is a procedure that removes antibodies from the blood. It may be used if your child’s glomerulonephritis is getting worse.
Read more about plasma exchange
Plasma is the liquid or watery part of blood. It helps carry blood cells, protein and other substances around the body. Plasma exchange is a procedure that removes antibodies that are harming your child’s kidneys from their blood. Each plasma exchange takes about 2–3 hours and is done in hospital. Children will usually need more than one exchange.
- A catheter, which is a flexible tube, is inserted into one of the large veins in their neck. Your child’s blood is taken from their body through the catheter.
- Using special equipment, your child’s blood is separated into two parts: their plasma and some other substances, including the harmful antibodies; and their blood cells.
- Your child’s blood cells are added to a plasma substitute – this is either plasma or a protein called albumin from a donor.
- This is returned to your child's body through the catheter.
- As blood is taken from your child and returned to them at the same rate, only a small amount of blood is outside their body at any time.
Your child’s doctor or nurse will give you more information about plasma exchange and how you and your child can prepare for it.
Managing reduced kidney function
For some children, the kidneys do not work as well as normal during this illness – they have reduced kidney function. The severity of this varies, but most do not need any special treatment and their kidney function will return to normal.
A very small number will have more serious kidney problems and will need further treatment. This may include dialysis, which uses special equipment or a machine to ‘clean’ the blood, removing waste products and extra water and salts..
Questions to ask the doctor or nurse
- What treatment will my child need?
- How will this help my child?
- How can I help my child prepare for procedures and treatments?
- If the first treatment does not work in my child, what happens next?
- How will I know if we need to go back to the hospital or see the doctor?
- Will the glomerulonephritis come back? How will I know?
Your healthcare team will speak with you and your child about any long-term effects your child might have with glomerulonephritis.
Most children fully recover from this disease. Some will need further care.
Follow up
Children who have been treated for glomerulonephritis have follow-up appointments throughout their childhood. It is important to go to these appointments even if your child seems well. You will also have the opportunity to ask any questions. At these appointments, your child may have:
- his or her height and weight checked
- a physical examination
- urine tests – to check for blood, protein and other substances in his or her urine
- blood tests – to check for the amount of protein and other substances in his or her blood, and measure his or her kidney function
- his or her blood pressure measured.
Long-term effects
Mild disease
For many children with glomerulonephritis, the disease is quite mild and they will get better after treatment. When the disease goes away, this is called remission. These children will usually have no more kidney problems in childhood.
Further care
If your child needs more treatment, or if their glomerulonephritis keeps coming back, your doctor will monitor them over a long period of time. If the glomerulonephritis is caused by another condition, this will need to be treated.
Acute kidney injury
Children with glomerulonephritis are at risk for acute kidney injury (AKI) – when the kidneys suddenly stop working. Some children with AKI get better after a few weeks, and some need to take medicines or have more intensive treatment.
Long-term problems
A few children develop long-term problems with their kidneys. Their kidneys stop working as well as they should – this happens slowly, often over many years. This is called chronic kidney disease (CKD). These children may need further care. They will need to go back to the hospital or clinic for regular follow-up appointments.
If this happens to your child, you will learn more over time about how to help manage the condition, and what to expect.
Impact on your child and your family
Children who have been successfully treated for glomerulonephritis can usually do the things that other children their age do. They should be able to continue going to school or nursery. They can play with other children and stay active.
Living healthily
Your child can help protect his or her kidneys by leading a healthy lifestyle through their child and adult years. This includes:
- eating a healthy diet – with at least five servings of fruit and vegetables a day, taking care not to eat too much salt, sugar and fats (especially saturated fats)
- getting plenty of exercise
- not smoking.
If you have any concerns or need additional support, speak with your doctor or nurse.