Patient's question:
How is acute nephritis treated? How can one go to school?Doctor's answer:
Okay, here is the English translation of the provided text, following your instructions:I. Rest is important in children with acute nephritis
1) Within the first 2 weeks of onset, children should rest in bed. Mild activity is only allowed after edema disappears, blood pressure returns to normal, and gross hematuria disappears.
2) Activity should be limited for 1-2 months after the illness, and strenuous activity should be avoided for 3 months. School can be attended once the number of red blood cells in the urine decreases and the erythrocyte sedimentation rate returns to normal, but sports activities should be avoided.
3) After the number of red blood cells in the urine returns to normal, return to normal daily activities.
II. Diet for children with acute nephritis varies depending on the condition
Generally, a low-salt diet with high sugar, high vitamins, and moderate protein and fat is provided.,,. to ensure the child's growth and development needs. 1) In the early stages of the illness, if the child has edema, high blood pressure, and little urine, a salt-free diet should be chosen. To adjust the taste, some salt-free soy sauce can be added. 2) If the edema subsides, a low-salt diet can be adopted, consisting of half salt-free vegetables and half normally salted vegetables. Combined, this makes a low-salt dish. Steamed buns made with soda dough are also considered salt-containing food and should not be given to the child. 3) When there is edema and little urine, fluid intake should also be limited. 4) When there is little urine, nitrogenous waste products and potassium are not easily excreted from the body. Therefore, during the acute phase, protein and potassium-containing foods should be appropriately restricted. Oranges have a high potassium content, so they should not be eaten or eaten only in small amounts.
III. Monitor the condition changes of children with acute nephritis closely
Observe urine volume and color, and accurately record 24-hour urine output.
1) Observe urine volume and color: An increase in urine volume and the disappearance of gross hematuria indicate improvement in the condition. If urine volume continues to decrease and symptoms such as headache, nausea, and vomiting appear, acute renal failure should be suspected. In the first month of the illness, urine samples should be collected 1-2 times a week for routine urine tests; the first urine of the day is preferred for collection. 2) Observe blood pressure changes. If there is a sudden increase in blood pressure, severe headache, dizziness, blurred vision, and vomiting, it suggests the occurrence of hypertensive encephalopathy. 3) Closely monitor changes in breathing, heart rate, or pulse rate, and be alert for the occurrence of heart failure. Monitor changes in vital signs to be alert for the occurrence of severe circulatory congestion, acute renal insufficiency, etc., and perform pre-dialysis psychological care.
IV. Pay attention to the therapeutic effect and medication reactions in children with acute nephritis
After taking the antihypertensive drug reserpine, side effects such as nasal congestion, facial flushing, and drowsiness may occur. Children taking antihypertensive drugs should avoid sudden standing to prevent orthostatic hypotension. After taking diuretics, attention should be paid to whether there is excessive diuresis, dehydration, or electrolyte disorders.
V. Tips:
1) Acute nephritis in children is a self-limiting disease. Controlling the child's activity is the main measure to control the progression of the disease, especially in the first 2 weeks. 2) Although more than 90% of acute glomerulonephritis can improve, exercising the body, enhancing physical fitness, and avoiding upper respiratory tract infections (mainly streptococcal infection) are the keys to prevention. If the child suffers from conditions such as tonsillitis or skin infections, timely and thorough treatment should be given. 3) Regular outpatient follow-up and regular urine routine tests should be conducted. The essence of acute nephritis is immune damage to the kidneys. Acute glomerulonephritis is generally referred to as acute nephritis and is a common kidney disease in children. Most children with acute nephritis have had a "precursor infection" or "precursor disease" 1-3 weeks before becoming ill. Most precursor infections of acute nephritis are caused by streptococcal infection, followed by pneumococcal infection, Staphylococcus aureus, influenzae, and viral infections such as Coxsackie virus, mumps virus, hepatitis B virus, and cytomegalovirus, among others. Streptococcal infection can cause upper respiratory tract infections, tonsillitis, acute pharyngitis, impetigo, scarlet fever, etc. Therefore, the above diseases can also become "precursor diseases" of acute nephritis. From the pathogenesis point of view, acute nephritis is related to bacterial and viral infections, but it is not inflammation of the kidneys caused by direct infection of bacteria and viruses. After the precursor infection, antigen-antibody complexes are formed in the blood circulation through the body's own immune mechanism. When these complexes flow through the kidneys, they deposit in the glomeruli, causing a series of injuries to the kidneys and leading to the onset of the disease. Some readers may hold the view that "antibiotics should be used to reduce inflammation for acute nephritis," which is a misunderstanding of the nature of the "inflammation" in acute nephritis. In fact, for kidney immune damage caused by immune mechanisms, it is not possible to solve the problem by simply using antibiotics to "reduce inflammation." The clinical manifestations of acute nephritis vary greatly in severity. Therefore, please first treat the child, focusing on rest and high nutrition, and do not rush to let the child return to school, so as not to lose out.