eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Nephritis: Follow-up

Author: Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
Coauthor(s): Richard Neiberger, MD, PhD, Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital
Contributor Information and Disclosures

Updated: Jul 18, 2008

Follow-up

Further Inpatient Care

  • Inpatient care is usually necessary only to manage severe hypertension or complications of acute or chronic renal failure (eg, dialysis access, uremic syndrome, congestive heart failure, electrolyte abnormalities such as hyperkalemia and pericardial effusion). These problems are infrequent in the general pediatric population.

Further Outpatient Care

  • Outpatient care is an extension of inpatient care.
  • Outpatient care may be as simple as observation in a child with tubulointerstitial nephritis or resolving poststreptococcal glomerulonephritis (GN) or may involve antihypertensives, diuretics, and diet modification as in a child with IgA nephropathy or membranoproliferative GN and preserved renal function.
  • Outpatient care may involve dialysis and transplantation in a child who develops end-stage renal disease.

Inpatient & Outpatient Medications

  • No specific change in medications is necessary for transition from inpatient to outpatient care.

Transfer

  • A physician who has experience in managing renal failure in children should care for children with renal failure. In the United States, this is frequently at a tertiary facility.

Deterrence/Prevention

  • No effective methods of deterrence or prevention are known.

Complications

  • Primary complications associated with hypertension
    • Seizure
    • Encephalopathy
    • Stroke
    • End-organ damage
  • Primary complications associated with kidney failure
    • Fluid overload
    • Electrolyte abnormality
    • Uremic symptoms
    • Anemia
    • Abnormal bone mineralization
    • Sexual dysfunction
    • Poor growth
    • Anorexia
    • Endocrine abnormalities

Prognosis

  • The overall prognosis for survival in children with all forms of nephritis is good.

Patient Education

  • Education about the specific nephritis is helpful.
  • Encourage medication compliance and a healthy lifestyle (eg, ideal body weight, no smoking, exercise, avoidance of risk behaviors).
  • For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Blood in the Urine.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis in a child with nephritis may delay diagnosis and treatment, which may allow progression to end-stage renal disease and allow complications, such as hypertensive seizures, to occur. A provider might be held responsible.
 


More on Nephritis

Overview: Nephritis
Differential Diagnoses & Workup: Nephritis
Treatment & Medication: Nephritis
Follow-up: Nephritis
References
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References

  1. Marcus SB, Brown JB, Melin-Aldana H, Strople JA. Tubulointerstitial nephritis: an extraintestinal manifestation of Crohn disease in children. J Pediatr Gastroenterol Nutr. Mar 2008;46(3):338-41. [Medline].

  2. Adler SG, Cohen AH, Glassock RJ. Secondary glomerular diseases. In: Brenner BM, ed. The Kidney. 5th ed. Philadelphia, PA: WB Saunders Co; 1996:1498-1596.

  3. Balow JE, Austin HA. Treatment of proliferative lupus nephritis. Am J Kidney Dis. Feb 2004;43(2):383-5. [Medline].

  4. Bargman JM. Management of minimal lesion glomerulonephritis: evidence-based recommendations. Kidney Int Suppl. Jun 1999;70:S3-16. [Medline].

  5. Cattran DC. Evidence-based recommendations for the management of glomerulonephritis. Introduction. Kidney Int Suppl. Jun 1999;70:S1-2. [Medline].

  6. Eddy AA. Mechanisms of immune glomerular injury. In: Barrett TM, Avener EV, Harmon H, eds. Pediatric Nephrology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:641-68.

  7. Eknoyan G. Tubulointerstial nephritis. In: Massry SG, Glassock RJ, eds. Massry and Glassock's Textbook of Nephrology. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:746-58.

  8. Flanc RS, Roberts MA, Strippoli GF, et al. Treatment of diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials. Am J Kidney Dis. Feb 2004;43(2):197-208. [Medline].

  9. Glassock RJ, Cohen AH, Adler SG. Primary glomerular diseases. In: Brenner BM, ed. The Kidney. 5th ed. Philadelphia, PA: WB Saunders Co; 1996:1392-1497.

  10. Goda C, Kotake S, Ichiishi A, et al. Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. Am J Ophthalmol. 2005;140(4):637-41. [Medline].

  11. Gonzalez B, Hernandez P, Olguin H, et al. Changes in the survival of patients with systemic lupus erythematosus in childhood: 30 years experience in Chile. Lupus. 2005;14(11):918-23. [Medline].

  12. Lee JW, Kim HJ, Sung SH, Lee SJ. A case of tubulointerstitial nephritis and uveitis syndrome with severe immunologic dysregulation. Pediatr Nephrol. 2005;20(12):1805-8. [Medline].

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Further Reading

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Keywords

nephritis, glomerulonephritis, GN, Bright disease, interstitial nephritis, tubulointerstitial disease, tubulointerstitial nephritis, TIN, hypertension, hematuria, edema, systemic lupus erythematosus, SLE, membranoproliferative glomerulonephritis, membranoproliferative GN, mesangial proliferative GN, Henoch-Schönlein purpura, immunoglobulin A nephropathy, Alport syndrome, vesicoureteral reflux, oxalosis, Crohn disease, cerebral hemorrhage, hyperkalemia, pulmonary edema, heart failure, ascites, encephalopathy, polyuria

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Contributor Information and Disclosures

Author

Sahar Fathallah-Shaykh, MD, Assistant Professor in Pediatric Nephrology, Northwestern University Feinberg School of Medicine; Consulting Staff, Division of Kidney Diseases, Children's Memorial Hospital
Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of Nephrology
Disclosure: emedecine Honoraria Other

Coauthor(s)

Richard Neiberger, MD, PhD, Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital
Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group
Disclosure: Nothing to disclose.

Medical Editor

Uri S Alon, MD, Director of Research and Education, Department of Pediatrics, Division of Pediatric Nephrology, Children's Mercy Hospital of Kansas City; Professor, University of Missouri at Kansas City
Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Frederick J Kaskel, MD, PhD, Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine
Frederick J Kaskel, MD, PhD is a member of the following medical societies: Academy of Medical Royal Colleges, American Academy of Pediatrics, American Association for the Advancement of Science, American Heart Association, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Abbott Honoraria Speaking and teaching; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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