American Medical Association Family Medical Guide - American Medical Association [204]
Symptoms and Diagnosis
The main symptom of poststreptococcal glomerulonephritis is reduced output of urine. The urine looks smoky or reddish brown because it contains blood. The reduced output of urine leads to edema, an abnormal accumulation of fluid in the body that causes swelling around the eyes and face and sometimes over the entire body. In addition to edema, some children with poststreptococcal glomerulonephritis may gain weight, lose their appetite, have abdominal pain or diarrhea, or develop high blood pressure (see page 574).
A diagnosis of poststreptococcal glomerulonephritis is based on a child’s symptoms and the results of a physical examination. If the doctor suspects poststreptococcal glomerulonephritis, he or she will order blood and urine tests to confirm the diagnosis.
Treatment
If your child is very ill, the doctor may recommend bed rest. The doctor will put your child on a special diet that restricts his or her intake of sodium, potassium, liquids, and, possibly, foods that are high in protein (such as meat, fish, and eggs). The diet is designed to reduce strain on the kidneys and prevent the accumulation of fluid.
The doctor may prescribe antibiotics to treat any remaining strep infection and a diuretic to increase the child’s output of urine, eliminate excess fluid from the body, and control blood pressure.
If the child’s condition worsens, he or she will be hospitalized to treat any complications that could develop, such as kidney failure, heart failure (see page 570), or severe high blood pressure. The doctor will monitor your child’s blood pressure and will prescribe antihypertensive medications if the child develops high blood pressure.
Hemolytic Uremic Syndrome
Hemolytic uremic syndrome is a rare complication of a severe gastrointestinal infection, usually with a specific type of E. coli bacteria (E. coli O157:H7). The bacteria can be acquired by eating contaminated food such as meat, poultry, or potatoes; drinking contaminated juice, water, or dairy products; or touching infected people or contaminated surfaces. Hemolytic uremic syndrome occurs when toxins from the bacteria get into the bloodstream and damage red blood cells (which carry oxygen to tissues) and platelets (which help blood to clot). The damaged red blood cells and platelets can then clog the tiny blood vessels in the kidneys, blocking the ability of the kidneys to filter and remove waste products.
Hemolytic uremic syndrome is one of the leading causes of acute kidney failure in children under 10. Although most children have no long-term complications from hemolytic uremic syndrome, some may have permanent kidney damage and may need dialysis (see page 818) or a kidney transplant (see page 820). In severe cases, hemolytic uremic syndrome can be fatal.
Proper food handling and preparation (see page 784) and frequent, thorough washing of hands and utensils can significantly reduce the risk of hemolytic uremic syndrome and other forms of food poisoning.
Symptoms
Symptoms of an E. coli infection, which can last about a week, include vomiting, abdominal pain, and diarrhea that may contain blood. Most children recover fully from an E. coli infection. However, some children go on to develop hemolytic uremic syndrome. The symptoms of hemolytic uremic syndrome include pale skin or jaundice (yellowing of the skin and whites of the eyes), bruising, weakness, lethargy, irritability, and low output of urine. The inability of the kidneys to remove waste can lead to fluid buildup, which can cause swelling of the hands and feet.
Diagnosis and Treatment
A doctor will recommend blood and urine tests and will test stool samples to determine if a child is infected with E. coli and has developed hemolytic uremic syndrome.
To treat an E. coli infection, a child is given fluids to replace lost fluids and help prevent dehydration. Severe cases of hemolytic uremic syndrome may require hospitalization. Treatment for children