Acute Glomerulonephritis in Children nursing care: what to assess and what to do first

Recognising it at the bedside

The signature picture is a child brought in with puffy eyes on waking and urine described as tea- or cola-coloured, appearing one to two weeks after a documented or suspected group A streptococcal infection, classically pharyngitis or impetigo. The latency period is the clue that separates this from an acute allergic or infectious process happening in real time.

Periorbital oedema is often the parent's first concern because it is visible on the face, but it typically represents a smaller fluid shift than the oliguria and hypertension developing simultaneously. Blood pressure should be checked early and against age-appropriate norms, since even a mild childhood illness rarely presents with true hypertension, and its presence here is diagnostic weight, not an incidental finding.

Why the classic presentation misleads

Because the face is puffy rather than the legs or abdomen, families and even less experienced clinicians can mistake this for an allergic reaction, particularly if there's a recent illness they're already attributing to a virus. The delay between the strep infection and the renal symptoms, often two weeks, means the sore throat has usually resolved and is easy to overlook unless specifically asked about.

The oedema itself can also be deceptively mild-looking while the more dangerous process, fluid retention driving hypertension, is well underway. A child who looks only "a bit puffy" can still have a blood pressure requiring urgent management, so the visible swelling should never be used alone to judge severity.

Priority nursing actions

Vital signs, particularly blood pressure, take priority on admission and should be repeated frequently, since hypertensive encephalopathy is the complication most likely to cause acute harm. Strict intake and output monitoring comes next, with daily weights to track fluid trends the way urine output alone cannot.

Fluid restriction is a central intervention while the child is oliguric, calculated against insensible losses and prior day's output rather than a flat volume, and sodium is restricted alongside it since dietary salt drives fluid retention. Potassium intake is also monitored and typically restricted if the child is oliguric, given the risk of hyperkalemia with reduced renal clearance.

Activity is generally limited to rest during the acute phase, and the child is monitored for signs of fluid overload progressing to pulmonary oedema, including increased respiratory effort or crackles, which would need prompt escalation.

Labs and diagnostics to expect

Urinalysis typically shows haematuria, often with red cell casts, and proteinuria that is usually less severe than in nephrotic syndrome. Serum studies commonly show an elevated antistreptolysin O titre confirming recent strep exposure, along with low complement C3, which typically normalises over six to eight weeks as the disease resolves.

Renal function studies, BUN and creatinine, are checked to gauge the degree of glomerular impairment, and mild elevation is expected during the acute phase. Electrolytes are monitored closely for hyperkalemia given reduced clearance, and a chest X-ray may be obtained if there are signs of fluid overload or respiratory compromise.

Complications and their early signs

Hypertensive encephalopathy is the complication nurses should be watching for most actively, presenting with headache, visual disturbance, vomiting, or altered mental status against a background of rising blood pressure. This requires immediate escalation rather than waiting for the next scheduled vital signs check.

Fluid overload progressing to pulmonary oedema is the second major concern, signalled by tachypnoea, crackles on auscultation, and worsening oxygenation, and it tracks closely with how well fluid and sodium restriction are being followed. Acute kidney injury with significant oliguria or anuria is less common but warrants close monitoring of output and electrolytes, since most children recover renal function fully within weeks without long-term damage.

Teaching that changes outcomes

Families need to understand why fluid and sodium restriction matters even though the child may not feel unwell: it is directly protective against the blood pressure spikes that cause the serious complications, not a general precaution. Concrete guidance, such as which foods are high in hidden sodium and how much fluid is allowed per day, is more useful than a general instruction to "cut back on salt."

Teach families to recognise and report warning signs promptly: decreasing urine output, headache, visual changes, or worsening swelling, since these can signal a complication needing urgent review rather than routine follow-up. Reassure them that the disease is typically self-limiting in children, with most recovering full renal function, but that the recovery period requires consistent home monitoring of blood pressure and urine output as advised by the care team, not just clinic visits.