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Nephritis

Submitted by, Mrs Bibi Baby 2 nd year MSc Nursing Medical Surgical Nursing PION.

Submitted to, Mrs. Prasanna Balaji HOD of Medical Surgical Nursing PION.

NEPHRITIS Introduction

The kidneys - the organs that filter the blood and get rid of excess fluid and unwanted chemicals. The word "nephritis" was imported from Latin word nephro- meaning "of the kidney" and -itis meaning "inflammation".
Definition

The term nephritis is used to describe an inflammation, affecting one or both the kidneys. A synonym for nephritis is Bright's disease.
Etiology

1. Streptococcus infection of the throat or an attack of scarlet fever.Nephritis usually

follows some streptococcus infection of the throat or an attack of scarlet fever, or rheumatic fever.

2. Heredity Factors: Nephritis disease has been known to run in the members of a
family.

3. Autoimmune Disorders. 4. Wrong feeding habit and weak defense mechanisms of the body. 5. The suppressive medical treatment of former diseases, 6. The habitual use of chemical agents of all kinds for the treatment of indigestion and
other stomach disorders and frequent use of aspirin and other painkillers.

7. Nutritional deficiencies can also lead to nephritis. The disease can result from a diet
lacking in vitamin B1 and choline.

8. It can also be caused by a diet deficient in essential fatty acids and magnesium. 9. When vitamin B6 and magnesium are undersupplied, the kidneys are further damaged
by sharp crystals of oxalic acid combined with calcium. Types

1.

Acute nephritis (come on suddenly) is most commonly caused by hypersensitivity (allergy) to drug therapy. Chronic nephritis ( long-term) can similarly be due to a very large number of causes, including drug hypersensitivity, autoimmunity, infections, radiation of the kidney, obstruction of the urinary tract, hypertension.

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Glomerulonephritis is inflammation of the glomeruli. (Often when the term "nephritis" is used without qualification, this is the condition meant.) Interstitial nephritis or tubulo-interstitial nephritis is inflammation of the spaces between renal tubules. Pyelonephritis is when a urinary tract infection has reached the pelvis of the kidney. Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system.

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Pathophysiology Due to etiological factors Abnormal immune response (T- cell mediated hypersentivity reaction) Antigen antibody immune complexes Renal interstitial Inflammation Kidney damage Clinical manifestation

1. Often, children suffer from sore throat, tonsillitis, boils or scabies, two or three weeks
before the onset of the disease.

2. The condition has a sudden onset with fever and backache. 3. Pain in the kidneys, extending down to the ureters.
4. Increase in blood pressure 5. Headaches 6. Drowsiness

7. Visual disturbances 8. Tiredness and general malaise (feeling ill) 9. Nausea 10. In rapidly progressive disease, loss of appetite, vomiting, abdominal pain and joint pain may occur

11. Passage of scanty and highly coloured urine. Urine may contain blood, albumin and
casts consisting of clumps of red and white cells which come from damaged kidneys, hematuria (bloody urine) , oliguria (diminished urine volume).

12. Swelling occurs around the eyelids and on the face giving a puffy appearance. Later,
swelling extends to feet, ankles, legs and other parts of the body.

13. Chronic nephritis may go unnoticed for years until symptoms of kidney failure
appear: tiredness, itchy skin, nausea and vomiting, shortness of breath. Diagnosis

1. A patient's history and possible genetic precursors for nephritis, any recent history of
sore throat or bladder infection can indicate infectious nephritis. Those who have lupus are usually told they are predisposed to nephritis and are urged to report signs of swelling in the extremities to their doctors as soon as possible.

2. Lab tests- urine analysis can be a significant help in diagnosing excess protein in the
urine stream, as well as the presence of infection.

3. Blood tests may also help diagnose nephritis. 4. Physical examination can reveal kidneys that are swollen, 5. Magnetic resonance imaging (MRI) is used to evaluate amount of swelling.
Medical management The treatment of nephritis depends on the type and cause of the condition. The aim is to reduce inflammation, limit the damage to the kidneys and support the body until kidney function is back to normal.

1. Restriction of sodium (salt), potassium, protein and fluids in the diet may be necessary. Sometimes bed rest is advised. Steroids, or more powerful immunosuppressant drugs, may be given to reduce the inflammation. 2. Antibiotics may be needed too, although in many cases the infection that initially triggered the nephritis has long since gone. 3. Medication may also be needed to control blood pressure. 4. In severe cases, renal dialysis may be necessary, although this may only be a temporary measure.

Surgical management 1. Nephrectomy Complications

1. Hypertensive encephalopathy
2. Acute renal failure 3. Secondary infection Nursing management 1. Check the patients vital signs and electrolyte values.

2. Monitor intake and output and daily weight. 3. Maintaining good hygiene when using the bathroom, like wiping front to back, 4. Drinking plenty of fluids. Increase intake of water and make sure to consume not
less than 8 to 10 glasses a day, as it flushes the toxins out of the body.

5. Urination every couple of hours to clear the bladder. 6. Intake proteins and salt in diet should be restricted. The diet given must supply
adequate calories from carbohydrate and fat sources.

7. Fasting on vegetable juices. The safest treatment for acute nephritis is fasting on
vegetable juices for seven to ten days. This will remove the toxins and systemic impurities responsible for the inflammatory kidney conditions.

8. Avoid overloading on kidneys. Take rest.

9. Fresh air and outdoor exercises will be of great benefit in all cases of nephritis and
grown-up children should be encouraged to undertake them whenever possible. Nursing diagnosis 1. Fluid volume excess related to glomerular inflammation and decreased renal function. 2. Infection (urinary tract) associated to instrumentation, contamination, or obstruction. 3. Imbalanced nutrition less than body requirement related to dietary restrictions. 4. Anxiety related to change in health status. 5. Knowledge deficit regarding treatment regimen and lifestyle changes.

Bibliography

1) Suzanne C, Brend G. Medical surgical nursing. 10th edition. Philadelphia: Lippincott

William & Wilkins; 2004 .

2) Lewis, Heitkemper, Dirksen, OBrien, Bucher. Medical surgical nursing. 7th edition.
Missouri: Elsevier; 2008.

3) Ignatavicius D, Workman L, Mishler A. Medical surgical nursing. 2nd edition.

Philadelphia: W.B Saunders company; 2000.

4) Doenges E, Moorhouse F, Murr C. Nursing care plans. 7th edition. New delhi: Jaypee
Brothers; 2007.