Glomerulonephritis

Definition
Glomerulonephritis is a kidney condition that
involves damage to the glomeruli.
Glomeruli are the tiny structures within the
kidney that filter blood.
The damaged glomeruli cannot effectively filter
waste products and excess water from the
bloodstream to make urine. The kidneys appear
enlarged, fatty, and congested.

Causes of glomerulonephritis include:

group A beta hemolytic
Streptococcal infection of the throat ( strep throat ) or skin
( impetigo )
Hereditary diseases
Immune diseases, such as lupus
Type 1 diabetes and Type 2 diabetes
High blood pressure
Vasculitis (inflammation of the blood vessels)
Viruses ( HIV , hepatitis B virus , and hepatitis C virus )
Endocarditis (infection of the valves of the heart)

There are two types of glomerulonephritis:

Acute glomerulonephritis
Begins suddenly.
is an inflammatory disease
of both kidneys
predominantly affecting
children from ages two to
12.

Chronic
glomerulonephritis
Develops gradually over
several years.
can develop over a period of
10-20 years and is most
often associated with other
systemic disease, including
diabetes, malaria, hepatitis,
or systemic lupus
erythematosus.

Risk factors for glomerulonephritis include:

Family history of glomerulonephritis.
The presence of a known cause of
glomerulonephritis

PATHOPHYSIOLOGY
Post-streptococcal infection
beta hemolytic)

(group-A,

Release of material from the organism, into

the circulation (antigen)

Formation of antibody

Immune complex reaction in the glomerular

capillary

Inflammatory response

Proliferation of epithelial cells lining

glomerolus & cells betweenendothelium &
epithelium of capillarymembrane

Swelling capillary membrane &infiltration

with leukocytes

Permeability of base membrane

Occlusion of the capillaries of the glomeruli

vasospasm of afferentventrioles

Glomerular filtration rate

Ability to form filtrate from glomeeruli

plasma flow

Retention of H2O & Na; hypovolemia;

circulatory congestion

Edema Hypertension urinary output Urine

dark in color Anorexia Irritability lethargy

ACUTEGL OMERULO - NEPHRITIS

Sign and Symptoms

Glomerulonephritis sometimes causes no symptoms and is
discovered during a routine urine test. When present, the
symptoms of acute and chronic glomerulonephritis differ from
one another.
The symptoms of acute glomerulonephritis
may include:
Blood in urine (red, brown, or tea-colored urine)
Foamy appearance of urine
Less frequent urination
Swelling in the morning, especially in the face, feet, hands, and
abdomen

Chronic glomerulonephritis can lead to

kidney failure, which may cause these
symptoms:
Feeling tired
Dry, itchy skin
Nausea
Vomiting
Poor appetite
Muscle cramps at night
Swelling of the face, feet, hands, or abdomen

Diagnosis
Urine test. A urinalysis may show red blood cells and red cell
casts in your urine, an indicator of possible damage to the
glomeruli. Urinalysis results may also show white blood cells, a
common indicator of infection or inflammation, and increased
protein, which may indicate nephron damage. Other indicators,
such as increased blood levels of creatinine or urea, are red
flags.
Blood tests. These can provide information about kidney
damage and impairment of the glomeruli by measuring levels of
waste products, such as creatinine and blood urea nitrogen.
Imaging tests. If your doctor detects evidence of damage, he or
she may recommend diagnostic studies that allow visualization
of your kidneys, such as a kidney X-ray, an ultrasound
examination or a computerized tomography (CT) scan.

Diagnostic Examinations:
Urinalysis: -presence of RBC, WBC cast
cells, CHON
Blood Test: - BUN & Creatinine
Clearance
- ASO (Anti-streptolysin O) Titer
- Serum CHON, Hgb
KUB - Bilateral Kidney enlargement.
Renal Biopsy

Complications
Acute kidney failure. Loss of function in the filtering
part of the nephron may cause waste products to
accumulate rapidly. This condition may mean you'll need
emergency dialysis, an artificial means of removing extra
fluids and waste from your blood, typically by an artificial
kidney machine (dialyzer).
Chronic kidney failure. In this extremely serious
complication, the kidneys gradually lose function. Kidney
function at less than 10 percent of normal capacity
indicates end-stage kidney disease, which usually requires
dialysis or a kidney transplant to sustain life.

High blood pressure. Damage to your kidneys and the

resulting buildup of wastes in the bloodstream can raise
your blood pressure.
Nephrotic syndrome. This is a group of signs and
symptoms that may accompany glomerulonephritis and
other conditions that affect the filtering ability of the
glomeruli. Nephrotic syndrome is characterized by high
protein levels in the urine, resulting in low protein levels
in the blood. It's also associated with high blood
cholesterol and swelling (edema) of the eyelids, feet and
abdomen.

Treatments
Treatment for high blood pressure
Keeping your blood pressure under control is key
to protecting your kidneys. To control your high
blood pressure and slow the decline in kidney
function, your doctor may prescribe one of
several medications, including:
Diuretics
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor agonists

Treatment for an underlying cause

Strep or other bacterial infection. Your
doctor likely will prescribe an appropriate
antibiotic.
Lupus or vasculitis. Doctors often prescribe
corticosteroids and immune-suppressing drugs
to control inflammation.

Therapies for associated kidney failure

For acute glomerulonephritis and acute kidney
failure, dialysis can help remove excess fluid
and control high blood pressure. The only
long-term therapies for end-stage kidney
failure are kidney dialysis and kidney
transplantation. When a transplant isn't
possible, often because of poor general health,
dialysis becomes the only option.

Medical Management:

It depends on the symptoms and includes antihypertensives, diuretics,

drugs to manage hyperkalemia, H2 blockers and phospate-binding agents.
Antibiotic therapy is initiated to eliminate infection.
Fluid intake is restricted.
Dietary protein is restricted moderately if there is oliguria and the BUN is
elevated.
Carbohydrates are increased liberally to provide energy and reduce
catabolism of protein.
Potassium and sodium intake is restricted in presence of hyperkalemia,
edema or signs of heart failure.

Nursing Management:
Promote renal function.
Strictly measure and monitor intake and output
and maintain dietary restrictions.
Encourage rest to facilitate diuresis and until
renal function test levels normalize.
Administer medications as ordered and
evaluate effectiveness of treatment.

Improve fluid balance.

Carefully monitor fluid balance and and
replace fluids according to patients fluid
losses. Get daily weight.Monitor for signs and
symptoms of heart failure and hypertensive
encephalopathy.