Acute-Chronic

Glomerulonephritis

introduction
Glomerulonephritisis also known as glomerular
nephritis(GN) orglomerular disease. It is a
disease of the kidney, characterized
byinflammationof the glomeruli.

AGN
Acute GN comprises a specific set of renal diseases
in which an immunologic mechanism triggers
inflammation and proliferation of glomerular tissue
that can result in damage to the basement
membrane, mesangium, or capillary endothelium.

CGN
Chronic glomerulonephritis is the advanced stage of
a group of kidney disorders, resulting in
inflammation and slowly worsening destruction of
internal kidney structures called glomeruli.

Epidemiology
Preschool-age and grade age school-age children
(2 to 6 years old) are most develop acute
glomerulonephritis. Spontaneous recovery usually
occurs after this acute illness. The severity of acute
illness does not relate to the prognosis. Less than
1% of children develop irreversible kidney failure.
Person with mild develop chronic disease, and those
with severe illness may completely recover over a
period of months and have no recurrence of the
illness.

Anatomy & Physiology

Put simply
The glomeruli are tiny filters in our kidneys that
take waste out of our blood. The waste is urine.

Symptoms of AGN
1. Urine may be foamy due to high protein
concentration
2. Blood in the urine: Cola colored urine
3. Decreased urine production
4. Fever
5. Chills
6. Nausea
7. Rash
8. Swelling: Leg, Foot, Face,Hand
9. Vomiting
10.Hiccups
11.Weight gain

Symptoms of CGN
Blood in the urine (dark, rust-colored, or brown
urine)
Foamy urine
Decreased alertness
Drowsiness, somnolence, lethargy
Confusion, delirium
Coma

Decreased sensation in the hands, feet, or other

areas
Decreased urine output
Easy bruising or bleeding
Fatigue
Frequent hiccups

Identify risk factors

Modifiable

Post-streptococcal GN
TB
Syphilis
Injecting illegal drugs
Bacterial endocarditis

Non-Modifiable

Family history of
glomerulonephrit
is

Pathophysiology

Pathophysiology
Acute post-streptococcal glomerulonephritis is a
result of an antigen-antibody reaction where
insoluble immune complexes develop and become
entrapped in glomerular tissue producing swelling
and death of capillary cells. Renal function is
depressed by scarring and obstruction of the
circular through the glomerulus.

Clinical manifestation
EARLY
Hematuria
Proteinuria
Azotemia
Increased urine specific
gravity
Elevated erythrocyte
sedimentation rate
Oliguria
Elevated antistreptolysin
O titer

LATE
Circulatory
congestion
Hypertension
Edema
End-stage kidney
failure

Colaborative Care Management

Diagnostic Test
Urine test
if the doctor suspects possible glomerulonephritis a
urine test may be ordered to check for blood or
protein.

Blood test
levels of antigens and antibodies in the blood may
help doctors in their diagnosis.

Throat swab
some cells from the back of the patient's throat are
taken and sent to the lab.

Renal function tests

Patients who have kidney disease may have to
undergo further tests to find out whether they have
glomerulonephritis. Renal function tests are a range
of tests, including blood and urine samples which
are checked for certain substances released by the
kidneys. This is also called a kidney function test.
Blood levels of sodium, chloride, potassium and urea
will be checked. The tests may also tell the doctor
whether the patient is producing less urine that
usual.

Kidney biopsy
Patients with chronic glomerulonephritis may need
to have a small sample of kidney tissue removed for
testing to find out how serious the condition is. The
doctor extracts tissue samples using a small needle.
The patient will normally receive a local anesthetic.
A kidney biopsy has a small risk of bleeding.

Imaging tests
if the doctor finds evidence of damage, diagnostic
studies may be ordered so that the kidneys can be
visualized. This may include a kidney X-ray, an
ultrasoundscan, or a CT (computerized tomography)
scan.

AGN Treatment
Kidney disease diet:

Low calorie diet

Low protein
Low sodium diet
Low potassiumdiet
Low phosphorus diet
Calcium supplements
Vitamin B supplements

AGN Treatment
Fluid restriction:
Limiting the amount of fluid in the diet

AGN Treatment
Oralcorticosteroid medications:
Prednisone
Methylprednisolone(Medrol)

Diuretic medications:
Furosemide(Lasix)

AGN Medication
Management
1. First of all, patients with infections require
antibiotics. Antimicrobial agents may
sometimes prevent poststreptococcal
glomerulonephritis from developing.
2. severe cases of hypertension induced
encephalopathy are treated with vasodilator
drugs such as nitroprusside, nifedipinem
hydralazine etc.

CGN Treatment
Corticosteroids, immunosuppressives, or
other medications may be used to treat some of
the causes of chronic glomerulonephritis.
Dietary restrictions on salt, fluids,protein, and
other substances may be recommended to help
control of high blood pressure or kidney failure.
Dialysisor kidney transplantation may be
necessary to control symptoms of kidney failure
and to sustain life.

CGN Medication
Management
angiotensin-converting enzyme (ACE) inhibitors
(ACEIs), diuretics, calcium channel blockers, betaadrenergic blockers, and alpha-adrenergic agonists.

Blood transfusion may be required for secere

anemia. Dialysis or kidney transplant may be
necessary to alleviate the fluid and waste product
buildup.

Surgical Management
Kidney Transplant
A kidney transplant is an operation that places a
healthy kidney in your body. The transplanted kidney
takes over the work of the two kidneys that failed,
and you no longer need dialysis.

Nursing Diagnosis
Excess fluid volume r/t plasma protein deficit
and sodium and water retention
Risk for imbalanced nutrition: Less than
body requirements r/t anorexia
Anxiety r/t prescribed activity restriction
Risk for ineffective therapeutic regimen
management r/t lack of information about
glomerulonephritis and treatment

Intervention
For Excess fluid volume :
Vital signs every 4 hours; notify physician of
significant changes.
Weigh daily, intake and output every 8 hours.
Schedule fluids allowing 650 mL on day shift, 450
mL on evening shift, and 100 mL on night shift.

Intervention
For Risk for imbalanced nutrition:
Arrange dietary consultation to plan a diet that
includes preferred foods as allowed.
Provide small meals with high-carbohydrate
between-meal snacks.

Intervention
For Anxiety:
Encourage the patien to talk about his condition and
its potential effects.
Assist with problem solving and exploring options for
maintaining studies.
Enlist friends and family to listen and provide
support.

Intervention
For Risk for ineffective therapeutic regimen
management:
Teach the patient and his family about acute
glomerulonephritis and prescribed treatment.

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