Glomerulonephritis

Definition Glomerulonephritis Glomeruli

is a kidney condition that involves damage to the 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 (group-A, beta hemolytic)

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.

Kidney biopsy. This procedure involves using a special needle to extract small pieces of kidney tissue for microscopic examination to help determine the cause of the inflammation. A kidney biopsy is almost always necessary to confirm a diagnosis of glomerulonephritis. A kidney biopsy, also called renal biopsy, is a procedure to remove a small piece of kidney tissue so that it can be examined under a microscope for signs of damage or disease. Your doctor may recommend a kidney biopsy if blood tests, urine tests or imaging techniques don't provide enough information to diagnose a kidney problem. A kidney biopsy may also be used to determine the severity of kidney disease or to find out if treatment for kidney disease is working. You may need a kidney biopsy if you've had a kidney transplant that's not working properly. Most kidney biopsies are performed by inserting a thin needle through the skin. In this procedure, an imaging device helps guide the needle into one of your kidneys to remove tissue

During a kidney biopsy, a needle is used to remove a small sample of kidney tissue for laboratory testing. The biopsy needle is inserted through your skin and is often directed using the guidance of an imaging device, such as ultrasound.

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 immunesuppressing 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.

ASSESSMENT

DIAGNOSIS

PLANNING
Short term: Within 1 hour of nursing care and intervention patient will verbalized that she understood the health teaching that has been advised or manifests low BP( / normal vital signs Long term: Within 1 week of nursing care and intervention patient will show improvement in her body weight from 54 to 49 kg., resumes to normal ADLs,exhibits normal v/s Will res

INTERVENTION Independent: Monitor patient vital sign Proper positioning For relief of DOB

RATIONALE To know the normal baseline data of patient

EVALUATION

SUBECTIVE: namamaga ang aking katawan at nahihilo akoas verbalized by the patient. OBJECTIVE: >Wt. gain noted >Edema >Restlessnes s, pale >Oliguria >with the following V/S Bp: 200/100 Temp: 39 C PR: 110 RR: 25

Fluid volume excess r/t failure of regulatory mechanism as manifested by anasarca

Monitor Intake and Output of the patient Compare current wt. with admission and/or previously stated weight Observe skin and mucous membranes

To monitor patient fluid excess To know changes of body her wt.

After 1 hour of nursing care and intervention patient verbalized that she understood the health teaching and responded to treatment After 1 week of nursing care and intervention patient show an improvement on her body weight from 54 to 50 kg.vital signs turned normal ,

Support emotional and spiritual well being dependent: Given medication as prescribed by the physician

To observe if there is any changes of her skin or having ulceration To prevent low self esteem

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.