Glomerulonephritis

Question 1

Glomerulonephritis

Answer 1

• inflammation of the glomerular capillaries that can be acute or chronic.
• immune complexes develop and become trapped in the kidney, producing swelling of tissue and eventually, capillary cell death.
• it is an immune complex disease, not an infection of the kidney.

Question 2

Acute glomerulonephritis (AGN)

Answer 2

• insoluble immune complexes develop and become trapped in the glomerular tissue–producing swelling and capillary death.
• prognosis varies depending upon specific cause, but spontaneous recovery generally occurs after the acute illness

Question 3

Chronic glomerularnephritis (CGN)

Answer 3

• can occur w/o any previous hx or known onset.
• involves progressive destruction of glomeruli and eventual hardening (sclerosis).
• it is the 3rd leading cause of end-stage renal disease (ESRD), with prognosis varying depending on specific cause

Question 4

Causes

Answer 4

-immunological reactions
primary infection with group A beta-hemolytic streptococcal infection (most common)
-systemic lupus erythematosus
-vascular injury (hypertension)
-metabolic disease (diabetes mellitus)
-excessively high protein and high sodium diets

Question 5

Manifestations

Answer 5

• decreased urine output
• smoky or coffee-colored urine (hematuria)
• proteinuria
• SOB
• orthopnea
• bibasilar rales
• periorbital edema
• mild to severe hypertension
• changes in LOC
• anorexia/nausea
• headache
• back pain
• fever (AGN)
• pruritus (CGN)

Question 6

Laboratory findings

Answer 6

• throat culture to identify possible streptococcus infection
• elevated serum BUN and creatinine
• decreased creatinine clearance
• urinalysis: proteinuria, hematuria, cell debris (red cells and casts), increased urine specific gravity
• electrolytes: hyperkalemia, hypoalbuminemia, and hyperphosphatemia
• anistreptolysin-O (ASO) titer (positive indicating the presence of strep antibodies)
• erythrocyte sedimentation rate (ESR) (elevated indicating active inflammatory response)
• WBC count (elevated indicating inflammation and presence of active strep infection)

Question 7

Diagnostic procedures

Answer 7

• x-ray of kidney, ureter, bladder (KUB), and renal ultrasound (to detect structural abnormalities)
• renal biopsy (to confirm or rule out diagnosis)
• in acute glomerulonephritis, dialysis can be an intervention to treat severe uremia (large amounts of urea and other nitrogenous waste found in the blood)

Question 8

Nursing Care of the Client with Glomerulonephritis

Answer 8

• client’s weight should be monitored daily and any recent weight gain noted
• I&O should be monitored
• client should be observed for changes in urinary pattern
• serum electrolytes, BUN, and creatinine should be monitored
• client should be observed for pruritis
• bed rest is maintained to decrease metabolic demands
• prescribed dietary and fluid restrictions should be observed (fluid, sodium, and protein restrictions)

Question 9

Medications Used in Treatment of Glomerulonephritis

Answer 9

• antibiotics maintain blood levels for an effective elimination of strep infection
• diuretics to reduce edema
• vasodilators to decrease BP
• corticosteroids to decrease inflammatory response

Question 10

Complications of Glomerulonephritis

Answer 10

• renal failure
• uremia
• pulmonary edema
• anemia