Glomerulonephritis Test 5

Question 1

Glomerulonephritis

Answer 1

Immunologic process involving the urinary tract predominantly affect the renal glomerulus
-glomerular injury as result of inflammation, affecting both kidneys equally

Question 2

Etiology of glomerulonephritis:

Answer 2

• immunological reaction
• SLE
• strep infection
• Vascular injury
• hypertension
• Metabolic disease
• diabetes mellitus
• Disseminated intravascular coagulation

Question 3

Glomerulonephritis patho:

Answer 3

• Antigen-antibody complex formation and reaction with glomerular tissue
• causes inflammation in glomerulous -primary vs. ssecondary-associated with systemic disease-acute, chronic, idiopathic or may occur as a complication of other diseases-rapidly progressive (loss of fx in days/weeks)

Question 4

Attacks the glomerular basement membrane which-

Answer 4

becomes more porous

• proteinuria, hematuria, azotemia
• decreased glomerular filtration
• retention of metabolic waste
• retention of water and sodium

Question 5

Early S/S of glomerulonephritis:

Answer 5

• proteinuria and hematuria: early sign
• bacteria neg in the U/A
• Azotemia: elevated BUN and Creatinine early sign
• Increased urine specific gravity
• Elevated antistreptolysin O titer/
• Elevated Sed rate
• Metabolic acidosis d/t impaired glomerular filtration causing retention of waste products
• Oliguria

Question 6

S/S of glomerulonephritis early/late:

Answer 6

• Anemia
• Fatigue
• Anuria
• HA
• Malaise
• mild fever
• anorexia
• flank pain or CVA tenderness

Question 7

S/S of glomerulonephritis (late):

Answer 7

• Increased B/P r/t fluid overload
• Edema
• JVD
• Periorbital edema
• End stage renal failure
• irreversible renal failure occurs in less than 1% of patients
• Circulatory congestion
• dyspnea
• CHF
• Complications r/t fluid overload
• CHF
• encephalopothy
• pulmonary edema
• sepsis from infection
• end stage renal failure
• *Irreversible renal failure occurs in less than 1% of patients

Question 8

Glomerulonephritis Diagnostic studies:

Answer 8

• Urinalysis
• bacteria neg
• RBC, WBC, and casts
• urine smoky or rusty in appearance
• hematuria
• proteinuria
• Possible decreased urine creatinine clearance
• Serum BUN/Creatinine
• ESR
• Antistreptolysin-O titer (ASO)
• Chronic
• fixed specific gravity
• metabolic acidosis

Question 9

Glomerulonephritis prevention:

Answer 9

• early detection and treatment of respiratory infections to prevent increase antigen/antibody complex formation
• supportive, symptomatic care
• diuretics for severe fluid overload
• antihypertensive therapy (only after fluid control has proven unsuccessful)
• Rest during acute stage to decrease workload on kidneys
• decrease the metabolic activity
• advance activity as symptoms disappear; no protein or blood in the urine

Question 10

Dietary management:

Answer 10

• Dietary sodium restriction
• fld volume deficit r/t decrease glomerular filtration rate
• Potassium restriction
• if GFR is <10 ml/min
• hyperkalemia can cause dysrhythmia and neuromuscular symtoms
• protein restriction
• 1-1.2 g/day when BUN/Creatinine is elevated
• to decrease metabolic waste products and decrease stress on the kidney
• Sufficient dietary carbohydrates
• carb prevention protein being used as energy, leading to muscle wasting and nitrogen imbalances
• 2500-3500 calories/day
• monitor pt for weight loss

Question 11

Chronic Glomerulonephritis:

Answer 11

• reflects the end stage of glomerular inflammatory disease from progressive destruction of the glomeruli
• Leads to gradual loss of renal function from tubular atrophy, chronic interstitial inflammation and arteriosclerosis
• Extremely variable
• Insidious or rapid
• May follow AGN but often there is no hx of infection
• Treatment mirrors AGN and is supportive and symptomatic
• No specific therapy to arrest or reverse the disease process
• Treatment of renal failure begins when illness progress to end stage

Question 12

S/S

Answer 12

• U/A- foamy dark smokey color, protein and blood will decrease as the fewer nephrons are intact. Urine specific gravity will become fix same as the plasma. Casts in the urine
• Metabolic Acidosis- r/t impaired glomerular filtration.
• HA especially in morning
• HTN- d/t activation of renin-angiotensin aldosterone system.
• dyspnea on exertion
• blurred vision

Question 13

S/S continued

Answer 13

• Lassitude
• weakness
• fatigue
• edema
• nocturia
• effects on the GI:
• anorexia
• weight loss