Glomerulonephritis

Glomerulonephritis

DefinitionGlomerulonephritis 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:

groupAbetahemolyticStreptococcal infection of the throat (strep throat) or skin (impetigo)Hereditary diseasesImmune diseases, such aslupusType 1 diabetesandType 2 diabetesHigh blood pressureVasculitis (inflammation of the blood vessels)Viruses (HIV,hepatitis B virus, andhepatitis C virus)Endocarditis(infection of the valves of the heart)

There are two types of glomerulonephritis:Acute glomerulonephritisBegins suddenly.is an inflammatory disease of both kidneys predominantly affecting children from ages two to 12.

Chronic glomerulonephritisDevelops 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, orsystemic lupus erythematosus.

Risk factors for glomerulonephritis include:Family history of glomerulonephritis.The presence of a known cause of glomerulonephritis

PATHOPHYSIOLOGYPost-streptococcal infection (group-A, beta hemolytic)Release of material from the organism, into the circulation (antigen)Formation of antibodyImmune complex reaction in the glomerular capillary

Inflammatory responseProliferation of epithelial cells lining glomerolus & cells betweenendothelium & epithelium of capillarymembraneSwelling 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 flowRetention of H2O & Na; hypovolemia; circulatory congestion

Edema Hypertension urinary output Urine dark in colorAnorexia Irritability lethargyACUTEGL 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 urineLess frequent urinationSwelling in the morning, especially in the face, feet, hands, and abdomen

Chronic glomerulonephritis can lead to kidney failure, which may cause these symptoms:Feeling tiredDry, itchy skinNauseaVomitingPoor appetiteMuscle cramps at nightSwelling 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, CHONBlood Test: - BUN & Creatinine Clearance - ASO (Anti-streptolysin O) Titer - Serum CHON, HgbKUB - 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.

TreatmentsTreatment for high blood pressureKeeping 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:DiureticsAngiotensin-converting enzyme (ACE) inhibitorsAngiotensin II receptor agonists

Treatment for an underlying causeStrep 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 failureFor 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.