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What is a primary reason for treating urinary tract infections promptly?
What is a primary reason for treating urinary tract infections promptly?
Which dietary choice is recommended for a client with renal failure?
Which dietary choice is recommended for a client with renal failure?
What symptom should a nurse assess for in a client that may indicate renal failure?
What symptom should a nurse assess for in a client that may indicate renal failure?
Which of the following is a complication associated with renal failure?
Which of the following is a complication associated with renal failure?
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Which nursing intervention is important for a client experiencing signs of renal failure?
Which nursing intervention is important for a client experiencing signs of renal failure?
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What is the primary presenting feature of acute glomerulonephritis?
What is the primary presenting feature of acute glomerulonephritis?
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Which of the following is a consequence of antigen-antibody complex deposition in the glomerulus?
Which of the following is a consequence of antigen-antibody complex deposition in the glomerulus?
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What may cause the urine to appear cola-colored in cases of acute glomerulonephritis?
What may cause the urine to appear cola-colored in cases of acute glomerulonephritis?
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Which laboratory findings are likely to be elevated due to decreased urine output in acute glomerulonephritis?
Which laboratory findings are likely to be elevated due to decreased urine output in acute glomerulonephritis?
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What is a common symptom of acute glomerulonephritis that involves swelling?
What is a common symptom of acute glomerulonephritis that involves swelling?
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What factor is noted in 75% of cases of acute glomerulonephritis?
What factor is noted in 75% of cases of acute glomerulonephritis?
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Which condition can result from the increased permeability of the glomerular membrane in acute glomerulonephritis?
Which condition can result from the increased permeability of the glomerular membrane in acute glomerulonephritis?
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What complication may elderly patients face due to acute glomerulonephritis?
What complication may elderly patients face due to acute glomerulonephritis?
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What is often the first indication of the disease discussed?
What is often the first indication of the disease discussed?
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What symptom may develop in patients as the disease progresses?
What symptom may develop in patients as the disease progresses?
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Which diagnostic measure reflects decreased kidney function?
Which diagnostic measure reflects decreased kidney function?
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What is a common complication of renal insufficiency identified in the content?
What is a common complication of renal insufficiency identified in the content?
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What nutritional strategy is recommended for patients with chronic glomerulonephritis?
What nutritional strategy is recommended for patients with chronic glomerulonephritis?
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What is a potential cardiac symptom of the disease as it progresses?
What is a potential cardiac symptom of the disease as it progresses?
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What is the recommended medical management for maintaining blood pressure?
What is the recommended medical management for maintaining blood pressure?
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Which condition can develop due to decreased erythropoiesis?
Which condition can develop due to decreased erythropoiesis?
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What may contribute to the hypertensive nephrosclerosis observed in renal diseases?
What may contribute to the hypertensive nephrosclerosis observed in renal diseases?
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What is one of the common clinical manifestations of chronic kidney disease?
What is one of the common clinical manifestations of chronic kidney disease?
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Which systemic disease can manifest as kidney damage due to glomerular injury?
Which systemic disease can manifest as kidney damage due to glomerular injury?
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What happens to the kidney cortex in chronic renal disease?
What happens to the kidney cortex in chronic renal disease?
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Which of the following conditions can lead to increased glomerular permeability?
Which of the following conditions can lead to increased glomerular permeability?
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What may be a suggested method for diagnosing chronic renal disease?
What may be a suggested method for diagnosing chronic renal disease?
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What consequence does chronic inflammation have on kidney structure?
What consequence does chronic inflammation have on kidney structure?
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What is the glomerular filtration rate expected to do as kidney damage progresses?
What is the glomerular filtration rate expected to do as kidney damage progresses?
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What is the primary cause of acute glomerulonephritis?
What is the primary cause of acute glomerulonephritis?
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Which of the following can lead to the leakage of blood cells and proteins in acute glomerulonephritis?
Which of the following can lead to the leakage of blood cells and proteins in acute glomerulonephritis?
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What type of infections can precede the onset of acute glomerulonephritis?
What type of infections can precede the onset of acute glomerulonephritis?
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Which term describes chronic nephritis in patients who progress from acute nephritis?
Which term describes chronic nephritis in patients who progress from acute nephritis?
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What can be a potential consequence of untreated chronic nephritis?
What can be a potential consequence of untreated chronic nephritis?
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What initiates the immune response in acute glomerulonephritis?
What initiates the immune response in acute glomerulonephritis?
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Which of the following is NOT a viral infection that may lead to acute glomerulonephritis?
Which of the following is NOT a viral infection that may lead to acute glomerulonephritis?
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What are endogenous antigens in the context of acute glomerulonephritis?
What are endogenous antigens in the context of acute glomerulonephritis?
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Study Notes
Acute Glomerulonephritis
- Inflammation of the glomeruli (capillaries that filter substances from plasma)
- Often triggered by Group A beta-hemolytic streptococcal infections of the throat
- May also be caused by other infections like impetigo, bacterial endocarditis, viral infections, hepatitis B, HIV, Schistosomiasis, Leishmaniasis, immunologic abnormalities, free radicals, vascular disorders, or exposure to antigens like medications, foreign serum, and toxins.
- Pathophysiology:
- Activation of the immune response, either by endogenous or exogenous antigens
- Formation of antibodies against the triggering antigen, leading to antigen-antibody complex deposition in the glomeruli
- Increased production of epithelial cells lining the glomerulus (cellular proliferation)
- Leukocyte infiltration of the glomerulus
- Thickening of the glomerular filtration membrane
- Scarring and loss of glomerular filtration membrane
- Decreased glomerular filtration rate (GFR)
Clinical Manifestations of Acute Glomerulonephritis
- Hematuria (blood in the urine), often the first sign, can be microscopic or macroscopic
- Proteinuria (primarily albumin) due to increased permeability of the glomerular membrane
- Elevated BUN and serum creatinine levels as urine output decreases
- Anemia
- Generalized edema, especially around the eyes, feet, or ankles
- Reduced urine volume (oliguria)
- Hypertension (noted in 75% of cases)
- Azotemia
- Protein casts in urine
- Headaches
- Malaise
- Flank pain
- In elderly patients, circulatory overload with dyspnea, engorged neck veins, cardiomegaly, and pulmonary edema
Chronic Glomerulonephritis
- Often results from repeated episodes of acute glomerulonephritis
- May be caused by hypertensive nephrosclerosis, hyperlipidemia, tubule interstitial injury, or systemic diseases like Systemic Lupus Erythematosis, Goodpasture's syndrome, and diabetic glomerulosclerosis
- Pathophysiology:
- Chronic inflammation leads to scar tissue formation, replacing normal nephrons
- Scar tissue distorts the cortex, making the kidney surface rough and irregular
- Kidney size can be reduced to as little as 1/5 of its normal size
- The cortex shrinks to a thin layer of 1-2 mm or less
- GFR progressively decreases as glomeruli and tubules become scarred, and renal arteries thicken
Clinical Manifestations of Chronic Glomerulonephritis
- Mild proteinuria, hematuria, hypertension, and occasional edema may be the only initial manifestations
- Smokily brown-tinged urine, red blood cell casts, and proteinuria exceeding 3-5g/day with albumin as the major protein
- Patients may be asymptomatic until blood pressure, BUN, and creatinine levels rise
- The diagnosis may be suggested during a routine eye examination when vascular changes or retinal hemorrhages are found
- First indication of the disease may be a sudden severe nosebleed, stroke, or seizure
- Pedal edema (swelling of the feet), especially at night
- As the disease progresses, signs and symptoms of renal insufficiency and chronic renal failure develop:
- Poorly nourished appearance (signs of malnutrition)
- Periorbital and peripheral edema
- Blood pressure may be normal or severely elevated
- Pale mucous membranes due to anemia
- Cardiomegaly, distended neck veins, and other signs of heart failure
- Crackles in the lungs
- Nocturia
- Confusion
Diagnostic Measures for Chronic Glomerulonephritis
- Urinalysis:
- Fixed specific gravity of urine (1.010)
- Variable proteinuria
- Urinary casts (protein plugs secreted by damaged kidney tubules)
- Decreased GFR below 50 ml/min (normal is 125-200 ml/min)
- Hyperkalemia (decreased excretion of potassium)
- Metabolic acidosis (decreased acid excretion by the kidney)
- Anemia (decreased erythropoiesis)
- Hypoalbuminemia (protein loss)
- Increased serum phosphorus (decreased renal excretion of phosphorus)
- Decreased serum calcium level (calcium binds to phosphorus to compensate for elevated serum phosphorus levels)
- Chest X-rays show cardiac enlargement
- ECG shows left ventricular hypertrophy or may be normal
- CT scans and MRI show decreased renal cortex
Medical Management of Chronic Glomerulonephritis
- Largely symptomatic, focused on managing complications:
- Hypertension management: sodium and water restriction, antihypertensive medications
- Fluid overload treatment: daily weight monitoring, diuretics
- Nutritional support: high-biologic value proteins (dairy products, eggs, meats) to promote good nutritional status and adequate calories to spare protein
- Prompt treatment of urinary tract infections to prevent further renal damage
- Medications:
- Antibiotics for urinary tract infections
- Antihypertensives
- Diuretics
- Dialysis (in severe cases)
Nursing Interventions for Chronic Glomerulonephritis
- Provide high-biologic value protein and adequate calories
- Monitor fluid intake and output
- Assess client's ability to pursue activities requiring mental concentration
- Assess for altered fluid and electrolyte balance
- Assess for signs of renal failure (nausea, vomiting, decreased urine output)
- Provide emotional support to the client and family
- Emphasize the importance of consistent follow-up to control hypertension
- Advise the client to avoid nephrotoxic agents
- Inspect the client's skin for yellowing, ecchymoses, rashes, dryness, or breaks
- Inspect the neck veins for engorgement and check for pedal edema
- Note any slurred speech, ataxia, or tremors
Complications of Glomerulonephritis
- Acute kidney failure
- Chronic kidney disease
- Hypertension
- Nephrotic syndrome
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Description
This quiz delves into the causes, pathophysiology, and implications of Acute Glomerulonephritis, a condition marked by inflammation of the glomeruli caused by various infections. Key topics include the immune response activation and complications related to glomerular filtration. Test your understanding of this critical renal condition!
