Glomerulonephritis Diagnosis and Clinical Features

Laboratory Investigations

• Urinalysis: hematuria, proteinuria
• Cultures of pharynx: positive for streptococci
• Serologic tests: Antistreptolysin O (ASO), Antistreptokinase (ASKase)
• Serum Complement level (C3)

Incidence

• Most common in school-aged children
• Ages of peak incidence: 2 to 6 years
• Predominantly in boys
• 60% to 80% have a history of a preceding upper respiratory tract infection or otitis media

Clinical Features

• Dark brown-colored / “coke” urine due to blood and protein
• Hematuria (blood in urine): may be microscopic or macroscopic
• Proteinuria (primary albumin): due to injury in the glomerular membrane and increased permeability of glomerular membrane
• Urinalysis: turbid; presence of pus, RBC and protein; specific gravity: >1.035
• Oliguria: diminished urine output, reduced GFR due to inflammation of glomerular membrane
• Fluid overload: may have shortness of breath or exercise intolerance
• High blood pressure: may have alteration in mental status; headaches, visual disturbances, signs of hypertensive encephalopathy
• Lab tests: elevated urea and serum creatinine level (Renal insufficiency)

Complications

• Kidney failure: Loss of function in the filtering part of the nephron may cause waste products to accumulate rapidly

Medical Management

• Goal: Reduce inflammation in the kidney, reduce fluid overload, and control blood pressure
• Fluid restriction
• Low protein, low salt, and potassium diet
• Pharmacological interventions: diuretics, anti-hypertensives (ACE inhibitors)

Nursing Interventions

• Nursing diagnosis: Risk for electrolyte imbalance, Risk for ineffective renal perfusion, Risk for poor growth, Risk for anemia
• Expected outcome: Risk of injury related to progression of disease (hypertension)
• Goal: Patient will gradually have stable BP and not experience any related injury (due to hypertensive encephalopathy)

Nephrotic Syndrome

• A collection of symptoms due to kidney damage: proteinuria, edema, hyperlipidemia, and hypoalbuminemia
• Most common among boys between ages 2 and 6 years old
• Nephrotic-range proteinuria: > 2 g protein/dl /24 hrs (dipstick 3+ = 2 - 5 g/24hrs)
• Clinical features: generalized edema, massive proteinuria, hypoalbuminemia, hyperlipidemia, frothy or foamy appearance of urine, weight gain, pale and shiny skin with prominent veins, irritability, anorexia, and malaise

Pathophysiology of Nephrotic Syndrome

• Normally, proteins are not excreted in the urine
• In nephrotic syndrome, some proteins are removed along with waste due to damage to glomeruli
• On microscopic exam, glomeruli appearance greatly changed
• Causes: glomeruli inflammation (as autoimmune response), minimal change nephritis

Laboratory Investigation of Nephrotic Syndrome

• Urinalysis: protein level is > or equal to 2 g/dL/24hrs, micro-hematuria, elevated specific gravity
• Serum albumin level < 25 g/dL (hypoalbuminemia)

Medical Management of Nephrotic Syndrome

• Medication: corticosteroid therapy (Prednisone @ 2mg/kg/day till no more proteinuria for 3 days), antibiotic therapy after blood and urine C/S

Nursing Care Management

• Objectives: identification of child with UTI, education of parents
• Prevention: perineal hygiene, avoid tight clothing/diapers, avoid ‘holding’ urine, increase fluid intake

ACUTE GLOMERULONEPHRITIS

• A common childhood condition: sudden onset of hematuria, proteinuria, and red blood cell (RBC) casts
• Often accompanied by hypertension, edema, uremia (due to decreased glomerular filtration rate)

Pathophysiology of Acute Glomerulonephritis

• History of streptococcal infection about 2 weeks ago
• Formation of anti-streptococcal antibodies; antigen-antibody complex lodges in the glomerular capillaries
• Activates the complement system to cause an inflammatory response in the glomeruli of both kidneys
• Increased capillary permeability and cell proliferation → leakage of some protein and large numbers of erythrocytes into the filtrate
• Immunoglobulin G and C3 (complement) are present in glomerular tissue and serum C3 is reduced
• Loss of filtration function of the nephron: reduced glomerular filtration rate → fluid and wastes product retention
• Decreased blood flow in the kidney - trigger renin secretion which leads to elevated blood pressure and edema
• Severe prolonged inflammation - scarring of kidneys

This quiz covers the laboratory investigations, incidence, and clinical features of glomerulonephritis, including urinalysis, cultures, serologic tests, and more. It also discusses the age range and sex most affected by the disease.