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Questions and Answers
What is the typical age range for peak incidence of Glomerulonephritis?
What is the typical age range for peak incidence of Glomerulonephritis?
What is the primary cause of proteinuria in Glomerulonephritis?
What is the primary cause of proteinuria in Glomerulonephritis?
Which of the following laboratory tests is used to diagnose Glomerulonephritis?
Which of the following laboratory tests is used to diagnose Glomerulonephritis?
What is the main goal of medical management in Glomerulonephritis?
What is the main goal of medical management in Glomerulonephritis?
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What is a potential complication of Glomerulonephritis?
What is a potential complication of Glomerulonephritis?
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What is a nursing diagnosis for a patient with Glomerulonephritis?
What is a nursing diagnosis for a patient with Glomerulonephritis?
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What is an expected outcome for a patient with Glomerulonephritis?
What is an expected outcome for a patient with Glomerulonephritis?
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What is a pharmacological intervention used to manage Glomerulonephritis?
What is a pharmacological intervention used to manage Glomerulonephritis?
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What is the normal excretion of proteins in the urine?
What is the normal excretion of proteins in the urine?
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What is the minimum level of proteinuria considered as nephrotic-range proteinuria?
What is the minimum level of proteinuria considered as nephrotic-range proteinuria?
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What is the characteristic appearance of urine in nephrotic syndrome?
What is the characteristic appearance of urine in nephrotic syndrome?
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What is the common age range for nephrotic syndrome?
What is the common age range for nephrotic syndrome?
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What is the purpose of corticosteroid therapy in the management of nephrotic syndrome?
What is the purpose of corticosteroid therapy in the management of nephrotic syndrome?
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What is the lab value that indicates hypoalbuminemia?
What is the lab value that indicates hypoalbuminemia?
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What is the laboratory investigation that shows micro-hematuria in nephrotic syndrome?
What is the laboratory investigation that shows micro-hematuria in nephrotic syndrome?
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What is the effect of nephrotic syndrome on the skin?
What is the effect of nephrotic syndrome on the skin?
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What is a common symptom of Urinary Tract Infections (UTI) in children that may indicate the need for further assessment?
What is a common symptom of Urinary Tract Infections (UTI) in children that may indicate the need for further assessment?
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What is the primary goal of antibiotic therapy in the management of Urinary Tract Infections (UTI) in children?
What is the primary goal of antibiotic therapy in the management of Urinary Tract Infections (UTI) in children?
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What is the characteristic laboratory finding in Acute Glomerulonephritis?
What is the characteristic laboratory finding in Acute Glomerulonephritis?
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What is the underlying pathophysiological mechanism of Acute Glomerulonephritis?
What is the underlying pathophysiological mechanism of Acute Glomerulonephritis?
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What is a common prevention strategy for Urinary Tract Infections (UTI) in children?
What is a common prevention strategy for Urinary Tract Infections (UTI) in children?
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What is a potential complication of untreated Acute Glomerulonephritis?
What is a potential complication of untreated Acute Glomerulonephritis?
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What is the role of the complement system in the pathophysiology of Acute Glomerulonephritis?
What is the role of the complement system in the pathophysiology of Acute Glomerulonephritis?
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What is an important aspect of nursing care management for children with Urinary Tract Infections (UTI)?
What is an important aspect of nursing care management for children with Urinary Tract Infections (UTI)?
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Study Notes
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
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Description
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.
