Glomerulonephritis: Etiology and Pathophysiology

• Glomerulonephritis involves inflammation of the capillary loops in the glomeruli, leading to kidney disease.

Etiology and Pathophysiology

• Glomerulonephritis is caused by an immunological reaction to an antigen.
• Endogenous antigens originate within the glomerulus or other body tissues.
• Exogenous antigens come from infections occurring in the body.

Description

• Antigen-antibody complexes trapped within glomeruli cause an inflammatory response that damages the glomeruli.
• Glomerulonephritis results in proliferative and inflammatory changes within the glomerular structure.
• Destruction and sclerosis of the glomeruli occur in either or both kidneys.
• Loss of kidney function is a result of glomerulonephritis.

Causes

• A history of pharyngitis or tonsillitis 2 to 3 weeks before symptoms may indicate glomerulonephritis.
• Group A beta-hemolytic streptococcal infection is a cause.
• Immunological or autoimmune diseases are causes.
• Drugs like pain killers, antibiotics, and toxins like cocaine can cause it.
• Viral infections such as HBV and HCV are causes.

Types

• Acute glomerulonephritis occurs 5 to 21 days after a streptococcal infection.
• Chronic glomerulonephritis occurs after the acute phase or slowly over time.

Clinical Manifestations

• Early symptoms include pharyngitis, fever, and malaise (weakness, fatigue).
• Additional early symptoms are recent upper respiratory or skin infection, pericarditis, and lower UTI.
• Advanced stages show gross hematuria.
• Coffee, cola-colored, or red-brown urine occurs in advanced stages.
• Proteinuria produces persistent & excessive foam in urine, a sign of advanced stages.
• Hypertension, edema in the face, periorbital area, and feet, plus fever with chills are further signs of advanced stages.
• Anorexia, nausea, and vomiting may occur.
• Pulmonary infiltration causing shortness of breath, ascites, and congestive heart failure are clinical manifestations
• Systemic lupus erythematosus (SLE) is a clinical manifestation.
• Other symptoms include oliguria or anuria, abdominal or flank pain, an elevated erythrocyte sedimentation rate (ESR), elevated BUN and creatinine, and a decrease in creatinine clearance (GFR).

Complications

• Potential complications include heart failure, hypertensive encephalopathy, and pulmonary edema.
• Renal failure and nephrotic syndrome may result.

Tests

• Testing includes streptococcal exoenzymes and antistreptolysin O titer.
• Creatinine clearance (glomeruli filtration rate) and electrolyte levels (Chem 7) are assessed.
• Urine tests, renal X-rays, ultrasound, CT scans, and renal biopsy are conducted.

Treatment

• Treatment depends on whether the condition is acute or chronic.
• Treatment type and severity level depends on signs and symptoms.
• Treat the underlying infections with antibiotics.
• Treatment involves addressing hypertension with medication.
• Plasmapheresis may conducted.
• Dialysis is needed if the disease progresses to renal failure.

Nursing Interventions

• Monitor vital signs, I/O, and urine characteristics.
• Monitor daily weight and edema, and implement fluid restriction as advised.
• Provide bed rest and limit activity.
• Administer diuretics, antihypertensives, and antibiotics as prescribed.

Patient Education

• Educate patients to obtain treatment for infections, especially sore throats, skin lesions, and upper respiratory infections.
• Patients should be instructed to report signs of bloody urine, headache, or edema.
• Teach patients about the importance of BP monitoring at periodical intervals.
• A high-calorie, low-protein, low-sodium, and low-potassium diet is recommended.

Evaluation

• Success of the treatment will be determined by ensuring normal blood pressure.
• Evaluate the absence of hematuria, proteinuria, oliguria, normal BUN and creatinine levels, and absence of edema.

NCLEX Questions and Rationales

• Question 1: A child with acute glomerulonephritis (AGN) shows positive results on several tests. What lab test is most indicative of AGN?
• Answer: A. Elevated antistreptolysin O (ASO) titers
• Rationale: An elevated ASO titer indicates a recent streptococcal infection, which is a precursor to AGN. Elevated ESR indicates inflammation in the body, hematuria may have many possible causes, and creatinine concentrations reflect kidney function.
• Question 2: A male client in the ER has coffee-colored urine and edema, and reports a recent sore throat. His BP is elevated, and urinalysis shows blood and protein in the urine.
• Answer: C. Acute glomerulonephritis
• Rationale: The symptoms are typical of acute glomerulonephritis. Hematuria and proteinuria are caused by a damaged glomerular capillary membrane, which allows blood cells and protein to escape into the renal filtrate.
• Question 3: In the client with glomerular disease to slow the progression of end stage renal disease the nurse will administer?
• Answer: A & B - Antihypertensives & non-steroidal anti-inflammatory drugs
• Rationale: Antihypertensives control systemic and renal hypertension, and non-steroidal anti-inflammatory drugs reduce proteinuria; Hypertension, inflammation and proteinuria lead to end stage renal disease.