Nephritis Treatment Overview

Nephritis Treatment Team

• A multidisciplinary team, including a nephrologist, primary care physician, nurses, dietitians, social workers, ostomy nurses, pharmacists, and potentially endocrinologists, immunologists, and a home healthcare team, is involved in caring for patients with nephritis.
• Pregnancy necessitates a maternal-fetal medicine specialist, while children require parental and school system involvement.

Treatment Goals

• Preventing further kidney damage
• Managing underlying conditions like hypertension and diabetes 
• Reducing symptoms

Diagnostic Tests

• Throat or skin cultures are used to identify group A beta-hemolytic streptococci infections, particularly in poststreptococcal glomerulonephritis.
• Antistreptolysin O (ASO) titer and other blood tests detect streptococcal exoenzymes.
• Erythrocyte sedimentation rate (ESR) is an indicator of inflammation.
• KUB x-ray evaluates kidney size and rules out alternative causes.
• Kidney scan visualizes kidney function by measuring radioactive material uptake and excretion.
• Renal biopsy, the gold standard for glomerular disorders, provides information about the type of nephritis, prognosis, and appropriate treatment.

Evaluating Kidney Function

• Blood Urea Nitrogen (BUN) measures urea nitrogen, a byproduct of protein metabolism. Elevated levels indicate impaired filtration and elimination of urea.
• Serum creatinine measures creatinine in the blood, a reliable indicator of kidney function due to its exclusive excretion by the kidneys.
• Urine creatinine levels decrease with impaired renal function due to ineffective creatinine elimination.
• Creatinine clearance evaluates glomerular filtration rate (GFR), providing a specific indicator of renal function.
• Serum electrolytes are monitored due to their altered excretion in impaired kidney function.
• Urinalysis often reveals red blood cells and proteins in the urine, indicating glomerular damage.
• A 24-hour urine specimen quantifies protein in the urine.

Pharmacologic Therapy

• Penicillin-type antibiotics are used to treat strep infections in poststreptococcal glomerulonephritis.
• Nephrotoxic antibiotics, such as aminoglycosides, are avoided.
• Corticosteroid drugs suppress inflammation and reduce edema.
• Long-term corticosteroid use can lead to Cushing syndrome.
• Immunosuppressant drugs, like cyclophosphamide, can be used to treat chronic inflammation.

Managing Hypertension

• Antihypertensive drugs, including ACE inhibitors, alpha-adrenergic blockers, angiotensin receptor blockers, beta-adrenergic blockers, and calcium channel blockers, are used to control blood pressure.
• Effective blood pressure management is crucial for a favorable prognosis.

Edema Management

• Diuretic drugs, such as loop diuretics and thiazide diuretics, eliminate excess fluid and lower blood pressure.
• Dietary restrictions on sodium and potassium are recommended.

Nonpharmacologic Therapy

• Strict intake and output monitoring, along with daily weight measurement, are crucial.
• Sodium intake may be restricted to 1 to 2 g per day in severe cases.
• Dietary protein may be restricted if azotemia is present.
• Bed rest may be prescribed during acute postinfectious glomerulonephritis.
• Plasma exchange therapy (plasmapheresis) is used to remove glomerular-damaging antibodies.
• Potential complications of plasmapheresis include IV catheter issues, fluid volume shifts, and altered coagulation.

This quiz covers the multidisciplinary team involved in nephritis treatment, including roles of various healthcare professionals and specific treatment goals. It also discusses diagnostic tests utilized in identifying and managing nephritis. Test your understanding of nephritis care and its critical components.