Glomerulonephritis Presentation PDF

GLOMERULONEPHRITIS Dr. Sibi Peter, PhD, RN, CCRN Etiology and Pathophysiology A group of kidney disease caused by inflammation of capillary loops in glomeruli Caused by immunological reaction to an antigen Endogenous - antigens already in the glomerulus or other body tissues Exogeno...

GLOMERULONEPHRITIS Dr. Sibi Peter, PhD, RN, CCRN Etiology and Pathophysiology A group of kidney disease caused by inflammation of capillary loops in glomeruli Caused by immunological reaction to an antigen Endogenous - antigens already in the glomerulus or other body tissues Exogenous – antigens comes from infections occurring in the body Description Antigen-antibody complexes trapped within glomeruli produce an inflammatory response that damages glomeruli Results in proliferative and inflammatory change within the glomerular structure Destruction and sclerosis of the glomeruli in either or both kidneys Results in lost of kidney function Causes History of pharyngitis or tonsillitis 2 to 3 weeks prior to symptoms Group A beta-hemolytic streptococcal infection Immunological or autoimmune disease Drugs – pain killers, antibiotics, toxins like cocaine Viral infections like – HBV, HCV Types Acute – occurs 5 to 21 days after a streptococcal infection Chronic – occurs after the acute phase or slowly overtime Clinical Manifestations Early symptoms are mild: – Pharyngitis – Fever – Malaise (Weakness, Fatigue) – Recent upper respiratory or skin infection – Pericarditis – Lower UTI Clinical Manifestations (cont.,) Advance stages: – Gross hematuria – Coffee, cola-colored or red-brown urine – Proteinuria – produces persistent & excessive foam in urine – Hypertension – Edema – face, periorbital, and feet – Fever with chills Clinical Manifestations (cont.,) – Anorexia, nausea, and vomiting – Oliguria or anuria – Pulmonary infiltration – SOB, ascites, CHF – Abdominal or flank pain – Elevated erythrocyte sedimentation (ESR) – Elevated BUN and creatinine – Decrease in creatinine clearance (GFR) – Systemic lupus erythematosus (SLE) What are the Complications? Heart failure Hypertensive encephalopathy Pulmonary edema Renal failure Nephrotic syndrome Tests Streptococcal exoenzymes Antistreptolysin O titer Creatinine clearance (Glomeruli Filtration Rate) Electrolyte levels (Chem 7) Urine test Renal X-ray, Ultrasound, CT scan Renal biopsy Treatment Depends on condition – acute or chronic Type and severity depending on signs and symptoms Treat the underlying infections with antibiotics Treat hypertension Plasmapheresis Dialysis if disease progresses to renal failure Nursing Interventions Monitor vital signs Monitor I/O, urine characteristics Monitor daily weight Monitor for edema Maintain fluid restriction as advised Provide bed rest and limit activity Administer diuretics, antihypertensives, and antibiotics as prescribed Patient Education Obtain treatment for infections, especially sore throats, skin lesions, and upper respiratory infections Report signs of bloody urine, headache, or edema BP monitoring at periodical intervals Diet : High–calorie, low-protein, low- sodium, and low-potassium diet Evaluation Normal blood pressure Absence of hematuria, proteinuria, oliguria Normal BUN and creatinine Absence of edema NCLEX QUESTION - 1 A child has been admitted with acute glomerulonephritis (AGN). All of the following tests are positive for AGN. The nurse concluded that which lab test is most indicative of this disease? A.Elevated antistreptolysin O (ASO) titers B.Elevated erythrocyte sedimentation rate (ESR) C.Presence of hematuria as per urinalysis D.Elevated creatinine concentration NCLEX Rational - 1 Answer A An elevated ASO titer indicates a recent streptococcal infection, which is a precursor to AGN. An elevated ESR indicates inflammation in the body and is associated with many diseases. Hematuria is simply blood in the urine, which has many possible causes Creatinine concentrations reflect the functioning of the kidney NCLEX QUESTION - 2 A male client who presents to the ER with coffee-colored urine and edema states he had a bad sore throat a few weeks ago. His BP is elevated, and urinalysis shows blood and protein in the urine. How does the nurse interpret this clinical picture ? A.Urinary calculi B.Urinary tract infection C.Acute glomerulonephritis D.Acute prostatitis NCLEX Rational - 2 Answer C 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. NCLEX QUESTION - 3 In order to slow the progression of end stage renal disease in the client who has been diagnosed with glomerular disease the nurse would plan to administer (Select all that apply) A.Antihypertensives. B.Nonsteriodal anti-inflammatory drugs. C.Packed red blood cells. D.Anti-platelet drugs. NCLEX Rational - 3 Answer A & B Antihypertensives & non- steriodal anti-inflammatory drugs. Rationale: Antihypertensives are administered to control systemic and renal hypertension. Non steroidal anti- inflammatory drugs reduce proteinuria. Hypertension inflammation and proteinuria lead to end stage renal disease.