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Acute Glomerulonephritis

Medical surgical notes

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jucelie082
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14 views17 pages

Acute Glomerulonephritis

Medical surgical notes

Uploaded by

jucelie082
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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ACUTE GLOMERULONEPHRITIS

• there are many forms of glomerulonephritis


• APSGN –Acute post streptococcal
glomerulonephritis which follows
streptococcal infection with certain groups A
beta-hemolytic streptococcus .
• these infection usually originate as upper
respiratory infections, middle ear infections
“STREP THROAT”.
• certain strains of staphylococcus are
occasionally responsible for initiating the
immune disorder in the kidney
• AGN develops 10 days to 2 weeks after
the antecedent infection.
• it affects primarily children between the
ages of 3 and 7 years especially boys.
• PATHOPHYSIOLOGY
• the antistreptococcal antibodies, formed
as usual from the earlier streptococcal
infection
• create an antigen-antibody complex that
lodges in the glomerular capillaries
• activates the complement system to
cause an inflammatory response glomeruli
of both kidneys
• this leads to increased capillary
permeability and cell proliferation
• And results in leakage of some protein and
large numbers of erythrocytes into the
filtrate
• immunoglobulin G and C3 are present in
glomerular tissue and serum C3 is
reduced
• when the inflammatory response is
severe, the congestion and cell
proliferation interfere with filtration in the
kidney causing decreased GFR and
retention of fluid and wastes
• ARF is possible if blood flow is sufficiently
impaired
• the decreased blood flow in the kidney is
less likely to trigger renin secretion which
leads to elevated BP and edema.
• severe prolonged inflammation will cause
scarring of the kidneys
• SIGNS AND SYMPTOMS
• the urine become dark and cloudy
(“smoky or coffee colored urine”) because
of the protein and red blood cells leaked
into it
• facial and periorbital edema occur initially,
followed by generalized edema as the
colloid osmotic pressure of the blood
drops and sodium and water are retained
• BP is elevated owing to increased renin
secretion and decreased GFR
• Flank or back pain develops as the kidney
tissue swells and stretches the capsule
• general signs of inflammation are present,
including malaise, fatigue, headache,
anorexia, and nausea
• urine output decreases (oliguria) as GFR
declines
• LABORATORY ASSESSMENT
• urinalysis shows hematuria and proteinuria –
early morning urine is preferred because the
urine is most acidic and formed elements are
more intact
• BUN levels are increased
• urea and creatinine are elevated as GFR
decreases
• blood levels of streptococcal antibodies,
ANTISTREPTOLYSIN O (ASO) and
exoenzyme antistreptokinase ASK are
elevated
• metabolic acidosis with decreased serum
bicarbonate and low serum pH is present
• INTERVENTIONS
• sodium restrictions
• protein and fluid intake is decreased
• glucocorticoid to reduce the inflammation
• antihypertensive to reduce high BP
• ANTIBIOTICS LIKE penicillin,
erythromycin or azithromycin
• for clients with fluid overload hypertension
and edema, diuretics, sodium and water
restrictions are prescribed
• instruct patient and so the purpose and
desired effects of prescribed medications
• ensure that the client and family
understand dietary or fluid modification
including methods of detecting fluid
retention
• advise patient to weigh himself and
measure BP daily at th same time each
day.
• CHRONIC GLOMERULONEPHRITIS
• chronic nephrotic syndrome
• develops 20 to 30 years or even longer
• cause is not known because the kidneys
are atrophied and tissue is not available
for biopsy
• SIGNS AND SYMPTOMS
• mild proteinuria and hematuria
• hypertension
• occasional edema
• Changes in the renal tissue because of
hypertension
• kidney tissue atrophies and the number of
functional nephron is greatly reduced
• biopsy in the late stages show glomerular
changes,cell loss, protein and colagen
deposits
• eventually chronic glomerulonephritis
leads to renal failure
• assess for uremic symptoms such as
slurred speech, ataxia, tremors
• DIAGNOSTIC ASSESSMENT
• urinalysis shows proteinuria
• presence of RBC in the urine
• serum creatinine is elevated
• BUN is increased
• kidneys are abnormally small on x-ray
• INTERVENTION
• focus on the slowing the progression of
the disease and preventing complications.
• treatment consist of diet changes, fluid
intake sufficient to prevent reduced blood
flow volume to the kidneys
• drug therapy to control the problems from
uremia

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