Download Glumorulonephritis

inflammation of the capillaries of the renal
glomeruli
A variety of diseases can affect the glomerular
capillaries, includin acute and chronic
glomerulonephritis, rapidly progressive .
In all of these disorder the glomerular capillaries
are primarily damaged and dead .
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Acute glomerulonephritis is primarily a disease of
children
older than 2 years of age, but it can occur at nearly
any age in most cases of acute glomerulonephritis .
- Antigen group A beta-hemolytic streptococcus
Antigen-antibody product
- Deposition of antigen–antibody complex in
glomerulus
- Increased production of epithelial cells lining
the glomerulus
- Leukocytes infiltrate the glomerulus
- Thickening of the glomerular filtration
membrane
- Scarring and loss of glomerular filtration
membrane
- Decreased glomerular filtration rate (GFR )
The primary presenting feature of acute
glomerulonephritis is :
1- hematuria (blood in the urine),
2- The urine may appear cola-colored because
of RBCs and protein plugs or casts. (RBC casts
indicate glomerular injury
3- the patient has acute renal failure with oliguria
.
4- Proteinuria (primarily albumin), which is present, is due
to the increased permeability of the glomerular
membrane
5- BUN and serum creatinine levels may rise as urine
output drops. The patient may be anemic .
6- edema and hypertension is noted in 75% of
patients.
.
7-the patient also complains of headache, malaise, and
flank pain
.8- Elderly patients may experience circulatory
overload with dyspnea, engorged neck veins,
cardiomegaly, and pulmonary edema .
.
Diagnosis of glomerulonephritis is established based on
medical history, combined with laboratory studies. A
"dipstick" test of urine will reveal increased protein levels.
A 24 hour urine collection allows measurement of the
excretion of proteins and creatinine. Creatinine clearance
from the bloodstream by the kidneys is considered an
index of the glomerular filtration rate. Blood studies may
reveal a low blood count, A kidney biopsy may also be
performed, using ultrasound to guide the needle for
obtaining the specimen.
- the kidneys become large, swollen
and congested
- All renal tissues—glomeruli, tubules, and blood vessels—
are
affected to varying degrees
- Some patients become severely uremic within weeks and
require dialysis for surviva
- Serial determinations of antistreptolysin O or anti-DNase
B
titers are usually elevated in poststreptococcal
glomerulonephritis
- Serum complement levels may be decreased
- Fluid volume excess R/T glomerular inflammation and
decreased renal filtration .
- Chronic pain
- Fluid Imbalance R/T hyperkalemia .
- Self care Deficit / Toileting R/ T loss of strength .
-
Complications of acute glomerulonephritis include
hypertensive , encephalopathy, heart failure, and pulmonary
edema , uremia
-
If residual streptococcal infection is suspected
penicillin is the agent of choice
- antibiotic agents may be prescribed
- Corticosteroids and immunosuppressant
medications may be prescribed
- Sodium is restricted
when the patient has hypertension, edema, and heart
failure
- Loop diuretic medications and antihypertensive agents
may be prescribed to control hypertension
-
In a hospital setting, carbohydrates
are given liberally to provide energy and reduce the
catabolism of protein .
- Intake and output are carefully measured and recorded .
- Fluids are given according to the patient’s fluid losses
and
daily body weight .
- patient education for safe and effective self-care at home
.
- Proteinuria and microscopic hematuria may persist for
many
months .
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. The kidneys are reduced to as little
as one-fifth their normal size (consisting largely
of fibrous tissue).
The cortex shrinks to a layer 1 to 2 mm thick or
less. Bands
of scar tissue distort the remaining cortex,
making the surface of
the kidney rough and irregular. Numerous
glomeruli and their
tubules become scarred, and the branches of the
renal artery are
thickened.
The symptoms of chronic glomerulonephritis vary. Some patients
with severe disease have no symptoms at all for many years.
- Their condition may be discovered when hypertension elevated
BUN and serum creatinine levels are detected
- severe nosebleed, a stroke,
or a seizure
- Many patients report that their feet are slightly
swollen at night
- The diagnosis
may be suggested during a routine eye examination when
vascular changes or retinal hemorrhages are found.
-
Most patients also have general symptoms, such
as loss of weight and strength, increasing irritability, and
an increased
need to urinate at night (nocturia).
- Headaches, dizziness, and digestive disturbances are
common.
- - The patient becomes confused and demonstrates a
limited attention span.
- The patient appears poorly nourished, with a yellowgray
Pigmentation
-
- Retinal findings include hemorrhage, exudate,
narrowed tortuous arterioles, and papilledema
- Crackles can be heard in the lungs
-
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Nephrotic syndrome
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- Acute nephritic syndrome
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- Chronic kidney failure
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- End-stage kidney disease
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- Hypertension
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- Malignant hypertension
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- Fluid overload congestive heart failure,
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- Chronic or recurrent urinary tract infection
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- Increased susceptibility to other infections
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- Hyperkalemia
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- pulmonary edema
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A number of laboratory abnormalities occur. Urinalysis
reveals
As renal failure progresses and the GFR falls below 50
mL/min, the following changes occur:
-
Hyperkalemia due to decreased potassium excretion,
acidosis,
catabolism, and excessive potassium intake from food and
medications
Metabolic acidosis from decreased acid secretion by the kidney
and inability to regenerate bicarbonate
-
- Anemia secondary to decreased erythropoiesis (production
of RBCs)
- Hypoalbuminemia with edema secondary to protein loss
through the damaged glomerular membrane
- Increased serum phosphorus level due to decreased renal
excretion of phosphorus
- Decreased serum calcium level (calcium binds to phosphorus
to compensate for elevated serum phosphorus levels)
- Hypermagnesemia from decreased excretion and inadvertent
ingestion of antacids containing magnesium
-If the patient has hypertension, the blood pressure is
reduced with sodium and water restriction
antihypertensive agents, or both
.- Weight is monitored daily, and diuretic
medications are prescribed to treat fluid overload
-Proteins of high biologic value (dairy products, eggs, meats) are
provided to promote good nutritional status
-Adequate calories are also important
to spare protein for tissue growth and repair
,
If the patient is hospitalized or seen by the
nurse in the home
,
the nurse should :
- observes the patient for changes in fluid and electrolyte
status
- signs and symptoms of deterioration of renal function
- in cardiac and neurologic status are reported promptly to
the physician
- Anxiety levels are often extremely high for both the
patient and Family
- Gives emotional support by providing opportunities for
the
patient and family to verbalize their concerns, have their
questions answered, and explore their options