Acute / Chronic Glomerulonephritis

1. Acute / Chronic Glomerulonephritis

2. Key Points • Glomerulonephritis is an inflammation of the glomerular capillaries, usually following a streptococcal infection. • It is an immune complex disease, not an infection of the kidney. • Glomerulonephritis exists as an acute, latent, and chronic disease. • Acute Glomerulonephritis (AGN) • Insoluble immune complexes develop and become trapped in the glomerular tissue swelling capillary cell death. • Prognosis varies depending upon specific cause but spontaneous recovery generally occurs after the acute illness. • Chronic Glomerulonephritis (CGN) can occur without previous history or known onset. • CGN is 3rd leading cause of end ESRD.

3. Risk Factors • Immunological reactions • Primary infection with group A beta-hemolytic streptococcal infection (most common) • SLE • Vascular injury (HTN) • Metabolic disease (DM) • Nephrotoxic drugs • Excessively high protein and high sodium diets

4. Diagnostic Procedures and Nursing Interventions • KFT: • Serum BUN (elevated: 100 to 200 mg/dL; normal: 10 to 20 mg/dL) and • Creatinine (elevated: greater than 6 mg/dL; normal: 0.6 to 1.2 mg/dL) • Urinalysis: Proteinuria, hematuria, cell debris (red cells and casts), increased urine specific gravity • Electrolytes: Hyperkalemia, hypermagnesemia, dilutionalhyponatremia if urine output is decreased • Throat Culture (to identify possible streptococcus infection) • Antistreptolysin-O (ASO) titer (positive indicating the presence of strep antibodies) • ESR (elevated indicating active inflammatory response) • White Blood Cell Count (elevated indicating inflammation and presence of active strep infection) • KUB & Ultrasound (to detect structural abnormalities such as atrophy) • Renal Biopsy

5. Therapeutic Procedures and Nursing Interventions • Plasmapheresis(to filter antibodies out of circulating blood volume) • Monitor the client carefully during and following the procedure. • Take interventions to reduce the risk of coagulation.

6. Assessments • Monitor for characteristic of systemic circulatory overload. • Renal symptoms; Decreased urine output, Smoky or coffee-colored urine (hematuria), and Proteinuria • Fluid volume excess symptoms; SOB, Orthopnea, Bibasilar rales, Periorbital edema, and Mild to severe hypertension • Change in LOC • Anorexia/nausea • Headache

7. Assessment • Back pain • Fever (AGN) • Pruritus (CGN) • Assess/Monitor • Dyspnea, orthopnea, • lung crackles • Weight gain • Edema • Hypertension • Intake and output • Changes in urinary pattern Serum electrolytes, BUN, creatinine Skin integrity (pruritus)

8. NANDA Nursing Diagnoses • Fluid volume excess • Fatigue • Acute pain • Fear • Anxiety • Deficient knowledge

9. Nursing Interventions • Administer prescribed medications: • AB. • Diuretics to reduce edema. • Vasodilators to decrease blood pressure. • Corticosteroids to decrease inflammatory response. • Maintain bedrest to decrease metabolic demands. • Maintain prescribed dietary restrictions: • Fluid restriction (24 hr output + 500 mL). Sodium restriction. Protein restriction (if azotemia is present). Correct electrolyte imbalances

10. Complications and Nursing Implications • Renal Failure • Uremia • muscle cramps, fatigue, pruritus, anorexia, metallic taste in mouth. • Intervene to maintain skin integrity. Assist with dialysis. • Pulmonary Edema, Congestive Heart Failure, Pericarditis • dyspnea, crackles, edema, and decreased cardiac output. • Intervene accordingly (oxygen, diuretics, inotropic medications). • Anemia • Monitor hemoglobin. Administer iron and erythropoietin as indicated.