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.

 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.blood countkidney biopsy

- 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 yellow- gray Pigmentation - - Retinal findings include hemorrhage, exudate, narrowed tortuous arterioles, and papilledema - Crackles can be heard in the lungs

- Nephrotic syndrome Nephrotic syndrome  - Acute nephritic syndromeAcute nephritic syndrome  - Chronic kidney failure  - End-stage kidney disease   - HypertensionHypertension  - Malignant hypertensionMalignant hypertension

  - Fluid overload congestive heart failure,heart failure   - Chronic or recurrent urinary tract infectionChronic or recurrent urinary tract infection  - Increased susceptibility to other infections  - HyperkalemiaHyperkalemia  - pulmonary edemapulmonary edema 

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