Nephritis Mike Parenteau

Etiology Nephritis is inflammation of the kidney. The word comes from the Greek nephro- meaning "of the kidney" and -itis meaning "inflammation". The two most common causes of nephritis are infection or an auto-immune process.

Sub Types glomerulonephritis is inflammation is of the glomeruli. (Often when the term "nephritis" is used without qualification, this is the condition meant.) interstitial nephritis or tubulo-interstitial nephritis is inflammation is of the spaces between renal tubules. pyelonephritis is when a urinary tract infection has reached the pyelum (pelvis) of the kidney. Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system.

Acute Glomerulonephritis GN) is a primary or secondary autoimmune renal disease characterized by inflammation of the glomeruli. It may be asymptomatic, or present with hematuria and/or proteinuria (blood resp. protein in the urine). There are many recognised types, divided in acute, subacute or chronic glomerulonephritis. Causes are infectious (bacterial, viral or parasitic pathogens), autoimmune or paraneoplastic.

Etiology Preceded by an infection, such as a sore throat or skin infection 2 to 3 weeks earlier. (most commonly strep) Pre existing multisystem diseases, such as systemic lupus

Etiology The infectious disease process triggers an immune response that results in inflammation of glomeruli that allows excretion of red blood cells and protein in the urine. This is common in children and young adults

acute glomerulonephritis

Symptom onset usually is abrupt. Nonspecific symptoms include weakness, fever, abdominal pain, and malaise. In the setting of postinfectious acute nephritis, a latent period of up to 3 weeks occurs before onset of symptoms. The latent period generally is 1-2 weeks for the postpharyngitis form of the disease and 2-4 weeks in the case of postdermal infection.

Generic symptoms of acute glomerulonephritis Onset of edema reported in approximately 85% of pediatric patients; mild-to-severe symptoms, from involving only the face to bordering on a nephrotic appearance Possible headache occurring secondary to hypertension

Gross hematuria is reported in 30% of pediatric patients. Oliguria Shortness of breath or dyspnea on exertion, due to cardiac failure or pulmonary edema; uncommon, particularly in children Confusion secondary to malignant hypertension in as many as 5% of patients Possible flank pain secondary to stretching of the renal capsule Universal finding of hematuria, even if microscopic; most evident with Berger disease

Diagnostic Tests 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.

Diagnostic Tests 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, and may also be checked for the presence of a streptococcal antibody titer(a sophisticated blood test indicating presence of streptococcal infection). A kidney biopsy may also be performed, using ultrasound to guide the needle for obtaining the specimen.

Diagnostic Tests Elevation of Bun, Serum Creatinine, Potassium, Erythrocyte sedimmentation rate (ESR), and Antistreptolysin-O Titer (ASO Titer)

Acute diffuse Glomerulonephritis Acute crescent Glomerulonephritis Acute diffuse Glomerulonephritis Glomerulonephritis

Medical Management The main objectives in the treatment of acute glomerulonephritis are to: decrease the damage to the glomeruli decrease the metabolic demands on the kidneys improve kidney function

Medical Management Bedrest helps in maintaining adequate blood flow to the kidney. If residual infection is suspected, antibiotic therapy may be needed. In the presence of fluid overload, diuretics may be used to increase output with urination.

Medical Management Iron and vitamin supplements may be ordered if anemia develops Antihypertensives, if high blood pressure accompanies the illness. In order to rest the kidney during the acute phase, decreased sodium and protein intake may be recommended.

Nursing Interventions Guided by individual patient needs. Focusing on control of symptoms and prevention of complications. Dietary intake will include protein restrictions, with carbohydrates providing a source of energy

Chronic Glomerulonephritis A slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. In some cases, the cause is found to be a specific attack to the body's immune system. Most cases, the cause is unknown. glomerulonephritis represents the end-stage

Chronic Glomerulonephritis

Clinical Manifestations Symptoms that gradually develop may include the following: Unintentional weight loss Nausea and vomiting General ill feeling (malaise) Fatigue Headache

Frequent hiccups Generalized itching Decreased urine output Need to urinate at night Easy bruising or bleeding Decreased alertness

Drowsiness, somnolence, lethargy Confusion, delirium Coma Muscle twitching Muscle cramps Seizures Increased skin pigmentation -- skin may appear yellow or brown Decreased sensation in the hands, feet, or other areas

Excessive urination Nosebleed High blood pressure Blood in the vomit or stools

Medical Management The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Current therapy includes aggressive treatment of high blood pressure with ACE inhibitors or angiotensin receptor blockers to slow the progression of kidney failure.

Medical Management Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis. Dietary restrictions on salt, fluids, protein, and other substances may be recommended to help control of high blood pressure or kidney failure.

Medical Management Dialysis or kidney transplantation may be necessary to control symptoms of kidney failure and to sustain life.

Diagnostic Test Urine specific gravity Urine concentration test Uric acid, urine Total protein Renal scan Urine RBC Urine protein Creatinine clearance Urine creatinine Complement component 3 Complement BUN Anti-glomerular basement membrane Albumin Abdominal MRI

Diagnostic Test The specific gravity becomes fixed and blood levels of nonprotein nitrogen wastes increase. Creatinine clearance may be as low as 5 to 10ml/minute

Nursing Interventions The interventions are the same with the acute phase. You have to remember that saver Kidney damage has already accured