Acute / Chronic Glomerulonephritis

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.

Risk Factors Immunological reactions Vascular injury (HTN) 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

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, dilutional hyponatremia 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

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.

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

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)

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

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

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.