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 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

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, 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

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 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.