Case Study of ACUTE GLOMERULONEPHRITIS

INTRODUCTION Acute Glomerulonephritis (AGN) is an inflammation of the internal kidney structures (glomeruli). Glomeruli itself has functions to help filter waste and fluids from the blood. This disease leads to proliferative and inflammatory changes within glomerular structure, as well as, destruction, inflammation and sclerosis of the glomeruli of both kidneys. The common signs and symptoms of AGN are as follows: Periorbital and facial edema(more prominent in the morning),decreased urinary output, cloudy, smoky, and brown-colored urine, anorexia, pallor, irritability and lethargy, headaches, abdominal or flank pain, dysuria, hypertension, proteinuria, azotemia, increased blood urea nitrogen and creatinine levels and Antistreptolysin O titer. The group encountered a patient with a condition as such and their clinical instructor gav ethem the opportunity to study the case; hence, this case study aims to help understand the disease process of AGN, and to orient one of the appropriate nursing interventions that could be offered to patients.

Nursing History Demographic Data Clients name: A.L Age: 8 yrs. Old Gender: Male Address: Pasig City Religion: Roman Catholic Nationality: Filipino

History of Present Illness Present illness started at nine months prior to admission; the patient had on and off headache in the temporal area. He was brought to a private clinic and was diagnosed with sinusitis and was given phenylpropanolamine. After one week prior to admission the patient had cough without fever and was given Salbutamol Syrup and nebulization which afforded temporary relief. After a few hours he had seizure with loss of sight and was admitted to Pasay City General Hospital (PCGH). Past Medical History The patient have no allergies of food and she said she have a complete immunization at birth like BCG, DPT3, OPV3, HepaB. He had no history of fall, and it was his first time to be confined in the hospital. Family History Positive Maternal Asthma Positive PTB grandmother

Medical Birth History -full term-G2P0 via Normal SD

Nutritional History -Breastfed for one month -Bottle-fed for two months

ANATOMY AND PHYSIOLOGY The Kidneys The kidneys are two bean shaped organs of the renal system located on the posterior wall of the abdomen one on each side of the vertebral column at the level of the twelfth rib. The left kidney is slightly higher than the right. Human kidneys are richly supplied with blood vessels which give them their reddish brown color .The kidneys measure about 10cm in length and,5cm in breadth and about 2.5 cm in thickness. The kidneys are protected by three highly specialized layers of protective tissues. The outer layer consists mainly of connective tissue which protects the kidneys from trauma and infection. This layer is often called the renal fascia or fibrous membrane. The technical name for this layer is the renal capsule. The next layer (second layer from the exterior) is called the fascia and it makes a fibrous capsule around the kidneys. This layer connects the kidneys to the abdominal wall. The inner most layer is made up of adipose tissue and is essentially a layer of fatty tissue which forms a protective cushions the kidney; and the renal capsule (fibrous sac) surrounds the kidney and protects it from trauma and infection. Kidney Function The main function of the kidney is to maintain the fluid, electrolyte, and pH balance of the body by filtering ions, macromolecules, water, and nitrogenous wastes from the blood based on the bodys condition. Wastes filtered out of the blood drains from canals in the kidney into the bladder as urine. Blockage of the drainage system can cause the kidney to become congested, stretched, and potentially scarred. Functioning kidneys are necessary to maintain life, and one measure of their function is the glomerular filtration rate. A loss of kidney function results in the need for dialysis, which is an artificial method of removing wastes from the blood by running the blood from the body, through an artificial kidney, and then back into the body THE NEPHRON The nephron is the functional unit of the kidney, responsible for the actual purification and filtration of the blood. About one million nephrons are in the cortex of each kidney, and each one consists of a renal corpuscle and a renal tubule which carry out the functions of the nephron. The renal tubule consists of the convoluted tubule and the loop of Henle. The nephron is part of the homeostatic mechanism of your body. This system helps regulate the amount of water, salts, glucose, urea and other minerals in your body. The nephron is a filtration system located in your

kidney that is responsible for the reabsorption of water, salts. This is where glucose eventually is absorbed in your body. One side note, diabetics have trouble reabsorbing the glucose in their body and hence a lot of it comes out in the urine - hence the name "diabetic" or "sweet urine." But that's another topic. The Loop of Henle is the part of the nephron that contains the basic pathway for liquid. The liquid begins at the Bowman's capsule (upper left) and then flows through the proximal convoluted tubule (that mess of tangled stuff up top). It is here that Sodium, water, amino acids, and glucose get reabsorbed. The filtrate then flows down the descending limb and then back up. On the way it passes a major bend called the Loop Of Henle. This is located in the medulla of the kidney. As it approaches the top again, hydrogen ions(waste) flow into the tube and down the collecting duct. Essentially, nutrients flow in through the left and exit through the right. Along the way, salts, carbohydrates, and water pass through and are reabsorbed.

Pathophysiology

Post-streptococcal infection(group-A,

betaRelease of material from theorganism, into the circulation

Antibody formation

Immune complex reaction in the Inflammatory response

Proliferation of epithelial cells lining glomerolus

Swelling capillary membrane& infiltration with leukocytes

Permeability of base

Glomerular filtration rate

Ability to form filtrate from glomeruli plasma flow

Retention of H2O & Na; hypovolemia

Edema Hypertension

urinary output Urine dark in

Color Anorexia Irritability lethargy

ACUTE GLOMERULONEPHRITIS

Laboratory Examination Parameter Segmenters Normal Values 0.55-0.65 Actual Values 0.86 Analysis Increased; indicate high glucose level in blood Increased; indicates infection

Lymphocytes

0.25-0.35

0.14

PARAMET ER BUN/Urea

NORMALVAL UES 1.7-8.3 Mmol/L

BLOOD CHEMISTRY ACTUALVAL ANALYSIS UES 10.10 IncreasedBUNlevelssuggestimpairedkidneyf unction.This maybe due to acute or chronic kidney disease, damage,or failure URINALYSIS REPORT

Parameter Color Transparency Reaction Specific Gravity Sugar Protein Squamous Epithelial Cells Red Blood Cells

Normal Values Yellow Amber Clear to slightly turbid 4.5-8 1.005-1.030 Negative Negative Few Few

Actual Values Light Yellow Slightly turbid 6.0 1.010 trace +2 Few 2-7

Analysis Normal Normal Normal Normal Indicative of glucosuria Indicative of proteinuria Indicative of nephrotic syndrome Hematuria, indicative of possible glomerular damage Indicative of bacterial infection Normal Normal Indicative of bacterial infection

Pus Cells Mucus Bacteria Amorp.Urates/Phosphates

Few Few Few Few

1-3 Few Few Moderate