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What is glomerulonephristis?
Glomerulonephritis is
is a kidney condition
that involves damage
/inflammation to the
glomeruli.
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Types of glomerulonephritis
Acute glomerulonephritis
- begins suddenly
Chronic glomerulonephritis
-develops gradually over
several years.
Glomeruli
Glomeruli The filters of the kidneys which
filter the blood and make urine.
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Etiology
Causes of glomerulonephritis include:
Streptococcal infection of the throat ( strep throat) or
skin ( impetigo)
Hereditary diseases
Immune diseases, such as lupus
diabetes
High blood pressure
Vasculitis (inflammation of the blood vessels)
Viruses ( HIV, hepatitis B virus, and hepatitis C virus)
Endocarditis (infection of the valves of the heart)
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Lupus
PATHOLOGY
glomerulonephritis are triggered by immunemediated injury.
The cellular immune response contributes to the
infiltration of glomeruli by circulating mononuclear
inflammatory cells (lymphocytes and macrophages)
and crescent formation in the absence of antibody
deposition.
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PATHOLOGY
The humoral immune response leads to immune
deposit formation and complement activation in
glomeruli.
Antibodies can be deposited within the glomerulus
when circulating antibodies react with intrinsic or
with extrinsic antigens that have been trapped within
the glomerulus.
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PATHOLOGY
Injury usually occurs as a consequence of the
activation and release of a variety of inflammatory
mediators.
Haemodynamic, and toxic stresses can also induce
glomerular injury.
A few glomerular diseases are due to hereditary
defects resulting in deformity of the glomerular
basement membrane.
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Signs/Symptoms
Most common symptoms:
Hematuria (dark, brown, or
rusty colored,)
Foamy urine due to
Proteinuria
Swelling of the face, eyes,
ankle, feet, legs, abdomen
High blood pressure
(hypertension)
Fatigue/SOB from anemia or
kidney failure.
Signs/Symptoms
Symptoms which may also
appear include:
Abdominal pain
Cough
Diarrhea
Fever
Joint aches
Muscle aches
Loss of appetite
Shortness of breath
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Risk Factors
History of cancer
Blood or lymphatic disorders
Exposure to hydrocarbon solvents
Diabetes
Infections
Strep infections
Heart infections
Viruses
Diagnosis
Because symptoms develop gradually, the
disorder may be discovered when there is an
abnormal urinalysis during a routine physical
or examination for unrelated disorders.
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Abdominal CT scan
Abdominal ultrasound
Chest x-ray
Intravenous Pyelogram (IVP)
Creatinine clearance
Urine concentration test
Urine specific gravity
Total protein
Glomerulonephritis
Nursing Care
Assessment: riwayat infeksi saluran nafas
dan kulit, pembedahan, prosedur invasif,
penyakit sistemik (SLE)
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Assessment
Assessment
Most common symptoms:
Hematuria (dark, brown, or
rusty colored,)
Foamy urine due to
Proteinuria
Swelling of the face, eyes,
ankle, feet, legs, abdomen
High blood pressure
(hypertension)
Fatigue/SOB from anemia or
kidney failure.
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Assessment
Symptoms which may also
appear include:
Abdominal pain
Cough
Diarrhea
Fever
Joint aches
Muscle aches
Loss of appetite
Shortness of breath
Physical assessment:
Dispnea
Ceackles/gallop
Neck vein distention
Elevated blood pressure
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Intervention
Managing infection
Preventing complication
Appropriate patients education
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Management of infection
Anti biotic
Stress personal hygiene
Prevent complications
Fluid overload: diuretic, sodium + water
restriction
Antihipertensive drugs
Potassium and protein intake restriction
Conserve energy: maintain restfull
environment
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Pts edu
Drugs
Diet & fluid restriction
Measure weight and BP daily
Peritoneal dialysis: teach how to prevent
infection and how to do it at home
Patients education:
Lifestyle Changes
Restrict salt and water intake.
Restrict intake of potassium,
phosphorous, and magnesium.
Cut down on protein in the diet.
Maintain a healthy weight through diet
and exercise.
Take calcium supplements.
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Treatments
Treatment varies depending the type and
severity of symptoms.
High blood pressure may be difficult to control,
and it is generally the most important aspect of
treatment.
Medicines that may be prescribed include:
Blood pressure medications are often needed to
control high blood pressure.
Medications that suppress the immune system may
also be prescribed, depending on the cause of the
condition.
Therapeutic management
Corticosteroids (prednisone)
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications: infections,
severe GI upset, ascites, or respiratory distress
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Physiotherapy treatment
Patient education
Endurance Exercise
Walking test
walking, swimming, bicycling, aerobic dancing
Circulatory exercise
Exercise
program during
dialysis
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Prognosis
Glomerulonephritis may be a temporary and
reversible condition, or it may get worse.
Progressive glomerulonephritis may lead to
chronic kidney failure and end-stage kidney
disease.
AGN
Treatment and nursing care:
Bed rest may be recommended during the
acute phase of the disease
A record of daily weight is the most useful
means for assessing fluid balance
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A case study
Jung-Lin Chang is a 23-year-old graduate
student in biology. He presents at the
university health center, brown and foamy
urine. The physician there admits him to the
infirmary and orders a throat culture,ASO
titer,CBC,BUN, serum creatinine, and
urinalysis.
Assessment
Connie King, the nurse admitting Mr. Chang, notes that his history is essentially
negative for past kidney or urinary problems. He relates having had a pretty bad
sore throat a couple of weeks before admission. However, it was during midterms,
so he took a few antibiotics he had from a previous bout of strep throat, increased
his fluids, and did not see a doctor. The sore throat resolved, and he felt well until
noticing the change in his urine. He admits that his eyes seemed a little puffy, but
he thought this was due to lack of sleep and fatigue. He has eaten little the past 2
days, but was not alarmed because his food intake is irregular most of the time.
Physical assessment findings include: T 98.8 F (37.1 C) PO, P 98, R 18, and BP
136/90. Weight 165 pounds (75 kg), up from his normal of 160 (72.5 kg). Moderate
periorbital edema and edema of hands and fingers noted. Throat culture is
negative, but the ASO titer is high. CBC essentially normal. BUN 42 mg/dL, serum
creatinine 2.1 mg/dL. Urinalysis reveals the presence of protein, red blood cells,
and RBC casts.A subsequent 24-hour urine protein analysis shows 1025 mg of
protein (normal 30 to 150 mg/24 hours). The physician diagnoses acute
poststreptococcal glomerulonephritis and places Mr. Chang on bed rest with
bathroom privileges. He orders fluid restriction (1200 mL/day) and a restricted
sodium and protein diet.
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DIAGNOSIS
Ms. King develops the following nursing diagnoses
for Mr. Chang:
Excess fluid volume related to plasma protein
deficit and sodium and water retention
Risk for imbalanced nutrition: Less than body
requirements related to anorexia
Anxiety related to prescribed activity restriction
Risk for ineffective therapeutic regimen
management related to lack of information about
glomerulonephritis and treatment
EXPECTED OUTCOMES
The expected outcomes are that Mr. Chang will:
Maintain blood pressure within normal limits.
Return to usual weight with no evidence of edema.
Consume adequate calories following prescribed
dietary limitations.
Verbalize reduced anxiety regarding ability to continue
studies.
Demonstrate an understanding of acute
glomerulonephritis and prescribed treatment regimen.
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Ms. King plans the following nursing interventions for Mr. Chang.
Vital signs every 4 hours; notify physician of significant changes.
Weigh daily; intake and output every 8 hours.
Schedule fluids allowing 650 mL on day shift, 450 mL on evening shift, and
100 mL on night shift.
Arrange dietary consultation to plan a diet that includes preferred foods as
allowed.
Provide small meals with high-carbohydrate between-meal snacks.
Encourage Mr. Chang to talk about his condition and its potential effects.
Assist with problem solving and exploring options for maintaining studies.
Enlist friends and family to listen and provide support.
Teach Mr. Chang and his family about acute glomerulonephritis and
prescribed treatment.
Instruct in appropriate antibiotic use
EVALUATION
Mr.Chang is released from the infirmary after 4
days.He decides to return to his parentshome for
the 6 to 12 weeks of convalescence prescribed by
his doctor. Mr. Changs renal function gradually
returns to normal with no further azotemia and
minimal proteinuria after 4 months. He verbalizes
understanding of the relationship between the
strep throat, his inappropriate use of antibiotics,
and the glomerulonephritis. He says,I may not
always remember to take every pill on time in the
future, but I sure wont save them for the next
time again!
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Nephrotic Syndrome
Chronic renal disorder in which the basement
membrane surfaces of the glomeruli are
affected, cause loss of protein in the urine.
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Etiology
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Pathophysiology
In nephrotic syndrome, type III hypersensitivity reaction occurs in which the immune
complex precipitated in the tissue.
Activation of the complement system also stimulates vaksoaktive amines (including
histamine) and this substance causes retraction of endothelial cells thus increasing
vascular permeability.
Changes in membrane glomerolus, causing increased permeability, allowing the
proteins (especially albumin) out through the urine (proteinurine).
Decreased oncotic pressure causing albumin moves from intra vascular space into
interstitiel.
Transfer of proteins to the interstitial cavity causing lipoproteinemia.
It stimulates the liver to compensate by increasing the production of lipoproteins and
increased concentrations of blood fats (hyperlipidemia).
When the liver is not able to compensate for damage in fat and protein metabolism.
Transfer of protein exit the vascular system, causing fluid to move into the space plasma
interstitisel resulting edema and hypovolemia.
Decrease in vascular volume stimulates renin angiotensin system, which allows the
secretion of aldosterone and antidiuretic hormone (ADH).
Aldosterone stimulates increased reabsorsi distal tubules of the sodium and water,
leading to increased edema.
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Pathogenesis of Proteinuria:
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pathogenesis of hypoalbuminemia
of
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Clinical Manifestation
weight increased
anorexia
edema anasarca
abdominal pain
swelling of the face, especially around the eyes
voleme urine decreased, sometimes colored thick and
foamy
pale skin
the child becomes irritable, tiredness / lethargy
celulitis, pneumonia, peritonitis or sepsis
azotemia
blood pressure is usually normal / up slightly
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Assessment
Four most common characteristics:
1. Massive proteinuria
2. Hypoalbuminemia (K+ normal, BP normal)
3. Edema usually starts in periorbital area and
dependent areas of the body and progresses to
generalized, massive edema. Pitting edema of 4+.
Caused by hypo albumin which causes shift of fluids
to extracellular space. *There is an insidious weight
gain- shoes don't fit, etc
4. Hyperlipidemia
* Of note is that there is no
hematuria or hypertension
Focus Assessment
Urinary System (oliguric, urine retention,
proteinurin and urine discoloration).
Fluid and electrolyte balance (excess fluid,
edema, ascites, weight gain, dehydration)
Circulation (increased blood pressure)
Neurology (decreased level of consciousness due
to dehydration)
Breathing (shortness of breath, tachypnea)
Mobility (redness, malaise)
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Nursing Diagnosis
Impaired Urinary Elimination related to Na
and water retention.
Excess Fluid Volume related to edema
Imbalanced Nutrition Less Than Body
Requirements related to damage protein
metabolism
Ineffective Breathing Pattern related to
suppression of the diaphragm due to ascites
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