Our Lady of Fatima University

College of Nursing

ACUTE GLOMERULONEPHRITIS

A Group Case Study

Submitted to:
Ms. Feliciano, RN

In Partial Fulfillment
of the Requirement for the Course
NCM102
RLE

Pasay City General Hospital

Pedia Ward

Submitted by:
Macatangay Jan Alex
Madriaga, Merry Grace
Marquez, Carmina
Martinez, Ricky
Navarro Jr., Noel
Palompon, Ma. Rafaela
Plaza, Jeanine Louise
2Y4-2D
JANUARY 2010

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Table of Contents

Chapter I

-Introduction 4

-Patient’s Profile 5

-Nursing History of Illness 7

Chapter II

-Anatomy and Physiology 9

-Pathophysiology 20

Chapter IV

-Laboratory Examinations 22

Chapter V

-Drug Study 26

Chapter VI

-Nursing Care Plan 147

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Narratives 148

News/Trends 171

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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.

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 The group encountered a patient with a
condition as such and their clinical instructor gave
them 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.

PATIENT’S PROFILE

Patient’s Name: Ajanun, Patrick Lleva

Age: 4 years old

Gender: Male

Address: 668 D. Bautista St. Pasay City

Date of Birth: April 23, 2005

Civil Status: Single

Religion: Roman Catholic

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Nationality: Filipino

Dialect: Tagalog

Date of Admission:

Time Admitted:

Attending Physician:

Chief Complaint:

Admitting Diagnosis:

Final Diagnosis:

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NURSING HISTORY OF ILLNESS

A. 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 phenypropanolamine. 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).

B. Past Medical History

-Pneumonia

C. Family History of Past Illness

-Positive Maternal Asthma
-Positive PTB grandmother

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D. Medical Birth History
-full term
-G2P0 via Normal SD

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

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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

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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 body’s 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

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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.

Cross-section of a kidney
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 PARTS OF KIDNEY

Capsule 

The renal capsule is the

membranous covering of the kidney.
It directly covers the renal cortex,
which forms the outer stratum 

Each part of the capsule links to its

explanation.
Cortex  The cortex of the kidney is the outer
section which covers the internal
medulla. The cortex is visible near
the outer edge of the cross-

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 sectioned kidney. It is composed of
blood vessels and urine tubes and is
supported by a fibrous matrix.
Calyx  The calyces (plural for calyx) are the
recesses in the internal medulla of
the kidney which enclose the
pyramids. They are used to
subdivide the sections of the kidney
anatomically, with distinction being
made between major calyces and
minor calyces.
Renal The renal columns are lines of the
Column  kidney matrix which support the
cortex of the kidney. They are
composed of lines of blood vessels
and urinary tubes and a fibrous,
cortical material.
Pyramid The renal pyramids are conical
segments within the internal
medulla of the kidney. The pyramids

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 contain the secreting apparatus and
tubules and are also known as the
malphighian pyramids.
Renal
Sinus 

The renal sinus is the cavity within

the kidney which houses the renal
pyramid. Nerves and blood vessels
pass into the renal sinus through the

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 hilus.
Hilus  The hilus is the slit-like opening in
the middle of the concave medial
border of the kidney. Nerves and
blood vessels pass through the hilus
into the renal sinus within.
Renal One quarter of the total blood
Artery   output from the heart comes to the
kidneys along the renal artery. Two
renal arteries arise from the
abdominal section of the aorta; each
artery supplies a lobe of the kidney.
The incoming artery divides into
four or five branches, eventually
forming arterioles, each of which
leads to the compact ball of
capillaries called the glomerulus.
Renal Cell waste is discharged in the veins
Vein  for excretion through the kidneys.

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The body circulates about 425
gallons of blood through the kidneys
on a daily basis, but only about a
thousandth of this is converted in
urine. The remainder goes back into
circulation through the renal
arteries. From the Bowman's
capsule, the blood is carried through
the compact network of capillaries
that forms the glomerulus within
the capsule. The capillaries
eventually reconverge into small
venules which lead to the larger
renal veins. There are two renal
veins, one extending from each lobe
of the kidney, and opening into the
vena cava.

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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 reaborption of water, salts. This
is where glucose eventually is absorbed in your
body. One side note, diabetics have trouble
reaborbing the glucose in their body and hence a

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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.

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3
PATHOPHYSIOLOGY

Post-streptococcal infection
(group-A, beta
hemolytic)

Release of material from the

organism, into the circulation

Antibody Formation

Immune complex
reaction in the
glomerular capillary

Inflammatory response

Proliferation of epithelial cells

lining glomerolus & cells between
endothelium & epithelium of
capillary membrane

Swelling capillary membrane

& infiltration with leukocytes

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 continued

↑ Permeability of base
membrane

Occlusion of the capillaries of the

glomeruli vasospasm of afferent
ventrioles

↓ Glomerular filtration rate

↓ Ability to form filtrate

from glomeruli plasma flow

Retention of H2O & Na;

hypovolemia;
circulatory congestion

Edema
Hypertension
↓ urinary output
Urine dark in color
Anorexia
Irritability lethargy

ACUTE
GLOMERULONEPHRITIS 3
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LABORATORY EXAMINATIONS

HEMATOLOGY REPORT
December 24, 2009

ACTUA
NORMA
L ANALYSI
PARAMETER L
VALUE S
VALUES
S
Increase
d;
indicate
0.55-
Segmenters 0.86 high
0.65
glucose
level in
the blood
Increase
0.25- d;
Lymphocytes 0.14
0.35 indicates
infection

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 BLOOD CHEMISTRY REPORT
December 28, 2009

ACTUA
NORMA
L ANALYSI
PARAMETER L
VALUE S
VALUES
S
Increase
d BUN
levels
suggest
impaired
kidney
function.
BUN/ 1.7-8.3
10.10 This may
Urea Mmol/L
be due to
acute or
chronic
kidney
disease,
damage,
or failure.

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 URINALYSIS REPORT
December 28, 2009
NORMA
ACTUAL
PARAMETER L ANALYSIS
VALUES
VALUES
Yellow Light
Color normal
Amber yellow
Clear to
Slightly
Transparency slightly
turbid normal
turbid
Reaction 4.5-8 6.0 normal
1.005-
Specific Gravity 1.010 normal
1.030
Indicative of
Sugar Negative trace
glucosuria
Indicative of
Protein Negative +2
proteinuria
Indicative of
Squamous
Few Few nephrotic
Epithelial Cells
syndrome
Red Blood Cells Few 2-7 Hematuria,
indicative of
possible
glomerular

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 damage
Indicative of
Pus Cells Few 1-3 bacterial
infection
Mucus Few Few Normal
Bacteria Few Few Normal
Amorp. Indicative of
Urates/Phosphate Few moderate bacterial
s infection