Glomerulonephritis - Concept map PDF

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Disease Glomerulonephritis is inflammation of glomeruli, affects both kidneys equally. Can be acute or chronic, diffused, or local

Etiology & Pathophysiology · 3rd leading cause of ESRD · Inflammation of glomerulus, tubular and intestinal changes, vascular scarring, and hardening (glomerulosclerosis) within kidney. · Acute glomerulonephritis – symptoms come on suddenly and may be temporary or reversible. · Chronic glomerulonephritis – slowly progressive that can lead to irreversible renal failure.

Risk Factors See table 45.8 · Conditions causing scarring of glomeruli · Immune disease · Infections · Vasculitis · Other causes

Diagnostics & Labs · Comprehensive Hx - including recent infection: sore throat, upper respiratory tract infection, diabetes.

Acute Poststreptococcal Glomerulonephritis (ASPGN) · Common in children, young adults, and adults older than 60 years. · Develops after 1 – 2 weeks of after an infection of tonsil, pharynx or skin (streptococcal sore throat, impetigo) by nephrotoxic strains of group A β-hemolytic streptococci. · Mechanism unknown, tissue injury occurs as antigen-antibody complexes deposit in glomeruli complement is acti ated and

Clinical Manifestation of ASPGN · Generalized body edema - Fluid retention d/t ↓ GF - 1st low pressure tissues – periorbital edema - Later ascites or peripheral edema in legs · HTN – d/t ↑ ECF · Oliguria · Hematuria - Smoky – bleeding in upper urinary tract · Proteinuria – degree varies with severity of glomerular nephropathy · Abdominal or flank pain · Can be asymptomatic – problems found on routine RA

Diagnosis of ASPGN · Antistreptolysin-O (ASO) titers – shows ASPGN – immune response to streptococci · ↓ complement components (C3 and C50) – immune-mediated response · Renal biopsy – confirm disease · Dipstick UA & Urine sediment microscopy – reveal # erythrocyte /erythrocyte cast · Proteinuria – mild to severe · BUN · Serum CrCl

Medical Management of ASPGN · Conservative management · Rest until signs subside · Severe HTN – antihypertensives given · Antibiotics – if positive streptococcal infection or still present · Corticosteroids – decrease inflammation

Nursing Diagnosis

Nursing Intervention · Restrict Na + fluid intake and give diuretics to reduce edema - Loop diuretics · Restrict dietary protein intake if ↑ in nitrogenous waste (BUN). - Give albumin to normalize oncotic pressure. Recall albumin sucks, so it will pull fluid into vascular space. · Diet: Low protein, low Na, fluid restricted · I/O · Skin hygiene, avoid skin breakdown · Turn q2h

Patient Education · Encourage early diagnosis of sore throats and skin lesions · Teach pt to take full course of antibiotic therapy · Good personal hygiene prevents the spread of cutaneous streptococcal infections

Chronic Glomerulonephritis

· A syndrome of permanent and progressive renal fibrosis · Can progress to ESRD over years. · Most types of glomerulonephritis and nephrotic syndrome can lead to chronic glomerulonephritis Pt h H kid di Dagnostics of Chronic Glomerulonephritis · Hx and physical · UA · Ultrasound · CT scan · Renal biopsy Clinical manefestations Chronic Glomerulonephritis · Slow and progressive, can be asymptomatic until discovered via diagnostics · Hematuria – microscopic to gross · Proteinuria · Urinary excretion of various formed elements – RBC, WBC, and casts. · ↑BUN · ↑CrCl · Uremia – slow development d/t ↓ renal function

Nursing Intervention · Assess exposure to drugs (NSAIDS), microbial infections and viral infections (Hepatitis) · Evaluate pt for immune disorders: systemic erythematosus lupus (SLE) · Supportive and systematic treatment. Refer to Management of CKD · See Acute interventions

Goodpasture Syndrome

· Rare autoimmune disease. Antibodies attack glomerular and alveolar basement membranes. · Occurs in children and adults (30 – 60 y/o) · Damage to kidneys and lungs when binding of antibody because inflammatory reaction mediated by complement activation. Clinical manefestations Goodpasture Syndrome

· Flu-like and pulmonary symptoms - Cough, SOB, hemoptysis, pulmonary insufficiency · Renal involvement - Hematuria, weakness, pallor, anemia · Pulmonary hemorrhage – after weeks or Medical Management of Goodpasture Syndrome

· Corticosteroids · Immunosuppressive drugs: cyclophosphamide azathioprine (Imuran), plasmapheresis, rituximab and dialysis · Renal transplant – after circulating anti-GBM titer decreases Nursing Intervention of Goodpasture Syndrome

· Smoking cessation · Critical care similar to AKI and respiratory distress · Death d/t hemorrhage in lungs and respiratory failure.

Additional Information · Erythrocyte cast highly suggestive of ASPGN. · ASPGN can progress to Chronic glomerulonephritis and result in ESRD. · Plasmapheresis – removes the circulating anti-glomerular basement membrane (GBM) · Immunosuppressive therapy – inhibit further antibody production · RPGN can recur after transplant

Rapidly Progressive Glomerulonephritis (RPGN) · A type of glomerular disease with glomerular crescent formation. · Rapid progressive loss of renal function over days to weeks · Occurs d/t a complication of inflammatory or infectious disease (ASPGN, goodpasture syndrome), a complication of a systemic disease (SLE) or an idiopathic disease

Clinical manefestations RPGN · · · · ·

HTN Edema Proteinuria Hematuria RBC cast

Medical Management RPGN · Correct fluid overload, HTN, uremia and inflammatory injury to kidney · Corticosteroids · Cyclophosphamide · Plasmapheresis · Dialysis therapy & transplant – maintenance therapy for pt with ESRD...