10.2 Acute Glomerulonephritis and Nephrotic Syndrome

Question 1

Acute Glomerulonephritis (AGN)

Answer 1

Pathophysiology
- Commonly comes after a streptococcal infection
- Glomerulus (filtering portion of the kidney)
- Streptococcal antibodies form clots and accumulate in the glomerulus which causes scarring and causes the glomerulus to not be able to filter. (Usually caused by not finishing full course of antibodies for strep or never received treatment)

S/S
- Recent Strep Infection (strep throat or skin infection)
- Headache (due to retention of toxins)
- Increased BUN and Creatinine
- Low volumes of cloudy (tea/cola colored) urine (due to dehydration
- Hematuria/Proteinuria
- Oliguria
- Edema and Hypertension
- Increased urine specific gravity

Treatment
- Antibiotics to get rid of lingering Strep Infection
- Diuretics and hypertensives

Nursing Care
- I&O (increasing output is good)
- Daily Weights (fluid retention)
- Electrolytes/Vitals
- Skin integrity
- LIMIT SALT INTAKE TO LIMIT WATER RETAINED

• Increased urine output and diuresis typically begins in 1-3 weeks to release all the retained water. GOOD SIGN

Question 2

Nephrotic Syndrome

Answer 2

• Unknown cause
• Inflammatory response within glomerulus which causes big holes in the glomerulus which causes protein to leak out of the holes into the urine. Because the protein is leaking patient becomes HYPOALBUMINEMIC (low albumin in the blood) which causes fluid to leave the vascular space into the tissue. This causes extreme edema and 3rd spacing. This lowers circulating blood volume which triggers the renin-angiotensin to activate, which activates ADH which causes water to be retained. There is still no protein in the vascular system which causes a cycle of water being retained from ADH but water instantly leaving the vascular system into 3rd spacing due to low albumin.

S/S
- Low volume of frothy/bloody urine
- Normal to low blood pressure
- EXTREME EDEMA AND ASCITES or FACIAL EDEMA
- Hypoalbuminemia
- Proteinuria (>2)
- Hyperlipidemia

Treatment
- Prednisone (to decrease inflammation and shrink the holes in the glomerulus) - must be frequent and high dose so must look out for infection
- Diuretics to help with third spacing
- Albumin supplements via IV
- DECREASE DIETARY SODIUM

• These patients are also loosing proteins that help prevent their blood from clotting (putting children at risk for thrombosis)

Question 3

AGN Symptoms

Answer 3

• Decreased Urine Output
• Dependent Edema
• Hematuria
• Preorbital Edema
• Hypertension

DIAGNOSIS
- Antistreptolysin O Titer