Glomerular Nephritis and Nephrotic Syndrome

Question 1

What is the cause of post-streptococcal glomerulonephritis? When does it happen?

Answer 1

Untreated group A strep infection. Can be present 1-2 weeks after pharyngitis or 4-6 weeks after a skin infection

Question 2

What type of hypersensitivity reaction is post streptococcal glomerulonephritis?

Answer 2

Type III

Question 3

What is the patho behind post streptococcal glomerulonephritis?

Answer 3

Immune complexes are formed and deposited in the glomerulus causing infiltration of leukocytes and proliferation of the structural mesangial cells of the glomerulus

Causes capillary perfusion impairment -> reduced GFR
-> sodium and water retention -> increased extracellular fluid volume and fluid overload
-> other electrolyte and waste accumulation

Question 4

CM for post streptococcal glomerulonephritis?

Answer 4

HTN
ASO+ titer
Decreased GFR
Swelling in face and eyes
Tea-colored urine (cola)
Recent strep infection
Elevated BUN and creatinine
Proteinuria (mild)

Triad of gross hematuria, edema, hypertension

Question 5

Tx for post streptococcal glomerulonephritis?

Answer 5

No tx. Manage HTN and maintain fluid volume. If strep infection is still present, tx with antibiotics, promote rest

Question 6

Potential complications with post streptococcal glomerulonephritis

Answer 6

Acute encephalopathy
Cardiac issues
Acute kidney injury
Electrolyte imbalances

Question 7

What is serum complement? Why are we checking it for post streptococcal glomerulonephritis?

Answer 7

Measures protein. Can be low which indicates recent infection. A marker of patients getting better is serum complement levels beginning to return to normal

Question 8

What meds might be given for post streptococcal glomerulonephritis?

Answer 8

Diuretics, antihypertensives, corticosteroids (to reduce inflammatory response)

Question 9

Patho of nephrotic syndrome

Answer 9

Change in charge of the glomerular basement membrane causing increased permeability of leading to excess loss of albumin and protein through the urine. Causes decreased protein concentration in the blood stream allowing fluid to shift from the bloodstream into the interstitial tissues. This causes decreased blood volume, edema, activation of the RAAS system (increased retention of sodium, water, and increased serum lipids

Question 10

CM of nephrotic syndrome

Answer 10

Generalized edema
Proteinuria/albuminuria
Hypoalbuminemia/hypoproteinemia
Hyperlipidemia
Mild hematuria
Lethargy, irritability, anorexia, pallor
Oliguria
Wt gain, ascites, pleural effusion, wasted stick-like extremities
Hypotension
Hypovolemia
Friable skin
Severe fluid overload → resp distress
Swollen face in morning, clothes fit more tightly

Question 11

What is done to diagnose nephrotic syndrome? Important points?

Answer 11

Renal biopsy

Teaching: rest 24-48 hours, don’t drive or shower for 24-48 hours after, remove bandage 24-48 hours after, don’t lift anything heavier than 10 lbs for 3-4 days

Risk of bleeding, infection
Lay flat on her back
Hematuria might be present

Provide pain relief

Biopsy examines for change in basement membrane

Question 12

Life changes that person might experience from nephrotic syndrome?

Answer 12

Alterations in body image (edema)
High risk for infection
Decrease salt and caloric intake
Periodic bone density test rt long term corticosteroid use
Has remissions and exacerbations

Question 13

Meds that are given for nephrotic syndrome

Answer 13

Corticosteroids (to decrease inflammatory response -> limit protein loss), antineoplastics to limit protein loss, furosemide and albumin to reduce edema, ace inhibitors for HTN, Immunosuppressants: Cyclophosphamide, Cyclosporine, Tacrolimus, Mycophenolate