Glomerulonephritis

Question 1

Definition

Answer 1

Inflammation of the filtering structure (glomerulus) of the nephron resulting in the permeability of proteins & red blood cells
- 14 days after a poststreptococcal infection which is a NEPHRITIC SYNDROME, usually seen in infants 2 - 10 years

Question 2

Classification of glomerulonephritis

Answer 2

Glomerulonephritis is an umbrella term for various disorders which cause damage to the glomerulus (acute & chronic). These different glomerular syndromes can be:

• Nephritic:- RBC and mild protein in the urine
• Nephrotic:- No RBC and massive protein in urine

Question 3

Etiology

Answer 3

“Come Hug Naruto”

Cellular immune response
- invasion of the glomerular capillaries by circulating inflammatory cells

Humoral immune response
- formation of immunological deposits and the activation of the complement system

Non-immunological stresses

• metabolic: diabetes
• hemodynamic: hypertension
• toxic stressors: drugs, chemicals

Question 4

Pathophysiology

Answer 4

This occurs when the immune system responds to the untreated streptococcal bacteria by creating antigen-antibody complexes which collect in the glomeruli, get stuck and cause inflammation. This allows large molecules (RBC & protein) to drain into the bowman’s capsule.

Cellular changes may take place which include:

• Increases in glomerular or inflammatory cells as with leukocyte infiltration
• Basement membrane thickening
• Fibrosis: healing that takes place resulting in a fibrotic tissue
• Sclerosis: hardening of kidney arteries due to prolonged hypertension

Question 5

Clinical manifestations

Answer 5

“Had Strep”

• Hypertension, Hyperventilation
• ASO antistreptolysin titer positive (test used to diagnose strep infections)
• Decreased GFR (glomerulus filtration rate) (low urine output)
• Swelling in face/eyes (edema)…mild: protein controls oncotic pressure, keeping water inside capillaries
• Tea-colored urine (cola colored)…from hematuria
• Recent strep infection
• Elevated BUN and creatinine: Normal BUN (6 to 24 mg/dL) Normal creatinine (0.7 to 1.3 mg/dL) There is also low albumin (Normal: 3.4 to 5.4 g/dL)
• Proteinuria (mild)

Question 6

Medical management

Answer 6

Patient may have: fluid overload, HTN, renal impairment. Therefore,

• Monitor fluid status
  
  • Administer diuretics (Lasix)
  • Daily weights
  • Monitor for hyperkalemia
  • Monitor edema, lung sounds and vital signs
• Initiate bed rest
• Antibiotics (Penicillin). Antihypertensive drugs, Corticosteroids (Prednisone)
• Fluid & Sodium restrictions

Question 7

Diagnostic measures

Answer 7

Urinalysis

• Blood
• Protein
• Creatinine

Blood test

• Blood test
• Serum creatinine

Question 8

Complications

Answer 8

• Hypertensive encephalopathy: massive amounts of blood pressure being pushed to the brain tissue which alters neural status and lead to seizures
• Urinary tract infection
• Renal failure
• Fatigue