Immunologic disorders of the kidney

Question 1

Glomerulonephritis

Answer 1

Inflamation of the glomeruli

• tubular and interstitial changes, vascular scarring and hardening (glomerulosclerosis –> affects both kidneys
• 3rd leading cause of ESRD in US
• associated conditions = kidney infections, nephrotoxic drugs, immune disorders, systemic diseases
• acute: sudden symptoms; temporary or reversible
• chronic; slow, progressive; irreversible renal failure

Question 2

Acute Poststreprococcal Glomerulonephritis (APSGN)

Answer 2

Common type of acute glomerulonephritis

• common in kids, young adults, and over 60
• dvlps 1-2 weeks afer infection of tonsils, pharynx, or skin by nephrotoxic strains of group A Beta-streptococcal antigen
• exact mechanism unknown

Question 3

APSGN manifestations

Answer 3

Generalized edema, hypertension, oligouria, hematuria, varying degrees of proteinuria, fluid retention

periorbital edema first then progresses to total body including ascites and peripheral edema

smoky urine – bleeding in UUT

Proteinuria - varies with glomerulonephropathy

HTN - increased ECF volume

Abdominal or flank pain

may be asymptomatic; found on routine urinalyisis

Question 4

APSGN glomerulonephritis diagnosis

Answer 4

H and P
ANtistreptolysin O (ASO) titers
Decreased complement components
renal biopsy – confirmation
Dipstick urinalysis and urine sediment microscopy (etythrocytes/casts and protein)
BUN and serum creatine for renal impairment

Question 5

ASPGN Management and prevention

Answer 5

95% recover or improve with treatment –> imp to recognize chronic conditions

Management: symptom relief

• rest –> decreases inflamation and HTN
• restrict Na and fluids; give diuretics –> edema
• restrict protein –> decreases BUN
• antibiotics - if streprococcal infection present

Prevention

• early diagnosis and treatment of sore throat and skin lesions
• pos streptococci culture - antibiotics
• teach patients to take entire perscreiption
• personal hygiene with skin infections

Question 6

Chronic Glomerulonephritis
what
how’s it found
long term

Answer 6

Syndrome of permanent and progressive renal fibrosis can progress to ESRD

• no history of kidney disease
• Alport syndrome (inherited)

Symptoms dvlp slowly – unaware
-found coincidentally with abnormal UA, high BP, or increased serum creatinine

Decreased renal func causes ESRD over years

Question 7

Chronic glomerulonephritis
manifestations
diagnosis
treatment

Answer 7

Manifestations

• hematuria, proteinuria, urinary excretion of formed elements (RBC, WBC, casts)
• increased BUN and creatinine

Diagnosis

• H&P, exposure to drugs (NSAIDs), microbial or viral infections
• evaluate for immune disorder
• ultrasound and CT scan –> renal biopsy

Treatment: depends on cause
-symptomatic and supportive care

Question 8

Goodpasture Syndrome
what
manifestations

Answer 8

Autoimmune disease - antibodies attack glomerular and basement membranes

• kidney and lung damage from antibody binding causes inflammatory reaction and complement activation
• rare disease; 30-70 year olds

Manifestations

• flu-like and pulmonary symptoms
• renal involvement

BASICALLY GLOMERULARNEPHRITIS CAUSED BY AUTOIMMUNE STUFF

Question 9

Goodpasture syndrome Management

Answer 9

Corticosteroids
Immunosuppressive drugs
Plasmapheresis
Rituximab
Dialysis
Renal transplant

Smoking cessation

Critical care: ask for AKI and respiratory disease

Might be fatal from hemorrhage and respiratory failure

Question 10

Rapidly progressive glomerulonephritis (RPGN)
occurance
manifestation
treatment

Answer 10

Glomerular disease with glomerular crescent formations; loss of renal func in days to weeks
-occurs as complication of inflammatory or infectious disease, complication of systemic disease, or idiopathic

Manifestations: HTN, edema, proteinuria, hematuria, RBC casts

Treatmets: correct fluid overload, HTN, uremia, and injury to kidney

• corticosteroids, cyclophosphamide, plasmapheresis
• dialysis and transplant

Question 11

Nephrotic syndrome
what
cause
manifestation

Answer 11

Glomerulus permeable to plasma protein causing proteinuria leading to low albumin and edema

Causes: allergens, cancers, drugs, infections, multisystem diseases

Maniphestation: peripheral edema massive proteinuria, HTN, hyperlipidemia, hypoalbuminemia, foamy urine

• decreased albumin – ascites and anasarca when severe
• immune response altered results in infection
• hypocalcemia and skeletal abnormalities
• hypercoagulability

Question 12

Nephrotic syndrome treatment, goals, nursing implements

Answer 12

Treatment depends on cause

Goals: cure or control primary disease and relieve smptoms

• corticosteroids and cyclophosphamide
• manage diabetes
• ACE inhibitor, ARB, diuretics
• Antihyperlipidemic drugs
• anticoagulants
• low sodium, moderate protein diet –> small, frequent meals

Nursing: manage edema and provide support

• daily weights, accurate I and O , measure abdomen or extremeties
• avoid infection