part 3

Question 1

What are the types of acute glomerulonephritis (AGN)?

Answer 1

• mostly post infection (pneumococcal, streptococcal, or viral)
• primary event
• manifestation of a systemic disorder (lupus, sickle cell, etc)

Question 2

What are the symptoms of AGN?

Answer 2

• generalized edema: due to decreased GFR (eyes and face and may spread to lower extremities)
• hypertension (due to increased extracellular fluid)
• oliguria (Beverly reduced volume)

Question 3

What is acute post streptococcal glomerulonephritis (APSGN)

Answer 3

• response to a group A beta-hemolytic streptococcal infectious of skin or pharynx
• inflammation of glomeruli of kidneys

Question 4

What is the pathophysiology of APSGN?

Answer 4

-host gets infection
-antibodies form
-antibodies and antigens form immune response
-antigen-antibody complex deposit into glomerular filtration membrane
-deposits activate inflammatory response
-enzymes cause damage to glomerular cell wall
-increases membrane permeability
-proteins and RBC’s can pass into urine
-this causes decreased GFR rate (renal insufficiency)
and alters capillary permeability (hematuria)

Question 5

What are the clinical manifestations of APSGN?

Answer 5

• can be asymptomatic
• preceded by skin/pharynx infection
• abrupt onset
• flank or mid abdominal pain
• face or dependent edema
• weight gain
• hematuria (tea colored urine)
• proteinuria
• oliguria
• moderately high BP

Question 6

One of the clinical manifestations of APSGN is moderately high BP. What can this acute hypertension cause?

Answer 6

-encephalopathy: 
headache
blurred vision
N/V
irritability
lethargy
confusion
seizures

Question 7

What are the diagnostic tests for APSGN?

Answer 7

• BUN and Creatinine
• decreased serum protein
• CBC
• serum lipid: usually increased
• elevated antistreptolysin O (ASO) titer: antibodies from the strep infection
• reduced C3
• urinalysis
• HGB and HCT: decreased due to hematuria

Question 8

What is the treatment for APSGN?

Answer 8

• supportive
• bed rest-acute phase, but not necessary throughout
• treat edema and mild hypertension: sodium restriction, diuretic, antihypertensive
• antibiotics: eradicate original infection

Question 9

What is the prognosis for a pt with APSGN?

Answer 9

good:

most recover without significant loss of renal function or recurrence

Question 10

What need to be monitored for the pt with APSGN?

Answer 10

• I and O
• daily weight
• electrolytes
• vitals esp BP
• renal function
• low sodium and protein diet