Acute Glomerulonephritis

May be resulted from primary event or a manisfestation of systemic disorder and ranging from minimal to severe (Hockenberry,
Wilson, Winkelstein. Kline, 2003)

Affected all children at any age but primary at early school age and the peak age of onset of 6-7 years and uncommon in children younger than 2 years of age (Milford,
1995)

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Lucia EH/renal disorder

 common characteristics comprise of oliguria, edema, hypertension and circulatory congestion, hematuria and proteinuria most cases are postinfectious and connected with pneumococcal,streptococcal, and viral infection resulted from immune complex and glomerular deposition and the manifestation may be indistinguishable
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Etiology

Generally accepted that AGN is an immune complex disease a reaction that occurs as a by-product of an antecedent streptococcal infection with certain strains of the group -hemolytic streptococcus streptococcal infection of the throat (pharyngitis) and skin (pyoderma)

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Lucia EH/renal disorder

Clinical manifestation

Edema moderate, periorbital, facial edema more prominent in the morning, spreads to abdomen and extremities Anorexia Urine cloudy, smoky brown (resemble to tea or cola), reduced in volume

Pallor Irritable Lethargy No specific complaint Mild to moderate hypertension may present Good apprearance until children experience the antecedent of infection
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Diagnostic evaluation

Urinalysis hematuria, proteinuria (not massive) and increase specific gravity (no exceeds than 1.020), bacteria is not seen and urine cultures are negative Unless the disease progressed to renal failure, blood electrolytes are normal, BUN , creatinin levels up to 50 % If proteinuria is heavy, may be changes to NS
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Cultures of pharynx are positive to streptococcus in few cases Serologic tests are necessary for diagnosis Other studies chest X-ray (cardiac enlargement, pleural effusion, pulmonary congestion) and renal biopsi

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Lucia EH/renal disorder

Therapeutic management
No specific treatment as spontaneous recovery will happen Children with normal BP and satisfactory urine output can be treated at home Those with substantial edema, hematuria, oliguria and hypertension should be hospitalized Diuretics are of limited value when severe RF is present

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Acute hypertension must be anticipated and identified early Antibiotics is indicated only for those with evidence of persistent streptococcal infections preventing transmission of nephritogenic streptococci to family members

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Lucia EH/renal disorder

Nursing management

During the acute phase bed rest is not significant, activities should be planned to allow for frequent rest and avoidance of fatigue Regular monitoring of vital signs Monitoring fluid balance recording of daily weight, measuring output and input (water allowed is equivalent to the calculated insensible loss plus the volume of urine excreted)
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Nutrition dietary restrictions depend on stage the stage and severity of the disease especially the extent of edema sodium, potassium (during period of oliguria) and protein restrictions (severe azotemia) Monitoring of the complications seizure, hypertensive encephalophaty, acute cardiac decompensation and acute renal failure

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