ACUTE

ACUTEGLOMERULONEPHRITIS
GLOMERULONEPHRITIS

MEDICAL SURGICAL NURSING

MRS.SHINCY GEORGE,MSN,RN,AUTHOR
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SHINCY GEORGE, MSN,RN,AUTHOR

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SHINCY GEORGE, MSN,RN,AUTHOR
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SHINCY GEORGE, MSN,RN,AUTHOR
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 A variety of diseases, including acute &
chronic glomerulonephritis, rapidly progressing
glomerulonephritis & nephrotic syndrome can affect glomerular
capillaries.

DEFINITION
Glomerulonephritis is defined as an inflammation
of the glomerular capillaries.

SHINCY GEORGE, MSN,RN,AUTHOR

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INCIDENCE

 More common in children older than 2 years but can

occur at any age.
leading cause for renal failure in US .
Deaths 1200/year.

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AETIOLOGY

Post infectious causes

Grp A beta haemolytic streptococcal infection of [ throat, skin ]
proceeds the onset by 2-3 weeks .
 Acute viral infection. [ RTI, mumps, rubella ]
 Varicella zoster virus.
 Epstein Barr virus.
 hepatitis B
 HIV.
 antigen –antibody reaction e.g. : medication, foreign serum.
 auto immunity.
 systemic lupus erythematous.
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PATHOPHYSIOLOGY
Antigen
Antigen [grp
[grp A
A beta
beta heamolytic
heamolytic streptococci
streptococci ]]

Antigen
Antigen –antibody
–antibody complex
complex formation
formation due
due to
to immune
immune response
response ..

Deposition
Deposition of
of antigen
antigen –– antibody
antibody complex
complex in
in glomerulus.
glomerulus.

Induces
Induces inflammatory
inflammatory response.
response.

Increases
Increases production
production of
of epithelial
epithelial cell
cell lining
lining the
the glomerulus.
glomerulus.

Leukocyte infiltration of glomerulus.

Thickening , scarring & loss of glomerular filtration membrane.

Decreases GFR .

Activation of renin -angiotensin mechanism…

Sodium & water retention.

SHINCYHematuria,
GEORGE, protenuria, edema, hypertension.
MSN,RN,AUTHOR
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 CLINICAL MANIFESTATIONS.
PRIMARY PRESENTING FEATURES.
 azotemia [10-14 days]
 protenuria
 edema
 hematuria

O THER FEATURES
 abrupt onset of hematuria [mild to severe ]
 Na & water retention
 hypertension [140/90 mm of Hg]
 coffee colored urine
 edema primarily in face [peri orbital edema]
 dependent edema in extremities
 fatigue
 nausea & vomiting
 head ache , anorexia
 oliguria [less than 40 ml /day]
 Hypoalbuminemia
 hyponatremia
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 hypocalcaemia www.nursingmanthra.com 11
 hyperkalemia ,hyper phosphatemia
Anemia
 increased BUN & serum creatinine level

Elderly
 circulatory over load
Dyspnea
Cardiomegaly
 pulmonary edema

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DIAGNOSTIC
EVALUATIONS.
History collection.
Physical examination.
Throat, skin culture & sensitivity test.
To determine grp A beta hemolytic streptococci.
antibody response test.[ ASO titre ] To assess streptolysin coenzyme, anti
streptolysin.
Blood & urinalysis.
ESR, BUN, serum creatinine, creatinine clearence , urine creatinine, serum
electrolytes.
Abdominal X ray. [KUB ] to identify the enlargement of kidney.
Kidney scan for visualization .
Renal biopsy.

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COMPLICATIONS.
 Hypertensive encephalopathy.
 Heart failure.
 Pulmonary edema.
 End stage renal disease [ESRD].
Renal failure.

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MANAGEMENT.
MEDICAL MANAGEMENT.
AIM: Primarily treating symptoms ,attempts to preserve kidney function & to avoid
complications.
PHARMACOLOGICAL MANAGEMENT.
Broad spectrum antibiotics .
 penicillin
 streptomycin
 amino glycoside antibiotics.
Corticosteroids
 methyl prednisolone
 prednisolone
Immuno suppressants
 cyclophosphamide
 cyclosporine
Loop diuretics
 mannitol
 frusemide SHINCY GEORGE, MSN,RN,AUTHOR
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Antihypertensive drugs.
 angiotensin converting enzymes
 calcium channel blockers
eg: calcitriol, nifedipine.
 beta adrenergic blockers
eg: metoprolol, atenalol.
PLASMAPHERESIS
It’s a method of removing a portion of plasma from circulation
,venesection is done, then blood is allowed to settle down. Then plasma
is removed & RBC is returned to the circulation.
DIALYSIS is done in severe cases
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NURSING MANAGEMENT.

NURSING DIAGNOSIS

 Fluid volume excess r/t decrease urine output & water retesion.
 Fluid electrolyte imbalance r/t improper tubular reabsorption.
 Imbalanced nutritional status r/t less intake.
 risk of circulatory over load r/t sodium & water retention.
 Activity intolerance r/t fatigue & edema.

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NURSING INTERVENTIONS
FLUID RETENSION.
 Administer diuretics ….Diuresis begins after onset of symptoms with a decrease in
edema & BP.
 Fluid calculations are done by using intake output chart.
 actual fluid loss & insensible fluid loss through lungs [500ml] ,skin [600 ml] is
considered while estimation.
 Check vital signs , BUN, & serum creatinine level.
 blood & urinalysis.
 Protenuria & hematuria are monitored.
 Check for pitting edema & skin turgor.
 Notify the physician if symptoms of renal failure occurs [fatigue, nausea, vomiting,
decrease urine output ]
 daily monitoring of weight.
 advice fluid restriction.
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DIET
 assess the weight changes regularly.
 increase intake of protein food [egg, diary foods, meat ]
 high calorie & low sodium diet are advised, avoid NaCl.
 avoid sea foods & pickle.
 advice fluid restriction.
HYPERKALEMIA
 Monitor serum potassium level. Notify if it’s more than 5.5mEq/l
 assess the patient for muscle weakness, diarrhoea, ECG changes [tall
ended T waves & wider QRS complex.
FATIGUE
 Advice adequate rest for energy conservation.
 Advice small frequent meals for easy digestion .
 advice balanced diet.
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