Acute Glomerulonep Hritis: By: Edelrose D. Lapitan BSN Iii-C

ACUTE
GLOMERULONEP
HRITIS
By: Edelrose D. Lapitan
BSN III-C
Introduction
• Acute glomerulonephritis is a common disease in
children and it is one of the diseases that are
presented commonly with hematuria.
• In all probabilities results secondary to a
proceeding streptococcal (beta-haemolyticus
type 12) infection of throat or skin. A history of
upper respiratory infection.
DEFINITION
• Acute glomerulonephritis or also known as Acute
nephritic syndrome is a type of disease with glomerular
inflammation. Glomerulonephritis is an inflammation of
the glomerular capillaries that can occur in acute and
chronic forms.
• It is an immune-mediated inflammatory disease of the
capillary loops in the renal glomeruli. The antigen-
antibody complex deposition within the glomeruli
results in glomerular injury which manifested as
hematuria, oliguria, edema and hypertension.
1.
ETIOLOGY
Presumed cause: antigen-antibody reaction secondary
to an infection in the body.
2. Initial infection:
 Usually either an upper respiratory infection or a
skin infection, usually one to 3 weeks before the onset of
symptoms.
 Most frequent causative agent- nephritogenic
strains of group- A beta-hemolytic streptococcus
(type12) , acute post- streptococcal glomerulonephritis
(APSGN) is the most common
 Most cases are post infectious and have been
associated with:
- Pneumococcal
- Viral infection
- Streptococcal pharyngitis is more common in
the winter.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
• The primary presenting features of an acute glomerular
inflammation are:
- Hematuria
- Edema
- Azotemia (an abnormal concentration of nitrogenous
wastes in the blood)
- Proteinuria
• Urinary symptoms:
 Decreased urine output
 Bloody or brown- colored urine
• Edema
 Present in most patients (usually mild)
 Often manifested by Periorbital edema in the
morning
 May appear only as rapid weight gain
 May be generalized and influenced by posture
• Proteinuria
 Increased permeability of the glomerular membrane
may also occur, with associated pitting edema,
hypoalbuminemia, hyperlipidemia, and fatty casts in the
urine.
 Anemia may be present
• Hypertension
 Usually mild
 Rise in blood pressure may be sudden
 Usually appears during the first 4-5 days of illness.
• Malaise
 Mild headache
 Gastrointestinal disturbances, especially
anorexia and vomiting, often with abdominal and
long pain.
 Pallor
 Irritability
 Lethargy
 Dysuria
 Fever
• Older patients may experience circulatory
overload with dyspnea, engorged neck veins,
cardiomegaly, and pulmonary edema.
•Typical symptoms include:
 Confusion
 Somnolence
 Seizures
COMPLICATIONS
• Complications of acute
glomerulonephritis include:
 Hypertensive encephalopathy
 Heart Failure
 Pulmonary edema
• Hypertensive encephalopathy:
 This can occur in nephritic
syndrome or preeclampsia with  Duration:
chronic hypertension of greater - Usually 1-2 days
than 140/90 mmHg.
 Manifestations: - Ends
- Restlessness
spontaneously with
decrease blood
- Convulsions
pressure
- Vomiting
- Severe Headache
- Visual disturbance
• Heart failure
 Cardiac failure may occur • Duration:
due to persistent
hypertension, hypervolemia - Variable
and peripheral - Usually subsides
vasoconstriction rapidly with the onset
 Manifestation: the fall in blood
- Dyspnea pressure
- Tachycardia
- Liver engorgement
DIAGNOSTIC STUDY
Tests finding
Urine routine & microscopy RBC, RBC cast, PMN leukocytes, proteinuria
ECG May be normal or may indicate left ventricular
hypertrophy
Kidney Biopsy Needed for definitive diagnosis

Throat culture If positive, support diagnosis or might represent carrier
state
Electron microscopy and Immunofluorescent Analysis Help identify the nature of the lesion
Chest X-ray For pulmonary edema

Blood Examination Demonstrates increased level of urea, creatine, ESR, ASO
titer and anti-DNAase B
MEDICAL & SURGICAL
MANAGEMENT
• Management consists primarily of treating symptoms, attempting to
preserve kidney function, and treating complications promptly.
• Treatment may include:
- Prescribing corticosteroids
- Managing hypertension
- Controlling proteinuria
• Dietary protein is restricted when renal insufficiency and nitrogen retention
develop (elevated BUN)
• Sodium is restricted when the patient has hypertension, edema, and heart
failure
• Activity. Bed rest is recommended until signs of glomerular inflammation
and circulatory congestion subside as prolonged inactivity is of no benefit in
the patient recovery process.
• Pharmacologic therapy goals are to reduce morbidity, to prevent
complications, and to eradicate the infection.
- Penicillin is the agent choice if residual streptococcal infection is suspected
• Antibiotics. In streptococcal infections, early antibiotic therapy may prevent
antibody response to exoenzymes and render throat cultures negative, but may
not prevent the development of AGN.
• Loop diuretics. Loop diuretics decrease plasma volume and edema by causing
diuresis. The reductions in plasma volume and stroke volume associated with
diuresis decrease cardiac output and, consequently, blood pressure.
• Vasodilators. These agents reduce systemic vascular resistance, which, in turn,
may allow forward flow, improving cardiac output.
• Calcium channel blockers. Calcium channel blockers inhibit the movement of
calcium ions across the cell membrane, depressing both impulse formation
(automaticity) and conduction velocity.
NURSING
MANAGEMENT
NURSING ASSESSMENT
• Obtain complete physical assessment
• Monitor daily weight to have a measurable account on the fluid elimination
• Monitor fluid intake and output every 4 hours to know progressing
condition via glomerular filtration.
• Assess vital signs. Monitor BP and PR every hour to know progression of
hypertension and basis for further nursing intervention or referral.
• Assess breath sounds. Assess for adventitious breath sounds to know for
possible progression in the lungs.
NURSING DIAGNOSIS
• Based on the assessment data, the major nursing diagnoses are:
 Ineffective breathing pattern related to the inflammatory process.
 Altered urinary elimination related to decreased bladder capacity or irritation

secondary to infection.
 Excess fluid volume related to a decrease in regulatory mechanisms (renal failure) with
the potential of water.
 Risk for infection related to a decrease in the immunological defense.
 Imbalanced nutrition less than body requirements related to anorexia, nausea,

vomiting.
 Risk for impaired skin integrity related to edema and pruritus.
 Hyperthermia related to the ineffectiveness of thermoregulation secondary to

infection.
NURSING CARE
PLANNING
• Nursing care planning goals in acute glomerulonephritis are:
 Excretion of excessive fluid through urination.
 Demonstration of behaviors that would help in excreting
excessive fluids in the body.
Improvement of distended abdominal girth.
Improvement of respiratory rate.
Participation and demonstration of various ways to achieve
effective tissue perfusion
NURSING IMPLEMENTATION
• Activity. Bed rest should be maintained until acute symptoms and gross
hematuria disappear.
• Prevent infection. The child must be protected from chilling and contact
with people with infections.
• Monitor intake and output. Fluid intake and urinary output should be
carefully monitored and recorded; special attention is needed to keep the
intake within prescribed limits.
• Monitor BP. Blood pressure should be monitored regularly using the same
arm and a properly fitting cuff.
• Monitor urine characteristics. The urine must be tested regularly for
protein and hematuria using dipstick tests.
PATIENTS EDUCATION
• Patients discharged from the emergency
department need to be counseled on the
importance of outpatient follow up with a
nephrologist.
• Patients with edema should be advised to avoid
salt and to restrict fluid intake until further workup
by a nephrologist.
EVALUATION OF THE OUTCOMES
OF CARE
• Goals are met as evidenced by:
• Excretion of excessive fluid through urination.
• Demonstration of behaviors that would help in excreting
excessive fluids in the body.
• Improvement of distended abdominal girth.
• Improvement of respiratory rate.
• Participation and demonstration of various ways to achieve
effective tissue perfusion.
DOCUMENTATION
• Individual findings, including factors affecting, interactions,
nature of social exchanges, specifics of individual behavior.
• Cultural and religious beliefs, and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcome.
REFERENCES
• https://
www.slideshare.net/yogeshdeyogeshdengale/acute-glomerulonephritis-agn
• https://nurseslabs.com/acute-glomerulonephritis/
• https://emedicine.medscape.com/article/777272-overview#a5
• Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14 th Edition Vol.2
page 1570-1571
• https://www.slideshare.net/DrDilip86/acute-glomerulonephritis-agn-by-dr-dilip

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ACUTE

Kidney Biopsy Needed for definitive diagnosis

Chest X-ray For pulmonary edema

 Altered urinary elimination related to decreased bladder capacity or irritation

 Imbalanced nutrition less than body requirements related to anorexia, nausea,

 Hyperthermia related to the ineffectiveness of thermoregulation secondary to

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