ATI Chapter 59 Acute and Chronic Glomerulonephritis

Terms in this set (18)

Glomerulonephritis

an inflammation of the glomerular capillaries, usually following a streptococcal infection. It is an immune complex disease, not an infection of the kidney.

Acute glomerulonephritis (AGN)

Insoluble immune complexes develop and become trapped in the glomerular tissue and we see swelling and capillary cell death. There will be a decrease in GFR • Prognosis varies depending upon the specific cause, but spontaneous recovery generally occurs after the acute illness

Chronic glomerulonephritis (CGN)

Can occur in a patient without a previous history or known onset • This involves the progressive destruction of glomeruli and eventual hardening (sclerosis) • CGN is the third leading cause of end-stage kidney disease (ESKD), with the prognosis varying depending on the specific cause, but it is not good

Immunological reactions • Primary infection with group A beta-hemolytic streptococcal infection (most common cause) • Systemic lupus erythematosus • Vascular injury (hypertension) • Metabolic disease (diabetes mellitus) • Excessively high protein and high sodium diets • Older adult clients - tend to have decreased working nephrons so they are at risk for chronic renal disease and may report vague symptoms (nausea, fatigue, joint aches) which may mask glomerular disease

Signs and symptoms

Decreased urine output
Smoky or coffee-colored urine (hematuria)
Proteinuria

Fluid volume excess symptoms

Shortness of breath • Orthopnea • Rales when you listen to their lungs • Periorbital edema • Mild to severe hypertension • Changes in the level of consciousness • Anorexia/nausea • Headache • Back pain • Fever (Acute) • Pruritus (Chronic

Serum BUN expected reference range:

creatinine expected reference range:

males: 0.6 to 1.2 mg/dL, and females: 0.5 to 1.1 mg/L

Glomerular filtration rate (GFR) expected reference range

greater than 90 mL/min

culture to identify possible streptococcus infection or any infection

In glomerulonephritis serum BUN

elevated: 100 to 200 mg/dL

creatinine clearance expected range

males: 90 to 139 mL/min/m2, females: 80 to 125 mL/min/m2

In glomerulonephritis (GFR) creatinine clearnance

decreased to 50 mL/min

In glomerulonephritis urinalysis:

proteinuria, hematuria, cell debris (red cells and casts), increased urine specific gravity

Electrolytes In glomerulonephritis

hyperkalemia, hypoalbuminemia, and hyperphosphatemia

Diagnostic procedures

X-ray of kidney, ureter, bladder (KUB) • Kidney biopsy (to confirm or rule out diagnosis) • In acute glomerulonephritis dialysis can be an intervention to treat severe uremia (large amounts of urea and other nitrogenous waste found in the blood)

Monitor the client's daily weight and note any recent weight gain • Monitor intake and output
• Observe the client for changes in urinary pattern
• Monitor serum electrolytes, BUN, and creatinine
• Observe the client's skin for pruritus • Maintain bed rest to decrease metabolic demands • Maintain prescribed dietary restrictions.• Fluid restriction (24 hr output + 500 to 700 mL) • Sodium restriction • Protein restriction (if azotemia is present = increased BUN)

Administer antibiotics eliminate strep infection • Administer diuretics • Use vasodilators to decrease blood pressure • Administer corticosteroids

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