18 terms

ATI Chapter 59 Acute and Chronic Glomerulonephritis

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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
Risk factors
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:
10 to 20 mg/dL
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
Throat culture
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)
Nursing care
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)
Medications
Administer antibiotics eliminate strep infection • Administer diuretics • Use vasodilators to decrease blood pressure • Administer corticosteroids
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