Glomerulonephritis

Question 1

Glomerulonephritis

Answer 1

Inflammation of renal glomerulus
Mostly caused by immunological reaction (antigen antibody reaction)
Results in proliferative and inflammatory changes
Destruction, inflammation and sclerosis of glomeruli occur

Question 2

Acute glomerulonephritis

Answer 2

Sudden
May be temporary and reversible
Acute post streptococcal glomerulonephritis (APSGN)
Occurs 5-21 days after a streptococcal infection

Question 3

Chronic glomerulonephritis

Answer 3

Is slow, progressive
Results in ESKD
Not reversible

Question 4

ESKD

Answer 4

End stage kidney disease

Question 5

ESRD

Answer 5

End stage renal disease

Question 6

What infections cause it

Answer 6

PSGN
Infective endocarditis
Viral infections - HIV HBV, HCV

Question 7

Immune diseases that cause it

Answer 7

SLE (lupus)
Scleroderma
Good pasture syndrome

Question 8

Good pasture syndrome

Answer 8

antibodies against glomerular and alveolar membranes, attacking it

Question 9

Other causes

Answer 9

Vasculitis - Polyarteritis
HT
Diabetic nephropathy

Question 10

Clinical manifestations

Answer 10

Gross hematuria
Dark, smoky, cola colored or red-brown urine
Oliguria, anuria
Red cell casts and proteinuria
Edema
Moderate to severe hypertension
Fever, chills, headache, flank pain, weakness, pallor, anorexia, N/V

Question 11

How do we diagnose?

Answer 11

Complete history and PE
Urinalysis (red cells, proteinuria, low pH)
Serum (BUN, creatinine, GFR, Hb, WBC, Antistreptolysin-O titers)
Renal biopsy

Question 12

What is the prognosis?

Answer 12

> 95% recover completely

Question 13

What is the treatment?

Answer 13

Treat infection with antibiotics and corticosteroids
Immunosupressants
Antihypertensives
Diuretics
Restrict sodium and K intake
High CHO and low protein diet
Fluid restriction as needed
Plasmapheresis/Dialysis

Question 14

Benefit of dialysis…

Answer 14

to get over the hump of the kidney disease

Question 15

Benefit of plasmapheresis

Answer 15

Done after dialysis

Cleans the blood to get rid of immune response situations

Question 16

Complications

Answer 16

Heart failure - CHF
Encephalopathy
Pulmonary edema
Pleural effusion
Ascites
Renal failure
ESKD

Question 17

Interventions

Answer 17

Monitor VS frequently, I/O closely, fluid overload, ascites, CHF, edema
Assess daily weights
Restrict fluids, proteins, Na, K
Provide high calorie, low protein diet
Encourage complete bed rest
Instruct pt to report blood in urine, headache

Question 18

When do we maintain bed rest?

Answer 18

In acute phase

Question 19

When do we report weight gain?

Answer 19

Gain of 1 lb in a day or 2 lbs in a week

*1 liter of fluid = 1 kg