Acute Glomerular Nephritis
Definition
Inflammation of the glomerular capillaries.
Primarily a disease of children older than 2 years
Pathophysiology
Group A Betahemolytic streptococcal infection of the throat
Skin infection impetigo
Acute viral infections like mumps
Hepatitis B
HIV
All the above may precede this disease
Some medications, foreign serum
These cause an antigen-anbibody complex deposited in the glomeruli
Clinical Features
Follows an episode of sore throat - Streptococcus haemolyticus A strain
In about 10 days after the above events (infections etc.)
Swelling in the morning, especially in the face, feet, hands, and abdomen Periorbital oedema puffiness of face
Head ache
Pain in the loin
Blood in urine (red, brown, or tea-colored urine) (coco coala colored)
Foamy appearance of urine (hematuria)
Less frequent urination
Feeling tired
Dry, itchy skin
Nausea
Vomiting
Poor appetite
Muscle cramps at night
Lab findings in urine
Proteinuria
RBCs
bacteria
casts : RBC casts, granular casts, hyaline casts etc.
Blood Tests
blood urea - raised Normal level 20 - 40 mg%
serum creatinine - raised Normal level 0.8 - 1.2 mg%
Other investigations to be done
Ultrasound Scan
Abdominal CT Scan
Kidney Biopsy
Complications
Hypertension → encephalopathy
Heart failure
Pulmonary edema
Optic neuropathy
Renal failure
Treatment
Penicillin/some other antibiotics for residual streptococcal infection
Diuretics to reduce fluid retention
Antihypertensives if needed
Medications to suppress the immune system - Steroids
Cytotoxic agents
Plasma exchange (plasmapheresis)
At times dialysis
Lifestyle Changes
Restrict salt and water intake
Restrict intake of potassium, phosphorous, and magnesium
Cut down on protein in the diet
Maintain a healthy weight through diet and exercise
Take calcium supplements .
Nursing Management
Teaching patients self care :
fluid and dietary restrictions
reporting to physician if symptoms of renal failure occur (fatigue, nausea, vomitting, diminishing urine output)
follow up evauation of BP, urine analysis of protein, BUN, creatinine
a visit of home care nurse
