Glomerulonephritis

fibrous capsule around the kidneys. This layer

This renal condition can be classified into two:

acute and chronic.

connects the kidneys to the abdominal wall.

The inner most layer is made up of adipose
tissue and is essentially a layer of fatty tissue

ACUTE GLOMERULONEPHRITIS

which forms a protective cushions the kidney;

Acute glomerulonephritis refers to a group of

kidney diseases in which there is an
inflammatory reaction in the glomeruli. It is not
an infection of the kidney, but rather the result
of the immune mechanisms of the body. The
glomerular injury is the result of antigenantibody deposits within the glomeruli. In less
than 60 days, patients regain normal renal
function.

and the renal capsule (fibrous sac) surrounds

the kidney and protects it from trauma and
infection.
Kidney Function
The main function of the kidney is to
maintain the fluid, electrolyte, and pH balance

ANATOMY AND PHYSIOLOGY

of the body by filtering ions, macromolecules,

The Kidneys

water, and nitrogenous wastes from the blood

The kidneys are two bean shaped

organs of the renal system located on the
posterior wall of the abdomen one on each
side of the vertebral column at the level of the
twelfth rib. The left kidney is slightly higher than
the right. Human kidneys are richly supplied
with blood vessels which give them their
reddish brown color. The kidneys measure
about 10cm in length and, 5cm in breadth and
about 2.5 cm in thickness.

highly specialized layers of protective tissues.

The outer layer consists mainly of connective
tissue which protects the kidneys from trauma
and infection. This layer is often called the
fascia

or

fibrous

out of the blood drains from canals in the

kidney into the bladder as urine. Blockage of
the drainage system can cause the kidney to
become congested, stretched, and potentially
scarred. Functioning kidneys are necessary to
maintain life, and one measure of their function
is the glomerular filtration rate. A loss of kidney
function results in the need for dialysis, which
is an artificial method of removing wastes from
the blood by running the blood from the body,

The kidneys are protected by three

renal

based on the bodys condition. Wastes filtered

membrane.

through an artificial kidney, and then back into

the body.
THE NEPHRON
The nephron is the functional unit of the

The

kidney, responsible for the actual purification

technical name for this layer is the renal

and filtration of the blood. About one million

capsule. The next layer (second layer from the

nephrons are in the cortex of each kidney, and

exterior) is called the fascia and it makes a

each one consists of a renal corpuscle and a

renal tubule which carry out the functions of the

liquid. The liquid begins at the Bowman's

nephron. The renal tubule consists of the

capsule (upper left) and then flows through the

convoluted tubule and the loop of Henle.

proximal convoluted tubule (that mess of

tangled stuff up top). It is here that Sodium,

The nephron is part of the homeostatic

mechanism of your body. This system helps
regulate the amount of water, salts, glucose,
urea and other minerals in your body. The
nephron is a filtration system located in your
kidney that is responsible for the reaborption of
water, salts. This is where glucose eventually is
absorbed in your body. One side note,

water,

amino

acids,

and

glucose

get

reabsorbed. The filtrate then flows down the

descending limb and then back up. On the way
it passes a major bend called the Loop Of
Henle. This is located in the medulla of the
kidney. As it approaches the top again,
hydrogen ions (waste) flow into the tube and
down the collecting duct.

diabetics have trouble reaborbing the glucose

in their body and hence a lot of it comes out in

Essentially, nutrients flow in through the left

the urine - hence the name "diabetic" or "sweet

and exit through the right. Along the way, salts,

urine." But that's another topic.

carbohydrates, and water pass through and

are reabsorbed.

The Loop of Henle is the part of the

nephron that contains the basic pathway for
continued

PATHOPHYSIOLOGY
Post-streptococcal infection
(group-A, beta

Release of material from the

organism, into the circulation

Swelling capillary
membrane & infiltration
Permeability of base

Occlusion of the capillaries of

the glomeruli vasospasm of
afferent ventrioles

Antibody Formation
Glomerular filtration rate
Immune complex
reaction in the
glomerular capillary

Ability to form filtrate

from glomeruli plasma
flow

Inflammatory response

Proliferation of epithelial cells

lining glomerolus & cells
between endothelium &
epithelium of capillary
membrane

Retention of H2O & Na;

hypovolemia;
circulatory congestion
Edema
Hypertension
urinary output
Urine dark in
color
Anorexia
Irritability

ACUTE
GLOMERULON
EPHRITIS

ESRD

Medical Management:

It depends on the symptoms and

includes antihypertensives, diuretics,
drugs to manage hyperkalemia, H2
blockers and phospate-binding agents.

Antibiotic therapy is initiated to eliminate

infection.

Fluid intake is restricted.

Dietary protein is restricted moderately if

there is oliguria and the BUN is
elevated.

Carbohydrates are increased liberally to

provide energy and reduce catabolism
of protein.

Potassium and sodium intake is

restricted in presence of hyperkalemia,
edema or signs of heart failure.

Clinical Manifestations:

History of infection such as pharyngitis

or impetigo

Tea-colored urine and oliguria

Puffiness of
extremities

face

and

edematous

Fatigue and anorexia with possible

headache

High blood pressure

Anemia from loss of RBCs into the urine

Diagnostic Evaluation:

Urinalysis for hematuria, proteinuria,

cellular elements and various casts.

24-hour urine collection to determine

protein and creatinine clearance.

Elevated BUN and serum creatinine

levels, low albumin level, increased
antistreptolysis titer and decreased
serum complement.

Needle biopsy of the kidney reveals

obstruction of the glomerular capillaries
from proliferation of endothelial cells.

Nursing Management:

Complications:

Hypertension, heart failure, endocarditis

Hyperkalemia,
hypervolemia

Malnutrition

Hypertensive enecephalopathy, seizures

hyperphosphatemia,

Promote renal function.

Strictly measure and monitor

intake and output and maintain
dietary restrictions.

Encourage rest to facilitate

diuresis and until renal function
test levels normalize.

Administer
medications
as
ordered
and
evaluate
effectiveness of treatment.

Improve fluid balance.

Carefully monitor fluid balance

and and replace fluids according
to patients fluid losses. Get daily
weight.

Monitor for signs and symptoms

of heart failure and hypertensive
encephalopathy.

Retinal hemorrhage

Cardiomegaly

If the patient is scheduled for dialysis,

explain the procedure fully.

Crackles in the lungs

Peripheral neuropathy

CHRONIC GLOMERULONEPHRITIS
This can be due to repeated episodes of
acute glomerulonephritis, hypertensive
nephrosclerosis, hyperlipidemia, chronic
tubulointerstitial
injury
or
hemodynamically mediated glomerular
sclerosis. The kidneys are reduced to as
little as one-fifth of their normal size.
Bands of scar tissue distort the
remaining cortex, making the surface of
the kidney rough and irregular.
Numerous glomeruli and their tubules
become scarred and the branches of the
renal artery are thickened. The result is
severe glomerular damage that can
progress to ESRD.

Clinical Manifestations:

Feet are slightly swollen at night

Loss of weight and strength

Irritability

Nocturia

Headaches and dizziness

Digestive disturbances

Appears poorly nourished

Yellow-gray pigmentation of the skin

Periorbital and peripheral dependent

edema

Medical Management:

Symptomatic management; medications

are prescribed based on the exhibited
symptoms.

Weight is monitored daily.

Proteins of high biologic value are given,

as well as ensuring adequate caloric
intake.

UTI must be treated promptly.

Initiation of dialysis must be considered.

Nursing Management:
Observe for deteriorating renal function;

report changes in fluid and electrolyte status

and in cardiac and neurologic status.
Give emotional support throughout the
disease and treatment course by providing
opportunities for patient and family to verbalize
concerns. Answer questions and discuss
options.
Educate patient and family about prescribed
treatment plan and the risk of noncompliance.