MARKING KEY

GROMERULONEPHRITIS

(a) Definition: 5%.

It is the inflammation of the glomeruli that results in sudden appearance
of blood in urine with clumps of red blood cells (casts) and variable
amounts of protein in urine.

(b) (i) Clinical features: (state) 15% for any 5 points

Asymptomatic in mild cases. The disease is discovered accidentally

through routine urinarysis.

Oedema (periorbital, leg or sacral) due to fluid retention

Raised blood pressure, may lead to headache and convulsions
Urine microscopy will show protenuria and haematuria due to
damaged glomeruli.
Concentration of urea and creatinine in blood due to glomeruli
damage
Fatique and anorexia.
Temporarily oliguria and uraemia
Anaemia due to blood loss through urine.

(ii) Investigations (15% for any 3 points)

History and physical examination
History of group A hemolytic streptococcus infection
Physical examination to confirm signs of the disease
Urinalysis; Dipstick and urine sediment microscopy will reveal the
presence of erythrocyte casts (suggestive of acute
glomerulonephritis) proteinuria which may range from mild to
severe.
Blood analysis. Blood tests may include BUN and serum creatinine
to assess the extent of renal impairement.
Renal function studies ESR is high
Throat swab and culture, if the patient has history of coughing or
coughing. To rule out streptococci infection.

(c) Management:
Objectives: 1%
To control the infection
To promote renal function
To improve fluid and electrolyte balance

Medication (12% for any 3 days

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The following groups of drugs may be given. They should be written in detail
pharmacologically.

Antibiotics: To combat any infection e.g. penicilins or

Erythromycin
Diuretics: To relieve the oedema e.g. Furosemide.
Antihypertensive drugs. If there is high blood pressure. E.g.
Nifedipine 20 mg daily.
Antinflammatory drugs e.g. Asprin 150 to 300 mg tds

NURSING CARE: 6%
Psychological care
Find out level of undertating and knowledge of the disease from
the patient and parents
Explain the condition to the patient and parents
Allow parent or care takers to express their fears to alley anxiety
Be empathetic, show love and concern when caring for the patient
Involve the patient and significant others in the care to relieve
undue anxiety
Arrange for continuation of his education with the school
authorities.

BED REST 4%
Bedrest should be encouraged in the acute phase until clinical
signs disappear. This may take several days.
This is necessary to allow healing of the kidneys
When the condition improves, ambulate the patient.
While on bedrest encourage passive and active exercise to
promote blood and body fluid circulation to all body parts.

OBSERVATIONS 10%
Monitor vital signs such as TPR and blood pressure to detect any
abnormalities like CCF.
Monitor fluid balance. Replace fluids according to the patients
losses. The fluid balance chart must be used to monitor intake
and out put.
Check body weight daily and record
Monitor signs of CCF such as distended jugular veins
Observe for hypertensive encephalopathy e.g. evidence of
seizures.
Check whether oedema is subsiding or becoming severe.
Consider the general condition of the patient whether there is
improvement or not.
Report all the findings and compare daily to assess the
effectiveness of treatment.

DIET 4%

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 While in the hospital give the patient foods with low content of
sodium and proteins. This assist control of oedema.
Proteins should be restricted according to the level of proteinuria
and uraemia.

A well balanced diet should be provided to meet patients

nutritional needs for energy, tissue repair and protection from
diseases.

HYGIENE 5%
maintain meticulous personal hygiene throughout the patients
stay in the hospital.
The oedematous skin needs careful cleaning every day, keep the
skin dry.
Relieve any pressure from oedematous areas to prevent skin
lesions.
Maintain good oral hygiene
The rationale is to maintain good skin intergrity and prevent
infection.

HEALTH EDUCATION: 5%
Explain importance of follow up care and encourage patient and
care takers to follow given dates or come to the hospital when
ever necessary.
The patient must report any infection and seek prompt medical
care to prevent complications.
Explain signs and symptoms of the disease to the patient. If he
observes or feel presence of some of the clinical features should
report to the health centre.
Medication if any, instructions must be clear. The patient should
not take unprescribed drugs
Encourage good personal hygiene and oral care to prevent skin
lessons and oral infection

(d) State 4 Complications (16% for any 4 points)

Renal failure may develop after sometime due to damage of the
glomekali glomeruli.
CCF may develop as result of fluid retention
Hypertenssive encephalitis may develop as a result of fluid
retention and uraemia.
Uraemia may develop as a result of accumulation of nitrogenous
waste.
Pulmonary oedema
Anaemia due to haematunia

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