Glomerulonephritis

- inflammatory condition of glomerulus

- acute or chronic
- primary kidney disorder or secondary to systemic disease
- affects the structure and function of glomerulus
- damages capillary membrane
- - blood cells and proteins escape into filtrate
- - hematuria,proteinuria,azotemia
- Lupus erythematosus
- Streptococcal infection
- Hypertension
- DM
- DIC
- Occurs 2-3 weeks after streptococcal infection
- Pharynx and tonsilar
- Preschool age and grade school
- 1 to 2% will develop end stage renal disease
- 90% children
- 50% adult
- recovery from the disease – 2 years

pathophysiology
- antigen-antibody reaction – glomerular tissue
- swelling and death of capillary cells
- activation of the reaction
- chemotaxis of polymorponuclear leukocytosis
- lyzosomal enzymes – glomerular basement
- increase in three types of glomerular cells ( endothelial,
mesangial and epithelial)
- increase in membrane porosity
- proteinuria and hematuria
- renal function is depressed- scarring and obstruction of the
circulation through the glomerulus

manifestations:
- proteinuria
- hematuria
- increased urine specific gravity
- mild generalized edema
- ASO titer is increased
- Hypertension
- Decreased urine output
- Elevated serum nitrogen
- Elevated serum creatinine
- Elevated sedimentation
- Anorexia
- Nausea
- Vomiting
- Headache
 - Older adults may show less characterisric manifestations
- Symptoms may subside spontaneously

Diagnostic test
- ASO TITER
- ESR
- BUN
- Serum creatinine
- serum electrolytes
- urinalysis
-KUB xray
- kidney scan or biopsy

Nursing diagnosis
- excess fluid volume
- fatigue
- risk for infection
- ineffective role performance

management
- prevention of streptococcal infection
- prophylactic antibiotics – penicillin
- months
- diuretic therapy – fluid overload
- antihypertensive(calcium channel blockers, ace inhibitors)
- prevention of overhydration and hypertension
- low sodium diet
- decrease protein in the diet when BUN and creatinine is
increased
- bed rest
- monitor I& O
- weigh patient daily
- VS- apical pulse
- Dysrhytmmia
- Edema
- JVD
- Heart failure
- Nature of the illness and effect of diet and fluids of fluid
balance and sodium retention
- Diet
- Medication regimen
- Activities
- Infection
- Recognition of signs and symptoms
Chronic glumerulonephritis
- slow progressive destruction of glomeruli
- gradual loss of nephrons
- kidney decrease in size
- symptoms develop slowly

manifestations:
- symptoms develop slowly caused by progressive destruction
of glomeruli and loss of nehrons
- signs of renal failure may be reason to seek diagnosis
- headache - morning
- dyspnea on exertion
- blurring of vision
- weakness and fatigue
- lassitude
- edema, nocturia and weight loss

Pathophysiology
- slow progressive destruction of the glomeruli
- gradual loss of renal function
- sclerosis (hardening)
- atrophy of the kidneys
- tubular atrophy
- interstitial inflammation
- Arteriosclerosis

Management
- monitor pt. pulmonary edema and CHF
- pregnant women – toxemia and spontaneous abortion
- avoid infection
- eat a balanced diet – prescribed limit
- exacerbation on the S/SX should be promptly reported

kidney stones (urinary calculi)

- urolithiasis most common cause of obstructed urine flow
- calculi(stones)
- masses of crystals formed from materials normally excreted in
urine
- most made from calcium oxilate, oxalate, oxidate

Risk factors
- family history
- dehydration
- excess calcium, oxalate, protein intake
- gout
- hyperparathyroidism
- urinary stasis
- prolonged immobilization
 - hypervitaminosis D
- bone cancer
- acidosis

kidney stones
- form when poorly soluble salt crystallizes
- when fluid intake adequate no stone growth
- often associated with hypercalcemia

pathophysiology
- location of the stones – pain location
- kidney pelvis – hydronephrosis( dull and constant –
costovertebral angle)
- ureter- excruciating and intermittent (suprapubic and extends
on the genitalia)

diagnostics:
- urinalysis
- KUB x-ray
- IVP
- Renal ultrasound
- CT scan or MRI
- Cystoscopy

Treatment
Surgery – ureterolithotomy, pyelolithotomy, nephrolithotomy or
lithoplaxy (removal of stones through suprapubic)

*Extracorporeal shock wave lithotripsy(ESWL) – 1-4mm of

stones. If > 4 surgery will be made

*Percutaneous lithotripsy – through skin

management:
- adequate hydration (2500ml)
- mobilization (sitting up)
- diet:
- acid ash- meat, whole grains, eggs, cheese, cranberries,
prunes and plums(alkalinic body)
- alkaline ash – milk, vegetables, fruit except cranberries,
prunes and plums (acidic body)
- neutral – sugars, fats and beverages ( both)

hydronephrosis
- abnormal dilation of renal pelvis and calyces
- results from urinary tract obstructions or backflow of urine
- manifestations depend on how rapid it develops
manifestations
- acute( colicky flank pain, hematuria, pyuria, fever,nausea and
vomiting abdominal pain)
- Chronic(intermittent dull flank pain, hematuria, pyuria, fever,
palpable mass)

Pathophysiology
- urinary obstruction
- dilation of structure behind obstruction
- backflow of urine
- dilation of renal pelvis
- pressure of kidney structure & stasis of urine (infection calculi)
- pressure on renal arteties
- ischemia
- tubular damage

diagnosis
- ultrasound
- CT scan
- Cystoscopy
- TREATMENT
- Stents

Nursing care
- focuses on ensuring urinary drainage
- monitor I&0
- irrigate tubules only as ordered
- monitor the following: presence of pain
- urine output
- nausea vomiting
- assess I & O at least 8 hours
- administrator and monitor prescribed IV fluids
- encourage appropriate diet
- maintain urinary drainage
- use aseptic technique when working with urinary drainage
- assess of bladder distention at least 8 hours
- assess of hematuria
- assess renal failure ( oliguria, proteinuria, anorexia and
lethargy)
- encourage activity as tolerated
- maintain a calm environment
- analgesics
- assist with ADLS
- teachings
1. diet and fluid retrictions
2. indwelling catheter
3. medications ( action, SE, dosage and frequency)