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 Glomerulonephritis

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ذكر عدد المساهمات : 80
تاريخ التسجيل : 06/12/2009

مُساهمةموضوع: Glomerulonephritis   الإثنين مارس 15, 2010 2:47 pm

Glomerulonephritis
What is glomerulonephritis?
Glomerulonephritis is a type of kidney disease that involves the glomeruli. The glomeruli are very small, important structures in the kidneys that supply blood flow to the small units in the kidneys that filter urine, called the nephrons. During glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine.
What causes glomerulonephritis?
Glomerulonephritis is caused by several different disease states, including the following:
• systemic immune disease such as systemic lupus erythematosus (SLE, or lupus)
• other systemic diseases may include:
o polyarteritis nodosa group - an inflammatory disease of the arteries.
o Wegener vasculitis - A progressive disease that leads to widespread inflammation of all of the organs in the body.
o Henoch-Schönlein purpura - A disease usually seen in children that is associated with purpura (small or large purple lesions on the skin and internally on the organs) and involves multiple organ systems.
• Glomerulonephritis can also result from a gene on the X chromosome passed on from carrier mothers who have no features, or minimal features of the problem, to their sons, who are affected with the disorder in 50 percent of the cases.
• In children, a common cause of glomerulonephritis is from a streptococcal infection, such as strep throat or upper respiratory infection. Glomerulonephritis usually occurs more than one week after an infection. This is often referred to as acute poststreptococcal glomerulonephritis, or APSGN.
What are the symptoms of glomerulonephritis?
The following are the most common symptoms of glomerulonephritis. However, each child may experience symptoms differently. Symptoms may include:
• dark brown-colored urine (from blood and protein)
• sore throat
• diminished urine output
• fatigue
• lethargy
• increased breathing effort
• headache
• high blood pressure
• seizures (may occur as a result of high blood pressure)
• rash, especially over the buttocks and legs
• weight loss
• joint pain
• pale skin color
• fluid accumulation in the tissues (edema)
The symptoms of glomerulonephritis may resemble other conditions and medical problems. Always consult your child's physician for a diagnosis.
How is glomerulonephritis diagnosed?
In addition to a thorough physical examination and complete medical history, your child's physician may recommend the following diagnostic tests:
• throat culture
• urine tests
• blood tests
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
• renal ultrasound (Also called sonography.) - a non-invasive test in which a transducer is passed over the kidney producing sound waves which bounce off of the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
• chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• renal biopsy - a procedure where a small sample of tissue is taken from the kidney through a needle. The tissue is sent for special testing to determine the specific disease.
Treatment for glomerulonephritis:
Specific treatment for glomerulonephritis will be determined by your child's physician based on:
• your child's age, overall health, and medical history
• the extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference
If glomerulonephritis is caused by a streptococcal infection, then treatment will be focused on curing the infection and treating the symptoms associated with the infection. Unfortunately, glomerulonephritis caused by a different reason cannot be cured. Therefore, treatments focus on slowing the progression of the disease preventing complications.
Treatment for glomerulonephritis may include:
• fluid restriction
• decreased protein diet
• decreased salt and potassium diet
• medication, such as:
o diuretics
o blood pressure medications
o phosphate binders - medications to decrease the amount of the mineral phosphorus in the blood.
o immunosuppressive agents
• dialysis
Dialysis may be required for short-term or long-term therapy. Dialysis is a medical treatment to remove wastes and additional fluid from the blood after the kidneys have stopped functioning

Nursing care for patient with acute glomerulonephritis
1- promoting renal function:

• monitor v/s., intake and output, and maintain dietary restriction during acute phase.
• Encourage bed rest during the acute phase until the urine clears and BUN , creatinine, And BP. Normalized.
• Administer medication as ordered.

2- improve fluid balance:

• carefully monitor fluid balance, replace fluid according to the patient fluid losses and daily body weight as prescribed.
• Monitor pulmonary artery pressure and central venous pressure, if indicated.
• Monitor for signs and symptoms of congestive heart failure: distended neck veins, gallop rhythm, tachycardia, enlarged liver, and crackles at bases of lungs.
• Observe for hypertensive encephalopathy, any evidence of seizure activity.

3- patient education and health maintenance:

• explain that the patient must have follow up evaluations of BP. , urinary protein, and BUN concentration to determine if there is exacerbation of disease activity.
• Encourage the patient to treat any infection promptly.
• Tell patient to report any signs of decreasing renal function and to obtain treatment immediately
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