ACUTE GLOMERULONEPHRITIS Definition Acute glomerulonephritis is an inflammatory disease of both kidneys predominantly affecting children from ages two

to 12. Chronic glomerulonephritis can develop over a period of 10-20 years and is most often associated with other systemic disease, including diabetes,malaria, hepatitis, or systemic lupus erythematosus.

Signs and Symptoms Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis. Signs and symptoms may include:

Pink or cola-colored urine from red blood cells in your urine (hematuria) Foamy urine due to excess protein (proteinuria) High blood pressure (hypertension) Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen Fatigue from anemia or kidney failure

Risk Factors Infections

Post-streptococcal glomerulonephritis. Glomerulonephritis may develop a week or two after recovery from a strep throat infection or, rarely, a skin infection (impetigo). An overproduction of antibodies stimulated by the infection may eventually settle in the glomeruli, causing inflammation. Symptoms usually include swelling, reduced urine output and blood in the urine. Children are more likely to develop post-streptococcal glomerulonephritis than are adults, and they're also more likely to recover quickly. Bacterial endocarditis. Bacteria can occasionally spread through your bloodstream and lodge in your heart, causing an infection of one or more of your heart valves. Those at greatest risk are people with a heart defect, such as a damaged or artificial heart valve. Bacterial endocarditis is associated with glomerular disease, but the exact connection between the two is unclear.

Viral infections. Among the viral infections that may trigger glomerulonephritis are the human immunodeficiency virus (HIV), which causes AIDS, and the hepatitis B and hepatitis C viruses.

Immune diseases

Lupus. A chronic inflammatory disease, lupus can affect many parts of your body, including your skin, joints, kidneys, blood cells, heart and lungs. Goodpasture's syndrome. A rare immunological lung disorder that may mimic pneumonia, Goodpasture's syndrome causes bleeding (hemorrhage) into your lungs as well as glomerulonephritis. IgA nephropathy. Characterized by recurrent episodes of blood in the urine, this primary glomerular disease results from deposits of immunoglobulin A (IgA) in the glomeruli. IgA nephropathy can progress for years with no noticeable symptoms. The disorder seems to be more common in men than in women.

Vasculitis

Polyarteritis. This form of vasculitis affects small and medium blood vessels in many parts of your body, such as your heart, kidneys and intestines. Wegener's granulomatosis. This form of vasculitis affects small and medium blood vessels in your lungs, upper airways and kidneys.

Conditions that is likely to cause scarring of the glomeruli

High blood pressure. Damage to your kidneys and their ability to perform their normal functions can occur as a result of high blood pressure. Glomerulonephritis can also cause high blood pressure because it reduces kidney function. Diabetic kidney disease. Diabetic kidney disease (diabetic nephropathy) can affect anyone with diabetes. Diabetic nephropathy usually takes years to develop. Good control of blood sugar levels and blood pressure may prevent or slow kidney damage. Focal segmental glomerulosclerosis. Characterized by scattered scarring of some of the glomeruli, this condition may result from another disease or occur for no known reason.

Chronic glomerulonephritis sometimes develops after a bout of acute glomerulonephritis. In some people there's no history of kidney disease, so the first indication of chronic glomerulonephritis is chronic kidney failure. Infrequently, chronic glomerulonephritis runs in families. One inherited form, Alport syndrome, may also involve hearing or vision impairment.

Complications of Acute Glomerulonephritis may include:

Acute kidney failure. Loss of function in the filtering part of the nephron may cause waste products to accumulate rapidly. This condition may mean you'll need emergency dialysis, an artificial means of removing extra fluids and waste from your blood, typically by an artificial kidney machine (dialyzer). Chronic kidney failure. In this extremely serious complication, the kidneys gradually lose function. Kidney function at less than 10 percent of normal capacity indicates end-stage kidney disease, which usually requires dialysis or a kidney transplant to sustain life. High blood pressure. Damage to your kidneys and the resulting buildup of wastes in the bloodstream can raise your blood pressure. Nephrotic syndrome. This is a group of signs and symptoms that may accompany glomerulonephritis and other conditions that affect the filtering ability of the glomeruli. Nephrotic syndrome is characterized by high protein levels in the urine, resulting in low protein levels in the blood. It's also associated with high blood cholesterol and swelling (edema) of the eyelids, feet and abdomen.

Test and Diagnosis Specific signs and symptoms may suggest glomerulonephritis, but the condition often comes to light when a routine urinalysis is abnormal. Tests to assess your kidney function and make a diagnosis of glomerulonephritis include:

Urine test. A urinalysis may show red blood cells and red cell casts in your urine, an indicator of possible damage to the glomeruli. Urinalysis results may also show white blood cells, a common indicator of infection or inflammation, and increased protein, which may indicate nephron damage. Other indicators, such as increased blood levels of creatinine or urea, are red flags.

Blood tests. These can provide information about kidney damage and impairment of the glomeruli by measuring levels of waste products, such as creatinine and blood urea nitrogen. Imaging tests. If your doctor detects evidence of damage, he or she may recommend diagnostic studies that allow visualization of your kidneys, such as a kidney X-ray, an ultrasound examination or a computerized tomography (CT) scan. Kidney biopsy. This procedure involves using a special needle to extract small pieces of kidney tissue for microscopic examination to help determine the cause of the inflammation. A kidney biopsy is almost always necessary to confirm a diagnosis of glomerulonephritis.

Treatment The treatment for acute glomerulonephritis depends on the underlying cause, as well as how poorly the kidneys are functioning. Mild cases of acute glomerulonephritis may resolve without treatment. Treatment is directed at the underlying cause, but also includes medications to control high blood pressure and a kidney diet to reduce the stress on the kidneys. Short-term dialysis may be necessary for severe cases of glomerulonephritis that result in sudden kidney failure. Treatment for acute glomerulonephritis may include: Kidney disease diet:
o o o o o o o

Low calorie diet Low protein Low sodium diet Low potassium diet Low phosphorus diet Calcium supplements Vitamin B supplements

Fluid restriction:
o

Limiting the amount of fluid in the diet

Oral Corticosteroid medications:

o o

Prednisone Methylprednisolone (Medrol)

Diuretic medications:
o

Furosemide (Lasix)

Medications that suppreses the immune system:

o

(Cytoxan, Neosar, Procytox)

Kidney dialysis
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For those who develop kidney failure

Drugs Medication Summary The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate the infection. Agents used include antibiotics, loop diuretics, vasodilators, and calcium channel blockers. Antimicrobials (Antibiotics)

Penicillin Cephalexin (Keflex) Erythmycin (E.E.S., Ery-Tab, Erythrocin)

Loop Diuretics

Furosemide (lasix)

Vasodilators

Sodium nitroprusside (Nitropress) Hydralazine

Calcium Channel Blockers

Nifedipine (Afeditab CR, Nifediac, Adalat CC, Procardia, Procardia XL)

Nursing Management Review fluid and diet restrictions. Measure and record intake and output. Instruct patient to schedule follow-up evaluations of blood pressure, urinalysis for protein, and BUN and creatinine studies to determine if disease has worsened. Instruct patient to notify physician if infection or symptoms of renal failure occur: fatigue, nausea, vomiting, diminishing urinary output. Refer to home care nurse as indicated for assessment and detection of early symptoms and follow-up evaluations.