CASE ABSTRACT

This is a case of J.V., female, 23 years old, who live at Annex 29 Bernardo
Square, Brgy. Don Bosco. Undergone treatment of hemodialysis at OGH under Dra. Lea
Grace Vasquez. Patient has a diagnosis of Acute Glomerulonephritis. Her first dialysis
was year 2007 with an AVF on her left arm and at 2008, AVF was on her right arm.
Medications taken are Calcium Carbonate and Vit. B Complex. CBC and Urinalysis was
also done to the patient.

Objectives:

CHRONIC GLOMERULUNEPHRITIS

Chronic glomerulonephritis is the advanced stage of a group of kidney

disorders, resulting in inflammation and gradual, progressive destruction of the
glomeruli (internal kidney structures). It occurs when there is slow, progressive
destruction of the glomeruli of the kidney, with progressive loss of kidney function.

CAUSES:

1. Infections

 Post-streptococcal glomerulonephritis
 Bacterial endocarditis
 Viral infections

2. Immune diseases

 Lupus
 Goodpasture's syndrome
 IgA nephropathy

3. Vasculitis

 Polyarteritis
 Wegener's granulomatosis

4. Conditions that cause scarring of the glomeruli

 High blood pressure

  Diabetic kidney disease
 Focal segmental glomerulosclerosis

SIGNS AND SYMPTOMS:

 Blood in the urine (dark, rust-colored, or brown urine)

 Foamy urine

Chronic renal failure symptoms that gradually developmay include the following:

 Unintentional weight loss

 Nausea and vomiting
 General ill feeling (malaise)
 Fatigue
 Headache
 Frequent hiccups
 Generalized itching
 Decreased urine output
 Need to urinate at night
 Easy bruising or bleeding
 Decreased alertness
o Drowsiness, somnolence, lethargy
o Confusion, delirium
o Coma
 Muscle twitching
 Muscle cramps
 Seizures
 Increased skin pigmentation -- skin may appear yellow or brown
 Decreased sensation in the hands, feet, or other areas

TREATMENTS:

 Kidney dialysis
 Kidney transplant
 Bed rest
 Decreased salt intake
 Decrease protein intake
 Blood pressure medications
 Corticosteroids
 Immunosuppressives
 Dialysis
 Kidney transplanantion
MANAGEMENT:

 Erythropoietin agonists
o for management of anaemia associated with chronic renal failure
 Phosphate binders
o for management of hyperphosphatemia in chronic renal failure
 Calcium supplements
o for hypocalcaemia associated with chronic renal failure
 Calcitriol and other Vitamin D supplements
o for hypocalcaemia and hyperparathyroidism associated with chronic
renal failure
 Sodium bicarbonate
o for acid-base disturbance
 Renal dialysis
o used when there are manifestations of uraemia and the GFR is <
10mL/min

PATHOPHYSIOLOGY:
ANATOMY AND PHYSIOLOGY OF KIDNEY:
 KIDNEY

o Removi
ng
wastes
and water from the blood
 o Balancing chemicals in your body
o Releasing hormones
o Helping control blood pressure
o Helping to produce red blood cells
o Producing vitamin D, which keeps the bones strong and healthy

 RENAL ARTERY
o an artery originating from the abdominal aorta and supplying the
kidneys and adrenal glands and ureters.

 RENAL VEIN
o are veins that drain the kidney. They connect the kidney to the inferior
vena cava.

 CALYCES
o calyx is a portion of the human renal system, predominantly located in
the kidney.
o The calyx is the method by which urine is passed from the kidney to the
bladder.
 RENAL PELVIS
o is the funnel-like dilated proximal part of the ureter in the kidney.
o act as a funnel for urine flowing to the ureter.
 RENAL MEDULLA
o is the innermost part of the kidney.
o contains the structures of the nephrons responsible for maintaining the
salt and water balance of the blood.
 RENAL CORTEX
o is the outer portion of the kidney between the renal capsule and the
renal medulla.
o the part of the kidney where ultrafiltration occurs.
 URETER
o are muscular tubes that propel urine from the kidneys to the urinary
bladder.
 COLLECTING DUCT
o It participates in electrolyte and fluid balance through reabsorption and
excretion, processes regulated by the hormones aldosterone and
antidiuretic hormone.
 LOOP OF HENLE
o is the portion of the nephron that leads from the proximal straight
tubule to the distal convoluted tubule.
o create a concentration gradient in the medulla of the kidney.
 TUBULE

o is a very small tube or fistular structure.

 o A system of surface-connected membranes in muscle that enables a
nerve impulse to travel to the interior of the muscle fibre.

 GLOMERULUS

o is a capillary tuft that performs the first step in filtering blood to form
urine.

o A glomerulus and its surrounding Bowman's capsule constitute a renal

corpuscle, the basic filtration unit of the kidney. The rate at which blood
is filtered through all of the glomeruli, and thus the measure of the
overall renal function, is the glomerular filtration rate (GFR).