Acute Glomerulonephritis Predisposing Factors School age children peaking 6 to 7 years of age common in boys than in girls Antigen

(group A beta- hemolytic Streptococcus) Circulatory formation of immune complexes Risk for infection r/t altered immune response s/t treatment Antigen- antibdy product Immune complex depostion on tissues Plasmapheresis Depostion of antigen- antibody in glomerulus Complement activation Coricosteroids Acute inflammation Release of chemotactic and vasoactive mediators Local vasodilation (hyperemia) Increased capillary permeability

Kidney ultrasound x-ray biopsy BUN and serum creatinine levels

Elevated BUN and serum creatinine Oliguria Decreased excretion of nitrgenous wastes CHRONIC GLOMERULONEPHRITIS Renal insufficiency (GFR 50% to 20% normal) Renal failure (GFR 20% to 5% normal) ESRD (<5% normal) DEATH

Excess fluid volume r/t reduced urine output

erulonephritis Precipitating Factors Environmental factors (e.g., bacteria, viruses, chemicals and drugs)

beta- hemolytic Streptococcus)

ASO titer Penicillin

Clinical Manifestations Complications Diagnostic Tests Medical Management

ation of immune complexes

epostion on tissues Increased prduction of epithial cellslining the glomerulus Alteration in glomerular basement membrane GBM becomes porous Leakage of proteins and blood cells

igen- antibody in glomerulus

actic and vasoactive mediators

Hematuria Proteinuria Cola-or- coffee colored urine

ary permeability

Leukocytes infiltrate the glomerulus Thickening of the glomerular filtration membrane Scarring and loss of glmerular filtration membrane Glomerular tissue injury Hypertension Decreased GFR Edema Excretion of less sodium and water Cardio Hypertension Abdomen Pain Respiratory Pleural Effusion PULMONARY EDEMA Fatigue

Dipstick and urine sediment microsc Urinalysis

Calcium channel blockers, diuretics, Beta-adrenergic blockers

Eyes Periorbital edema and face

Increased volume of blood Ascites blood Anorexia, nausea Increased workload vomiting

of heart HEART FAILURE

Fatigue r/t metabolic demands

Imbalanced nutrition: less than body requirements r/t anorexia and increased me

Clinical Manifestations Complications Diagnostic Tests Medical Management Nursing Management

Hematuria Proteinuria

la-or- coffee colored urine

pstick and urine sediment microscopy

Calcium channel blockers, diuretics, Beta-adrenergic blockers

Extremities Periorbital edema and face Edema Risk for impaired skin integrity r/t edema

nts r/t anorexia and increased metablic demand