a. Pathophysiology a.

2 Patient-centered
Non-modifiable: Modifiable factors: High sodium diet Post Streptococcal Infection

Age: 6 years old Sex: MALE

Invasion of antigen Group A beta hemolytic streptococcus

Antigen-antibody reaction stimulating plasma

Deposition of antigenantibody complexes in glomerulus

Increase in production of epithelial cells lining the glomerulus

Chemotactic attraction

Infiltration of WBC to the glomerulus Swelling of the cells Phagocytosis + release of proteases and free radicals

Release of endogenous pyrogens

Inflamed tissue containing varying portion of necrotic tissue, dead neutrophils and macrophages

Damage to the glomeruli Basement membrane of glomerulus is exposed Platelet aggregation

Stimulates release of prostaglandins

Reset the hypothalamic thermostat to higher temperature

Increase passage of pus in the urine (Pus cells of 25hpf, 01-24-12; 10-15hpf 1-2512;on the urinalysis)

Thickening of glomerular filtration membrane Some loss of glomerular filtration membrane Acute Glomerulonephritis

Absence of disruption of excretory function

Altered kidney function

Increase permeability of glomerular membrane

Decrease excreation of nitrogenous waste

Altered glomerular function

Retention of nitrogenous waste in the body

Passage/release of red blood cells (Hematuria: 10-15hpf 01-24-12; 15-20 01-25-12 in the urinalysis) Decrease red blood cell count (Hemoglobin of 100g/l in the urinalysis, 01-24-12)

increase protein loss ( +2 01-24-12; +3 01-25-12 in the urinalysis )

Increase BUN and Creatinine

Loss of plasma albumin, Hypoalbuminemia

Decrease colloid oncotic pressure

Fluid diffuse into the interstitial space

Decrease intravascular volume (Hypovolemia)

Accumulation of fluid in the face and extremities

Reduced glomerular filtration rate

Stimulation of renninangiotensin aldosterone system

Facial, both hands and feet edema Release of rennin from juxtamedullary of kidneys onto the bloodstream feet edema during the admission and only at the lower extremeties at 01/24-25/12

Rennin reacts with angiotensin from the liver

Angiotensin I

Angiotensin will interact with angiotensin converting enzyme from the lungs

Release of Angiotensin II (potent vasoconstrictor)

Stimulation of adrenal cortex, excretion of aldosterone Sodium and water retention

Generalized vasoconstriction

Hypertension (BP of 130/90 mmHg, 01/24-26/12)

Adding to the accumulation of extracellular fluid

edema during admission and only lower extremities 01/24-25/12)

Boost blood pressure

Hypertension (BP of 130/90 mmHg, 01/24-26/12)

Sodium dilution

Extracellular fluid hypoosmolality

Potassium shifts from intracellular fluids compartment to extracellular fluids