CHRONIC GLOMERULONEPHRITIS

CHRONIC GLOMERULONEPHRITIS – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management

Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scaring of tiny blood filters in the kidneys. These filters known as glomeruli, remove waste products from the blood.

  • In  chronic glomerulonephritis, scarring of glomeruli impedes the filtering process, trapping waste products in the blood while allowing red blood cells or protein to escape into the urine, eventually producing the characteristic signs of high blood pressure and swelling in legs and ankles
  • The disorder may first come to one’s attention because of high blood pressure. In other, fluid retention or urine may be first signs. Long-term inflammation and scarring of the kidneys may lead to kidney failure in severe cases. Damage may progress without symptoms for months or years by the months or year, by the time symptoms appear, the course of the disorder maybe irreversible

ETIOLOGY

Specific cause is unknown

  • Viral infections such as Hepatitis B, C, HIV leads to chronic glomerulonephritis
  • Autoimmune disorder such as systemic lupus erythematosus, vasculitis may cause chronic glomerulonephritis
  • Acute glomerulonephritis may after a symptom less period of many years, reappear as chronic glomerulonephritis

PATHOPHYSIOLOGY

It is an autoimmune disease caused by the loss of tolerance to self-antigens —- glomeruli have varying degree of hypercellularity and become sclerosed (hardened) —- size of kidney is decreases, and eventually tubular atrophy, chronic interstitial inflammation occur —- kidney’s ability to regulate the internal environment begins to decrease as glomeruli become scarred and resulting in fewer functional nephrons —- results into various symptoms of renal dysfunction that leads to edema, weight loss, irritability, poorly nourished, high blood pressure, nocturia

SIGNS AND SYMPTOMS

Patient with severe disease has no symptoms at all for many years. There condition may be detected when BUN level and serum creatinine level are detected

  • Blood or protein in the urine
  • Swelling of legs or ankle and other parts of body due to fluid accumulation (edema)
  • Shortness of breath due to less blood
  • Headache or blood pressure high
  • Fatigue, nausea, vomiting, loss of appetite, abdominal pain
  • Nocturia (increased need to urinate at night)
  • Crackles sound in the lungs, poorly nourished, pale skin color

DIAGNOSTIC EVALUATION

  • History: collect any history of acute glomerulonephritis if present

Ask patient for the history of urination changes in patient

Ask for the presence of signs and symptoms

Ask patient for history of abdominal pain, etc

Physical examination: assess patient for edema and swelling, check patient body weight

Monitor patient blood pressure

  • Urinalysis and blood tests to know about the elevated level of for the presence of hematuria. A urinalysis may show red blood cells in urine an indicator of damage to the glomeruli. Urinalysis results may also show white blood cells, a common indicator of infection and inflammation and increased protein which results nephron damage
  • A blood test to measure protein and creatinine level. Level of creatinine and protein is elevated
  • An ultrasound of kidneys maybe performed to evaluate the size of kidneys and any blockages
  • CT scan or abdominal ultrasound can be performed to show the damage to the glomeruli
  • Renal biopsy maybe performed, under local anesthesia, to extract a small sample of tissue from kidney, to determine the exact cause and the nature of the glomerulonephritis

MANAGEMENT

  • Antihypertensive drugs (propranol) maybe prescribed to reduce high blood pressure
  • Diuretics (frusemide) may be prescribed to reduce excess fluid retention and increase urine production
  • Steroid medications, if immunosuppressive drugs (prednisolone and methyl prednisolone), maybe prescribed for some patients. Prednisolone and methylprednisolone is useful and most commonly prescribed drug. It can suppress the inflammatory response in kidney and reduce the permeability of renal blood vessels and reducing the proteinuria
  • In severe cases, where kidney failure occurs, dialysis maybe necessary. Dialysis performs the function of the kidney by removing waste products and excess fluid from the blood when kidney cannot
  • A kidney transplant is also an alternative in case of kidney failure. A kidney transplant is a surgical procedure performed to replace a diseases kidney with a healthy kidney from another person

DIET MANAGEMENT

  • Provide low salt diet and provide low protein diet, because it reduces the workload on the kidney
  • Nuts, dried beans, cereals, vegetables, rice, breads are low in protein
  • Limit the amount of animal products
  • Take vitamin supplements
  • Fluid intake should be restricted
  • Provide adequate diet and fruits
  • Get proper rest
  • Take medication regularly

PREVENTION

  • In prevention it can be prevented by limit the salts, fluids, protein
  • Control blood pressure, controlling high blood pressure is the most important part of treatment
  • Maintain good hygiene practices
  • Practicing safe sex helps in preventing the viral infection such as HIV infection and hepatitis which leads to this illness
  • Take calcium supplements

NURSING MANAGEMENT

Nursing Assessment

  • Observe patient for changes in fluid and electrolyte status and for the signs and symptoms
  • Monitor vital signs of patient blood pressure
  • Anxiety levels are often extremely high for both the patient and family
  • Throughout the course of disease and treatment, the nurse should gives emotional support by providing opportunities for the patient and family to verbalize their concerns, have their questions answered, and explore their options

Nursing Diagnosis

  • Ineffective renal tissue perfusion related to damage of glomerular infiltration
  • Excess fluid volume related to compromised renal function
  • Imbalanced nutrition less than body requirement related to anorexia, nausea, vomiting
  • Deficient knowledge regarding condition and treatment
  • Activity intolerance related to fatigue, retention of waste products
  1. Excess fluid volume related to compromised renal function, decreased urine output, retention of sodium and water

Interventions

  • Assess the fluid status of patient
  • Check weight daily and record
  • Maintain intake output chart
  • Monitor vital signs
  • Limit fluid intake to the patient
  • Explain the rationale for restriction of fluid
  • Assist patient to cope up with the discomforts results from fluid restriction
  • Provide and encourage oral hygiene, it minimizes the dryness of oral membranes
  • Imbalanced nutrition pattern less than body requirements related to anorexia, nausea, vomiting

Interventions

  • Assess the nutritional status of the patient
  • Monitor weight of patient daily and record it
  • Assess the patient nutritional dietary patterns-diet history, food preferences
  • Provide patients food preference within dietary restrictions
  • Provide low salt and protein diet
  • Restrict fluids rich diet to the patient
  • Encourage for proper rest
  • Provide pleasant surroundings at the meal time
  • Deficient knowledge related to disease condition and treatment

Interventions

  • Assess the understanding of patient regarding disease condition and treatment
  • Provide explanation regarding renal function and consequences of disturbed renal function at the level of patient understanding and guided by patient’s readiness to learn
  • Assist patient to identify ways to incorporate changes related to illness and its treatment into lifestyle
  • Provide oral and written information as appropriate about: renal function, fluid and dietary restrictions
  • Clear all the doubts of the patient
  • Provide psychological support to the patient
CHRONIC GLOMERULONEPHRITIS – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management
CHRONIC GLOMERULONEPHRITIS – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management

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