Our Lady of Fatima University

College of Nursing

ACUTE GLOMERULONEPHRITIS

A Group Case Study

Submitted to:
Ms. Feliciano, RN

In Partial Fulfillment
of the Requirement for the Course
NCM102
RLE

Pasay City General Hospital

Pedia Ward

Submitted by:
Macatangay Jan Alex
Madriaga, Merry Grace
Marquez, Carmina
Martinez, Ricky
Navarro Jr., Noel
Palompon, Ma. Rafaela
Plaza, Jeanine Louise
2Y4-2D
JANUARY 2010

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Table of Contents

Chapter I

-Introduction 4

-Patient’s Profile 5

-Nursing History of Illness 7

Chapter II

-Anatomy and Physiology 9

-Pathophysiology 20

Chapter IV

-Laboratory Examinations 22

Chapter V

-Drug Study 26

Chapter VI

-Nursing Care Plan 147

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Narratives 148

News/Trends 171

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INTRODUCTION

Acute Glomerulonephritis (AGN) is an

inflammation of the internal kidney structures
(glomeruli). Glomeruli itself has functions to help
filter waste and fluids from the blood. This disease
leads to proliferative and inflammatory changes
within glomerular structure, as well as, destruction,
inflammation and sclerosis of the glomeruli of both
kidneys.

The common signs and symptoms of

AGN are as follows: Periorbital and facial edema
(more prominent in the morning),decreased
urinary output, cloudy, smoky, and brown-colored
urine, anorexia, pallor, irritability and lethargy,
headaches, abdominal or flank pain, dysuria,
hypertension, proteinuria, azotemia, increased
blood urea nitrogen and creatinine levels and
Antistreptolysin O titer.

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 The group encountered a patient with a
condition as such and their clinical instructor gave
them the opportunity to study the case; hence, this
case study aims to help understand the disease
process of AGN, and to orient one of the
appropriate nursing interventions that could be
offered to patients.

PATIENT’S PROFILE

Patient’s Name: Ajanun, Patrick Lleva

Age: 4 years old

Gender: Male

Address: 668 D. Bautista St. Pasay City

Date of Birth: April 23, 2005

Civil Status: Single

Religion: Roman Catholic

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Nationality: Filipino

Dialect: Tagalog

Date of Admission:

Time Admitted:

Attending Physician:

Chief Complaint:

Admitting Diagnosis:

Final Diagnosis:

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NURSING HISTORY OF ILLNESS

A. History of Present Illness

-Present illness started at nine months prior
to admission;the patient had on and off headache
in the temporal area. He was brought to a private
clinic and was diagnosed with sinusitis and was
given phenypropanolamine. After one week prior
to admission the patient had cough without fever
and was given Salbutamol Syrup and nebulization
which afforded temporary relief. After a few hours
he had seizure with loss of sight and was admitted
to Pasay City General Hospital (PCGH).

B. Past Medical History

-Pneumonia

C. Family History of Past Illness

-Positive Maternal Asthma
-Positive PTB grandmother

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D. Medical Birth History
-full term
-G2P0 via Normal SD

E. Nutritional History
-Breastfed for one month
-Bottle-fed for two months

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ANATOMY AND PHYSIOLOGY

The Kidneys

The kidneys are two bean shaped

organs of the renal system located on the
posterior wall of the abdomen one on each side of
the vertebral column at the level of the twelfth rib.
The left kidney is slightly higher than the right.
Human kidneys are richly supplied with blood
vessels which give them their reddish brown color.
The kidneys measure about 10cm in length and,
5cm in breadth and about 2.5 cm in thickness.

The kidneys are protected by three

highly specialized layers of protective tissues. The
outer layer consists mainly of connective tissue
which protects the kidneys from trauma and
infection. This layer is often called the renal fascia
or fibrous membrane. The technical name for this
layer is the renal capsule. The next layer (second

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layer from the exterior) is called the fascia and it
makes a fibrous capsule around the kidneys. This
layer connects the kidneys to the abdominal wall.
The inner most layer is made up of adipose tissue
and is essentially a layer of fatty tissue which
forms a protective cushions the kidney; and the
renal capsule (fibrous sac) surrounds the kidney
and protects it from trauma and infection.

Kidney Function

The main function of the kidney is to

maintain the fluid, electrolyte, and pH balance of
the body by filtering ions, macromolecules, water,
and nitrogenous wastes from the blood based on
the body’s condition. Wastes filtered out of the
blood drains from canals in the kidney into the
bladder as urine. Blockage of the drainage system
can cause the kidney to become congested,
stretched, and potentially scarred. Functioning
kidneys are necessary to maintain life, and one

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measure of their function is the glomerular filtration
rate. A loss of kidney function results in the need
for dialysis, which is an artificial method of
removing wastes from the blood by running the
blood from the body, through an artificial kidney,
and then back into the body.

Cross-section of a kidney
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 PARTS OF KIDNEY

Capsule

The renal capsule is the

membranous covering of the
kidney. It directly covers the
renal cortex, which forms
the outer stratum

Each part of the capsule

links to its explanation.
Cortex The cortex of the kidney is
the outer section which
covers the internal medulla.

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 The cortex is visible near the
outer edge of the cross-
sectioned kidney. It is
composed of blood vessels
and urine tubes and is
supported by a fibrous
matrix.
Calyx The calyces (plural for calyx)
are the recesses in the
internal medulla of the
kidney which enclose the
pyramids. They are used to
subdivide the sections of the
kidney anatomically, with
distinction being made
between major calyces and
minor calyces.
Renal The renal columns are lines
Column of the kidney matrix which
support the cortex of the
kidney. They are composed

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 of lines of blood vessels and
urinary tubes and a fibrous,
cortical material.
Pyramid The renal pyramids are
conical segments within the
internal medulla of the
kidney. The pyramids
contain the secreting
apparatus and tubules and
are also known as the
malphighian pyramids.

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Renal
Sinus

The renal sinus is the cavity

within the kidney which
houses the renal pyramid.
Nerves and blood vessels
pass into the renal sinus
through the hilus.
Hilus The hilus is the slit-like
opening in the middle of the
concave medial border of

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 the kidney. Nerves and
blood vessels pass through
the hilus into the renal sinus
within.
Renal One quarter of the total
Artery blood output from the heart
comes to the kidneys along
the renal artery. Two renal
arteries arise from the
abdominal section of the
aorta; each artery supplies a
lobe of the kidney. The
incoming artery divides into
four or five branches,
eventually forming
arterioles, each of which
leads to the compact ball of
capillaries called the
glomerulus.
Renal Cell waste is discharged in
Vein the veins for excretion

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through the kidneys. The
body circulates about 425
gallons of blood through the
kidneys on a daily basis, but
only about a thousandth of
this is converted in urine.
The remainder goes back
into circulation through the
renal arteries. From the
Bowman's capsule, the
blood is carried through the
compact network of
capillaries that forms the
glomerulus within the
capsule. The capillaries
eventually reconverge into
small venules which lead to
the larger renal veins. There
are two renal veins, one
extending from each lobe of

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 the kidney, and opening into
the vena cava.

THE NEPHRON

The nephron is the functional unit of the

kidney, responsible for the actual purification and
filtration of the blood. About one million nephrons
are in the cortex of each kidney, and each one
consists of a renal corpuscle and a renal tubule
which carry out the functions of the nephron. The
renal tubule consists of the convoluted tubule and
the loop of Henle.

The nephron is part of the homeostatic

mechanism of your body. This system helps
regulate the amount of water, salts, glucose, urea
and other minerals in your body. The nephron is a
filtration system located in your kidney that is

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responsible for the reaborption of water, salts. This
is where glucose eventually is absorbed in your
body. One side note, diabetics have trouble
reaborbing the glucose in their body and hence a
lot of it comes out in the urine - hence the name
"diabetic" or "sweet urine." But that's another topic.

The Loop of Henle is the part of the

nephron that contains the basic pathway for liquid.
The liquid begins at the Bowman's capsule (upper
left) and then flows through the proximal
convoluted tubule (that mess of tangled stuff up
top). It is here that Sodium, water, amino acids,
and glucose get reabsorbed. The filtrate then flows
down the descending limb and then back up. On
the way it passes a major bend called the Loop Of
Henle. This is located in the medulla of the kidney.
As it approaches the top again, hydrogen ions
(waste) flow into the tube and down the collecting
duct.

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Essentially, nutrients flow in through the left and
exit through the right. Along the way, salts,
carbohydrates, and water pass through and are
reabsorbed.

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PATHOPHYSIOLOGY

Post-streptococcal infection
(group-A, beta
hemolytic)

Release of material from the

organism, into the circulation

Antibody Formation

Immune complex
reaction in the
glomerular capillary

Inflammatory response

Proliferation of epithelial cells

lining glomerolus & cells
between endothelium &
epithelium of capillary 3
membrane
 continued
Swelling capillary membrane
& infiltration with leukocytes
↑ Permeability of base
membrane

Occlusion of the capillaries of the

glomeruli vasospasm of afferent
ventrioles

↓ Glomerular filtration rate

↓ Ability to form filtrate

from glomeruli plasma
flow

Retention of H2O & Na;

hypovolemia;
circulatory congestion

Edema
Hypertension
↓ urinary output
Urine dark in color
Anorexia 3
Irritability lethargy
 ACUTE
GLOMERULONEPHRITIS

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LABORATORY EXAMINATIONS

HEMATOLOGY REPORT
December 24, 2009

NORMAL ACTUAL
PARAMETER ANALYSIS
VALUES VALUES
Increased;
indicate
0.55- high
Segmenters 0.86
0.65 glucose
level in the
blood
Increased;
0.25-
Lymphocytes 0.14 indicates
0.35
infection

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 BLOOD CHEMISTRY REPORT
December 28, 2009

NORMAL ACTUAL
PARAMETER ANALYSIS
VALUES VALUES
Increased
BUN
levels
suggest
impaired
kidney
function.
BUN/ 1.7-8.3
10.10 This may
Urea Mmol/L
be due to
acute or
chronic
kidney
disease,
damage,
or failure.

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URINALYSIS REPORT
December 28, 2009

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 NORMAL ACTUAL
PARAMETER ANALYSIS
VALUES VALUES
Yellow Light
Color normal
Amber yellow
Clear to
Slightly
Transparency slightly
turbid normal
turbid
Reaction 4.5-8 6.0 normal
1.005-
Specific Gravity 1.010 normal
1.030
Indicative of
Sugar Negative trace
glucosuria
Indicative of
Protein Negative +2
proteinuria
Indicative of
Squamous
Few Few nephrotic
Epithelial Cells
syndrome
Hematuria,
indicative of
Red Blood Cells Few 2-7 possible
glomerular
damage
Indicative of
Pus Cells Few 1-3 bacterial
infection
Mucus Few Few Normal
Bacteria Few Few Normal
Amorp. Indicative of
Urates/Phosphate Few moderate bacterial
s infection

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