Schematic Diagram

RISK FACTORS
Predisposing Factors: Precipitating Factors:
• Previous bacterial and viral infections • Unhealthy lifestyle (alcoholic, smoker,
such as sore throat, mumps, and high sodium, high cholesterol diet)
measles • Use of mefenamic acid and ibuprofen
as pain relievers

DEVELOPMENT OF CHRONIC GLOMERULONEPHRITIS

Antigen-antibody production

Deposition of antigen-antibody complex in glomerulus

Activation of complement
components in the glomerulus

Chemotaxis of inflammatory Alteration in glomerular membrane Cytokine release and fibrosis

cells and cell lysis permeability

Damage to glomerular cell Glomerular hyperfiltration Passage of proteins and

walls RBCs from the membrane

Activation of RAAS Development of glomerular sclerosis Proteinuria Hematuria

and chronic interstitial damage (protein +4)

Hypertension Decreasing glomerular filtration rate Hypoalbuminemia

(150/90 mmHg) (GFR) and persistent nephron damage

CHRONIC KIDNEY DISEASE Generalized edema

STAGE 1: GFR of 90 ml/min or more

Kidney damage with normal or high GFR

STAGE 2: GFR of 60-89 ml/min

Kidney damage with mild decrease in GFR

STAGE 3: GFR of 30-59 ml/min

Kidney damage with moderate decrease in GFR

STAGE 4: GFR of 15-29 ml/min

Kidney damage with severe decrease in GFR
 STAGE 5: GFR of 15 ml/min or less
Kidney failure

Loss of kidney functions

Impaired fluid Impaired Impaired acid Impaired calcium Erythropoeisis

excretion electrolytes balance excretion phosphate balance
and regulation

SIGNS AND SYMPTOMS LABORATORY EXAMS/DIAGNOSTICS

• Decreased urine output Serum Electrolyte:

• Hypertension (BP of 150/100 mmHg) • Decreased ionized calcium level (0.97
• Grade 1 bipedal edema (2 mm mmol/L)
indentation)
• Dry skin Blood Chemistry:
• Pale conjunctivae • Increased creatinine level (1210.3
• Easy fatigability mmol/L)
• Increased BUN level (19.44 mmol/L)

CPC with QPC:

• Low hemoglobin level (83 g/L)
• Low RBC count (3.40)

No management Management

Complications Nursing Medical

• Pulmonary edema Monitoring and Assessment Hemodialysis

• Uremic • Response to HD treatments • Frequency: 2x a week
encephalopathy • Complications • UF volume: 1000-
• Uremic GI bleeding 1500ml/session
• Hyperkalemia Health Teachings • Dialyzer: LO PS 18
• Hypocalcemia • Diet: Low salt, low potassium,
• Metabolic acidosis low phosphorus, uremic diet Medications
• Severe anemia • Fluid restrictions • Sodium bicarbonate 650
• Care of AVF / HD access mg/tab TID
• Activity and Exercise • Ferrous sulfate 100 mg/cap OD
• Folic acid 5 mg/tab OD
Multiple Organ Failure
• Calcium carbonate 500 mg/tab
Surgical
TID
Death • Subclavian catheter insertion • Nifedipine GITS 30 mg/tab TID
(1st week of Jan 19) • Carvedilol 6.25 mg/tab BID
• AVF creation at left arm (05 • Erythropoeitin beta 5000 units
Feb 19) 2 x a week
• Kidney transplant

Prolong life