Assessment

kidneys become large, swollen, and congested. More than half of patients with IgA nephropathy (the most common type of primary glomerulonephritis) have an elevated serum IgA and a normal complement level.

If the patient improves, the amount of urine increases and the urinary protein and sediment diminish. Some patients become severely uremic within weeks and require dialysis for survival. Others, after a period of apparent recovery, insidiously develop chronic glomerulonephritis.

Physiology/Pathophysiology
Antigen (group A beta-hemolytic streptococcus) Antigen-antibody product Deposition of antigenantibody complex in glomerulus Increased production of epithelial cells lining the glomerulus

Leukocytes infiltrate the glomerulus Thickening of the glomerular filtration membrane Scarring and loss of glomerular filtration membrane

Decreased glomerular filtration rate (GFR)

proteinuria

hematuria

Alteration in sodium excretion

Edema and hypertention

5 nursing diagnosis
excess Fluid Volume may be related to failure of regulatory mechanism (inflammation of glomerular membrane inhibiting filtration) acute Pain may be related to effects of circulating toxins and edema/distention of renal capsule, imbalanced Nutrition: less than body requirements may be related to anorexia and dietary restrictions

deficient Diversional Activity may be related to treatment modality/restrictions, fatigue, and malaise. risk for disproportionate Growth: risk factors may include infection, malnutrition, chronic illness.

Medical Management

Management consists primarily of treating symptoms, attempting to preserve kidney function, and treating complications promptly. Pharmacologic therapy depends on the cause of acute glomerulonephritis. If residual streptococcal infection is suspected, penicillin is the agent of choice; however, other antibiotic agents may be prescribed. Corticosteroids and immunosuppressant medications may be prescribed for patients with rapidly progressive acute glomerulonephritis, but in most cases of poststreptococcal acute glomerulonephritis, these medications are of no value and may actually worsen the fluid retention and hypertension.

Dietary protein is restricted when renal insufficiency and nitrogen retention (elevated BUN) develop. Sodium is restricted when the patient has hypertension, edema, and heart failure. Loop diuretic medications and antihypertensive agents may be prescribed to control hypertension. Prolonged bed rest has little value and does not alter long-term outcomes.

Nursing Management

Although most patients with acute uncomplicated glomerulonephritis are treated as outpatients, nursing care is important no matter what the setting. In a hospital setting, carbohydrates are given liberally to provide energy and reduce the catabolism of protein. Intake and output are carefully measured and recorded. Fluids are given according to the patients fluid losses and daily body weight. Insensible fluid loss through the respiratory and GI tracts (500 to 1,000 mL) is considered when estimating fluid loss.

Diuresis begins about 1 week after the onset of symptoms with a decrease in edema and blood pressure. Proteinuria and microscopic hematuria may persist for many months, and some patients may go on to develop chronic glomerulonephritis. Other nursing interventions focus primarily on patient education for safe and effective self-care at home.

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