Acute glomerulonephritis

Acute glomerulonephritis pediatric

1. ACUTE GLOMERULO
NEPHRITIS
SURENDRA SHARMA
Associate Professor
Amity College of Nursing
Amity university, Gurgoan

2. ACUTE GLOMERULO NEPHRITIS
Definition:-
Itisanimmunecomplexdiseaseduetoantigen
antibodyreactionfollowinghemolyticstreptococcal
infection.
Incidence:-
- Schoolagechildren.
- Rareinyoungerchildrenthantheage2.
- Morefrequentlyinmalesthaninfemales.
Etiology:-
- Antigenantibodyreactionsecondarytoan
infection( Haemolyticstreptococcalinfection).
- RecurrentURTI.

3. Pathophysiology: -
Antigen groups A beta hemolytic streptococcus.
Antigen antibody product.
Deposition of antigen-antibody complex in glomerulus.
Increased production of epithelial cells lining the glomerulus.
Leukocytes infiltrate the glomerulus
Thickening of the glomerulus filtration membrane.
Scarring and loss of glomerulus filtration membrane.
Decreased glomerulus filtration rate.

4. Clinicalmanifestation:-
Onset:-
1.Usually10to20daysafteracutepharynges.In
streptococcalskininfection,thelatencyperiodmaybe
as6weeks.
2.Maybeabrupt&severeormildanddetectedonly
laboratorymeasures.
Signs&symptoms:-
1.Urinarysymptoms:-
a)Decreasedurineoutput.
b)Bloodyorbrowncoloredurine.
2.Edema:-
a).Presentinmostpatients.
b).Usuallymild.

5. a)Commonlymanifestedbyperiorbitaloedemainthemorning
b)Mayappearonlyasrapidweightgain.
c)Generalizedandinfluencedbyposturemaybepresent.
2.Hypertension:-
a)Presentinmorethan50%ofpatients.
b)Usuallymild.
c)RiseinBPmaybesudden.
d)Usuallyappearduringthefirst4-5daysoftheillness.
3.Malaise
4.Mildheadache.
5.GIdisturbances,especiallyanorexiaandvomiting.
6.Fevermayormaynotbepresent.
7.Childrenlookpale,lethargic,andirritable.

6. Diagnosticevaluation:-
1.Urinalysis:-
a)Decreasedoutput(oliguria)–mayapproachin
anuria.
b)Grosshematuria.(Microscopic)
c)Specificgravity-moderatelyelevated.
d)Proteinuriamaybemildtosevere.
e)Microscopic-redbloodcells,leucocytesepithelial
cells&caste.
f).Flow urinary sodium

7. 1.BUN:-creatinine-usuallymildlytomoderately
elevatedin50%patients.
2.Antistreptolysintiteriselevated.
3.AntidnaseB(ADB)titer-elevated.
4.Erythrocytesedimentationratealsoelevated.
5.ComplementC3&C4depressed.
6.Serumalbumintest.
7.Electrocardiography.
8.ChestX-ray-pulmonarycongestion,cardio
enlargementduringtheedematousphase.

8. Treatment:-
•ThereisnospecifictreatmentAGN.
•Itisself-limitingandpatientsrecoverwithintwoto
threeweeks.
•Deathmaybeduetocomplications.
Supportivetreatment:-
•Antibioticse.g.Penicillinmaybegiventotreatthe
infection.Giveantihypertensivedrugs.
•Givemagnesiumsulphatetoreducethecerebral
oedema&enchaphalopathy.
•Sedativesgivetoreducetherestlessness.
•Cardiacfailuremeansgivedigitalis.
•If end stage means advice for dialysis

9. Nursingmanagement:-
•Givecompletebedrest.
•Checkthevitalsignstodetectearlysignsof
complicationssuchasthedeviationinthepulsemay
indicatecardiacfailure.
•Headache,convulsions&behavioralchangesmay
beindicativeofhypertensiveenchephalopathy.
•Followthestrictintake&outputchart.
•Checktheweightdaily,oedema.&appearanceof
theurineismust.
•Nutritionshouldbeplannedaccordingtotheblood
reportsinthespecificstage.

10. •Mildcases:-saltrestrictedregularfoodmaybe
allowed.
•Saltyfooditemsshouldbeavoidedinearlyphaseof
oliguria.
•Foodshouldcontainlowproteins,highCHO&
vitaminsupplement.
•Smallfrequentfeedingshouldbegiven.
•Fluidshouldbe suppliedaccordingtothe
prescription.
•Parentsshouldbeexplainedabouttheaccuratefluid
intake.
•Secondphase:-Diuresisstartsthenormalfoodwith
theadequatefluidcanbegivenasthebloodreports
improve.
•Giveplaytherapy.

11. Parentaladvice:-
•Parentalshouldbetaughtabouttheearlysignsof
complicationsandimportanceofearlytreatment.
•Propercareoftheskinandtimelytreatmentofthe
skinlesionsshouldbeexplained.
•Promptcareoftherespiratoryproblemsshouldbe
insisted.
•Parentsshouldbeinstructedaboutthefollowup
visits.
Complications:-
•Hypertensiveenchaplopathy.
•Heartfailure
•Uremia
•Anemia
•Hypertension

12. Nursingdiagnosis:-
•Impairedurinaryeliminationrelatedtoglomerular
dysfunction.
•Excessfluidvolumerelatedtoimpairedrenalfunction.
•Deficientdiversionalactivityrelatedtofocusonfluid&
saltrestriction.
•DeficientknowledgeregardingAGN &its
management.
Nursinginterventions:-
Promotingnormalurineoutput:
1.Monitordailyintakeoutputchart.
2.Test&recordurineforhematuriaandproteinuriaas
directed&notecolorofurine.
3.Monitordailyweights.

13. Reducingexcessfluidvolume:-
•Promoteanosaltdietduringacutephase.
•Restrictthefluids.
•ChecktheBPasordered&needed.
Promotingdiversionalactivity:-
1.Explainfluidrestrictionofatanageappropriatelevel
&directthechild’sfocusawayfromrestrictions.
2.Providethechildwithdiversionalactivity&play
therapy.
•Encourage activity as tolerated

14. Providinginformation:-
1.Explainallaspectsofthediagnostictests&treatmentin
termsthefarmingcanunderstand.
2.Explainthepurposeofallmedications&therestricteddiet.
3.Givegoodhomeenvironment.
4.Arrangeforappointmentsforcontinuedmedicalsupervision
&initiatereferralswhenappropriate.
5.Encouragefamilyparticipationinthechild’scare.
Healtheducation:-
•Reinforcemedicalexplanationofthediseaseprocess.
•Reinforceactivityrecommendationusuallynotrestricted.
•Explainaboutthepreventionofrecurrentrespiratorytract
infection.
•Regularcheckup.