Glomerulonephritis

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1. Glomerulo -nephritis JOHNY WILBERT, M.Sc [N] LECTURER, APOLLO INSTITUTE OF HOSPITAL MANAGEMENT AND ALLIED SCIENCE

2. Definition Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction .

3. The disorder results in proliferative and inflammatory changes within the glomerular structure. Destruction , inflammation, and sclerosis of the glomeruli of the kidneys occur . Inflammation of the glomeruli results from an antigen-antibody reaction produced by an infection elsewhere in the body. Loss of kidney function develops

4. Causes 1. Immunological diseases 2. Autoimmune diseases 3. Antecedent group A beta- hemolytic streptococcal infection of the pharynx or skin 4. History of pharyngitis or tonsillitis 2 to 3 weeks before symptoms

5. Types of Glomerulonephritis Acute Occurs 2 to 3 weeks after a streptococcal infection Chronic Can occur after the acute phase or slowly over time

6. Clinical manifestation 1. Periorbital and facial edema that is more prominent in the morning 2. Anorexia 3. Decreased urinary output 4. Cloudy, smoky, brown- colored urine ( hematuria ) 5. Pallor, irritability, lethargy 6. In an older child: Headaches, abdominal or flank pain, dysuria

7. 7. Hypertension 8. Proteinuria that produces a persistent and excessive foam in the urine 9. Azotemia 10. Increased blood urea nitrogen and creatinine levels 11. Increased antistreptolysin O titer (used to diagnose disorders caused by streptococcal infections)

8. Diagnostic evaluation History collection Physical examination Urine examination Blood tests investigating the cause, including FBC , inflammatory markers, and special tests ( including ASLO, ANCA, Anti-GBM,  Complement levels ,  Anti-nuclear antibodies ) Biopsy of the kidney Renal ultrasonography is useful for prognostic purposes in finding signs of  CKD , which however may be caused by many other diseases than glomerulonephritis .

9. Mananagement 1. Monitor vital signs, weight, intake and output, and characteristics of urine. 2. Limit activity; provide safety measures. 3. Provide high-quality nutrient foods. a. Restrictions depend on the stage and severity of the disease, especially the extent of the edema .

10. b. In uncomplicated cases, a regular diet is permitted, but sodium is restricted to a “no added salt to foods” diet. c. Moderate sodium and fluid restriction is prescribed for a child with hypertension or edema . d. Foods high in potassium are restricted during periods of oliguria. e. Protein is restricted if the child has severe azotemia resulting from prolonged oliguria.

11. 4. Monitor for complications (e.g., renal failure, hypertensive encephalopathy, seizures, pulmonary edema , heart failure). 5. Administer diuretics (if significant edema and fluid overload are present), antihypertensives (for hypertension), and antibiotics (to a child with evidence of persistent streptococcal infections) as prescribed.

12. 6. Initiate seizure precautions and administer anticonvulsants as prescribed for seizures associated with hypertensive encephalopathy. 7. Instruct parents to report signs of bloody urine, headache, or edema . 8. Instruct parents that the child needs to obtain appropriate adequate treatment for infections, specifically for sore throats, upper respiratory infections, and skin infections.

13. Complications 1. Renal failure 2. Hypertensive encephalopathy 3. Pulmonary edema 4. Heart failure