GLUMERULONEPHRITIS notes natunga ronald.pptx

summarised

1. GLOMERULONEPHRITIS BUYO REMALIAH ISRON DCN/BPAM/BMED

2. OUT LINE Definition Types of glumerulopathies General signs and symptoms General diagnosis Acute nephritic syndrome Rapidly progressive nephritic syndrome Chronic nephritic syndrome Nephrotic syndrome

3. Definition These are kidney diseases in which inflammation affects mainly the glomeruli and are termed as glumerulopathies. The causes may vary but the glumeruli respond to injuries in the same way. There are many types of glomerulopathies as indicated below.

4. Types of glumerulopathies Acute nephritic syndrome . starts suddenly and usually resolves quickly. Rapidly progressive nephritic syndrome. starts at one sport suddenly and spreads quickly to other parts of kidney. Chronic nephritic syndrome is mild and spreads gradually to the rest of the parts of kidney over a period of years. Nephrotic syndrome leads to the loss of large amount of proteins in urine.

5. General signs and symptoms of glomerulopathies Leakage of proteins, blood cells in urine Blockage of blood vessels leading to nephrones. Reduction of the amount of urine produced Lowering kidney capacity with retention of urea, uric acid Loin pain Retention of water and salts

6. General diagnosis Urine for urinalysis: Proteins Blood cells or immune cells Bacteria Sample blood test to assess elevated urea Kidney biopsy to visualize immune reactions

7. Acute nephritic syndrome Acute nephritic syndrome (acute glomerulonephritis ) is an inflammation of glumeruli that results into sudden appearance of blood in urine with clumps of red blood cells and variable amount of proteins in the urine Causes Reactions to immune complexes Local infections with bacteria

8. Causes 1. Focal proliferative IgA nephropathy chronic liver failure SLE 2. Diffuse proliferative membranoproliferative glomerulonephritis (malaria, hepatitis B, hepatitis C, chronic infection, sickle-cell disease, SLE, hemolytic uremic syndrome/thrombotic thrombocytopenic purpura SLE rapidly progressing glomerulonephritis (RPGNs) - several. 7/30/2018 8 MUGAMBE.S. - MED II URINARY

9. Pathophysiology 7/30/2018 9 MUGAMBE.S. - MED II URINARY

10. C.P History of a throat, skins strep infection 2-3 wks ago Age > 3 years and adolescents Hematuria with red blood cell (RBC) casts present in the urine proteinuria- small amounts of protein are lost in the urine, but this is usually trivial (<3.5 g/day) Hypertension mild Duinal variation oedema uremia - due to retention of waste products and variable Azotemia oliguria (low urine output <400 mL /day) Mnemonic: PHAROAH At risk; poverty, overcrowding, slums, skin conditions 7/30/2018 11 MUGAMBE.S. - MED II URINARY

11. Signs and symptoms cont , Fluid retention in the body (oedema) Dark colored and small amount urine that contains blood High blood pressure and brain swelling may lead to head ache Visual disturbances and brain function impairment. Low blood protein and high urine protein. High urea and cretinine content in blood.

12. Dx Symptomatology Inv. Blood – RFTs, ASOT, culture, Fasting lipid profile Urinalysis – 24 hr protein, RBCs, RBC casts Throat swab 7/30/2018 13 MUGAMBE.S. - MED II URINARY

13. Diff Dx Kidney infections, eg. TB, pyelonephritis, Kidney tumours Heart failure Malnutrition Allergic reactions 7/30/2018 14 MUGAMBE.S. - MED II URINARY

14. Supportive involves maintaining a high fluid intake (greater than 2 liters a day) a diet low in salt and fats and modestly restricted in animal protein, regular exercise, cessation of smoking and tight blood pressure control using blood pressure medication that will be beneficial to the kidneys. It is important to return the blood cholesterol and triglycerides (fats in the blood) to normal if they are raised, achieve and maintain ideal body weight and avoid excess alcohol intake. MANAGEMENT 7/30/2018 15 MUGAMBE.S. - MED II URINARY

15. Treatment Corticosteroids e.g. hydrocortisone 200mg 3-4 times daily for 3 days or prednisolone 10-20mg daily. Antibiotics e.g. ampiclox 500mg 4 times daily for 2 weeks. Low salt and protein diet. Diuretics e.g. frusemide 40-80mg daily Antihypertensives e.g. atenolol 25-100mg or propranolol 80-160mg

16. Note Ciprofloxacin, tetracycline, doxycyline and cotrimoxazole are unsuitable and should not be used for treating primary streptococcal infection

17. Tabs oral prednisone at 1 mg/kg/(not to exceed 80 mg) for 3 weeks then oral prednisone at 2 mg/kg every other day (not to exceed 120 mg) for 3 months. This dose is decreased by 25% every 4 weeks until the patient stops taking prednisone until the protenuria reduces toward no protenuria NOTE: a 24hr urine protein assessment should be done for proteins. Predinslone TX 7/30/2018 18 MUGAMBE.S. - MED II URINARY

18. Treat throat and skin infections promptly and effectively Avoid overcrowding Adequate ventilation in dwellings Monitor urine output, BP, daily weight Restrict fluid input (in oliguria) Restrict salt and protein in the diet (in oliguria) Prevention 7/30/2018 19 MUGAMBE.S. - MED II URINARY

19. Avoid or use with caution any drugs excreted by the kidney Treat any continuing hypertension Treat primary streptococcal infection ( 10-day course ): Prevention con’t………. 7/30/2018 20 MUGAMBE.S. - MED II URINARY

20. Rapidly progressive nephritic syndrome Termed as rapidly progressive glomerulonephritis is an un common disorder in which most of the glumeruli are partly destroyed resulting in severe kidney failure with proteins and blood clumps in the urine. The normal kidney cell shapes destroyed and become crescent shaped.

21. The immune complex causes rapid destruction of cells covering a large kidney tissue within days Glomerular filtration rate usually reduce to less than 50% within short time It happens in good posture syndrome and vasculitic disorder.

22. Good pasture Syndrome Goodpasture syndrome is a rare but serious autoimmune disease that attacks the lungs and kidneys . The disease occurs when the body's immune system mistakenly produces antibodies against collagen in the lungs and kidneys . Collagen is a protein that helps form connective tissue. Good pasture syndrome initially causes vague symptoms such as fatigue . But it can rapidly involve the lungs and kidneys. It is almost always fatal if it is not quickly diagnosed and treated.

23. Causes of Good pasture Syndrome Researchers do not fully understand why the immune system attacks collagen in the lungs and kidneys. Good pasture syndrome can run in families. So some researchers believe it may have a genetic component. Other factors that may increase the risk of Good pasture syndrome include: Exposure to certain chemicals, such as hydrocarbon solvents and the weed killer paraquat . Exposure to metallic dust

24. Causes cont , Use of certain drugs, such as cocaine , Tobacco smoking Viral infections Good pasture syndrome usually affects young men. It more often occurs among whites, and it most commonly affects people who are: Between ages 20 and 30 Older than age 60

25. Symptoms of Good pasture Syndrome The first signs of Good pasture syndrome may include: Fatigue Nausea and vomiting Difficulty breathing Pale skin Because Good pasture syndrome may rapidly involve the lungs, initial symptoms such as shortness of breath can quickly progress to a persistent cough , sometimes with blood . When Good pasture syndrome affects the kidneys, symptoms may include:  

26. Blood in the urine Foamy urine Swelling in the legs High blood pressure Burning or difficulty when urinating Back pain below the ribs Swelling of the hands and feet Although Good pasture syndrome may cause life-threatening bleeding in the lungs, it usually does not result in long-term lung damage. The most serious consequence of Good pasture syndrome is kidney failure , which may require either dialysis or a kidney transplant

27. Vasculitis This is an inflammation of the blood vessel and it affects any body part but more pronounced in the kidneys and It appears to be caused by autoimmune responses

28. Causes Antibodies made else where in the body Reaction to anti body-antigen complex Allergic reaction to chemicals unknown

29. Signs and symptoms Body weakness Fever and fartique Nausea and vomiting Loss of appetite Coughing of blood Joint and abdominal pain Oedema Oliguria Haematuria and protein in urine Anaemia leukocytosis

30. Diagnosis of RPNS Ultra sound shows enlarged kidney Kidney biopsy and analysis shows crescent cells Treatment High doses of corticosteroid Dialysis: haemodialysis or peritoneum dialysis Diuretics Kidney transplant

31. Hypertension Hypercholesterolemia (hyperlipidemia) Nephrotic syndrome Acute renal failure Chronic renal failure Complications of nephric syndrome 7/30/2018 32 MUGAMBE.S. - MED II URINARY

32. Nephrotic syndrome

33. Definition of Nephrotic syndrome This is non specific kidney disease caused by many other diseases that affect the kidney resulting into: Triad of: MASSIVE Proteinuria >3g/24hours Hypoalbuminaema <25g/L Oedema And often: Hypercholesterolaemia / dyslipidaemia (total cholesterol >10mmol/L)

34. There is retention of excess salt and water in the body and increased level of fats(lipids) in blood. Nephrotic syndrome can occur at any age but most common in children of age 18 month to four years It affects more boys than girls

35. Causes of Nephrotic syndrome Amyloidosis ( presence of starch( amiloids ) in kidney and liver or spleen which results from TB and DM. Cancers of kidney nephrones Diabetes mellitus Glomerulopathies HIV Leukemia lymphoma

36. Systemic lupus erythematosis Drugs like aspirins Heavy metal poisoning , gold , lead Heroin Allergy to sun light, insects bites Monoclonic gammapathy ( artificial antibodies produced)

37. Symptoms and signs Loss of appetite General malaise Anasarca Abdominal pain Muscle wasting on limbs

38. Tissue swelling from excess fluids and salts Excess protein in urine (3.5g/day) Hypoalbunaemia ( <25g/l) Thrombophilia Lipiduria and hyperlipidaemia

39. Risk of coagulation Shortness of breath due to pleural effusion Generally low blood pressure in children but adults may have hypertension Urine out put drops leads to kidney failure Increased ESR Nutritional deficiencies of calcium Opportunistic infections take advantage due to loss of anti bodies

40. Diagnosis Urinalysis – high proteins ( >3.5g/day) Low albumin in blood High blood lipid Low potassium High sodium Clinical presentation

41. Urine microscopy Bloods – the usual ones, plus renal screen Immunoglobulins , electrophoresis (myeloma screen), complement (C3, C4) autoantibodies Renal ultrasound Renal biopsy (all adults) Children generally trial of steroids first Investigations

42. Treatment Treatment is aimed at the underlying causes: Stop poisonous substances like heroin Cancers should be treated Allergies avoid them If no cause identified give steroids Diet include normal protein but low salt and fat Treat hypertension with antihypertensive

43. Conservative Monitor BP, fluid balance, weight Salt and fluid restriction Treat underlying cause Medical Diuretics: ACE-inhibitors eg capitopril 25mg orally 3 times daily Corticosteroids/ immunosuppression Dialysis Anticoagulation Surgical Renal transplant Management

44. Nursing care Admit in severe cases Give drugs as prescribed Restrict salt, give protein Monitor fluid intake and out put by fluid balance chart Special skin care for patients of oedema Discourage excessive exercises and activities Have the patient change position often, deep breathing exercises and move limps Reassure the patient

45. Complications Frequent infections (lowered immunity) Acute kidney failure Pulmonary edema Growth retardation Vitamin D deficiency Hypertension

46. References Carol et al (2002). Pathology. Concepts of altered health states, 6 th edition,lippincott. Barbara et al(1996). Pathphysiology. Adaptation and alteration in function of body, 4 th edition. Robert Berkow (1997). The merk manual of medical information, home edition. Stephen R Bloom (1995). Tooheys medicine, 15 th edition. Stanley l (1993). The professional guide to signs and symptoms Philips (2007). Medical and surgical nursing.