ACUTE GLOMERULONEPHRITIS

By: Jhaziel E. Bermejo

•DEFINITION•CAUSES•LABORATORY•MANIFESTATIONS

INTRODUCTION

DEFINITION

Aka glomerular nephritis, (GN) is a renal disease characterized by

inflammation of the glomeruli, or small blood vessels in the kidneys.

refers to a specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium.

CAUSES

Post infectious etiologies Streptococcus species

(i.e., group A, beta-hemolytic).

Systemic causes

Vasculitis (ie, Wegener granulomatosis causes glomerulonephritis that combines upper and lower granulomatous nephritides).

Collagen vascular diseases (ie, systemic lupus erythematosus causes glomerulonephritis through renal deposition of immune complexes).

Cryoglobulinemia causes abnormal quantities of cryoglobulin in plasma that result in repeated episodes of widespread purpura and cutaneous ulcerations upon crystallization.

Polyarteritis nodosa causes nephritis from a vasculitis involving the renal arteries.

Henoch-Schönlein purpura causes a generalized vasculitis resulting in glomerulonephritis.

Goodpasture syndrome causes circulating antibodies to type IV collagen and often results in a rapidly progressive oliguric renal failure (weeks to months).

Drug-induced (ie, gold, penicillamine)

Renal diseases

Idiopathic rapidly progressive glomerulonephritis is a form of glomerulonephritis characterized by the presence of glomerular crescents. Three types have been distinguished. Type I is an antiglomerular basement

membrane disease, type II is mediated by immune complexes,

and type III is identified by antineutrophil

cytoplasmic antibody.

Laboratory tests

Antistreptolysin-O (ASO) Titer. Urinalysis. Renal Biopsy. Is the most

confirmatory diagnostic procedure. Electrolytes, including BUN and

creatinine (to estimate the glomerular filtration rate [GFR]): The BUN and creatinine levels will exhibit a degree of renal compromise.

Complete blood cell count Streptozyme test Erythrocyte sedimentation ratio (ESR)

usually is increased. Urine or plasma creatinine level greater

than 40; decreased renin level is noted. Cultures of throat and skin lesions to

rule out Streptococcus species may be obtained.

Blood cultures

Imaging Studies Radiography Echocardiography renal ultrasonography CT scan

MANIFESTATIONS

Hematuria Hypertension Generalized

edema Proteinuria Oliguria Anorexia

Nausea and vomiting

fatigue and tiring easily,

headaches, twitchy

movements mental confusion

and disorientation.

Diagram presentation

PATHOPHYSIOLOGY

•Antibiotic and antihypertensive drugs•Follow up care•Patient teachings

MANAGEMENT

MANAGEMENT

Antibiotics. Antihypertensive. Bed rest. Increase oral fluid intake.

Antibiotic and antihypertensive drugs

Antibiotics The Penicillin is the DOC in treating acute

glomerulonephritis of a poststreptococcal group A beta-hemolytic etiology.

  Penicillin V (Veetids)

Inhibits enzymes and cell wall receptors, resulting in cell wall synthesis inhibition. Other autolytics enzymes are also activated, degrading the bacterial cell wall.

Nonselective beta-blocker with cardioselective alpha1 blocker Labetalol is used for hypertensive

encephalopathy and malignant hypertension.  Labetalol (Normodyne)

Has nonselective beta-antagonist and cardioselective alpha1-antagonist effects. Beta-blocking effects predominate, particularly when used IV. Low lipid solubility means bioavailability is reduced by first pass metabolism and enhanced by coadministration of food. Drug is not removed by hemodialysis.

Loop diuretics Loop diuretics are used for hypertensive

encephalopathy with CNS signs and circulatory congestion or pulmonary edema. Furosemide is DOC for this indication.

  Furosemide (Lasix)

Inhibits absorption of sodium and water in ascending limb of loop of Henle by interfering with Na+/K+/Cl- channel. An antihypercalcemic effect is mediated by an increased excretion of calcium.

Corticosteroids Methylprednisolone is used for

nonstreptococcal etiologies of acute glomerulonephritis, particularly in lupus nephritis and in idiopathic progressive glomerulonephritis.

  Methylprednisolone (Medrol)

Has anti-inflammatory effect and is immunosuppressive. Metabolized by hepatic transformation and renal excretion.

Follow-up

Further Outpatient Care Urinalysis at 2, 4, and 6 weeks and at 4, 6,

and 12 months Cessation of follow-up care when urinalysis

is normal Blood pressure monitoring during each visit Serum creatinine level monitoring at 2, 6,

and 12 months Serum complement usually normal by 6

weeks

Patient Education

Upon discharge from the ED, patient education should emphasize the importance of close follow-up care.

Indicate that strenuous exercise should be avoided because exercise can induce proteinuria, hematuria, and cylindruria (renal cylinders or casts in the urine) in healthy individuals.

Limit the patient to a diet with no added salt until edema, hypertension, and azotemia clear.

Restrict fluids in patients with significant edema. Restrict protein in the presence of azotemia and

metabolic acidosis (ie, approximately 0.5 g/kg/d). The patient should avoid high-potassium foods.