3

Our Lady of Fatima UniversityCollege of Nursing

ACUTE GLOMERULONEPHRITIS

A Group Case Study

Submitted to:Ms. Feliciano, RN

In Partial Fulfillmentof the Requirement for the Course

NCM102RLE

Pasay City General HospitalPedia Ward

Submitted by:Macatangay Jan Alex

Madriaga, Merry GraceMarquez, Carmina

Martinez, RickyNavarro Jr., Noel

Palompon, Ma. RafaelaPlaza, Jeanine Louise

2Y4-2DJANUARY 2010

3

Table of Contents

Chapter I

-Introduction 4

-Patient’s Profile 5

-Nursing History of Illness 7

Chapter II

-Anatomy and Physiology 9

-Pathophysiology 20

Chapter IV

-Laboratory Examinations 22

Chapter V

-Drug Study 26

Chapter VI

-Nursing Care Plan 147

3

Narratives 148

News/Trends 171

3

INTRODUCTION

Acute Glomerulonephritis (AGN) is an

inflammation of the internal kidney structures

(glomeruli). Glomeruli itself has functions to help

filter waste and fluids from the blood. This disease

leads to proliferative and inflammatory changes

within glomerular structure, as well as, destruction,

inflammation and sclerosis of the glomeruli of both

kidneys.

The common signs and symptoms of

AGN are as follows: Periorbital and facial edema

(more prominent in the morning),decreased

urinary output, cloudy, smoky, and brown-colored

urine, anorexia, pallor, irritability and lethargy,

headaches, abdominal or flank pain, dysuria,

hypertension, proteinuria, azotemia, increased

blood urea nitrogen and creatinine levels and

Antistreptolysin O titer.

3

The group encountered a patient with a

condition as such and their clinical instructor gave

them the opportunity to study the case; hence, this

case study aims to help understand the disease

process of AGN, and to orient one of the

appropriate nursing interventions that could be

offered to patients.

PATIENT’S PROFILE

Patient’s Name: Ajanun, Patrick Lleva

Age: 4 years old

Gender: Male

Address: 668 D. Bautista St. Pasay City

Date of Birth: April 23, 2005

Civil Status: Single

Religion: Roman Catholic

3

Nationality: Filipino

Dialect: Tagalog

Date of Admission:

Time Admitted:

Attending Physician:

Chief Complaint:

Admitting Diagnosis:

Final Diagnosis:

3

NURSING HISTORY OF ILLNESS

A. History of Present Illness

          -Present illness started at nine months prior

to admission;the patient had on and off headache

in the temporal area. He was brought to a private

clinic and was diagnosed with sinusitis and was

given phenypropanolamine. After one week prior

to admission the patient had cough without fever

and was given Salbutamol Syrup and nebulization

which afforded temporary relief. After a few hours

he had seizure with loss of sight and was admitted

to Pasay City General Hospital (PCGH).

B. Past Medical History

-Pneumonia

C. Family History of Past Illness

-Positive Maternal Asthma

-Positive PTB grandmother

3

D. Medical Birth History

-full term

-G2P0 via Normal SD

E. Nutritional History

        -Breastfed for one month

        -Bottle-fed for two months

3

ANATOMY AND PHYSIOLOGY

The Kidneys

The kidneys are two bean shaped

organs of the renal system located on the

posterior wall of the abdomen one on each side of

the vertebral column at the level of the twelfth rib.

The left kidney is slightly higher than the right.

Human kidneys are richly supplied with blood

vessels which give them their reddish brown color.

The kidneys measure about 10cm in length and,

5cm in breadth and about 2.5 cm in thickness.

The kidneys are protected by three

highly specialized layers of protective tissues. The

outer layer consists mainly of connective tissue

which protects the kidneys from trauma and

infection. This layer is often called the renal fascia

or fibrous membrane. The technical name for this

layer is the renal capsule. The next layer (second

3

layer from the exterior) is called the fascia and it

makes a fibrous capsule around the kidneys. This

layer connects the kidneys to the abdominal wall.

The inner most layer is made up of adipose tissue

and is essentially a layer of fatty tissue which

forms a protective cushions the kidney; and the

renal capsule (fibrous sac) surrounds the kidney

and protects it from trauma and infection.

Kidney Function

The main function of the kidney is to

maintain the fluid, electrolyte, and pH balance of

the body by filtering ions, macromolecules, water,

and nitrogenous wastes from the blood based on

the body’s condition. Wastes filtered out of the

blood drains from canals in the kidney into the

bladder as urine. Blockage of the drainage system

can cause the kidney to become congested,

stretched, and potentially scarred. Functioning

kidneys are necessary to maintain life, and one

3

measure of their function is the glomerular filtration

rate. A loss of kidney function results in the need

for dialysis, which is an artificial method of

removing wastes from the blood by running the

blood from the body, through an artificial kidney,

and then back into the body.

Cross-section of a kidney

3

PARTS OF KIDNEY

Capsule

The renal capsule is the

membranous covering of the kidney.

It directly covers the renal cortex,

which forms the outer stratum

Each part of the capsule links to its

explanation.

Cortex The cortex of the kidney is the outer

section which covers the internal

3

medulla. The cortex is visible near

the outer edge of the cross-

sectioned kidney. It is composed of

blood vessels and urine tubes and is

supported by a fibrous matrix.

Calyx The calyces (plural for calyx) are the

recesses in the internal medulla of

the kidney which enclose the

pyramids. They are used to

subdivide the sections of the kidney

anatomically, with distinction being

made between major calyces and

minor calyces.

Renal

Column

The renal columns are lines of the

kidney matrix which support the

cortex of the kidney. They are

3

composed of lines of blood vessels

and urinary tubes and a fibrous,

cortical material.

Pyramid The renal pyramids are conical

segments within the internal

medulla of the kidney. The pyramids

contain the secreting apparatus and

tubules and are also known as the

malphighian pyramids.

3

Renal

Sinus

The renal sinus is the cavity within

the kidney which houses the renal

pyramid. Nerves and blood vessels

pass into the renal sinus through the

hilus.

3

Hilus The hilus is the slit-like opening in

the middle of the concave medial

border of the kidney. Nerves and

blood vessels pass through the hilus

into the renal sinus within.

Renal

Artery

One quarter of the total blood

output from the heart comes to the

kidneys along the renal artery. Two

renal arteries arise from the

abdominal section of the aorta; each

artery supplies a lobe of the kidney.

The incoming artery divides into

four or five branches, eventually

forming arterioles, each of which

leads to the compact ball of

capillaries called the glomerulus.

3

Renal

Vein

Cell waste is discharged in the veins

for excretion through the kidneys.

The body circulates about 425

gallons of blood through the kidneys

on a daily basis, but only about a

thousandth of this is converted in

urine. The remainder goes back into

circulation through the renal

arteries. From the Bowman's

capsule, the blood is carried through

the compact network of capillaries

that forms the glomerulus within

the capsule. The capillaries

eventually reconverge into small

venules which lead to the larger

renal veins. There are two renal

veins, one extending from each lobe

of the kidney, and opening into the

vena cava.

3

THE NEPHRON

The nephron is the functional unit of the

kidney, responsible for the actual purification and

filtration of the blood. About one million nephrons

are in the cortex of each kidney, and each one

consists of a renal corpuscle and a renal tubule

which carry out the functions of the nephron. The

renal tubule consists of the convoluted tubule and

the loop of Henle.

The nephron is part of the homeostatic

mechanism of your body. This system helps

regulate the amount of water, salts, glucose, urea

and other minerals in your body. The nephron is a

filtration system located in your kidney that is

responsible for the reaborption of water, salts. This

is where glucose eventually is absorbed in your

body. One side note, diabetics have trouble

3

reaborbing the glucose in their body and hence a

lot of it comes out in the urine - hence the name

"diabetic" or "sweet urine." But that's another topic.

The Loop of Henle is the part of the

nephron that contains the basic pathway for liquid.

The liquid begins at the Bowman's capsule (upper

left) and then flows through the proximal

convoluted tubule (that mess of tangled stuff up

top). It is here that Sodium, water, amino acids,

and glucose get reabsorbed. The filtrate then flows

down the descending limb and then back up. On

the way it passes a major bend called the Loop Of

Henle. This is located in the medulla of the kidney.

As it approaches the top again, hydrogen ions

(waste) flow into the tube and down the collecting

duct.

Essentially, nutrients flow in through the left and

exit through the right. Along the way, salts,

3

carbohydrates, and water pass through and are

reabsorbed.

3

PATHOPHYSIOLOGY

Post-streptococcal infection (group-A, beta

hemolytic)

Release of material from the organism, into the circulation

Antibody Formation

Immune complex reaction in the

glomerular capillary

Inflammatory response

Proliferation of epithelial cells lining glomerolus & cells between endothelium & epithelium of capillary

membrane

Swelling capillary membrane & infiltration with leukocytes

3

↑ Permeability of base membrane

continued

↓ Glomerular filtration rate

Occlusion of the capillaries of the glomeruli vasospasm of afferent

ventrioles

↓ Ability to form filtrate from glomeruli plasma

flow

Retention of H2O & Na; hypovolemia;

circulatory congestion

Edema Hypertension

↓ urinary outputUrine dark in color

AnorexiaIrritability lethargy

3

ACUTE GLOMERULONEPHRITIS

3

LABORATORY EXAMINATIONS

HEMATOLOGY REPORTDecember 24, 2009

PARAMETERNORMALVALUES

ACTUALVALUES

ANALYSIS

Segmenters0.55-0.65

0.86

Increased; indicate

high glucose

level in the blood

Lymphocytes0.25-0.35

0.14Increased; indicates infection

3

BLOOD CHEMISTRY REPORTDecember 28, 2009

PARAMETERNORMALVALUES

ACTUALVALUES

ANALYSIS

BUN/Urea

1.7-8.3Mmol/L

10.10

Increased BUN levels

suggest impaired kidney

function. This may be due to acute or chronic kidney

disease, damage, or failure.

3

URINALYSIS REPORTDecember 28, 2009

PARAMETERNORMAL VALUES

ACTUAL VALUES

ANALYSIS

ColorYellow Amber

Light yellow

normal

TransparencyClear to slightly turbid

Slightly turbid normal

Reaction 4.5-8 6.0 normal

Specific Gravity1.005-1.030

1.010 normal

Sugar Negative traceIndicative of glucosuria

Protein Negative +2 Indicative of proteinuria

Squamous Epithelial Cells

Few FewIndicative of

nephrotic syndrome

Red Blood Cells Few 2-7

Hematuria, indicative of

possible glomerular

damage

Pus Cells Few 1-3Indicative of

bacterial infection

Mucus Few Few NormalBacteria Few Few Normal Amorp. Few moderate Indicative of

3

Urates/Phosphates

bacterial infection