1.

Introduction It is a term used to refers to several kidney disease (both kidney)

characterized by inflammation either of the glomeruli or of the small blood vessels in the
kidney. But not all the disease necessarily have an inflammatory component. It occurs
due to repeated episodes of acute nephrotic syndrome, nephrosclerosis and
hyperlipidemia.
2. 5. Definition • Glomerulonephritis is a kidney condition that involves damage
/inflammation to the glomeruli.
3. 6. Incidence Incidence rates of primary GN vary between 0.2/100,000/year and
2.5/100,000/ year. this disease can exist sub clinically and is therefore only detected by
chance in some patients. In addition, referral policies for diagnostic biopsy vary between
countries. This will affect the incidence rates found.
4. 7. Anatomy and physiology of Nephron The nephron consist of a tubule closed at one
end, to form the cup-shaped glomerular capsule (bowman’s capsule), which almost
completely enclose a network of tinny arterial capillaries, the glomerulus. Continuing from
the glomerulus capsule, the remainder of the nephron is about 3cm long & is described in
three parts- • The proximal convoluted tubule • loop of henle ( medullary loop ) • distal
convoluted tubule lead them to collecting duct.
5. 8. Etiology & risk factor • Streptococcal infection of the throat ( strep throat) or skin
( impetigo) • Hereditary diseases • Immune diseases, such as SLE • diabetes • High
blood pressure • Vasculitis (inflammation of the blood vessels) • Viruses ( HIV, hepatitis B
virus, and hepatitis C virus) • Endocarditis (infection of the valves of the heart)
6. 9. Types of glomerulonephritis  Acute glomerulonephritis - begins suddenly. It occurs
after 5-21 days of streptococcal Infection.  Chronic glomerulonephritis -develops
gradually over several years. It occurs after the acute phase.
7. 10. Pathophysiology Due to any etiological factor Release of Ag substance into the
circulation Formation of Ab formation of Ag and Ab complex in the glomerulus
Inflammatory response proliferation of epithelial cells lining the glomerulus Leukocytes
infiltration of the glomerulus Thickening of the glomerular filtration membrane
8. 11. Cont… scarring and loss of glomerular filtration membrane decrease GFR and
glomerulus plasma flow Retention of sodium and water Edema and hypertension
9. 12. Clinical manifestations • Flank pain • Foamy urine • Cola color or diluted iced tea
color urine • Hematuria • Oliguria, Dysuria • Fatigue to anemia and kidney failure •
Hypertension • Fluid Retention
10. 13. Diagnostic evaluation • History • Physical examination • Urinalysis • Biopsy • IVP •
Blood Test • USG
11. 14. Management
12. 15. Management • Treatment depend on the cause of the disorder, type and severity of
the symptoms. • High B.P. may be hard to control. Controlling the B.P. usually the most
important part of the treatment. • Dialysis • Medication  Diuretics  Immuno-
suppressants  Anti-hypertensive
13. 16. Cont… • Life style changes  Sodium and water restriction  Potassium,
phosphorus, magnesium restriction.  Limit intake of protein in the diet.  Take calcium
supplements.  Maintain a healthy weight through diet and exercise. • Physiotherapy
treatment
14. 17. Cont… • Patient education  Lymphatic message to reduce the edema.  Breathing
exercise – pursed lip and diaphragmatic breathing.  Endurance exercise such as
walking, swimming, bicycling, aerobic dancing, circulatory exercise. This exercise
improve your blood circulation, accelerate kidney to discharge waste and toxins.
15. 18. Complication • Acute and chronic renal failure • Nephrotic syndrome • Hypertension •
Electrolyte imbalances • Pulmonary edema • CHF due to fluid overload
16. 19. Nursing Management
17. 20. 1. Nursing diagnosis - Acute pain related to inflammation of renal cortex as evidenced
by facial expressions and verbalization of patient. • Goals: reduce pain • Intervention: •
Assess the onset, duration, location, severity and intensity of pain. • Provide comfort
devices, quite environment and calm activities. • Encourage use of relaxational
 technique. • Provide diversion therapy. • Administer the analgesic according to physician
order.
18. 21. 2. Nursing diagnosis - excess fluid volume related to accumulation of fluid in the body
as evidenced by edema and weight gain. • Goal: to maintain the fluid volume •
Intervention: To change the position frequently. • To elevate the edematous extremities. •
Allow the patient to heard the running water to promote the diuresis. • Apply hot
application on the bladder to promote the diuresis. • To administer the diuretics to
promote the diuresis. • To administer the albumin helps in shifting the fluid from the ISC
to IVC.
19. 22. 3. Nursing diagnosis – Ineffective breathing pattern related to accumulation of fluid in
the peritoneal cavity as evidence by respiration rate, dyspnea. • Goal: to improve the
breathing pattern • Intervention: • Instruct the patient to perform the deep breathing
exercise. • To provide the semi-fowler position. • Encourage the rest between the
activities to Avoid The overexertion. • Instruct not to wear the tight dress to promote the
breathing. • To administer the diuretics and albumin.
20. 23. Abstract Shashidhar Baikunje conducted a retrospective study on Post-infectious
glomerulonephritis with crescents in adults. Sample consisted of adults who underwent
kidney biopsy from February 2010 to June 2014. Major finding of the study reveals that
the mean percentage of glomeruli with crescents was 36.13%. This study concluded that
Non- streptococcal infections are more common precipitants. There was no correlation
between histological and clinical severity. Patients treated with steroids had better renal
outcomes.

Glomerulonephritis
 A condition in which the tissues in the kidney become inflamed
and have problems filtering waste from the blood. Nephritis may
be caused by infection, inflammatory conditions (such as lupus),
certain genetic conditions, and other diseases or conditions.

 Nephritis is a condition in which the nephrons, the functional units of the kidneys,
become inflamed. This inflammation, which is also known as glomerulonephritis, can
adversely affect kidney function.

What Is Glomerulonephritis?

Glomerulonephritis (gluh-MARE-you-low-ne-FRY-tis) is a kidney problem.

The kidneys are fist-sized organs shaped like kidney beans. They clean blood and help
remove waste that goes into pee (urine).
When a child has glomerulonephritis (GN), the kidneys don't work properly and can't
clean the blood well. This can happen quickly (acute GN) or slowly over time (chronic
GN).
GN causes problems with urinating (peeing) and swelling in parts of the body, like the
face and hands. In some cases, it can lead to kidney damage or kidney failure.
Medicine and changes in diet and other health habits can help slow down or reverse
damage to the kidneys.

What Happens in Glomerulonephritis?

Inside the kidneys are balls of tiny blood vessels called glomeruli. They are the part of
the kidneys that clean the blood and remove waste and extra fluids, which leave the
body in pee.
In glomerulonephritis, the glomeruli are swollen and irritated (inflamed). They stop
working well, and blood cells and protein can leak into the pee. When this happens, fluids
can also leak out of the blood vessels into the body's tissues. This causes swelling in the
face, belly, hands, and feet.

What Are the Signs & Symptoms of Glomerulonephritis?

Glomerulonephritis can cause:

 puffiness in the face (more noticeable in the morning)
 the kidneys to make less pee than usual
 red or brown pee (hematuria)
 foamy or bubbly pee (proteinuria)
 high blood pressure (hypertension)
With chronic GN, symptoms can develop slowly over many months or years. Some kids
won't have noticeable symptoms at first. Doctors may find the condition if a routine urine
test detects blood and/or protein, or after a child is diagnosed with high blood pressure.
In some cases, chronic GN can lead to more kidney damage, and even kidney failure
(when the kidneys no longer can clean the blood well). Symptoms of kidney failure
include:
 peeing too much or too little
 loss of appetite
 nausea and vomiting
 weight loss
 muscle cramps at night
 tiredness
 pale skin
 high blood pressure
 headaches
 swelling or puffiness
If your child has any of these problems, it's important to see a doctor right away to find
the cause. Having one of these signs alone doesn't mean a child has kidney failure. But
when a few of these things happen together, that's a clue that kidney failure is possible.

What Causes Glomerulonephritis?

Acute GN sometimes happens after streptococcal bacteria cause a throat or skin

infection. Other causes include:
 an infection with a different bacteria or virus
 immunological problems like lupus or Henoch-Schönlein purpura
Chronic GN can be passed down in families, but sometimes doctors don't know what
causes it.

How Is Glomerulonephritis Diagnosed?

Doctors diagnose glomerulonephritis by doing an exam and asking about symptoms.

The doctor may order blood tests and get a urine sample for testing. The doctor also
might order a kidney ultrasound to get a better look at the kidneys. Ultrasounds use
sound waves to create images of organs and other body parts.
In some cases, a child may have a kidney biopsy. During a kidney biopsy, a tiny bit of
kidney tissue is removed and sent to a lab for testing.

How Is Glomerulonephritis Treated?

Acute Glomerulonephritis

Sometimes acute glomerulonephritis gets better on its own. Treatment, if needed,

depends on the cause and a child's age and overall health.
When an immune system problem causes GN, kids will get steroids and other drugs that
help suppress the immune system. Antibiotics can treat a bacterial infection. Some kids
may need a treatment to clean the blood using an artificial filter, called dialysis, if their
kidneys are greatly and irreversibly damaged.
To deal with uncomfortable symptoms, doctors may give medicines to lower blood
pressure or help the kidneys make pee and get rid of waste. A child might need to drink
less fluids than usual and eat a diet that's low in protein, salt, and potassium.
In most cases of acute GN, the damage to the glomeruli eventually heals. How long this
takes is different for every child. Acute GN that doesn't respond to treatment can
become chronic.

Chronic Glomerulonephritis

To help healing and prevent more damage to the kidneys, kids should:
 eat a healthy diet with less protein, potassium, phosphorus, and salt
 get plenty of exercise (at least 1 hour a day for kids age 2 and older)
 drink less fluids
 take calcium supplements
 take medicines to lower high blood pressure
When these methods don't help enough to prevent lasting kidney damage, kids may
need dialysis treatments or a kidney transplant.

How Can Parents Help?

Follow the doctor's advice to help protect your child's kidneys and give your child the
best chance of slowing down or stopping kidney damage or failure.
You also can find more support and information online at:
 The National Kidney Foundation