Acute Glomerulonephritis

What is acute glomerulonephritis (poststreptococcal)? It is the inflammation of the

filtering structure of the nephron (what is the filtering structure of the nephron?
Glomerulus) that causes permeability to protein and red blood cells due to previous
strep infection. Therefore, protein and red blood cells will be present in the urine.

Facts about Acute Glomerulonephritis

 It tends to present 14 days after a strep infection of the throat or skin (impetigo).
 It mainly affects the pediatric population ages 2-10.
 It is not caused from the strep bacteria attacking the glomerulus but the immune
system’s response to the bacteria by creating antigen-antibody complexes,
which inflames the glomerulus. This is why you see it AFTER a strep infection
 Glomerulonephritis is an umbrella term for various types of kidney disorders where
there is injury to the glomerulus and they can be nephritic or nephrotic.

o Poststreptococcal glomerulonephritis is a type of NEPHRITIC

SYNDROME meaning there is the leakage of BOTH red blood cells and a
mild amount of protein from the inflamed glomerulus.

 Contrasting: Nephrotic Syndrome is an inflamed glomerulus that is

leaking massive amount of proteins into the filtrate (NOT red blood
cells)
Reviewing the Basics about Nephron Anatomy
What is the nephron? the functional unit of the kidney that filters the blood (specifically
the glomerulus with the assistance of Bowman’s capsule) and reabsorbs and secretes
substances taken from the filtrate/blood with the help of the renal tubule and peritubular
capillaries .

Role of Glomerulus (this is what is damaged in acute glomerulonephritis): it filters the

blood and removes ions, water, waste EXCEPT proteins and bloods cells (they are
too big to pass through)

What is happening in Poststreptococcal Glomerulonephritis?

The glomerulus becomes inflamed due to a recent infection from a group of bacteria
called streptococcus.
The bacteria itself doesn’t cause the inflammation to the glomerulus but the immune
system which has created immune complexes. These complexes become stuck in the
glomeruli which leads to inflammation and permeability of PROTEINS (albumin) and
RED BLOOD CELLS.

This causes major problems:

Hematuria: patient will present with cola colored or tea colored urine

Proteinuria (mild): this can lead to low amounts of protein found in the blood

What happens when there is a low amount of protein the blood? Swelling in the
interstitial tissue…hence EDEMA. The swelling mainly presents in the face/eyes and
will be mild.

Why mild swelling? Within the capillaries are a protein called albumin that
regulates oncotic pressure. Albumin creates oncotic pressure by controlling how much
water stays within the capillaries.

Capillaries have fenestrations (pores) that allow water and other substance to flow out
of the capillaries into the interstitial tissue. Hydrostatic pressure (controlled by the blood
pressure) regulates the flow of substances out of the capillaries but oncotic pressure
regulates the amount of water that leaves the capillaries. When the glomerulus filters
proteins into the urine the patient experiences PROTEINURIA which decreases the
amount of protein/albumin in the blood. Therefore, when low amounts of albumin are left
in the blood, the water will leave the capillaries’ fenestrations and leak into the tissues.
This is because the protein albumin isn’t there to control the water. Therefore, it leaks
into the interstitial tissue.

Fluid overload: at risk for heart failure, renal failure, and respiratory distress due to
congestion of fluid in lungs (retaining salt and water), hypertension

Decrease glomerular filtration rate (GFR): What is GFR? It is the flow rate of filtered
fluids through the kidneys, specifically the glomerulus.

 Why does the GFR decrease? Inflammation of the glomerulus leads to other
immune cells to present at the site of inflammation. The site becomes congested.
Therefore, the glomerulus isn’t able to filter the blood normally. Due to this, waste
in the blood build-ups (remember the kidneys are NOT filtering normally) and this
increases the blood urea nitrogen (BUN) and creatinine levels.
Low Urine Output: Oliguria (watch potassium levels…hyperkalemia…the potassium
will start to build-up in the blood because the kidney’s filtration rate has decreased)

Hypertension: WHY? decreased filtration rate of the kidneys, increased blood volume,
and retaining sodium
  At risk for hypertensive encephalopathy due to prolonged/untreated high blood
pressure which can affect the brain…watch for neuro changes, headaches, and
seizures
Signs and Symptoms of Acute Glomerulonephritis
“Had Strep”

Hypertension

ASO antistreptolysin titer positive (test used to diagnose strep infections)

Decreased GFR (low urine output)

Swelling in face/eyes (edema)…mild

Tea-colored urine (cola colored)…from hematuria

Recent strep infection

Elevated BUN and creatinine

Proteinuria (mild)

Nursing Interventions for Acute Glomerulonephritis

Monitor fluid status VERY closely: patient may be prescribed diuretics (if renal function
is normal)

Daily weights (weight gain is the earliest sign of fluid retention): use same standing
scale every day. Try to avoid bed scale if possible…standing scales are the best.

Since the disorder mainly affects the pediatric population remember these patients
should void 1mL/kg/hr.

How much should a patient who is 30 lbs void? 13.6 mL/hr

  If Oliguric (low urinary output) watch for hyperkalemia WHY? When the GFR is
decreased, potassium is not excreted properly which leads to hyperkalemia
 Assess color of urine…is the urine starting to look normal?
Assess swelling status in face/around the eyes and extremities (mainly in the
face/around the eyes and it is worst in the mornings)

Monitor lung sounds for crackles…signs of pulmonary edema

Monitor BUN and Creatinine levels ….renal failure

Monitor vital signs ESPECIALLY blood pressure (may experience hypertension…it

can become severely elevated and this can lead to hypertensive encephalopathy)

Bedrest until recovered: due to hypertension

Sodium restriction along with fluid restriction diet (helps with edema and hypertension)
and if oliguria is present restrict potassium-rich foods until recovered

Administering diuretics and antihypertensives or antibiotics to treat presenting strep

infection (if needed…not always ordered) per MD order

Education: importance of seeking treatment for infections of the skin or throat…strep

infection can reoccur

References:
1. “Glomerular Diseases | NIDDK”. National Institute of Diabetes and Digestive and Kidney Diseases. N.p., 2014. Web. 5 June 2017.

2. “Group A Strep | Post-Streptococcal Glomerulonephritis | | PSGN | GAS | CDC”. Cdc.gov. N.p., 2016. Web. 5 June 2017.