Graduated as a practical nurse March 29th 🎊 Now I’m trying to read for my entrance exams 📖😓

What is it? (patho)

First things first, let me explain that while there is an arraaay of different GN-type disorders, this review is focusing on acute glomerulonephritis and chronic glomerulonephritis. 

So now we break it down. For this we are going to break down this biiiiiiiig word.

Firstly, glomerulo: The origin word being “glomerus”. The glomerus is the conglomerate of specialized capillaries that filter blood to make urine.  Second, nephr: The origin word being “nephron”. The nephron is the functioning unit in the kidney. It encapsulates the glomerus, in fact.  Lastly, -itis: The meaning of -itis is literally inflammation or inflammatory process. 

Lets put it all together!! :)  Glomerulonephritis is the inflammatory process affecting the nephron and glomerus. 

What causes it? 

The difference between acute and chronic glomerulonephritis is that acute is an active infection in the body. Most commonly this is going to be two of our favorites(yeah, right), Group A Beta Streptococcus and Staphyloccocal. There IS an array of many other infections that can cause an acute flare, however these are your two most common infections. Another common cause can be systemic lupus erythematous. 

** Just a note, the causes of chronic GN are not known however a correlation between kidney damage and hypertension is commonly connected to patients with GN.

What does it look like? (s/s) 

So most any time that your kidneys are damaged or inflamed, they are obviously not going to do their job as well as they normally would. In that way, we are going to see a change in blood filtration and fluid balance. Now think to yourself, what are signs of those two things going wrong?

Starting with blood filtration, the kidneys aren’t filtering blood quite as they should. Here you are going to see the hallmark sign of GN, coca-cola colored urine. Some patients like to describe it as reddish-brown. The reason why it takes on this rusty color is because your kidneys are spilling microscopic traces of blood into the urine, turning it a darkened color. Another few things you might see are uremic manifestations. Uremia is an excess of the wastes normally excreted by the kidneys. So what are these uremic symptoms? Asterixis, tremors, and slurred speech are just a few. Asterixis is the flapping tremor of the hand. To test this, you ask the patient to maintain a fixed posture with the wrist hyperextended. They will not be able to. 

Next, looking at fluid and electrolyte imbalances, we’re going to see signs and symptoms of fluid overload. I’ve already spoke a little about those signs with my heart failure review, but as a reminder, this is the bounding pulses, hypertension, crackles in the lungs, EDEMAA(big one for this patient), and changes in voiding patterns (most commonly decreases). 

How can I help this patient? (treatment)

With your patients who are experiencing AGN (acute), remember that this is an ACTIVE infection. My teachers have always stressed to us to treat the cause first. So, most of these patients are going to be put on an antibiotic prescription. Why, again? Because they have a bacterial infection!!!! Usually, we see these patients are prescribed penicillin, erythromycin, or azithromycin. Caregivers and close contact family members may also be prescribed antibiotics, prophylactically. What do we want to teach them about these drugs? Use the whole prescription! 

They also need to have stressed to them the importance of preventing infection spread. This includes hand-washing and hygiene. 

These patients are showing signs and symptoms of fluid overload. It needs to be regulated quickly to prevent further problems, such as hypertension and heart failure. Diuretics and a fluid restriction may be prescribed for these patients to get the edema and fluids down. We also need to teach that they should monitor their daily weights, if they’re treated at home. 

We also need to treat uremic symptoms and we treat it by treating fluid overload. However, if our standard drug therapy doesn’t treat it we can try dialysis, as it helps alleviate fluid overload as well. 

What should I monitor? (Okay, I’m only going to make a list, follow YOUR teachers lab values)

BUN

Cr

Electrolytes (especially potassium)

H&H

24 hour urine specimen possibly

Culture and Sensitivity