What Is It?

Glomerulonephritis is inflammation of the filtering units of the kidneys, which are called glomeruli. This inflammation can cause too
much protein and other substances to leak from the blood into the urine. Eventually, the kidney becomes less effective at filtering
out waste products, water and salt from the blood, a condition called kidney failure. When this occurs, waste products build up to
very high levels in the blood, and the body retains salt and water. When very large amounts of protein are lost in the urine, the
person also can retain fluid and develop high cholesterol.

Glomerulonephritis can be a complication of streptococcal infections, including strep throat, particularly in children ages 6 to 10.
Less often, it results from other bacterial or viral infections, especially measles, mumps, mononucleosis and HIV. Other causes
include some problems with the immune system (especially those involving immunoglobulin A antibodies), systemic lupus
erythematosus (also called SLE or lupus), and inflammation of the kidney's blood vessels (vasculitis). Sometimes, the cause can't be
identified.

Doctors divide glomerulonephritis into different types, depending on the cause of the illness, its symptoms and the kind of urine
problems it causes. Three examples of these types are:

 Acute postinfectious glomerulonephritis This form of glomerulonephritis follows an infection and often causes high blood
pressure, dark urine, water retention and swelling because of kidney failure.
 Mesangial glomerulonephritis This type seems to be related to immune-system abnormalities involving a type of antibody
called immunoglobulin A (IgA). In most cases, the cause of this immune problem is not known, though it may be associated
with a number of conditions, including cirrhosis of the liver, celiac disease (also called gluten enteropathy, celiac sprue or
non-tropical sprue) and HIV infection. It can cause red blood cells to spill into the urine, but rarely causes high blood
pressure, leg swelling or kidney failure.
 Membranous glomerulonephritis In this disease, the glomeruli leak large amounts of protein into the urine from the blood.

Symptoms

If glomerulonephritis is mild, it will not cause any symptoms. When that happens, the disease is discovered only if protein or blood is
found in the urine during a routine test. In other people, the first clue can be the development of high blood pressure. If symptoms
appear, they can include swelling around the eyes, reduced urination and dark urine from the presence of red blood cells in the
urine. If high blood pressure develops, some people will have headaches. If a large amount of protein is lost in the urine, there also
can be swelling, particularly of the face, abdomen, lower legs, ankles or feet.

Severe or chronic (long-lasting) forms of the disease can cause kidney failure. When this happens, the person passes very small
amounts of urine, feels generally ill and has swelling.

 Symptoms of acute glomerulonephritis:

Diagnosis

Your doctor will look for a history of infection, evidence of kidney problems and other medical disorders that can affect the kidneys.
He or she also will ask how often you are urinating, how much urine you are producing and the color of the urine. To check for a
history of swelling, your doctor may ask whether you've noticed puffiness around your eyes, unusual tightness in your shoes or
waistband or a feeling of heaviness in your legs or ankles.

Your doctor will examine you. He or she will measure your blood pressure, and your weight to check for weight gain resulting from
water retention, and will check for swelling in your legs or elsewhere. To confirm the diagnosis, he or she will evaluate your kidney
function through blood tests and a urinalysis, an analysis of urine that detects blood, protein or signs of infection. You also may need
specialized blood testing to check for specific immune problems and a kidney biopsy, in which a tiny piece of kidney tissue is
removed and examined in a laboratory.

Expected Duration

How long glomerulonephritis lasts depends on its cause and on the severity of kidney damage. When glomerulonephritis follows an
infection, the problem usually goes away within weeks to months. In other cases, glomerulonephritis becomes a chronic (long-
lasting) condition that lasts for years and eventually can lead to renal failure.

Prevention

To prevent glomerulonephritis following an infection, the infection must be treated promptly. Most forms of glomerulonephritis
cannot be prevented.

Treatment

When glomerulonephritis is caused by an infection, the first step in treatment is to eliminate the infection. If bacteria caused the
infection, antibiotics may be given. However, children who develop the disease following a streptococcal infection often recover
without any specific treatment.
When glomerulonephritis has slowed the amount of urine a person is producing, he or she may be given medications called
diuretics, which help the body to rid itself of excess water and salt by producing more urine. More severe forms of the disease are
treated with medications to control high blood pressure, as well as changes in diet to reduce the work of the kidneys. A small
percentage of people with severe glomerulonephritis may be treated with medications called immunosuppressive drugs, which
decrease the activity of the immune system, such as corticosteroids and/or cyclophosphamide (Cytoxan). If glomerulonephritis
progresses to end-stage renal failure, treatment options include dialysis and a kidney transplant.

When To Call A Professional

Call your doctor if you or your child is putting out less urine then normal or if urine looks bloody or abnormally dark. Also call your
doctor if you notice unusual swelling, particularly around the eyes or in the legs or feet. If you have a history of a kidney problem and
you develop any of these symptoms, you should seek medical assistance without delay.

Prognosis

Children with glomerulonephritis usually recover completely if their illness is mild or if it develops following a strep infection.
Although adults often have a poorer outlook, some recover completely. More severe forms of the disease may eventually lead to
kidney failure, which may ultimately require lifelong treatment with dialysis or a kidney transplant.

History

The history of psychiatry and psychiatric nursing, although disjointed, can be traced back to ancient philosophical
thinkers. Marcus Tullius Cicero, in particular, was the first known person to create a questionnaire for the mentally ill
using biographical information to determine the best course of psychological treatment and care. [2] Some of the first
known psychiatric care centers were constructed in the Middle East during the 8th century. The medieval Muslim
physicians and their attendants relied on clinical observations for diagnosis and treatment. [3]

In 13th century medieval Europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses
to care for them and treatment was rarely provided. These facilities functioned more as a housing unit for the insane. [3]
Throughout the highpoint of Christianity in Europe, hospitals for the mentally ill believed in using religious intervention.
The insane were partnered with “soul friends” to help them reconnect with society. Their primary concern was
befriending the melancholy and disturbed, forming intimate spiritual relationships. Today, these soul friends are seen as
the first modern psychiatric nurses.[4]

In the colonial era of the United States, some settlers adapted community health nursing practices. Individuals with mental
defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community
attendants. Wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to
care for them. In other communities, the mentally ill were sold at auctions as slave labor. Others were forced to leave
town.[5] As the population in the colonies expanded, informal care for the community failed and small institutions were
established. In 1752 the first “lunatics ward” was opened at the Pennsylvania Hospital which attempted to treat the
mentally ill. Attendants used the most modern treatments of the time: purging, bleeding, blistering, and shock techniques.
Overall, the attendants caring for the patients believed in treating the institutionalized with respect. They believed if the
patients were treated as reasonable people, then they would act as such; if they gave them confidence, then patients would
rarely abuse it.[5]

The 1790s saw the beginnings of moral treatment being introduced for people with mental distress. [6] The concept of a
safe asylum, proposed by Phillipe Pinel and William Tuke, offered protection and care at institutions for patients who had
been previously abused or enslaved. [6] In the United States, Dorothea Dix was instrumental in opening 32 state asylums to
provide quality care for the ill. Dix also was in charge of the Union Army Nurses during the American Civil War, caring
for both Union and Confederate soldiers. Although it was a promising movement, attendants and nurses were often
accused of abusing or neglecting the residents and isolating them from their families. [6]

The formal recognition of psychiatry as a modern and legitimate profession occurred in 1808. [3] In Europe, one of the
major advocates for mental health nursing to help psychiatrists was Dr. William Ellis. He proposed giving the “keepers of
the insane” better pay and training so more respectable, intelligent people would be attracted to the profession. In his 1836
publication of Treatise on Insanity, he openly stated that an established nursing practice calmed depressed patients and
gave hope to the hopeless. [4] However, psychiatric nursing was not formalized in the United States until 1882 when Linda
Richards opened Boston City College. This was the first school specifically designed to train nurses in psychiatric care. [7]
The discrepancy between the founding of psychiatry and the recognition of trained nurses in the field is largely attributed
to the attitudes in the 19th century which opposed training women to work in the medical field. [2]

In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part
of its general curriculum. The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, was not
published until 1920. It was not until 1950 when the National League for Nursing required all nursing schools to include a
clinical experience in psychiatry to receive national accreditation. [6] The first psychiatric nurses faced difficult working
conditions. Overcrowding, under-staffing and poor resources required the continuance of custodial care. They were
pressured by an increasing patient population that rose dramatically by the end of the 19th century. As a result, labor
organizations formed to fight for better pay and fewer hours. [4] Additionally, large asylums were founded to hold the large
number of mentally ill, including the famous Kings Park Psychiatric Center in Long Island, New York. At its peak in the
1950s, the center housed more than 33,000 patients and required its own power plant. Nurses were often referred to as
“attendants” to imply a more humanitarian approach to care. During this time, attendants primarily kept the facilities clean
and maintained ordered among the patients. They also carried out orders from the physicians. [4]

In 1963, President John F. Kennedy accelerated the trend towards deinstitutionalization with the Community Mental
Health Act. Also, since psychiatric drugs were becoming more available allowing patients to live on their own and the
asylums were too expensive, institutions began shutting down. [4] Nursing care thus became more intimate and holistic in
nature. Expanded roles were also developed in the 1960s allowing nurses to provide outpatient services such as
counseling, psychotherapy, consultations, prescribing medications, along with the diagnosis and treatment of mental
illnesses.[7]

The first developed standard of care was created by the psychiatric division of the American Nurses Association (ANA) in
1973. This standard outlined the responsibilities and expected quality of care of nurses. [6]