This case study is done on a 9 year old male who is

diagnosed with Acute glomerulonephritis (AGN). AGN is, in

simple terms, the inflammation of the tubules in the
kidneys. These tubules are called glomeruli and they act as
microscopic screens to filter out waste products in blood.
With close to one million of these tubules in each kidney,
inflammation can lead to some serious complications. This
study will explain a more in depth view of what AGN is and
how it can affect the body as well as the complications that
can arise if left untreated. It will also explain the steps you
can take in identifying, treating, and preventing it.

The estimated worldwide burden of AGN is approximately

472,000 cases per year, with approximately 404,000 cases
being reporting in children and 456,000 cases occurring in
less developed countries. AGN is associated with skin
infections and is most common in tropical areas where
pyoderma is endemic, whilst pharyngitis-associated AGN
predominates in temperate climates (WHO, 2011)

Patient Profile:
Name: Patient X
Address: 157 Pangalangan, San Carlos City Pangasinan
Age: 9y/o
Birthday: August 24, 2005
Sex: Male
Nationality: Filipino
Religion: Roman Catholic
Occupation: None
Admitting Diagnosis: Acute glomerulonephritis
Admitting Physician: Dr. Fama
Chief Complaint: Facial edema
No Medical Past History

General Objective
It is the aim of those who prepared this case study to acquire
knowledge, experience and learn professional approach to Acute
Glomerulonephritis(AGN) that will be useful in the future as we move
forward to become effective nurse both locally and internationally.
Specific objective
Define Acute Glomerulonephritis(AGN).

Raise awareness to local and international nurses so they can be better

prepared
Physical Assessment and Laboratory results.
Discuss the medication taken by the client, its action, side effect and
nursing responsibilities.
Explain the Anatomy and Physiology of Excretory System.
Trace the Pathophysiology of Acute Glomerulonephritis(AGN).
Create effective and efficient nursing care plan required by a patient
with the above mentioned disease process.

This case study will provide information on Acute

Glumerulonephritis. Particularly on the signs, symptoms,
anatomy/physiology and pathophysiology of the disease.
Furthermore, this study aims to provide knowledge that will
be useful in the future as we become effective nurses locally
and internationally. This case study will be beneficial to the
nurses and the health care providers as this study will provide
the necessary information on the different causes and effects
of AGN. Our objective is to heighten the awareness of the

nurses and health care providers to be equipped with

effective nursing interventions to possible threats. To the
future nurses, this study can provide baseline information on
the said disease.

Post Streptococcal Infection

Release of material from the organism into the blood stream

Formation of Antibodies

Antigen-antibody product

Immune complex reation in the glomular

capillary

Disposition of antigen-antibody
complex in glomerulus

Inflammatory response

Proliferation of epithelial cell lining glomerulus and cells

between endothelium and epithelium of capillary
membrane

Thickening of the glomular filtration

membrane

Swelling of capillary membrane

Leukocyte infiltration of glomerulus

Increased permeability of base membrane

Proteinuria

Occlusion of the capillaries of the glomeruli

casospasm of afferent ventricles

Scarring and loss of glomular filtration membrane

Hematuria/dark colored urine (due to red blood

cell and protein plugs or casts)
/

Anorexia, irritability, lethargy

Hypervolemia

Increase BUN and serum

creatinine levels

Decreased urine output

Edema

Retention of
H20 and Na

Increased ability to form

filtrate from glomeruli
plasma flow

Glomerular
Filtration Rate

Circulatory congestion

Vasoconstriction

Hypertension

Increased blood pressure

Assessment

Neurological

Skin

Result

Significance

Responsive
GCS score 15/15
(+)conscious (+)coherent
(+)cognitive

Normal
Normal
Normal
Normal
Normal

(-) lesions

Normal

(-)rashes
(-)scars
(-)flushing, warm and
moist
(-)poor skin tugor
Symmetrical

Normal
Normal
Normal
Normal

Head

Face

Hair

Smooth

(-)masses and
depressions
(-)tenderness
(+)round face
(-)no presence of nodules
an infestation
symmetrical
(+) Facial edema

Abnormal

Evenly distributed
Fine
Black in color
Coarse/dry

Normal
Normal
Normal
Normal

*
*

Scalp

Normal
Normal
Normal
Normal

(+)lice and nits

Abnormal

(+)dandruff

Abnormal

*
*

(-)scars
(-)tenderness
(-)wearing eyeglasses

Normal
Normal
Normal

*
*

Symmetrical
(+)periorbital edema
(-)redness in both eyes

Normal
Abnormal
Normal

Proper olfactory function

Normal

*
*

Symmetrical
With sense of smell
(-)tonsilo pharyngeal
congestion

Normal
Normal
Normal

Ears

*
*
*

(-)tinnitus
(-)discharges
Gross hearing intact

Normal
Normal
Normal

Lips

Eyes

Nose

Mouth

(-)moist and smooth

(-)lesion
(-)pain

Indication

Normal

PE A

Abnormal
Normal
Normal

Due to excess fluid volume

Due to an unsanitary
environment
Due to poor management
of the scalp

Due to excess fluid

volume

Dry due to fluid/sodium

retention

Assessment

PE

Result

Significance

(-)lumps/masses
(-)stomatitis
(+)moist
(+)pink in color
(-)masses

Normal
Normal
Normal
Normal
Normal
Normal
Normal

(-)tenderness
(-)deviation to the side of the
mouth
(-)mass noted
(+)dull sound
Brown colored nipples

Normal
Normal
Normal

(-)sagging of breast

Normal

(-) Inversion of nipples

(-)nipple discharges
(-)lesion
(-)mass

Normal
Normal
Normal
Normal

Symmetrical chest expansion

Normal

*
*

PR (117)
BP(130/90)

Normal
Abnormal

Heart sounds
RR (19)
Temperature (38.2)

Normal
Normal
Abnormal

HGB (100 g/1)

Hct (30 vo 1%)

Abnormal
Abnormal

(-)lesion
(+)pink in color
(-)masses
(-)numbness at right arm
(+)nail beds

Normal
Normal
Normal
Normal
Abnormal

(-)large abdomen
(-)peristalsis
(-)mass
(-)scars
(+)tympanic sound
(+)abdominal pain

Normal
Normal
Normal
Normal
Normal
Abnormal

(+)oliguria

Abnormal

(+)hematuria
(-)pain in the suprapubic
urinalysis result
(-)burning sensation
(-)involuntary movements

Abnormal
Normal

(+)bipedal edema

Abnormal

(-)wounds
(+)pain in the lower extremities

Normal
Abnormal

*
*
Tongue

*
*
*

Chest

Cardiovascular

Upper
extremities

*
*

Abdomen

Assessment

Genitourinary

*
*

PE

*
*
Lower
extremities

Indication

Due to circulatory
congestion

Due to inflammation
Indication of hypoxemia
Indicated anemia, which
can lead to hemolysis

Due to decrease blood

flow

Due to distention
Due to fluid/sodium
retention
Due to renal compromise

Normal
Normal
Due to fluid retention low
urine volume, and
production of urine that is
dark because it contains
blood.
Due to edema

PHYSICAL URINALYSIS CHEMICAL

Color: dark yellow
Transparency:
Reaction: 6 0

Albumin:
Sugar:
Sp. Gr.: 1.000

MICROSCOPIC:
Pusleukocytes: 10 15/
Erythrocytes: >100/

BLOOD CHEMISTRY

TEST
Chloride
Potassium

Sodium

NORMAL VALUES

RESULT

98 108 mmol/l

109.1

3.5 5.5 u/l

4.10

135 145 mmol/l

140.6

HEMATOLOGY
TEST

NORMAL VALUES

RESULT

HEMOGLOBIN

M = g/1:M140 170 g/1

100

F = g/1:F120 150 g/1

HEMATOCRIT

M = 40 50 vo 1%

30

F = 37 47 vo 1%
WBC

X 109/1
(N.V.-5 10 x 10 9/1

9.2

VITROS CLINICAL CHEMISTRY PATIENT REPORT

TEST

NORMAL VALUES

RESULT

Cholesterol

0.0 5.2

3.1 mmol/L

Total protein

60. 80.

64. g/L

Albumin

35.0 50.0

LO

28.9 g/L

A/G Ratio

1.5 2.5

LO

0.8

Globulin

23. 35.

35. g/L

TEST

NORMAL VALUE

RESULT

CREATININE

71. 133.

LO

45. Usol/L

Film Results
TEST

NORMAL VALUES

RESULT

Segmenters:

.50 - .70

.52

Lymphocytes

.20 - .40

.37

Eosinophils:

.02 - .04

.03

Monocytes:

.02 - .08

.08

Platelet count:

N.V. 150 300 X 10/1

360 x 10/1

ULTRASOUND RESULTS
KUB:
RIGHT KIDNEY: 9.7 x 3.7 x 3.7 cm; Cortical thickness: 0.8 cm
LEFT KIDNEY: 10.4 x 4.4 x 4.0 cm; Cortical thickness: 0.9 cm
` Both kidneys are enlarged for age with increase echogenicity
and fairly distinct corticomedullary differentiation. Renal sinuses are
centrally located with no lithiasis, mass or hydronephrosis present.
Urinary bladder is partially distended with urine. Wall is thin and the
mucosa is smooth. No intravesical calculi or masses seen.
IMPRESSION: ACUTE INFLAMMATORY CHANGES OF BOTH
KIDNEYS. SONOGRAPHICALLY NORMAL URINARY BLADDER.

MEDICATION
- PenG 900000 IVP every 6hrs after ANST(-)
- Furosemide 25 MG IVP once a day

DIET:
- Assure a low sodium, low protein diet
- Limitation of fluid and salt intake to
minimize vascular overload
and hypertension

EXERCISE:
- Advice client to have non-strenuous and non jarring exercise
such as walking
- Tell client to initiate exercise through repetitive and low
intensity exercise first.
- Advice cliet and her family to try have or maintain
safe,clean,comfortable invironment
- Advice significant others to be supportive
TREATMENT:
- Ensure follow up and self care
- Advice client or significant others to take in time prescribed medicines
specially highblood pressures
- Ensure dietary restriction on salt,fluids,protein and other substances may
be recommended
- Tells significant others to closely watched and monitor for signs of
developing
kidney failure
OUT-PATIENT FOLLOW-UP CARE:
- Instruct the family members to have a check
up or to consult physician once a while
to monitor patient's condition and for
detection of recurrences and other
complications that may arise on to it.
HEALTH TEACHINGS
- Describe to the client the signs and symptoms to be reported immediately(Blood in
the
urine, swelling on her face, legs, and abdomen)
- Clearly and specifically explain the nature of the disease, its coarse and eventual
prognosis of the condition to the child( if old enough to understand) and parents
or caregivers,they need to understand the while complete resolution is expected a
small possibility exist progression.
- Advise significant others to immediately consult her physician if sign and symptom
occurs or persist.
- Remind client of her check-up schedules and appointments tell him to attend them as
he can.this is to rule out the recurrence of the problem