Official (Closed) - Non Sensitive

Glomerulonephritis

@Ngee Ann Polytechnic INS1 Oct 2022 sem 1

 Official (Closed) - Non Sensitive

Overview
• Definition of Glomerulonephritis
• Pathophysiology of Glomerulonephritis
• Risk factors of Glomerulonephritis
• Clinical Manifestations of Glomerulonephritis
• Investigations undertaken to diagnose Glomerulonephritis
• Nursing Diagnosis of Glomerulonephritis

@Ngee Ann Polytechnic INS1 Oct 2022 sem 2

Official (Closed) - Non Sensitive

Review of the Kidney

Glomerulus:
• A tiny ball-shaped
structure
• Composed of capillary
blood vessels actively
involved in the filtration of
the blood to form urine.
• It is one of the key
structures that make up
the nephron, the
functional unit of the
kidney.
@Ngee Ann Polytechnic INS1 Oct 2022 sem Image retrieved from google 3
 Official (Closed) - Non Sensitive

Definition

• Inflammation of the glomerular capillary membrane.

Classification based on histology and immunofluorescent studies of
renal biopsies.
•Acute Glomerulonephritis can result from systemic diseases.
(Acute post infectious glomerulonephritis – commonly caused by
infection of the pharynx or skin with group A beta-haemolytic
streptococcus)
•Chronic Glomerulonephritis result of progressive glomerular
disorders.
@Ngee Ann Polytechnic INS1 Oct 2022 sem 4
 Official (Closed) - Non Sensitive

Pathophysiology

• Glomerular disease affects the structure and function of the

glomerulus, disrupting GFR
• The capillary membrane becomes more permeable to plasma
proteins and blood cells.
• The increased permeability in the glomerulus causes the
manifestations common to glomerular disorders- haematuria,
proteinuria and oedema.
• The GFR falls, leading to azotaemia and hypertension.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 5

 Official (Closed) - Non Sensitive

Risk factors
Acute Glomerulonephritis Chronic Glomerulonephritis
• Post-infectious • Can be hereditary, relate to
glomerulonerphritis is the most diabetes & high BP
common form. • Systemic lupus erythematous
• Staphylococcal infection (SLE) - autoimmune system
• Viral infections (Hepatitis B, disorder which immune system
mumps, varicella) attacks own tissues and organs

@Ngee Ann Polytechnic INS1 Oct 2022 sem 6

 Official (Closed) - Non Sensitive
Acute Glomerulonephritis Clinical Manifestations related to
Pathophysiology
SN MANIFESTATION RELATED PATHOPHYSIOLOGY
1 Haematuria Disruption of the glomerular capillary membrane allows red
blood cells to escape from vascular system into Bowman's capsule
and is excreted.

2 Proteinuria Plasma protein cross the damaged capillary membrane and is

excreted.
3 Salt and Water Loss of plasma proteins reduces oncotic pressure.
retention Decreased GFR stimulates the renin-angiotensin-aldosterone
system prompting salt and water retention.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 7

 Official (Closed) - Non Sensitive

Acute Glomerulonephritis Clinical Manifestations related to

Pathophysiology
SN MANIFESTATION RELATED PATHOPHYSIOLOGY
4 Hypertension Activation of the renin-angiotensin –aldosterone leads to
vasoconstriction.
5 Azotemia Vasoconstriction reduces renal flow, reducing filtration and
excretion of metabolic waste.
6 Fatigue, anorexia Retained metabolic waste products and fluid and
Nausea & vomiting electrolytes affects energy, levels and vomiting centre in
central nervous system.
7 Headache Increased intravascular volume , fluid and electrolytes
leads to intra cranial vasodilation.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 8

Official (Closed) - Non Sensitive

Chronic Glomerulonephritis Clinical Manifestations

• Oedema
• Hypertension
• Yellow-grey discoloration of skin
• Anaemia
• Irritability
• Loss of weight and strength
• Signs of heart failure/ uremic
• Peripheral neuropathy

@Ngee Ann Polytechnic INS1 Oct 2022 sem 9

 Official (Closed) - Non Sensitive

Investigations
• Throat or skin swabs for culture – to detect streptococci
• Erythrocyte sedimentation (ESR) – elevated due to inflammation.
• BUN- assess renal impairment
• Serum Creatinine
• GFR
• X-rays of the Kidney Ureter Bladder (KUB)
• Renal Biopsy
• Kidney Scan

10
Retrieved
@Ngee Ann Polytechnic INS1 Oct 2022 sem 12 April 2017 from http://renalmed.com/kidney-biopsy/
 Official (Closed) - Non Sensitive

Treatment
• Treat underlying cause Eg. antibiotics
• Immunosuppressive therapy
• Antihypertensive

@Ngee Ann Polytechnic INS1 Oct 2022 sem 11

 Official (Closed) - Non Sensitive

Excess fluid volume r/t impaired renal functions

SN INTERVENTION
1 Monitor vital signs and breath
sounds at least every 4 hours.
2 Record intake and output every 4 Accurate intake and output records
to 8 hours.
3 Weight patient daily using
consistent technique.
4 Monitor serum electrolytes,
haemoglobin, blood urea
nitrogen and creatinine.
RATIONALE
Excess fluid increases the cardiac
workload and the blood pressure.
Tachycardia may result.
help determine fluid volume status.
Accurate daily weights are the best
indicator of fluid balance.
Glomerular disorders affect fluid
balance and may alter electrolyte
balance.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 12

 Official (Closed) - Non Sensitive

Excess fluid volume r/t impaired renal functions

SN INTERVENTION RATIONALE
5 Maintain fluid restriction as Offer ice chips and frequent mouth
ordered. care to relieve thirst.
5 Arrange dietary consultation Including the patient and dietician in
regarding sodium or protein planning allows individualization of
restricted diet. diet to patient preferences.
6 Monitor for desired and adverse Diuretics help reduce excess fluid
effect of prescribed medication. volume.
7 Provide frequent position Perfusion may be altered by tissue
changes and good skin care. oedema, increasing the risk of skin
breakdown.
@Ngee Ann Polytechnic INS1 Oct 2022 sem 13
 Official (Closed) - Non Sensitive

Fatigue r/t anaemia and anorexia

SN INTERVENTION RATIONALE
1 Document energy level. As glomerular function improves fatigue
begins to resolve and energy increases.
2 Schedule activities and Adequate rest and energy conservation
procedures to provide reduce fatigue and improve the patient’s
adequate rest and energy ability to tolerate and cope with
conservation. required treatment and activities.
3 Assist in activities of daily The goal is to conserve limited energy
living. reserves.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 14

 Official (Closed) - Non Sensitive
Fatigue r/t anaemia and anorexia
SN INTERVENTION
4 Discuss the relationship between
fatigue and disease process with
patient and family.
5 Reduce energy demands with
frequent, small meals and short
period of activity.
Limit the number of visitors.
@Ngee Ann Polytechnic INS1 Oct 2022 sem
RATIONALE
Understanding the nature of the
disease and associated fatigue
helps the patient and family cope.
Small frequent meals reduce the
energy needed for eating and
digestion. Limiting visitors helps
conserve energy.
15
Official (Closed) - Non Sensitive

Discharge plan
• Educate disease process
• Medication compliance
• Preventing infection
• Recognize the abnormal manifestations and seek for professional
help eg. haematuria
• Appropriate diet eg. restrict protein, salt and potassium intake
• Follow up

@Ngee Ann Polytechnic INS1 Oct 2022 sem 16

 Official (Closed) - Non Sensitive

Summary
• Definition of Glomerulonephritis
• Pathophysiology of Glomerulonephritis
• Risk factors of Glomerulonephritis
• Clinical Manifestations of Glomerulonephritis
• Investigations undertaken to diagnose Glomerulonephritis
• Management and Nursing Diagnosis of Glomerulonephritis

@Ngee Ann Polytechnic INS1 Oct 2022 sem 17

Official (Closed) - Non Sensitive

REFERENCE
• Bauldoff, G., Gubrud, P., & Carno, M. (2019). LeMone
and Burke’s Medical-Surgical Nursing: Clinical
Reasoning in Patient Care (7th ed.). Boston: Pearson.

@Ngee Ann Polytechnic INS1 Oct 2022 sem 18