Acute Defuse Glomerulonephritis:Post

Streptococcal Acute Glomerulonephritis

 (ADGN) is an acute diffuse inflammatory
disease of glomeruli, mediated by immune
complex deposition and presenting as acute
nephritic syndrome
 (PSAGN): Classical nephritic syndrome, due to
non–bacterial inflammation of glomeruli
secondary to previous group A- Beta- hemolytic
streptoccocal infection of pharynx or skin.
Causes, types of glomerulonephritis

 Most are post infectious

 Pneumococcal, streptococcal, or viral
 May be distinct entity ‫ مستقل‬or
 May be a manifestation of systemic disorder
 SLE (system lupus erythematosus).
 Sickle cell disease
 Others
Glomerulonephritis Symptoms
 Generalized edema due to decreased
glomerular filtration
 Begins with periorbital
 Progresses to lower extremities and then to
ascites
 HTN ( hypertension) due to increased
ECF( extracellular fluid)
 Oliguria
Glomerulonephritis Symptoms

 Hematuria
 Bleeding in upper urinary tract→smoky urine
 Proteinuria
 Increased amount of protein = increased severity
of renal disease not more than 1 mg in 12 hrs
 Increase ESR
Acute Post-Streptococcal
Glomerulonephritis

 Is a noninfectious renal disease

 Autoimmune
 Onset 5 to 12 days after other type of
infection( pharyngitis, skin infection)
 Often group A ß-hemolytic streptococci
 Most common in 6 to 7 years old
 Uncommon in <2 years old
 Can occur at any age
Diagnosing APSG
 1- urine analysis reveal hematuria with red cell casts,
proteinuria is also present but not severe
2- elevated blood urea nitrogen, creatinine levels
3- electrolyte disturbances
4- complete blood count reveals mild anemia
5- positive antistereptolycin O titer (ASO)
6-chest X-RAY: for (cardiac enlargement, pulmonary
congestion, pleural effussion)
Prognosis
 95%—rapid improvement to complete
recovery
 5% to 15%—chronic glomerulonephritis
 1%—irreversible damage
 In 1-2 weeks: edema starts to disappear
 In 2-3 weeks: grosshematuria, hypertension,
acute renal failure disappear
 In 3 months : ESR returns to normal
Nursing Management of APSG
 Vital signs
 Fluid intake and out put( limit as ordered)
 Manage edema
 Daily weights
 Accurate I&O
 Daily abdominal girth
 Keep skin dry, clean
 Nutrition
 Low sodium, low to moderate protein
 Decrease potassium to prevent cardiac
decompansation
 Susceptibility to infections
 Bed rest is not necessary except in acute renal
failure.
:Treatment
 Mainly supportive and symptomatic
 Diurtics

 Peritonial or haemodialysis

 Prevention:

- Ttt of streptococcal infection

 Procaine pencillin 400.000 IU/DAY, IM for 10 day or,

 A single IM injection of 1,200.000 IU BENZATHINE

Pencillin or,
 Oral pencillin V: 200.000- 400.000 IU dose, 3 times/day

for 10 days or,

:Treatments
 Erthromycin: 40 mg/kg/day, orally in 4 divided
doses for 10 days or,
 Amoxicillin:30 mg/kg/day, orally in3 divided doses
for 10 days or,
 Cefadroxil: 30 mg/kg/day, orally in 2 divided doses
for 10 days
:Ng diagnosis
 Fluid volume excess related to compromised
regulatory mechanism ( kidney) lead to edema,
hypertension,
 Potential for injury related to complications of
edema and fluid retention
 High risk for infection
 Altered family process related to having child with
series illness.
COMPLICATION:
 HYPERTENSION
 CEREBRAL SYMPTOMS
 CARDIAC FAILURE
 ACUTE RENAL FAILURE
Nephrotic Syndrome
 Nephrotic syndrome is state characterized by
heavy proteinuria (urine albumin excretion
>2 g/m2 / day), hypoalbuminemia (serum
albumin <2.5 g/dL), hyperlipidemia (serum
cholesterol >200 mg/dL) and edema.
Nephrotic Syndrome
 Most common presentation of glomerular injury in
children
 Characteristics
 Proteinuria
 Hypoalbuminemia
 Hyperlipidemia
 Edema
 Massive urinary protein loss
 Fluid shifts from plasma to interstitial spaces (oncotic
pressure)
 Hypovolemia
 Ascites
Types of Nephrotic
‫ملغى‬Syndrome
 Minimal change nephrotic syndrome (MCNS)
 AKA
 Idiopathic nephrosis
 Nil disease
 Uncomplicated nephrosis
 Childhood nephrosis
 Minimal lesion nephrosis
 Congenital nephrotic syndrome
 Secondary nephrotic syndrome
C/M
 Edema
 Ascites
 Incresed body weight
 Decreased urinary out put
 Pain in flank, respiratory dificulty.
 Pallor, anemia
 Vomiting, diarrhea, anorexia, malnutrition
 Blood pressure at first is normal , then elevated
 Febril
 ESR is rapid
Nephrotic Syndrome
Management
Medical intervention
 Supportive care
 Diet
 Low to moderate protein
 Sodium restrictions when large amount edema
present
 Steroids
 2 mg/kg mainly to reduce proteinuria divided
into BID( twice) doses
 Prednisone drug of choice ($$ and safest)
 Immunosuppressant therapy (Cytoxan)
 Diuretics ( Aldosterone antagonist )

-Treatment of Relapse‫االنتكاس‬
-Frequent Relapse and Steroid Dependence
 Nursing Interventions
Urinary aspects:
 Aseptic technique during catheterizations

 Avoid unnecessary catheterization and early

removal of indwelling catheters

 Wash hands before and after contact
 Wear gloves for care of urinary system
 Routine and thorough perineal care for all
hospitalized children.
 Avoid incontinent episodes by answering call light
and offering bedpan at frequent intervals
Nursing Interventions
Fluid intake:
 Measure intake and out put

 Administer diuretics according to Dr. order

 Ensure adequate fluid intake (patient with urinary

problems may think will be more uncomfortable)

 Dilutes urine, making bladder less irritable
 Flushes out bacteria before they can colonize
 Avoid caffeine, alcohol, citrus juices, chocolate, and
highly spiced foods
 Potential bladder irritants
 Nursing Care

 Diet:
 Balanced diet, adequate calories.
 Patients with persistent proteinuria should receive
2-2.5 g/kg of protein daily.
 Salt restriction until edema resolved.
 give protein according to the degree of dysfunction
of the kidney measured by serum creatinine.
 Fluids should be given according to urinary
output.
 Edema
 Edema should be managed at hospital.
 Diuretics should not be given to patients with diarrhea, vomiting or
hypovolemia.
 Blood pressure should be monitored. serum electrolytes
 Provide skin care is important particularly the edematous area.
 Keep skin clean and dry.
 Wash genitalia several times day and dust it with soothing powder.
Support it with soft pad held in place by a T binder. Avoid the use of
adhesive tape on edematous skin. Place pillow between the knees
when child is lying on his side.
 Use cotton to separate skin surface.
 Irrigate the eyes with warm saline solution
 Change position frequently to prevent tissue breakdown.
 Family Issues
Inform parents about:
 Chronic condition with relapses

 Developmental milestones

 Social isolation
 Lack of energy
 Immunosuppression/protection
 Change in appearance due to edema
 Self-image
 Emotional support
 Allows parents to visit and stay with the child and help
in his care.
 Stay with the child to help him to express his feelings
Nursing Interventions
 Discharge to home instructions
 Follow-up urine culture
 Recurrent symptoms typically occur in 1 to 2 weeks after
therapy
 Encourage adequate fluids even after infection
 Low-dose, long-term antibiotics to prevent relapses
or reinfections
 Explain rationale to enhance compliance
:Patient and parent education

 Ensure normal activity and school attendance

 Patients should receive appropriate immunization
and prevent of infection
 Dietary restriction.
 Administration of medication.
 Skin care.
 Explain how to test the urine for albumin.
 Corticosteroid side effects
Increased appetite, impaired growth, behavioral
changes, risk of infections, salt and water retention,
hypertension, bone demineralization, diabetes mellitus,
Complications
 Heart failure
 Hypertension
 Azotemia
 Hematuria
 Infections
 Thrombotic complications
 Hypovolaemia hypotension, tachycardia, cold
extremities and poor capillary refill.
 and Acute renal Failure