ACUTE GLOMERULONEPHRITIS TREATMENT

ACUTE GLOMERULONEPHRITIS TREATMENT

ACUTE GLOMERULONEPHRITIS TREATMENT

ACUTE GLOMERULONEPHRITIS TREATMENT

 

Definition of Nephritis

It is a diffuse inflammatory disorder affecting both kidneys especially the glomeruli . It is non supportive in nature with many and varied etiological factors "Acute Glomerulonephritis Treatment".

Etiology of Nephritis

  • Immunological reactions e.g Lupus Erethenatosus, Streptococcal infection
  • Metabolic diseases e.g Diabetic mellitus
  • Vascular injury e.g in hypertension
  • Disseminated intra muscular coagulation

Classification of Nephritis

  1. Acute
  2. Latent
  3. Chronic

Acute Nephritis

This generally follows in Streptococci infection of the upper respiratory tract. Commonly after tonsilitis, throat infection due to streptococci organism. It could also follow skin condition like Impetigo

Incidence

Children of pre-school age and grade school age are commonly affected

"Acute Glomerulonephritis Treatment"

Pathophysiology

Both kidneys are affected, there is an inflammatory reaction due to antigen-antibody reaction. Usually the kidney maintains a normal size on microscopic view of the kidney, there minute hemorrhages which block the normal filtering capacity of the glomeruli. There may however be presence of areas of necrosis.

Second Pathophysiology

Results from an antigen antibody reaction with the glomeruli tissue. When this occurs there is death. This reaction results in chemotaxis . Leucocytes along with release of lysosomal enzymes. These enzymes digest the glomerular basement membrane. In the membrane, there is increase in the glomerular cellular tissue. Thus the endothelial, mesengeal and epithelial cell resulting in a marked membrane porosity thus proteinuria and haematuria occurs. There is scarring of the glomerulus, renal function becomes depressed, oliguria, retention of water, sodium and nitrogeneous waste product occur, oedema and uremia may also occur.

Clinical Manifestation

  • sudden onset
  • headache
  • vomiting
  • oedema of the face
  • back ache
  • raised temperature
  • raised blood pressure that will lead to convulsion
  • small urinary output
  • blood stained urine
  • smoky and albumin urine which also lasts
  • increased weight
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"Acute Glomerulonephritis Treatment"

Investigations

  • daily ward urine analysis for presence of albumin
  • throat swab
  • examination of tonsil for foccal infection
  • lab urine test for cells and casts
  • blood for urea which is usually above 7.47milmol/litre or 45mg per 100ml of blood
  • There is raised phosphorus or cretinine level
  • full blood count
  • x-ray of sinusis of the nose
  • general appearance and history
  • anti streptolysin O

Management (Treatment and Nursing Care)

Treatment

  • patient should be kept at rest in a warm room till symptoms start to disappear
  • rest of the kidney and general body rest should be emphasized
  • drugs like penicillin can be given
  • give sulphadimedin 1g daily
  • Iron therapy can be given for anaemia
  • sedatives, antipyretic, antihypertensive drugs should also be given

Nursing Care

  • Bed rest till urine output and blood pressure becomes good also
  • when haematuria reduces
  • keep the child in a warm ventilated room or in a side ward
  • control of infection to the patient
  • nurse the child in semi-recumbent position so that he will be looking around and see everything going on in the ward so that he will not get up from the bed

Clinical Observation

T P R B/P, i/o recording, frequent weighing of patient degree of oedema, appearance of urine specimen early morning urine, general appearance of the child

Diet

  • low protein
  • low fluid intake till diuresis occur
  • give fresh fruit drinks with high glucose content
  • avoid orange juice because of high pottassium content
  • give light diet till cell count improves
  • restrict salt if odema is present

Elimination

Maintain normal bowel and bladder function by encouraging equal amount of fluid by encouraging equal amount of fluid loss and intake. encourage elimination of fluid by daily blanket bath.

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"Acute Glomerulonephritis Treatment"

Control of infection (Hygiene)

  • ensure strict hygiene
  • do oral care of the child
  • employ other general hygiene measure
  • treat pressure area

Emotional Support

  • Encourage parental visit
  • allow child to take part in activities of hospital, school and other routine emotional support

Complications

  • Acute heart failure
  • Uraemia due to renal failure
  • infection
  • hypertensive encephalopatty
  • Chronic nephritis

Prognosis

Majority of uncomplicated cases resolve in about 6 weeks rarely hypertension may lead to cardiac failure aand encephalopathy. Few enter chronic nephritis or nephrotic syndrome with appearance of anuria , the outlook is grave

 

"Acute Glomerulonephritis Treatment"

 

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