Nephrotic Syndrome & APSGN

Concept of Inflammation

Glomerulonephritis

Glomerulonephritis

is the inflammation of the glomerulus it can be caused by an acute post-streptococcal or be chronic in the end stage of the glomerular disorder which is slow progressive destruction and decline in renal function

Hallmark signs of Nephrotic Syndrome

• Proteinuria +3 to +4/frothy urine

• Severe edema = anasarca (Full body edema)

• Hypovolemic

• Hematuria

• Anorexia

• HYPOtension

• Fatigue

• oliguria

Nephrotic Syndrome URINE Labs

• Protein (+3 to +4)

• Hyperalbuminuria

• Elevated specific gravity

• Microscopic hematuria

Nephrotic Syndrome BLOOD Labs

• Hypoalbuminemia: <2.5

• Increased Hgb/Hct, platelets

• Elevated cholesterol/trig

Medical Management NS

• Corticosteroids – prednisone

• Immunosuppressant  - if relapses

• IV albumin

• Diuretics

• ACE inhibitors

• Vaccinations

Potential Problems NS

• Risk for skin breakdown

• Infection potential

• Risk for dehydration

• Fluid retention

• Poor nutritional intake

• Altered Body Image

• Anxiety

Diet/Nutrition NS

• Strict I+O’s; daily weights

• Fluid restriction

• Salt restrictions

• Increase protein in diet 1-2 g/kg/day

• Adequate Potassium intake (diuretics use)

Nursing Interventions NS

• Monitor edema and ascites (abdominal girth)

• Monitor lab data

• Meticulous skin care

• Rest; diversional activities

• Pain management if needed

• Emotional support

• Monitor for complications

Infection Control NS

• hand hygiene

• antibiotic prophylaxis

• monitor for signs of infection

• minimize exposure to communicable diseases

Skin Care NS

• frequent turning and positioning

• skin hygiene (bathing, lotions)

• elevation of edematous areas

Complications of NS

hypovolemic shock

respiratory compromise

hypercoagulability

Prednisone Therapy

• 2-3 months to induce remission

• Goals – diuresis and significant drop (less than 1+) in urine protein

• Tapering

  • Tapering of total mg occurs slowly

Discharge Teaching

• Medications

• Skin care

• Nutrition

• Infection prevention

• Activity limitations

• Follow-up with MD/nephrologist

Types of Glomerulonephritic

• Acute – poststreptococcal*

  • (Most common type)

• Chronic

Acute Poststreptococcal Glomerulonephritis (APSGN)

• Streptococcus

• Immune complexes inflame glomerulus

• Damage to capillary walls causes larger molecules (proteins) to pass into urine

• Ineffective filtration causes enlarged kidneys with sodium, water, and waste retention

• Edema

APSGN S/S

• Tea/smoky/cola-colored urine

• Edema – periorbital

• Oliguria

• HYPERtension

• Fatigue/malaise

• Fever

Diagnostic Test APSGN

• Urinalysis

  • Hematuria (microscopic to gross)

  • Proteinuria (1-2+)

• Blood

  • CMP (↑BUN/Cr; ↑K)

  • CBC (↑WBC; ↓Hgb/Hct)

  • Positive ASO or ADB titer

• Renal biopsy

Glomerulonephritis Medication

• Antihypertensives

  • ACE inhibitors

  • if severe HTN – hydralazine

• Diuretics

• Antibiotics

Nursing Interventions APSGN

• Preventing consequences of fluid excess

• Provide adequate rest

• Maintain skin integrity

• Maintain nutritional status

• Relieve anxiety

• Monitor for complications

Discharge Teaching APSGN

• Medications

• Monitor BP

• Obtain urinalyses

• Follow up with nephrologist

• Dietary restrictions

• Activity restrictions

Patient Education on Corticosteroids

• Monitor growth (Growth suppression)

• Monitor BP (Hypertension)

• Monitor for Hyperglycemia

• Don’t abruptly stop it

• Infection control

  • no live vax

• Delays wound healing