Pediatric Problems Renal Disorders Immunologic and Onlocogy

Acute Glomerulonephritis

Inflammation of the glomeruli, often post - infectious, leading to impaired kidney function

Post streptococcal infection (throat or skin infection)

Acute Glomerulonephritis Causes (Most Common)

Autoimmune diseases, viral infections, idiopathic

Acute Glomerulonephritis other causes

1 -3 weeks

Preceeding Infection ( Group A Beta - Hemolytic Streptococcus ) often occurs after pharyngitis or impetigo

after pharyngitis or impetigo

Preceeding Infection ( Group A Beta - Hemolytic Streptococcus) often occurs 1 - 3 weeks

streptococcal antigens

Body initiates immune response against

formation of antigen - Antibody Complexes

Preceeding Infection ( Group A Beta - Hemolytic Streptococcus ) often occurs 1 - 3 weeks after pharyngitis or impetigo leads to

glomerular basement membrane

Immune complexes are deposited in the

Inflammatory response in the glomeruli

formation of antigen - Antibody Complexes

Immune complexes are deposited in the glomerular basement membrane causes

complement system

Activation of

leukocytes

infiltration of

swelling

glomerular

proliferation

glomerular swelling and cellular

glomerular capillary injury and increased permeability

Inflammatory response in the glomeruli

Activation of complement system

Infiltration of leukocytes

glomerular swelling and cellular proliferation results in

RBCs and proteins

Allows to pass into urine

urine

allows RBCs and proteins to pass into

glomerular filtration rate

reduced GFR

Hematuria, proteinuria, and oliguria

Glomerular Capillary injury and increased permeability

allows RBCs and proteins to pass into urine

reduced glomerular filtration rate (GFR)

leads to

cola

- colored urine from RBCs

RBCs

cola colored urine from

foamy

urine from protein

protein

foamy urine from

urine

reduced output

sodium and water retention

Hematuria, proteinuria, and oliguria

cola colored urine from RBCs

foamy urine from protein

reduced urine output

results in

decreased filtration and renal perfusion

sodium and water retention due to

hypertension, edema, and risk of acute kidney injury

sodium and water retention causes

hematuria

cola colored urine

Hematuria

Acute Glomerulonephritis (Clinical Manifestation) 1

Proteinuria

Acute Glomerulonephritis (Clinical Manifestation) 2

Edema

Acute Glomerulonephritis (Clinical Manifestation) 3

Hypertension

Acute Glomerulonephritis (Clinical Manifestation) 4

Oliguria

Acute Glomerulonephritis (Clinical Manifestation) 5

Fatigue

Acute Glomerulonephritis (Clinical Manifestation) 6

Urinalysis, RBCs, and protein

Acute Glomerulonephritis (Diagnostics) 1

Elevated BUN and creatinine

Acute Glomerulonephritis (Diagnostics) 2

antistreptolysin 0

Acute Glomerulonephritis (Diagnostics) 3 ASO titer

serum complement

Acute Glomerulonephritis (Diagnostics) 4 decreased

renal ultrasound or biopsy

Acute Glomerulonephritis (Diagnostics) 4 if needed

Antihypertensives

Acute Glomerulonephritis Medical and pharmacological management 1

Diuretics

Acute Glomerulonephritis Medical and pharmacological management 2

Antibiotics

Acute Glomerulonephritis Medical and pharmacological management 3 (if post infectious)

fluid and salt

Acute Glomerulonephritis Medical and pharmacological management 4 restriction

treat underlying cause

Acute Glomerulonephritis Medical and pharmacological management 5

Blood pressure BP

Acute Glomerulonephritis nursing management and considerations especially

Intake and output monitoring

Acute Glomerulonephritis nursing management and considerations strict

daily weights

Acute Glomerulonephritis nursing management and considerations 4

encourage rest

Acute Glomerulonephritis nursing management and considerations 5

disease course and home care

Acute Glomerulonephritis nursing management and considerations educate family on

fluid volume

Acute Glomerulonephritis possible nursing diagnoses excess

Risk for impaired renal perfusion

Acute Glomerulonephritis possible nursing diagnoses 2

imbalanced nutrition

Acute Glomerulonephritis possible nursing diagnoses 3 less than body requirements

Nephrotic Syndrome

a kidney disorder causing massive proteinuria, hypoalbuminemia, and edema due to increased glomerular permeability.

idiopathic

Nephrotic Syndrome primary cause

lupus, diabetes

Nephrotic Syndrome secondary to systemic diseases

glomerular basement membrane damage

due to minimal change disease, infections, immune disorders, or idiopathic causes

increased glomerular permeability to protein

glomerular basement membrane damage leads to

loss of selective filtration barrier

increased glomerular permeability to protein

Massive proteinuria

increased glomerular permeability to protein causes

>3.5g/day, especially albumin lose in urine

massive proteinuria

Hypoalbunemia

massive proteinuria results in

low plasma oncotic pressure

Hypoalbunemia

fluid shifts from intravascular to interstitial spaces

Hypoalbunemia leads to

Generalized Edema (Anasarca)

fluid shifts from intravascular to interstitial spaces causes

Anasarca

Generalized Edema

periorbital, ascites, pleural effusion, scrotal/ labial edema

Generalized Edema (Anasarca)

liver compensation

Generalized Edema (Anasarca) accompanied by

increased lipoprotein synthesis

liver compensation

hyperlipidemia and increased risk of infection & thrombosis

liver compensation - increased lipoprotein synthesis results in

increased cholesterol and triglycerides

hyperlipidemia

due to immunoglobulin and antithrombin IIi loss in urine

increased risk of infection & thrombosis

generalized edema

(clinical manifestation) anasarca

frothy urine

proteinuria

Generalized edema (anasarca)

proteinuria (frothy urine)

hypoalbuminemia

hyperlipidemia

weight gain

fatigue

nephrotic syndrome (clinical manifestations)

thromboelism

monitor for signs and infections of

weight and abdominal girth

daily

skin breakdown

prevent

steroid therapy and relapse signs

family education on

excess fluid volume

nephrotic syndrome (possible nursing diagnosis 1 )

risk for infection

nephrotic syndrome (possible nursing diagnosis 2 )

imbalanced nutrition

nephrotic syndrome (possible nursing diagnosis 3 )

heavy proteinuria

urinalysis

serum albumin

low

cholesterol and triglycerides

high

renal biopsy

if atypical presentation

corticosteroids

prednisone

diuretics

nephrotic syndrome (medical and pharmacological management 2)

albumin

infusion

ACE

inhibitors

low - sodium, moderate protein diet

nephrotic syndrome (medical and pharmacological management 2)

thromboembolism

monitor for signs and infections of

weight and abdominal girth

daily

skin breakdown

prevent

steroid therapy and relapse signs

family education on

fluid volume

excess

for infection

risk

nutrition

imbalanced

Renal failure

inability of the kidneys to excrete waste and maintain fluid/electrolyte balance

hypovolemia, nephrotoxic drugs, infections

renal failure acute causes

congenital anomalies, chronic glomerulonephritis, polycystic kidney disease

renal failure congenital causes

initial renal insult or progressive nephron damage

what leads to decreased glomerular filtration rate GFR