1. Acute Glomerulonephritis
A group of kidney diseases in which there is an inflammatory reaction in the glomeruli.
It is not an infection of the kidney , but rather the result of the immune mechanisms of the body.

2. Etiology
Occurs after an infection elsewhere in the body / may develop secondary to systemic disorders.
An antigen – antibody reaction produces immune complexes that lodge in the glomeruli.
The immune reaction activates the inflammatory response. The lysosomes released during the inflammatory response damage the glomerular basement membrane.

3. Proliferation of glomerular cells then occurs
Proliferation of glomerular cells then occurs. The damaged glomeruli lose the ability to filter selectively. Permeability is increased, therefore, protein molecules and RBCs are filtered from the plasma to the urine.
Eventual scarring and loss of filtering surface may lead to renal failure.

4. Initiate event:
Infection
Chronic Dx
Glomerular capillary inflammation
Glomerular Permeability
GFR

5. GFR GP Proteinuria Hypoalbuminemia Edema Azotemia Hematuria
Activation of Renin Angiotensin Aldesterone System
Na&water Retention
Hypertension, Edema
Proteinuria
Hypoalbuminemia
Edema
Azotemia
Hematuria

6. Clinical Manifestations
Mild disease is frequently discovered accidentally through a routine analysis.
History of infection: Pharyngitis / impetigo from group A streptococcus, such viral infections as Epstein Barr and hepatitis B
Tea coloured urine, oliguria
Puffiness of face, edema of extremities
fatigue and anorexia, possible headache

7. Hypertension ( mild, moderate, or severe) headache
Anemia from loss of RBCs into the urine

8. Promoting Renal Function
Monitor vital signs, I&O, and maintain dietary restrictions during acute phase.
Encourage rest during the acute phase as directed until the urine clears and BUN, creatinine and blood pressure normalize. (Rest also facilitates diuresis)
Administer medications as ordered, and evaluate pt’s response to antihypertensives, diuretics, H2 blockers, phosphate – binding agents and antibiotics. (If indicated)

9. Improving Fluid Balance
Carefully monitor fluid balance; replace fluids according to the pt’s fluid losses( urine, respiration, feces) and daily body weight as prescribed.
Monitor pulmonary artery pressure and CVP, if indicated.

10. Monitor for signs and symptoms of heart failure: distended neck veins, tachycardia, gallop rhythm, enlarged and tender liver, crackles at bases of lungs.
Observe for hypertensive encephalopathy, any evidence of seizure activity.