glomerulonephritis

(glō-mer″yŭ-lō-nĕ-frīt′ĭs)

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[glomerulo- + nephritis]
A form of nephritis in which the lesions primarily involve the glomeruli. The nephritis may be acute, subacute, or chronic. Acute glomerulonephritis (acute nephritic syndrome) frequently follows infections, esp. those of the upper respiratory tract caused by particular strains of streptococci. It may also be caused by systemic lupus erythematosus, subacute bacterial endocarditis, cryoglobulinemia, various forms of vasculitis including polyarteritis nodosa, Henoch-Schönlein purpura, and visceral abscess. The condition is characterized by hematuria, proteinuria, red cell casts, oliguria, edema, pruritus, nausea, constipation, and hypertension. Investigation of serum complement levels and renal biopsy facilitates diagnosis and helps establish the prognosis.
SEE: glomerular disease; SEE: rapidly progressive glomerulonephritis

PATIENT CARE
The primary causative condition must be treated. Serum creatinine, blood urea nitrogen, and urine creatinine clearance levels are monitored to assess renal function, and the patient is assessed for electrolyte and acid-base imbalance. Fluid balance is monitored, and changes in the amount of edema, daily weight, and fluid intake and output are documented. Vital signs are monitored every 4 hr or as necessary, and skin is inspected for signs of breakdown. Skin care and frequent repositioning are provided. General patient care concerns apply during hospitalization.

The patient is instructed to limit activities while at home during acute periods of hematuria, azotemia, gross edema, and hypertension. Self-care is encouraged as acute symptoms subside, depending on the patient’s fatigue and changes in blood pressure, and appropriate activities are encouraged. Instruction is provided in dietary and fluid restrictions; the importance of low-sodium, high-calorie meals with adequate (though at times restricted) protein content is stressed. Prescribed medications should be taken as scheduled; the patient must be made aware of desired effects, as well as adverse effects, that should be reported.

The patient should avoid people with communicable illnesses, practice good handwashing, and immediately report signs of infection, particularly respiratory and urinary tract infections. The patient must be instructed about the importance of keeping follow-up appointments during and after convalescence to detect any recurrence. Pregnant women with a history of glomerulonephritis should be encouraged to have frequent medical evaluations because of the added stress placed on the kidneys by the pregnancy (increasing the risk for renal failure). The patient should be encouraged to express feelings and concerns. Staff should provide honest but sympathetic answers to questions and explain all procedures and treatments. The patient's response is monitored, and the patient with severe renal dysfunction is prepared for dialysis or kidney transplant.

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