Glomerulo-nephritis, chronic

Glomerulo-nephritis, chronic: Excerpt from Handbook of Diseases

A slowly progressive disease, chronic glomerulonephritis is characterized by inflammation of the glomeruli, which results in sclerosis, scarring and, eventually, renal failure.

This condition usually remains subclinical until the progressive phase begins, marked by proteinuria, cylindruria (presence of granular tube casts), and hematuria. By the time it produces symptoms, chronic glomerulonephritis is usually irreversible.

Causes

Common causes of chronic glomerulonephritis include primary renal disorders, such as membranoproliferative glomerulonephritis, membranous glomerulopathy, focal glomerulosclerosis, rapidly progressive glomerulonephritis and, less commonly, poststreptococcal glomerulonephritis.

Systemic disorders that may cause chronic glomerulonephritis include lupus erythematosus, Goodpasture’s syndrome, and diabetes mellitus.

Signs and symptoms

Chronic glomerulonephritis usually develops insidiously and asymptomatically, commonly over many years. It may suddenly become progressive at any time, producing nephrotic syndrome, hypertension, proteinuria, and hematuria.

Late stages

In late stages, progressive chronic glomerulonephritis may accelerate to uremic symptoms, such as azotemia, nausea, vomiting, pruritus, dyspnea, malaise, and fatigability. Mild to severe edema and anemia may accompany these symptoms.

Severe hypertension may cause cardiac hypertrophy, leading to heart failure, and may accelerate the development of advanced renal failure, eventually necessitating dialysis or kidney transplantation.

Diagnosis

Patient history and physical assessment seldom suggest glomerulonephritis. Suspicion develops from:

❑ urinalysis, which reveals proteinuria, hematuria, cylindruria, and red blood cell casts

❑ rising blood urea nitrogen and serum creatinine levels, which indicate advanced renal insufficiency

❑ X-ray or ultrasonography, which shows smaller kidneys

❑ kidney biopsy, which identifies underlying disease and provides data needed to guide therapy.

Treatment

Effective treatment, essentially nonspecific and symptomatic, aims to control hypertension with antihypertensives and a sodium-restricted diet, to correct fluid and electrolyte imbalances through restrictions and replacement, to reduce edema with diuretics such as furosemide, and to prevent heart failure.

Treatment may also include antibiotics (for symptomatic urinary tract infections), dialysis, and transplantation.

Special considerations

❑ Patient care is primarily supportive, focusing on continual observation and sound patient teaching.

❑ Accurately monitor vital signs, intake and output, and daily weight to evaluate fluid retention. Observe for signs of fluid, electrolyte, and acid-base imbalances.

❑ Ask the dietitian to plan low-sodium, high-calorie meals with adequate protein.

❑ Administer medications and provide good skin care (because of pruritus and edema) and oral hygiene. Instruct the patient to continue taking prescribed antihypertensives as scheduled, even if he’s feeling better, and to report any adverse effects.

Clinical tip  Advise the patient to take diuretics in the morning so he won’t need to disrupt his sleep to void, and teach him how to assess ankle edema.

❑ Warn the patient to report signs of infection, particularly urinary tract infection, and to avoid contact with people who have infections. Urge follow-up examinations to assess renal function.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

 » Next page: Hematuria (Signs & Symptoms: A 2-in-1 Reference for Nurses)

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