Chronic glomerulonephritis

Chronic glomerulonephritis: Excerpt from Professional Guide to Diseases (Eighth Edition)

A slowly progressive disease, chronic glomerulonephritis is characterized by inflammation of the glomeruli, which results in sclerosis, scarring, and eventual 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 and incidence

Common causes of chronic glomerulonephritis include primary renal disorders, such as membranoproliferative glomerulonephritis, membranous glomerulopathy, focal glomerulosclerosis, rapidly progressive glomerulonephritis and, less often, poststreptococcal glomerulonephritis. Systemic disorders that may cause chronic glomerulonephritis include lupus erythematosus, Goodpasture’s syndrome, or hemolytic-uremic syndrome.

Chronic glomerulonephritis is twice as common in males as it is in females.

Signs and symptoms

Chronic glomerulonephritis typically develops insidiously and asymptomatically, usually over many years. At any time, however, it may suddenly become progressive, producing nephrotic syndrome, hypertension, proteinuria, and hematuria. In late stages of progressive chronic glomerulonephritis, it 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 transplantation.

Diagnosis

Patient history and physical assessment seldom suggest glomerulonephritis. Suspicion develops from urinalysis revealing proteinuria, hematuria, cylindruria, and red blood cell casts. Rising blood urea nitrogen and serum creatinine levels indicate advanced renal insufficiency. X-ray or ultrasound shows smaller kidneys. Kidney biopsy identifies the underlying disease and provides data needed to guide therapy.

Treatment

Treatment is essentially nonspecific and symptomatic, with its goals 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 [UTIs]), dialysis, or 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 as ordered, 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. Advise him to take diuretics in the morning, so he won’t have to disrupt his sleep to void. Teach him how to assess ankle edema.

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

❑ Help the patient adjust to this illness by encouraging him to express his feelings. Explain all necessary procedures beforehand, and answer the patient’s questions about them.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 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: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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