성장을 멈추지 마세요

체험은 만족하셨나요?

현재 45,782명이 마이메르시로 공부 중이에요

지식 자료를 소장하고 멋진 의료인으로 성장하세요

학습 자료 둘러보기 →
Glomerulonephritis | 마이메르시 MyMerci
제안하기

뭔가 하고 싶은 말이 있는거야?

0 / 2000
컨텐츠 수정하기

컨텐츠 내용을 수정할 수 있습니다

수정하기
닫기

Glomerulonephritis

NCLEX Review Guide: Glomerulonephritis in Pediatric Patients

Pathophysiology & Etiology

Understanding Glomerulonephritis

  • Glomerulonephritis refers to inflammation of the glomeruli within the kidneys, causing damage to the filtering mechanisms that remove waste and excess fluid from the blood.
  • In children, acute post-streptococcal glomerulonephritis (APSGN) is the most common form, typically occurring 1-2 weeks after a Group A beta-hemolytic streptococcal infection of the throat or skin.

Key Points

  • The immune complex deposition in the glomerular basement membrane activates the complement cascade, leading to inflammation and reduced filtration capacity.
  • Other causes include IgA nephropathy, lupus nephritis, and Henoch-Schönlein purpura.

Pathophysiological Process

  • In APSGN, antibody-antigen complexes form in response to streptococcal antigens and become trapped in the glomerular basement membrane, activating the complement system.
  • This immune response leads to glomerular damage, causing increased permeability of the membrane, allowing protein and red blood cells to leak into the urine.

Key Points

  • The damaged glomeruli have reduced ability to filter blood, resulting in decreased glomerular filtration rate (GFR).
  • Sodium and fluid retention leads to edema and hypertension.

Clinical Manifestations

Cardinal Signs & Symptoms

  • The classic triad of glomerulonephritis includes hematuria (often described as "tea-colored" or "cola-colored" urine), edema (particularly periorbital edema in the morning), and hypertension.
  • Children may present with decreased urine output (oliguria), fatigue, malaise, and sometimes flank pain.

Key Points

  • Periorbital edema is often the first noticeable sign parents observe, especially prominent upon waking.
  • Hypertension may be severe enough to cause headaches, visual disturbances, or altered mental status.

Clinical Scenario

A 7-year-old boy presents with puffy eyes in the morning, decreased urination, and dark urine. His mother reports he had a sore throat 2 weeks ago that resolved without treatment. Vital signs show BP 130/85 mmHg. Urinalysis reveals RBCs, protein, and RBC casts. These findings are highly suggestive of acute post-streptococcal glomerulonephritis.

Diagnostic Tests

Laboratory Findings

  • Urinalysis: Shows hematuria (microscopic or gross), proteinuria, and RBC casts. Specific gravity is typically increased.
  • Blood tests: May reveal elevated BUN and creatinine levels, indicating decreased renal function. Complete blood count may show mild anemia.
  • Serologic tests: Elevated antistreptolysin O (ASO) titers, anti-DNase B, or streptozyme confirm recent streptococcal infection. Low C3 complement levels are characteristic during the acute phase.

Key Points

  • The presence of RBC casts in urine is pathognomonic for glomerular disease.
  • C3 complement levels typically normalize within 6-8 weeks; persistent depression suggests another form of glomerulonephritis.

Imaging and Other Diagnostics

  • Renal ultrasound may show enlarged, edematous kidneys during the acute phase but is primarily used to rule out other causes of hematuria or evaluate complications.
  • Kidney biopsy is rarely indicated in typical APSGN but may be necessary for cases with atypical presentation, prolonged or severe symptoms, or to diagnose other forms of glomerulonephritis.

Key Points

  • Biopsy findings in APSGN show diffuse proliferative glomerulonephritis with subepithelial "humps" on electron microscopy.
  • Chest X-ray may be ordered if pulmonary edema is suspected in cases with severe fluid overload.

Nursing Management

Assessment Priorities

  • Closely monitor vital signs, especially blood pressure, as hypertension can lead to encephalopathy and seizures.
  • Assess fluid status by monitoring daily weights, intake and output, edema, and respiratory status for signs of fluid overload.
  • Evaluate renal function through urine characteristics, output volume, and laboratory values.

Key Points

  • Weight is the most accurate indicator of fluid status; sudden weight gain indicates fluid retention.
  • Blood pressure should be measured using an appropriately sized cuff for accurate readings in pediatric patients.

Interventions

  1. Implement strict monitoring of intake and output, daily weights, and vital signs.
  2. Administer antihypertensive medications as prescribed to control blood pressure.
  3. Enforce fluid and sodium restrictions as ordered to manage edema and hypertension.
  4. Provide diuretics as prescribed to reduce fluid overload.
  5. Administer antibiotics if streptococcal infection is still present.
  6. Monitor for and prevent complications such as acute kidney injury, hypertensive crisis, or heart failure.

Key Points

  • Most children with APSGN can be managed as outpatients if blood pressure is controlled and there are no signs of significant fluid overload.
  • Hospitalization is required for severe hypertension, significant edema, or signs of acute kidney injury.

Clinical Alert!

Monitor closely for signs of hypertensive encephalopathy (severe headache, altered mental status, visual disturbances, seizures) which requires immediate intervention. Report BP readings >95th percentile for age, height, and gender immediately.

Pharmacological Management

Medication Therapy

  • Antihypertensives: Calcium channel blockers (amlodipine), ACE inhibitors (once acute phase has resolved), or beta-blockers may be used to control hypertension. Short-acting agents like hydralazine or labetalol may be used for severe hypertension.
  • Diuretics: Loop diuretics such as furosemide may be prescribed to manage fluid overload and edema. Thiazide diuretics are less commonly used in acute settings.
  • Antibiotics: If throat culture is positive for Group A Streptococcus, penicillin or amoxicillin is typically prescribed to eradicate the infection, even though the glomerulonephritis is a post-infectious process.

Key Points

  • ACE inhibitors should be used cautiously during the acute phase as they may worsen renal function.
  • Monitor potassium levels closely when administering diuretics, especially in patients with decreased renal function.

Patient & Family Education

Home Care Instructions

  • Teach parents how to monitor blood pressure, administer medications, and recognize signs of complications.
  • Provide instructions on dietary modifications, including sodium restriction and appropriate fluid intake based on the child's condition.
  • Emphasize the importance of follow-up appointments to monitor renal function and blood pressure.

Key Points

  • Educate families that bed rest may be recommended during the acute phase, with gradual return to normal activities as symptoms improve.
  • Reassure parents that most children with APSGN recover completely within 6-8 weeks without long-term kidney damage.

Commonly Confused Points

Glomerulonephritis vs. Nephrotic Syndrome

Feature Glomerulonephritis Nephrotic Syndrome
Primary Manifestation Hematuria (tea-colored urine) Massive proteinuria (frothy urine)
Edema Moderate, often periorbital Severe, generalized (anasarca)
Blood Pressure Hypertension common Usually normotensive
Serum Albumin Normal or slightly decreased Markedly decreased (<2.5 g/dL)
Lipid Profile Usually normal Hyperlipidemia
Common Cause in Children Post-streptococcal infection Minimal change disease

Acute vs. Chronic Glomerulonephritis

Feature Acute Glomerulonephritis Chronic Glomerulonephritis
Onset Sudden, often following infection Insidious, progressive
Duration Self-limiting (weeks to months) Persistent (months to years)
Kidney Size Normal to enlarged Small, scarred kidneys
Prognosis Usually complete recovery Often progresses to ESRD
C3 Complement Transiently decreased May be normal or decreased

Study Tips

Memory Aid: "PHARAOH" for Glomerulonephritis Assessment

  • P - Proteinuria (in urine)
  • H - Hematuria (tea-colored urine)
  • A - Azotemia (elevated BUN/creatinine)
  • R - RBC casts in urine
  • A - Antistreptolysin O titers (elevated)
  • O - Oliguria (decreased urine output)
  • H - Hypertension

Remember the Classic Triad with "HEH"

  • H - Hematuria
  • E - Edema
  • H - Hypertension

Common Pitfalls

  • Don't confuse the decreased C3 complement levels in APSGN (which recover in 6-8 weeks) with persistently low levels seen in other forms of glomerulonephritis.
  • Remember that antibiotics for streptococcal infection will not alter the course of APSGN once it has developed but are given to prevent spread to others.
  • Avoid confusing the moderate proteinuria of glomerulonephritis with the massive proteinuria (>3.5g/day) characteristic of nephrotic syndrome.

Summary of Key Points

  • Acute post-streptococcal glomerulonephritis (APSGN) is the most common form of glomerulonephritis in children, occurring 1-2 weeks after a streptococcal infection.
  • The classic triad of symptoms includes hematuria (tea-colored urine), edema (especially periorbital), and hypertension.
  • Diagnostic findings include hematuria, proteinuria, RBC casts, elevated ASO titers, and decreased C3 complement levels.
  • Management focuses on controlling hypertension, managing fluid balance, and monitoring for complications.
  • Prognosis is generally excellent in children, with most cases resolving within 6-8 weeks without permanent kidney damage.

Quick Check

  1. What is the most common cause of acute glomerulonephritis in children?
  2. What are the three classic symptoms of glomerulonephritis?
  3. What lab finding is pathognomonic for glomerular disease?
  4. What complement component is typically decreased in APSGN?
  5. What is the typical timeframe for recovery from APSGN in children?

Self-Assessment Checklist








Remember, while glomerulonephritis may seem complex, understanding the underlying immune mechanism will help you connect the pathophysiology to the clinical presentation. Most children recover completely with appropriate supportive care – your nursing assessments and interventions are crucial to ensuring positive outcomes!

다음 이론을 계속 학습하려면 로그인하세요.

로그인하고 계속 학습
컨텐츠를 그만볼래?

필기노트, 하이라이터, 메모는 잘 쓰고 있어?

내보내줘
어떤 폴더에 저장할래?

컨텐츠 노트에는 총 0개의 폴더가 있어!

폴더 만들기
컨텐츠 만들기
만들기
신고했어요.

운영진이 검토할게요!

해당 유저를 차단했어요.

마이페이지에서 차단한 회원을 관리할 수 있어요.