8.9 Glomerulonephritis

Glomerulonephritis refers to an inflammatory disease that specifically affects the kidney glomeruli. Glomeruli are tiny structures within the kidneys responsible for filtering waste and excess fluids from the blood to produce urine. In glomerulonephritis, the inflammation within the glomeruli impairs their ability to function properly. This condition can be acute and occur suddenly or develop gradually over time and become chronic.^[1]

Pathophysiology and Risk Factors

There are several potential causes of acute glomerulonephritis. A common cause of acute glomerulonephritis is an immune system response triggered by Streptococcus bacterial infection (commonly referred to as strep throat). When the immune system produces antibodies to fight the infection, they mistakenly attack the glomeruli in the kidneys. This immune response leads to inflammation and damage to the glomeruli, affecting their ability to filter waste and fluids properly. Other common causes of acute glomerulonephritis include viral infections (like hepatitis B or C, HIV, or upper respiratory infections) and certain medications or toxins.

Chronic glomerulonephritis develops from sustained inflammatory processes that occur over time. Conditions such as systemic lupus erythematosus (SLE), vasculitis, or other autoimmune diseases can cause ongoing inflammation and damage the kidneys.^[2],[3]

Assessment

Assessment findings across different body systems can help clinicians identify and monitor the effects of glomerulonephritis on a client’s overall health. See Table 8.9 for clinical manifestations of glomerulonephritis across body systems.

Table 8.9. Clinical Manifestations of Glomerulonephritis Across Body Systems^[4],[5]

Diagnostic Testing

Diagnostic testing for glomerulonephritis includes laboratory and imaging studies to confirm the diagnosis and determine the underlying cause and severity of the condition. Laboratory tests often include BUN, creatinine, glomerular filtration rate, and electrolyte panel. Creatinine and BUN results are typically increased and GFR is decreased. In the electrolyte panel results, the potassium and phosphorous may be elevated and the calcium level may be decreased. Complete blood counts are also monitored for signs of anemia (decreased red blood cells) due to decreased erythropoietin production. A urinalysis is typically performed to assess the presence of infection. Review normal reference ranges for common diagnostic tests in “Appendix A – Normal Reference Ranges.”

A kidney biopsy may be performed to determine the cause of the nephritis. Additionally, imaging studies such as a CT scan and renal ultrasound may be performed to identify inflammation within the kidneys and structural abnormalities.^[6]

Nursing Diagnoses

Nursing diagnoses for clients with glomerulonephritis help guide nursing care and address the specific needs of these individuals.

Common nursing diagnoses include the following:

• Excess Fluid Volume
• Acute Pain
• Impaired Urinary Elimination
• Readiness for Enhanced Knowledge
• Imbalanced Nutrition

Outcome Identification

Outcome identification includes setting short- and long-term goals and creating expected outcome statements customized for the client’s specific needs. Expected outcomes are statements of measurable action for the client within a specific time frame that are responsive to nursing interventions. Examples of expected outcomes for clients with acute glomerulonephritis are as follows:

• The client will exhibit a reduction in fluid retention within 48 hours, as evidenced by decreased edema in the extremities and a weight decrease of at least two pounds.
• The client will exhibit improved urinary output, achieving at least 75% of the expected urine output for age and body weight within 72 hours.
• The client will verbalize an understanding of glomerulonephritis, its causes, treatment regimen, and recommended lifestyle modifications.

Interventions

Medical Interventions

Medical interventions for glomerulonephritis aim to treat any underlying infection, alleviate symptoms, and prevent recurrence. Common medical interventions include medication therapy, dialysis, plasmapheresis, and treating underlying conditions.

Medication Therapy

Medication therapy for glomerulonephritis may include several classes of medications:

• Antibiotics: When glomerulonephritis is caused by a bacterial infection, antibiotics are prescribed to eliminate the infection.
• Immunosuppressants: In cases of autoimmune or immune-mediated glomerulonephritis, medications that suppress the immune system, such as corticosteroids or other immunosuppressants, may be used to reduce inflammation and immune response attacking the kidneys.
• Diuretics: To manage excess fluid volume and edema, diuretics may be prescribed to increase urine output and reduce fluid retention.
• Antihypertensives: Controlling high blood pressure is crucial to prevent further kidney damage. Medications like ACE inhibitors or angiotensin II receptor blockers (ARBs) are commonly used to manage hypertension and reduce proteinuria (excessive protein in the urine).

Dialysis

When glomerulonephritis results in acute kidney failure, dialysis may be required to restore fluid and electrolyte balance. (Review information about types of dialysis under the “Chronic Kidney Disease” section.)

Plasmapheresis

If excessive antibodies or immune response complexes are formed as the result of the glomerulonephritis, plasmapheresis may be required. Plasmapheresis involves removal of blood plasma and replacement with donor plasma.

Treatment of Underlying Conditions

Treating underlying conditions that contribute to glomerulonephritis, such as diabetes or infections, is essential to prevent further kidney damage.^[7],[8]

Nursing Interventions

Nursing interventions for glomerulonephritis focus on management of infection, prevention of complications, and health teaching.

Management of Infection

Nurses monitor the client’s temperature, blood pressure, heart rate, and respiratory rate to monitor for signs of worsening infection and promptly report changes in condition. They ensure timely administration of prescribed antibiotics to treat underlying bacterial infections that are causing glomerulonephritis. They monitor white blood cell count levels to assess the body’s response to infection and the effectiveness of antibiotic therapy. The client, family, and caregivers are educated on infection control practices and proper hand hygiene to prevent the spread of infections.

Prevention and Management of Fluid Imbalances

Nurses monitor daily weights, fluid intake and output, and 24-hour I/O trends for indications of fluid overload. Blood pressure is monitored, and antihypertensive medications are administered as prescribed to maintain optimal blood pressure levels and prevent further kidney damage. Health teaching is provided to the client on elevating extremities to reduce edema, if present. If prescribed, information on fluid restrictions and limited sodium intake is provided.

Health Teaching

Health teaching is provided about the importance of adhering to prescribed antibiotic regimens and other medications (such as immunosuppressants or antihypertensives) to manage the condition effectively. Individuals with kidney disorders may need guidance for carefully managing their protein intake. The level of recommended protein intake varies depending on the stage of kidney disease and individual health conditions.

Clients are taught about symptoms of worsening kidney function to report to the health care provider, such as increased edema and decreased urine output. The importance of adhering to follow-up appointments for monitoring kidney function, blood pressure, and overall health status is emphasized.

Evaluation

During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client. The previously identified expected outcomes are reviewed to determine if they were met, partially met, or not met by the time frames indicated. If outcomes are not met or only partially met by the time frame indicated, the nursing care plan is revised. Evaluation should occur every time the nurse implements interventions with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with other members of the interprofessional team.