Acute glomerulonephritis pediatric

1. ACUTE GLOMERULO
NEPHRITIS
SURENDRA SHARMA
Associate Professor
Amity College of Nursing
Amity university, Gurgoan

2. ACUTE GLOMERULO NEPHRITIS
Definition: -
It is an immune complex disease due to antigen
antibody reaction following hemolytic streptococca
infection.
Incidence: -
- School age children.
- Rare in younger children than the age 2.
- More frequently in males than in females.
Etiology: -
- Antigen antibody reaction secondary to an
infection ( Haemolytic streptococcal infection).
- Recurrent URTI.

3. Pathophysiology: -
Antigen groups A beta hemolytic streptococcus.
Antigen antibody product.
Deposition of antigen-antibody complex in glomerulus.
Increased production of epithelial cells lining the glomerulus.
Leukocytes infiltrate the glomerulus
Thickening of the glomerulus filtration membrane.
Scarring and loss of glomerulus filtration membrane.
Decreased glomerulus filtration rate.

4. Clinical manifestation: -
Onset: -
1.Usually 10 to 20 days after acute pharynges. In
streptococcal skin infection, the latency period may be
as 6 weeks.
2.May be abrupt & severe or mild and detected only
laboratory measures.
Signs & symptoms: -
1.Urinary symptoms: -
a) Decreased urine output.
b) Bloody or brown colored urine.
2.Edema: -
a).Present in most patients.
b).Usually mild.

5. a) Commonly manifested by periorbital oedema in the morning
b) May appear only as rapid weight gain.
c) Generalized and influenced by posture may be present.
2. Hypertension: -
a) Present in more than 50% of patients.
b) Usually mild.
c) Rise in BP may be sudden.
d) Usually appear during the first 4-5 days of the illness.
3. Malaise
4. Mild headache.
5. GI disturbances, especially anorexia and vomiting.
6. Fever may or may not be present.
7. Children look pale, lethargic, and irritable.

6. Diagnostic evaluation: -
1.Urinalysis: -
a) Decreased output (oliguria) – may approach in
anuria.
b) Gross hematuria. (Microscopic)
c) Specific gravity- moderately elevated.
d) Proteinuria may be mild to severe.
e) Microscopic- red blood cells, leucocytes epithelial
cells & caste.
f). Flow urinary sodium

7. 1. BUN: -creatinine - usually mildly to moderately
elevated in 50% patients.
2. Antistreptolysin titer is elevated.
3. Antidnase B (ADB) titer- elevated.
4. Erythrocyte sedimentation rate also elevated.
5. Complement C3 &C4 depressed.
6. Serum albumin test.
7. Electrocardiography.
8. Chest X-ray- pulmonary congestion, cardio
enlargement during the edematous phase.

8. Treatment: -
• There is no specific treatment AGN.
• It is self-limiting and patients recover within two to
three weeks.
• Death may be due to complications.
Supportive treatment: -
• Antibiotics e.g. Penicillin may be given to treat the
infection. Give antihypertensive drugs.
• Give magnesium sulphate to reduce the cerebral
oedema & enchaphalopathy.
• Sedatives give to reduce the restlessness.
• Cardiac failure means give digitalis.
• If end stage means advice for dialysis

9. Nursing management: -
• Give complete bed rest.
• Check the vital signs to detect early signs of
complications such as the deviation in the pulse may
indicate cardiac failure.
• Headache, convulsions & behavioral changes may
be indicative of hypertensive enchephalopathy.
• Follow the strict intake & output chart .
• Check the weight daily, oedema. & appearance of
the urine is must.
• Nutrition should be planned according to the blood
reports in the specific stage.

10. • Mild cases: - salt restricted regular food may be
allowed.
• Salty food items should be avoided in early phase of
oliguria.
• Food should contain low proteins, high CHO &
vitamin supplement.
• Small frequent feeding should be given.
• Fluid should be supplied according to the
prescription.
• Parents should be explained about the accurate fluid
intake.
• Second phase: -Diuresis starts the normal food with
the adequate fluid can be given as the blood reports
improve.
• Give play therapy.

11. Parental advice: -
• Parental should be taught about the early signs of
complications and importance of early treatment.
• Proper care of the skin and timely treatment of the
skin lesions should be explained.
• Prompt care of the respiratory problems should be
insisted .
• Parents should be instructed about the follow up
visits.
Complications: -
• Hypertensive enchaplopathy.
• Heart failure
• Uremia
• Anemia
• Hypertension

12. Nursing diagnosis: -
• Impaired urinary elimination related to glomerular
dysfunction.
• Excess fluid volume related to impaired renal function.
• Deficient diversional activity related to focus on fluid &
salt restriction.
• Deficient knowledge regarding AGN & its
management.
Nursing interventions:-
Promoting normal urine output:
1.Monitor daily intake out put chart .
2.Test & record urine for hematuria and proteinuria as
directed & note color of urine.
3.Monitor daily weights.

13. Reducing excess fluid volume: -
• Promote a no salt diet during acute phase.
• Restrict the fluids.
• Check the BP as ordered & needed.
Promoting divers ional activity: -
1.Explain fluid restriction of at an age appropriate level
& direct the child’s focus away from restrictions.
2.Provide the child with divers ional activity & play
therapy.
• Encourage activity as tolerated

14. Providing information: -
1.Explain all aspects of the diagnostic tests & treatment in
terms the farming can understand.
2.Explain the purpose of all medications & the restricted diet.
3.Give good home environment.
4. Arrange for appointments for continued medical supervision
& initiate referrals when appropriate.
5. Encourage family participation in the child’s care.
Health education: -
• Reinforce medical explanation of the disease process.
• Reinforce activity recommendation usually not restricted.
• Explain about the prevention of recurrent respiratory tract
infection.
• Regular checkup.