Chronic glomerulonephritis results from gradual damage to the glomeruli in the kidneys that filter waste and control fluid, which can lead to irreversible renal failure. It affects about 4 in 100,000 people and 20-50% of those with acute glomerulonephritis may develop the chronic form. Causes include infections, immune disorders, hypertension, and diabetes. Symptoms may include hypertension, edema, anemia, and renal failure. Diagnosis involves urinalysis, blood tests, imaging, and kidney biopsy. Treatment focuses on controlling blood pressure and the underlying cause while restricting diet and fluid intake to prevent further kidney damage.

1. CHRONIC
GLOMERULONEPHRITIS

2. Chronic glomerulonephritis results when tufts of
blood capillaries in the kidney (glomeruli) that
filter waste and control fluid excretion
gradually become unable to function properly.
Glomerulonephritis is a patrial damaged of
kidneys. Chronic glomerulonephritis a slowly
progressive glomerulonephritis generally
leading to irreversible renal failure.

3. Incidence and Prevalence
This is rare and affects only 4 out of every
1,00,000 individuals. 20-50% of individuals
with acute glomerulonephritis will eventually
develop chronic glomerulonephritis. About
25% of individuals with chronic
glomerulonephritis have no prior history of
kidney disease, and in these cases, the
disorder first appears as chronic renal failure.
In the US, chronic glomerulonephritis is
responsible for 10% of all patients on dialysis.

4. Causes
• The cause of glomerulonephritis is unknown.
• Known causes include infections: post-
streptococcal glomerulonephritis, bacterial
endocarditis, viral infections, lupus nephritis,
Goodpasture’s syndrome, and immune
diseases: IgA nephropathy, polyarthritis,
Wegener’s granulomatosis and
• Conditions that cause scarring of the
glomeruli are HTN, diabetic kidney disease,
focal segmental glomerulosclerosis.

5. Risk factors of glumerulonephritis
• Blood or lymphatic system disorders
• Exposure to hydrocarbon solvents
• History of cancer
• Infections such as streptococcal infections,
viruses, heart infections, or abscesses.

6. Conditions cause or increase the risk for this
disease including:
• Amyloidosis
• Anti-glomerular basement membrane antibody
disease
• Blood vessel diseases: vasculitis or polyarteritis
• Focal segmental glomerulosclerosis
• Heavy use of NSAIDs
• Henoch-Schonlein purpura
• Membranoproliferative GN

7. Pathophysiology of Glomerulonephritis
Reduction in nephrons mass from the initial
injury reduces the GFR. This reduction leads to
hypertrophy and hyper filtration of the
remaining nephrons and to the initiation of
intraglomerular hypertension. These changes
occur to increase the GFR of the remaining
nephrons, thus minimizing the functional
consequences of nephrons loss.

8. Continue Pathophysiology…………………..
In early renal disease, a substantial decline in
the GFR may lead to only slight increases in
serum creatinine levels. Azotemia is apparent
when the GFR decreases to less than 60-70
ml/min. Accumulation of toxic waste products
affects all organ systems. Uremia occurs at a
GFR of approximately 10 ml/min. Some of
these toxins have been identified, but none
has been found to be responsible for all the
symptoms.

9. Signs and Symptoms of Glomerulonephritis
• Asymptomatic for long time.
• Hypertension caused by fluid retention and
altered renal regulation of blood pressure.
• Symptoms of chronic renal failure may appear:
anemia, increased BUN, cardiomyopathy, CCF,.
• Peripheral neuropathy.

10. Client may have Following Symptoms:
• Cough and shortness of breath
• Abdominal pain
• Blood in vomit or stools Nose bleed
• Excessive urination
• General ill feeling, fatigue, and loss of appetite
• Joint or muscle aches

11. Diagnosis
• History and physical examination
• Urinanalysis: may show RBCs and red casts, an
indicator of possible damage to the glomeruli,
WBCs, a common indicator of infection or
inflammation. Increased protein, which may
indicate nephrons damage.
• Blood tests: creatinine and BUN
• Imaging tests: chest x-rays, kidney X-rays,
IVU,USG, CT Scan
• Kidney biopsy: A kidney biopsy is necessary for
confirm a diagnosis of glomerulonephritis.

12. Prognosis
GN is the most common cause of chronic renal
failure (25%) or ESRD may result.
In PSGN, the long-term prognosis generally is good.
More than 98% of individuals are asymptomatic
after 5 years, with chronic renal failure reported
1-3% of the time.
Generally, the prognosis is worse in patients with
heavy proteinuria, severe hypertension, and
significant elevations of creatinine level. Nephritis
associated with methicillin-resistant
Staphylococcus aureus (MRSA) and chronic
infections usually resolves after treatment of the
infection.

13. Complications:
• Malignant HTN
• Chronic or repeated UTI
• Congestive heart failure, pulmonary edema
• Chronic kidney disease
• End-stage kidney disease
• Increased susceptibility to other infections
• Nephrotic syndrome

14. Treatment
• Prescription of antihypertensive medication:
diuretics, angiotensin-converting enzyme
inhibitors, angiotensin II receptor agonists.
• Other drugs to treat the underlying cause of
glomerulonephritis are:
For streptococcal or other bacterial infections
use antibiotic
• Fluid restriction with prescription of low
sodium, low protein, low potassium.

15. Continue Treatment…………
• For lupus or vasculitis, use corticosteroids and
immune suppressing drugs.
• For IgA nephropathy, fish oil supplements
have been successful in some people.
• Goodpasture’s Syndrome: plasmapheresis
(mechanical process that removes antibodies
from blood by taking the plasma out of blood
and replacing it with fluid or donated plasma.

16. Nursing management
same as acute
glomerulonephritis

17. Prevention
• Seek prompt treatment of streptococcal
infection causing a sore throat or impetigo
• To prevent infections, such as HIV and hepatitis
that can lead to some form of
glomerulonephritis follow safe-sex guidelines
and avoid intravenous drug use.
• Control blood sugar if client having diabetes
mellitus.
• Control blood pressure if client having
hypertension.

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