Chapter 70 Glumerolunephritis and Degenerative Kidney Disorders.docx

Chapter 70 Glumerolunephritis and Degenerative Kidney Disorders.docx

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Chapter 70 Glumerolunephritis and Degenerative Kidney Disorders Acute Glomerulonephritis Pathophysiology o An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection. Usually, patients recover quickly and completely from acute GN. The term acute nephritic syndrome also describes this disorder. o The incidence of acute GN is unknown. GN after a systemic streptococcal infection is more common in men. Patient assessment o Connection with sore throat? Ask about recent infections, particularly of the skin or upper respiratory tract, and about recent travel or other possible exposures to viruses, bacteria, fungi, or parasites. Recent illnesses, surgery, or other invasive procedures may suggest infections. Ask about any known systemic diseases, such as systemic lupus erythematosus (SLE), which could cause acute GN. o Proteinuria Physical assessment MODERATE PROTEIN LOSS o Inspect the patient’s skin for lesions or recent incisions (including body piercings). Assess the face, eyelids, hands, and other areas for edema (present in about 75% of the patients with acute GN). Assess for fluid overload and circulatory congestion (which may accompany the sodium and fluid retention occurring with acute GN). Ask about any difficulty in breathing or shortness of breath. Assess for crackles in the lung fields, an S3 heart sound (gallop rhythm), and neck vein distention. o Ask about changes in urination pattern and any change in urine color. Microscopic blood in the urine occurs most of the time, and patients often describe their urine as. Ask about dysuria or oliguria. Weigh him or her to assess for fluid retention. o Take the patient’s blood pressure and compare it with the baseline blood pressure. Mild to moderate hypertension often occurs with acute GN as a result of sodium and fluid retention. Clinical manifestations o Edema of the face, eyelids, hands and other areas, Fluid retention, circulatory congestion, Difficulty breathing, SOB, Crackles in the lungs, S3 heart sounds, neck vein distention o Microscopic blood in the urine, smoky, reddish brown, rusty, or cola colored, dysuria or oliguria, Mild to moderate hypertension o The patient may have fatigue, a lack of energy, anorexia, nausea, and/or vomiting if uremia from severe kidney impairment is present. o SPECFIC GRAVITY DROPS o CONSIDERATIONS FOR OLDER ADULTS The less common manifestations of acute GN are more likely to occur in older adults. Circulatory congestion often is present, causing acute GN to be easily confused with congestive heart failure.
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Laboratory assessment o Urinalysis shows red blood cells (hematuria) and protein (proteinuria). An early morning specimen of urine is preferred for urinalysis because the urine is most acidic and formed elements are more intact at that time. Microscopic examination often shows red blood cell casts, as well as casts from other substances. The urine sediment assay is usually positive.
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  • Spring '17
  • Acevedo

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