OBJECTIVES At the end of the class students will be able to • explain glomerulonephritis and its management • enlist the congenital anomalies • list down the features of renal failure • explain nephrotic syndrome • enumerate UTI
HELLO K I D N E Y G l o m e r u l o n e p h r I t I s
What is glomerulonephritis? • Glomerulonephritis is is a kidney condition that involves damage /inflammation to the glomeruli.
Incidence and etiology • More in males • Between 5-8yrs • Peak age 7yrs • Beta Hemolytic streptococcus • Primary site or infection is usually the throat or skin after nephritis.
Types of glomerulonephritis • Acute glomerulonephritis - begins suddenly • Chronic glomerulonephritis -develops gradually over several years.
Kidney pain normally happens in the “flank” region, which is just below the bottom of rib cage.
Sign and symptoms • Cola-colored or diluted, iced-tea-colored urine from red blood cells in your urine (hematuria) • Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension) • Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen • Fatigue from anemia or kidney failure. • Less frequent urination than usual.
Diagnosis • Urine analysis • Blood investigation • Culture • Renal biopsy
Management • Treatment depends on the cause of the disorder, and the type and severity of symptoms. • High blood pressure may be hard to control. Controlling high blood pressure is usually the most important part of treatment. • Dialysis and Transplant
Medications • Diuretics to reduce fluid retention • Medications to suppress the immune system Lifestyle Changes • Restrict salt and water intake. • Restrict intake of potassium, phosphorous, and magnesium. • Cut down on protein in the diet. • Maintain a healthy weight through diet and exercise. • Take calcium supplements.
Physiotherapytreatment • Patient education • Endurance Exercise • Walking test • walking, swimming, bicycling, aerobic dancing • Circulatory exercise
Precautions • Do not give an exercise to patient with consideration of these condition: • Changed their dialysis schedule • Changed their medicine schedule • Overeaten • Physical condition has changed; • Fever • Have joint or bone problems • Do not give exercises in an indoor, air-conditioned environment.
Discontinue routine earlier if experience any of the following: • shortness of breath • fatigue, • rapid or irregular heartbeat, • chest pain, • nausea, • leg cramps or dizziness.
NURSINGMANAGEMENT • History collection • Monitor fluid status • Prevention from infection • Prevent skin breakdown • Meet nutritional needs • Emotional support
NURSINGDIAGNOSIS • Fluid volume excess related to decreased urine output secondary to damaged nephrons • Activity intolerance related to fatigue • Imbalanced nutrition less than the body requirement related to anorexia • Fatigue related to increased metabolic demands and anemia • Risk for impaired skin integrity related to edema
COMPLICATION • Hypertensive encephalopathy • Acute cardiac decompensation • Acute renal failure
DEFINITION • It is a clinical state that includes massive proteinuria, hypoalbumineamia, hyperlipidemia and edema.
INCIDENCE • 2-6yrs of age • More in males
TYPES/CAUSES • Primary nephrotic syndrome • Primary disease known as idiopathic nephrosis, childhood nephrosis, or minimal change nephrotic syndrome.(MCNS) • 80% of cases with MCNS • Non specific illness (viral infection , URI) • Disease limited to kidney • Protenuria and edema
Secondary nephrotic syndrome: • Acute/chronic glomerular nephritis • Toxicity of drugs (trimethdione) • Rare • Sickle cell disease • Hepatitis • Malaria • TB, • Renal vein thrombosis • AIDS, • lymphoma, • infective endocarditis
Congenital nephrotic syndrome: • Hereditary • Recessive gene and autosomal disease. • Gene mutation
CLINICAL FEATURES • Edema around eyes, legs and labia • Anasarca (generalized body edema)
Ascites • Hydrothorax and hydrocele • Decrease urine output, urine appears to be frothy • Hematuria • Fever, rashes and joint pain • Pallor, Irritability • Loss of appetite but weight gain • Susceptibility of infection
DIAGNOSTICEVALUATION • 24Hrs urine total protein • Blood investigation: elevated cholestrol, albumin, urea
Therapeutic management • General measures • Prednisolone is the drug of choice 2mg/Kg/day orally in divided doses for 6 weeks Then 1.5mg/Kg single dose on alternate days for 6 weeks • Diuretic and salt poor albumin indicated –severe edema • Well balanced diet rich in proteins • Sodium, water restriction
NURSINGMANAGEMENT • Monitoring intake output • Urine examination • Daily weight measurement • Measurement of abdominal girth • Assessment of edema • Monitoring the vitals signs • Protect children from contact with infected roommates • Recreational therapy • Parental education • Serve alternative meals
NURSING DIAGNOSIS • Excess fluid volume related to retention of urine • Imbalanced nutrition less than the body requirement related to anorexia • Fatigue related to loss of protein • Disturbed body image related to edema • Activity intolerance related to fatigue • Risk for impaired skin integrity related to edema
COMPLICATIONS • Acute renal failure • Chronic kidney disease • Fluid overload • Infection • Pulmonary edema • Congestive cardiac failure • Growth retadation
Urinary Tract Infection (UTI) Concept of “asymptomatic bacteria” in urinary tract
Causes • E. coli most common pathogen • Streptococci • Staphylococcus saprophyticus • Occasionally fungal and parasitic pathogens
Classificationof UTI • Upper tract: involves renal parenchyma, pelvis, and ureters • Typically causes fever, chills, flank pain • Lower tract: involves lower urinary tract • Usually no systemic manifestations
Classification of UTI Lower tract • Cystitis • Urethritis Upper tract • Pyelonephritis • Glomerulonephritis
Classification of UTI • Uncomplicated infection • Complicated infections • Stones • Obstruction • Catheters • Diabetes or neurologic disease • Recurrent infections
Types of UTIs • Recurrent—repeated episodes • Persistent—bacteriuria despite antibiotics • Febrile—typically indicates pyelonephritis • Urosepsis—bacterial illness; urinary pathogens in blood
Etiology and Pathophysiologyof UTI • Physiologic and mechanical defense mechanisms maintain sterility • Emptying bladder • Normal antibacterial properties and urine and tract • Ureterovesical junction competence • Peristaltic activity
Alteration of defense mechanisms increases risk of UTI • Organisms usually introduced via ascending route from urethra • Less common routes • Bloodstream • Lymphatic system
Contributing factor: urologic instrumentation • Allows bacteria present in opening of urethra to enter urethra or bladder • Sexual intercourse promotes “milking” of bacteria from perineum and vagina • May cause minor urethral trauma
UTIs rarely result from hematogenous route • For kidney infection to occur from hematogenous transmission, must have prior injury to urinary tract • Obstruction of ureter • Damage from stones • Renal scars
UTI is a common nosocomial infection • Often E. coli • Seldom Pseudomonas • Urologic instrumentation common predisposing factor
Clinical Manifestations of UTI • Symptoms • Dysuria • Frequent urination (>q2h) • Urgency • Suprapubic discomfort or pressure
Urine may contain visible blood or sediment (cloudy appearance) • Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)
Pediatric Manifestations • Frequency • Fever in some cases • Odiferous urine • Blood or blood-tinged urine • Sometimes NO symptoms except generalized sepsis