glomerulonephritis
(glō-mer‵yŭ-lō-nĕ-frīt'ĭs 
)
[glomerulo- + nephritis]
A form of nephritis in which the lesions primarily involve the glomeruli. The nephritis may be acute, subacute, or chronic. Acute glomerulonephritis (acute nephritic syndrome) frequently follows infections, esp. those of the upper respiratory tract caused by particular strains of streptococci. It may also be caused by systemic lupus erythematosus, subacute bacterial endocarditis, cryoglobulinemia, various forms of vasculitis including polyarteritis nodosa, Henoch-Schönlein purpura, and visceral abscess. The condition is characterized by hematuria, proteinuria, red cell casts, oliguria, edema, pruritus, nausea, constipation, and hypertension. Investigation of serum complement levels and renal biopsy facilitates diagnosis and helps establish the prognosis.
SEE: glomerular disease; rapidly progressive glomerulonephritis.
Patient Care: The primary causative condition must be treated. Serum creatinine, blood urea nitrogen, and urine creatinine clearance levels are monitored to assess renal function, and the patient is assessed for electrolyte and acid-base imbalance. Fluid balance is monitored, and changes in the amount of edema, daily weight, and fluid intake and output are documented. Vital signs are monitored every 4 hr or as necessary, and skin is inspected for signs of breakdown. Skin care and frequent repositioning are provided. General patient care concerns apply during hospitalization.
The patient is instructed to limit activities while at home during acute periods of hematuria, azotemia, gross edema, and hypertension. Self-care is encouraged as acute symptoms subside, depending on the patient’s fatigue and changes in blood pressure, and appropriate activities are encouraged. Instruction is provided in dietary and fluid restrictions; the importance of low-sodium, high-calorie meals with adequate (though at times restricted) protein content is stressed. Prescribed medications should be taken as scheduled; the patient must be made aware of desired effects, as well as adverse effects, that should be reported.
The patient should avoid people with communicable illnesses, practice good hand washing, and immediately report signs of infection, particularly respiratory and urinary tract infections. The patient must be instructed about the importance of keeping follow-up appointments during and after convalescence to detect any recurrence. Pregnant women with a history of glomerulonephritis should be encouraged to have frequent medical evaluations because of the added stress placed on the kidneys by the pregnancy (increasing the risk for renal failure). The patient should be encouraged to express feelings and concerns. Staff should provide honest but sympathetic answers to questions and explain all procedures and treatments. The patient's response is monitored, and the patient with severe renal dysfunction is prepared for dialysis or kidney transplant.
ABBR: FG
A rare form of glomerulonephritis in which tiny, filament-shaped collections of protein clog the glomeruli of the kidneys. FG is usually identified in people with other underlying illnesses, such as chronic lymphocytic leukemia, Crohn disease, diabetes mellitus, chronic hepatitis C, or systemic lupus erythematosus.membranoproliferative g.Glomerulonephritis in which renal biopsy shows subendothelial deposits and proliferating mesangial cells in the glomerulus. Some patients have progressive renal impairment.
SEE: dense deposit disease.
Edema and hypertension are frequently noted. Laboratory findings typically show proteinuria and hematuria.
Patients with hypertension are medicated to lower their blood pressure. If creatinine levels rise, steroids or other immunosuppressive agents are used.
postinfectious g.Glomerulonephritis in which the filtration system of the kidneys is clogged by immune complexes made of foreign antigens, immunoglobulins, and complement after an infectious disease, such as strep throat, endocarditis, or influenza.
ABBR: RPGN
Glomerulonephritis in which there is rapid loss of renal function, usually with crescent-shaped lesions in more than 50% of the glomeruli.