8.9 Glomerulonephritis
Glomerulonephritis refers to an inflammatory disease that specifically affects the kidney glomeruli. Glomeruli are tiny structures within the kidneys responsible for filtering waste and excess fluids from the blood to produce urine. In glomerulonephritis, the inflammation within the glomeruli impairs their ability to function properly. This condition can be acute and occur suddenly or develop gradually over time and become chronic.[1]
Pathophysiology and Risk Factors
There are several potential causes of acute glomerulonephritis. A common cause of acute glomerulonephritis is an immune system response triggered by Streptococcus bacterial infection (commonly referred to as strep throat). When the immune system produces antibodies to fight the infection, they mistakenly attack the glomeruli in the kidneys. This immune response leads to inflammation and damage to the glomeruli, affecting their ability to filter waste and fluids properly. Other common causes of acute glomerulonephritis include viral infections (like hepatitis B or C, HIV, or upper respiratory infections) and certain medications or toxins.
Chronic glomerulonephritis develops from sustained inflammatory processes that occur over time. Conditions such as systemic lupus erythematosus (SLE), vasculitis, or other autoimmune diseases can cause ongoing inflammation and damage the kidneys.[2],[3]
Assessment
Assessment findings across different body systems can help clinicians identify and monitor the effects of glomerulonephritis on a client’s overall health. See Table 8.9 for clinical manifestations of glomerulonephritis across body systems.
Table 8.9. Clinical Manifestations of Glomerulonephritis Across Body Systems[4],[5]
| Body System | Assessment Findings |
|---|---|
| Urinary | Hematuria, proteinuria, and oliguria |
| Cardiovascular | Hypertension and fluid overload (edema, heart murmurs, jugular venous distention) |
| Hematologic | Anemia due to decreased production of erythropoietin by the kidneys, bleeding tendencies due to platelet dysfunction, and increased susceptibility to infections |
| Neurologic | Confusion and altered mental status (in severe cases with uremia) |
| Gastrointestinal | Nausea, vomiting, and poor appetite due to uremia, signs of gastrointestinal bleeding (if severe kidney impairment), and metallic taste in the mouth |
| Musculoskeletal | Muscle weakness and cramping (related to electrolyte imbalances) |
| Dermatologic | Pallor due to anemia, pruritus due to uremic toxins accumulating in the skin, easy bruising, and petechiae (if platelet dysfunction present) |
Diagnostic Testing
Diagnostic testing for glomerulonephritis includes laboratory and imaging studies to confirm the diagnosis and determine the underlying cause and severity of the condition. Laboratory tests often include BUN, creatinine, glomerular filtration rate, and electrolyte panel. Creatinine and BUN results are typically increased and GFR is decreased. In the electrolyte pane