Glomerulonephritis

Glomerulonephritis is a type of inflammation of the kidney that affects the ability of the glomerulus to filter blood. Acute and chronic glomerulonephritis are the two types of glomerulus inflammation. Acute glomerulonephritis results from secondary illnesses that present as renal disease or from a primary renal cause. According to Kazi and Hashmi (2024), acute post-glomerulonephritis can result from a streptococcal infection. Diseases such as hepatitis B and C can also lead to secondary glomerulonephritis. Acute glomerulonephritis can progressively result in chronic glomerulonephritis if treatment is delayed. Chronic glomerulonephritis causes gradual deterioration of the glomerulus, reducing the glomerulus rate of filtration.

Etiology

Numerous causes and risk factors are associated with glomerulonephritis, especially those that lead to inflammation of the glomeruli. Infections that trigger post-streptococcal glomerulonephritis include throat and skin infections caused by streptococcus bacteria (Anders et al., 2023). The build-up of antibodies in the glomerulus causes glomerular inflammation. HIV-associated neuropathy, bacterial endocarditis, and kidney viral infections such as hepatitis B and C are among the other illnesses that trigger the inflammation of the glomerulus.

Autoimmune diseases such as IgA neuropathy, lupus nephritis, and Goodpasture syndrome are disorders caused by the immune system. They attack healthy tissues, which may subsequently lead to inflammation of the glomeruli.

Another risk factor is vasculitis, which is a health condition that leads to the inflammation of blood vessels, including those that are found in the kidneys. There are two types of vasculitis, and they include polyarteritis and granulomatosis with polyangiitis.

Other predisposing factors of glomerulonephritis include diabetic nephropathy, also known as diabetic kidney disease; this condition leads to the scarring of the glomeruli due to high blood sugar levels and increases the rate of blood flow in the nephrons (Kazi & Hashmi, 2023). High blood pressure can also lead to inflammation and scarring of the glomeruli.

Signs and Symptoms

Signs and symptoms of glomerulonephritis vary depending on whether the infection is acute or chronic, and it includes the presence of abnormal urinary sedimentation, hypertension (high blood pressure), headache, edema ( fluid retention with swellings), azotemia, and fatigue. According to Kazi & Hashmi (2023), signs and symptoms can also be related to underlying systemic conditions, and they include the presence of skin rashes in case of hypersensitivity vasculitis and hemoptysis, especially when Goodpasture syndrome is an underlying risk factor for glomerulonephritis.

Diagnostic Tests

During the initial evaluation of rapidly progressive glomerulonephritis, the following laboratory tests can be carried out: urinalysis and ELISA test to assess serology for anti-GBM antibodies (Naik & Shawar, 2020) According to Kazi & Hashmi (2023) to conduct a comprehensive diagnostic test, a computed tomography scan, and a chest x-ray can be used to scan for indications of vasculitis cavitary lesions or diffuse alveolar hemorrhage. In the event that diffuse alveolar bleeding is suspected, bronchoscopy may be carried out. For vasculitis, otolaryngologic assessment and skin biopsy are options. The foundation for a conclusive diagnostic test is a kidney biopsy histological diagnosis.

Treatment

Managing the underlying cause of glomerulonephritis, which is linked to a systemic condition, is the primary method of treatment that aims at preserving renal functions, and therefore, treatment should be initiated as soon as possible. Treatment for primary glomerulonephritis consists of both disease-modifying medications and supportive care. The primary determinant of the outcome is prompt intervention. Failure to do so may result in a series of events that progress from glomerulonephritis to chronic kidney disease, which raises the risk of concurrent cardiovascular disease development. Eventually, this sequence leads to end-stage renal disease (ESRD).

According to Rout and Leslie (2024), immunosuppression therapy should be used, beginning with disease therapeutic categories to disease-specific therapeutics. Glucocorticoids are the most commonly used drug. There are receptor inhibitors that help minimize cellular crescent formation and reduce the migration of parietal epithelial cells into the Bowman capsule. Other medications that can be used include methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine.

Complications

Complications related to glomerulonephritis can be categorized into two categories: treatment-related complications and disease-related complications. For disease-related complications, pulmonary hemorrhage is evident in cases of anti-GBM disease (Rout & Leslie, 2024). Lupus-related glomerulonephritis can contribute to extrarenal manifestations such as skin lesions, cerebritis, and serositis.

According to Rout and Leslie (2024 treatment-related complications lead to opportunistic infections, some of which are potentially fatal and are the main side effects of immunosuppressive treatment. Other specific side effects of cyclophosphamide include hematuria and cystitis. Older patients are more vulnerable to infections and side effects when using cyclophosphamide.

Patient Education

Timely screening and timely treatment greatly enhance recovery from glomerulonephritis. Vulnerable individuals should be made aware of the signs and symptoms of the disease and advised to consult a doctor if they experience hemoptysis, shortness of breath, decrease in urine output, presence of blood in urine, or other abnormal symptoms.

Every patient should get education regarding therapy compliance, treatment problems, and the necessity of seeking medical assistance prior to ceasing any drugs (Rout & Leslie, 2024). Every patient needs to be informed about the severe side effects of immunosuppressive medications, such as teratogenic effects, many infections, and the need for prophylactic antibiotic use and the proper vaccines to reduce opportunistic infections.

Patients should also be educated on dietary restrictions to minimize waste accumulation. Therefore, it's essential for the patient to cut down on salt consumption; the patient should be advised to cease smoking to decrease the severity of the disease. The patient should also change their lifestyle to counter diabetes and increased high blood pressure.

Expected priority nursing diagnosis

The expected priority nursing diagnoses are based on the assessment data and include the following: management of fluid and electrolyte balance, control of dysfunctional breathing patterns related to inflammation, minimizing renal injury and inflammation that alters urine elimination due to reduced bladder capacity and irritation caused by infection, prevent exposure to infection due to decrease in the immunity response and lastly monitoring and assessing renal function to avoid excess fluid volume caused by interference of the fluid regulatory mechanisms (Alhamoud et al., 2021).