Nursing Care and Pathophysiology of Glomerulonephritis

In this lesson, we’re gonna talk about glomerulonephritis. As you can deduce from the name, this is inflammation (that’s the -itis) of the glomerulus in the kidneys (remember nephro means kidneys).
Remember from anatomy that the glomerulus is the little tuft of capillaries that sits in Bowman’s Capsule and filters the blood into the nephron. So it forces the blood through the capillary walls like a strainer, that fluid gets collected in this tubule and goes through the nephron to be excreted as urine. So glomerulonephritis is inflammation of this glomerulus caused by some sort of immune reaction. Common predisposing factors are respiratory or skin infections or autoimmune diseases like Lupus. These things cause an immune response in our systems that can come here into the nephron and damage the glomerulus. If this gets all inflamed and swollen, it’s going to really struggle to filter the blood like it should.

So we essentially see that the kidneys stop doing what they’re supposed to do. If the blood can’t get into the nephron - we can’t filter the toxins out. We also can’t regulate our fluid and electrolytes if that fluid isn’t available to us in the nephron. Our kidneys will also struggle to retain that bicarb buffer for acid-base balance.

So, in addition to seeing those signs of infection because of the inflammation, like fever and increased WBC’s, we also see evidence of impaired kidney function. The azotemia causes anorexia, nausea, vomiting, and malaise. The retention of water and sodium can cause hypertension and signs of volume overload. And something else we see is that the kidneys aren’t uptaking or excreting dye on scans - that’s because it’s not being filtered through the glomerulus. So, what do we see in our lab values? Well first and foremost, obviously, we see a decreased glomerular filtration rate. I’ve said this before and I’ll say it again - the GFR is the Number One indicator of kidney function - we will still see increased BUN and Creatinine, but since they’re not always specific, looking at that GFR gives us an even better picture of what’s happening to the kidneys. We’ll also possibly see hematuria, which is blood in the urine because of this damage to the glomerulus, and we can also see leakage of protein into the urine. We talked about this in the lesson about nephrotic syndrome - when protein leaks into the urine, we see hypoalbuminemia, which further contributes to that edema and volume overload. And then because we lose that bicarb buffer, we’ll see metabolic acidosis - that’s a pH less than 7.35 and HCO3- less than 22.

So, our goal for management of these patients is to decrease that inflammatory process and prevent complications like permanent kidney damage, which can lead to CKD. So we give corticosteroids to decrease inflammation. We can also do dialysis to support kidney function until we’ve addressed the source of the problem. We also do something called plasmapheresis. This is a plasmapheresis machine here. It works sort of like dialysis, except the goal is to remove harmful antibodies from the plasma. This is helpful because we know that glomerulonephritis can be caused by immune responses - if we can get those harmful antibodies out, we can stop that immune response. We also want to put some restrictions on their diet including protein, fluids, potassium, and sodium. We know kidney failure comes with hyperkalemia, so we restrict potassium intake. We restrict fluids, protein, and sodium, because we want to try to avoid further retention of fluid and volume overload. And finally we’re going to measure their intake and output and measure daily weights to see if they’re retaining fluid. Remember that 1 kg of body weight equals 1 L of fluid retained!

So, our priority nursing concepts for a patient with glomerulonephritis are, obviously, fluid & electrolytes and elimination, as well as infection control because we want to address the source of the inflammation and prevent any further urinary tract infections. Check out the care plan attached to this lesson to see more detailed nursing interventions and rationales.

Let’s recap quickly. Glomerulonephritis is inflammation of the glomerulus caused by some sort of immune or infectious process. This means that our kidneys will not be functioning appropriately - we see a decreased GFR, azotemia, and volume overload. We want to decrease the inflammatory process and stop the immune response that’s causing the problem. All the while, we want to support the kidneys and prevent long-term complications like chronic kidney disease.

That’s it for glomerulonephritis, make sure you check out all the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!