CASE ABSTRACT:

ACUTE GLOMERULONEPHRITIS

In partial fulfillment of requirements in Care of Mother Child

and Adolescents RLE

Submitted by:
Bimuyag, Rodalyn P.
Bravo, Ailex Jimlet B.
Camagong, Roxette Jel J.
Chilagan, Mary Joy P.
Dumlao, Hans Breiham P.
Lizardo, Jotricia Lara Marie B.
Ocampo, Janawagimunik D.
Puno, Jirah Daniela B.
Sabidra, Jyramay Rose P.
Sunio, Emmanuel T.
Velasco, Marjorie D.

BSN 2A- Group 2

Submitted to:
Romalyn G. Rivera, RN
College of Nursing, Clinical Instructor

November 25, 2023

 OVERVIEW OF THE DISEASE

GENERAL OBJECTIVES
This case study is designed to help us students broaden our knowledge and provide good
nursing care to a patient who has Acute Glomerulonephritis. Furthermore, to improve nursing
interventions that may aid our patients in recognizing their needs, to raise awareness of everyone
who may have this condition, and to provide proper nursing management to patients with Acute
Glomerulonephritis.

SPECIFIC OBJECTIVES:

This study aims to:

 To have knowledge about the disease of the patient
 To know the anatomy and physiology of the systems that are affected by the condition of patient
 Discuss the pathophysiology of the condition
 To identify the signs and symptoms of the condition manifested by the patient
 To know the analysis and interpretation of laboratory and findings of patient
 To determine the actions, adverse effect and communication of drug administer to patient
 To provide holistic care appropriate for the patient’s condition
 To impart health teaching to the patient

OVERVIEW OF ACUTE GLOMERULONEPHRITIS

Acute glomerulonephritis is defined as inflammation and subsequent damage of the

glomeruli leading to hematuria, proteinuria, and azotemia; Glomeruli remove excess fluid,
electrolytes and waste from bloodstream and pass them into urine. The acute disease may be
caused by infections such as strep throat. It may also be caused by other illnesses, including
lupus, Good pasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis
and prompt treatment are important to prevent kidney failure.

EPIDEMIOLOGY

The patients in the Philippines are younger [mean age 36.7±13.7 years vs 46.7±17.5 years
(p<0.001)]. The proportion of male patients are similar (44.0% vs. 46.0% in the Philippines and
Singapore respectively, p= 0.25). In the Philippines, the three most common glomerular diseases
are IgA Nephropathy (IgAN) (34.4%); focal segmental glomerulosclerosis (FSGS) (16.0%)
followed by lupus nephritis (LN) (9.9%). On the other hand, in Singapore, these were LN (20.4%);
IgAN (17.2%) followed by diabetic glomerulosclerosis (DG) (10.9%). Primary nephrotic syndrome
[minimal change disease (MCD), FSGS and membranous nephropathy (MN)] is more common in
patients from the Philippines (21.5% vs 17.4%, p=0.004), with patients from the Philippines being
younger (38.9±14.6 years vs 54.2±17.8 years, p<0.001). In addition, IgAN is more prevalent in
patients from the Philippines (34.4% vs 17.3%, p<0.001), with patients from the Philippines being
younger (35.0±11.8 years vs 40.0±15.6 years, p<0.001) and having lower serum creatinine at
biopsy (174.0±169.1 umol/L vs 226.7±297.9 umol/L, p<0.001). Conversely, LN is more common in
patients from Singapore (20.5% vs 9.9%, p<0.001), with patients from the Philippines being
younger (30.8±11.0 years vs 36.8±12.1 years, p<0.001) and having lower serum creatinine at
biopsy (112.3±97.8 umol/L vs 171.8±178.0 umol/L, p<0.001). Interestingly, biopsy-proven DG is
more common in Singapore (10.9% vs 2.0%, p<0.001) and infection-related glomerulonephritis
(IRGN) is similar in frequency in both countries (Philippines 0.6% vs Singapore 0.7%, p=0.72).
SIGNS AND SYMPTOMS

Symptoms can occur a bit differently in each child. They can include:
 Urine that is dark brown, from blood and protein
 Sore throat
 Less urine
 Lack of energy or tiring easily (fatigue)
 Trouble breathing
 Headache
 High blood pressure
 Seizures from high blood pressure
 Rash, especially over the buttocks and legs
 Weight loss
 Joint pain
 Pale skin color
 Fluid buildup in the tissues (edema)
The symptoms of glomerulonephritis can be like other health conditions. Make sure your
child sees his or her healthcare provider for a diagnosis.

RISK FACTORS

A child is more at risk for glomerulonephritis if he or she has:

 Systemic autoimmune diseases. With these types of diseases, the body’s immune
system attacks healthy cells by mistake. Systemic means that many parts of the body are
affected. An example of this is systemic lupus erythematosus (SLE or lupus).

 Polyarteritis nodosa. This is an inflammatory disease of the arteries.

 Granulomatosis with polyangiitis. This is a progressive disease that leads to widespread

inflammation of all of the body's organs.

 Henoch-Schönlein purpura. This disease causes small or large purple lesions (purpura)
on the skin and internal organs. It causes other symptoms in several organ systems.

 Alport syndrome. This is a form of inherited glomerulonephritis that affects both boys and
girls. But boys are more likely to have kidney problems. Treatment focuses on preventing
and treating high blood pressure and preventing kidney damage.

 Streptococcal infection. In children, glomerulonephritis is often caused by strep throat or

an upper respiratory infection. The disease usually occurs 1 week or more after an
infection.

 Hepatitis B. This infection can be passed from mother to baby or rarely contracted through
a blood transfusion.
DIAGNOSTICS

The healthcare provider will ask about your child’s symptoms and health history. He or she
may also ask about your family’s health history. He or she will give your child a physical exam. Your
child may also have tests, such as:

 Throat culture. This may be done to check for strep throat. A swab is gently wiped in
your child’s throat to collect bacteria.

 Blood tests. These look at blood cell counts, electrolyte levels, and kidney function.

 Urine test. This test looks for protein and blood in urine and other problems.

 Electrocardiogram (ECG). This is a test that records the electrical activity of the heart,
shows abnormal heart rhythms, and detects heart muscle damage.

 Renal ultrasound (sonography). This is a painless test that uses sound waves and a
computer to create images of body tissues. During the test, a healthcare provider moves
a device called a transducer over the belly in the kidney area. This sends a picture of the
kidney to a video screen. The healthcare provider can see the size and shape of the
kidney. He or she can also see a growth, kidney stone, cyst, or other problems.

 Chest X-ray. This test uses a small amount of radiation to make images of tissues,
bones, and organs on film.

 Renal biopsy. The healthcare provider takes a small sample of kidney tissue. This is
done through the skin with a needle or during surgery. The sample is looked at under a
microscope.

TREATMENT

Most children with kidney disease see both a pediatrician or family healthcare provider and a
nephrologist. A nephrologist is a healthcare provider with special training to treat kidney
problems.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend
on the severity of the condition and the cause. Treatments focus on slowing the progression of the
disease and preventing complications.
Treatment may include changes to your child’s diet. Your child may need to limit:
 Protein. Protein is vital for proper growth and nutrition. But the kidneys may not be able to
get rid of the waste products that come from eating too much protein. Your child's
healthcare provider will talk with you about how much protein your child needs.

 Potassium. Potassium is an important nutrient. But when the kidneys don’t work well, too
much potassium can build up in the blood. Potassium comes from certain foods. Your
child may need to limit or not eat foods with a lot of potassium.

 Phosphorus. The kidneys help remove excess phosphorus from the body. If the kidneys
are not working well, too much phosphorus builds up in the blood and can cause calcium
to leave the bones. This can make your child's bones weak and easy to break. Your child
may need to limit foods with phosphorus.
  Sodium. A low-sodium diet can help prevent or reduce fluid retention in your child's body.
The healthcare provider will talk with you about the amount of sodium allowed in your child's
diet.
Treatment may include medicines to:
 Increase urination (diuretic)
 Reduce blood pressure
 Lower the amount of the mineral phosphorus in the blood (phosphate binders)
 Lessen the body’s immune system response (immunosuppressive medicine)

In some cases, a child may develop severe problems with electrolytes. This may cause
dangerous levels of waste products in the blood that are normally removed by the kidneys. A child
may also develop fluid overload. A child may need dialysis in these cases.
Dialysis is a procedure that filters waste and extra fluid from the blood. This is normally done
by the kidneys. There are 2 types of dialysis.

 Peritoneal dialysis
This can be done at home. This method uses the lining of the belly (abdominal) cavity to filter
the blood. This cavity is the space that holds organs such as the stomach, intestines, and liver. The
lining is called the peritoneum.
First, a surgeon places a thin, flexible tube (catheter) into your child’s belly. After the tube is
placed, a sterile cleansing fluid (dialysate) is put through the catheter into the peritoneal cavity. The
fluid is left in the belly for a period of time. This fluid absorbs the waste products through the
peritoneum. The fluid is then drained from the belly, measured, and discarded. This process of
filling and draining fluid is called an exchange.

 Hemodialysis
This is done in a dialysis center or hospital by healthcare providers. A special type of access,
called an arteriovenous (AV) fistula, is placed during a small surgery. This fistula is an artery and a
vein that are joined together. It is usually done in your child's arm. An external IV (intravenous)
catheter may also be inserted. This is less common for long-term dialysis.
Your child will then be connected to a large hemodialysis machine. Blood is pumped through a
tube into the machine to filter out the wastes and extra fluid. The filtered blood then flows through
another tube back into your child's body.
Hemodialysis is usually done several times a week. Each session lasts for 4 to 5 hours.
It may be helpful to bring games or reading materials for your child to keep him or her busy during
this procedure.
Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all
treatments.
REFERENCES:
https://www.slideshare.net/MYSTUDENTSUPPORTSYST/acute-glomerulonephritis-in-children-in- english

https://www.kidney.org/atoz/content/glomerul#:~:text=Nighttime%20muscle%20cramps-
,What%20causes%20acute%20glomerulonephritis%3F,important%20to%20prevent%20kidney%20
failure.

https://www.ncbi.nlm.nih.gov/books/NBK560644/#article-22279.s4
https://www.stanfordchildrens.org/en/topic/default?id=glomerulonephritis-in-children-90-P03085

PATIENT’S PROFILE

Name: Patient B.E.

Age: 6yrs. old
Gender: Female
Birthday: January 13, 2017
Religion:
RomanCatholic Educational Attainment:
Grade 1 Occupation: Student
Height: 118 cm
Weight: 19.50 kgs
BMI: 14.02
Address: P5 Dabubu Grande, San Agustin, Isabela
Date of Admission: October 25, 3023
Time of Admission: 2:27 P.M.
Chief Complaint: Fever
Admitting Diagnosis: Acute Glomerulonephritis
 PATIENT MEDICAL HISTORY

PAST MEDICAL HISTORY

Patient B.E., a 6 years old female, was born in Echague District Hospital, she completed her
vaccinations at birth which is BCG and Hepatitis B, while her other vaccines like Oral Polio Vaccine,
Pentavalent Vaccine, Measles, Mumps and Rubella Vaccine were given at their respective Barangay
Health Center from her 1st month up until her 12th month of age. She also completed her COVID-19
vaccination but they cannot recall what type of vaccine was given to her. Year 2020, she was
hospitalized due to fever, and was admitted in Echague District Hospital, they cannot recall her
attending physician and any other details from it. Patient has no noted involvement in any vehicular
and non-vehicular accidents, she also has no allergy in any kind of food or medicine. Patient has no
history of Diabetes Mellitus, Hypertension and Heart Disease.

PRESENT MEDICAL HISTORY

Two days prior to confinement the patient started feeling cold, but the patient still prepared to
go to school, at 12:30 in the afternoon she was experiencing mild cough which they disregard, after
lunch the patient went to school again, and when her class was finished in the afternoon, her parents
noticed that she was having fever which they treated with over-the-counter Paracetamol, after eating
dinner she went to sleep. One day prior to confinement, at 7 in the morning her parents noticed that
her fever was on and off, meaning when she was given Paracetamol the fever subsided but when
the medicine was no longer working, she had fever again. At 11 in the morning, they decided to go
RHU San Agustin to have her checked, then they were referred to Medicare Jones, she was given
Paracetamol for her fever and after that they went home and the patient went to take a nap. At 3 in
the afternoon, she ate her prescribed medicine, and ate her late lunch, they noticed that her
condition is not getting well so they monitored her until night, at 7 in the evening she ate her dinner
and went to sleep after that. On October 23, 2023 they decided to bring her to ISSHI, with cc of
fever and hematuria. Upon admission they got her interviewed and took her vital signs, and
administered medicines as follows to her condition.

SOCIAL HISTORY

The patient is known to be very friendly with other people especially with the ones she spends
her daily routine with, she loves playing with her classmate at school, and she is a very active
student. She also loves to play mobile games and watch movies in her mobile phone. She is a very
good kid to her parents; at a very young age she was taught of some house chores that she can do
when she has her free time.

PSYCHOLOGICAL HISTORY

Patient B.E., a 6 years old female, sleeps at 8 in the evening and wakes up at 6 in the
morning, at weekends she also takes naps at 3 in the afternoon until 5 in the afternoon. She eats
three times a day, her favorite food is fried eggs, she also consumes junk foods and soft drinks very
often. Before admission she weighed 20 kilograms and after admission she weighed 19 kilograms,
which means she lost 1 kilogram after being hospitalized. Patient has no noted experience of stress.
She is a cheerful kid before she was even hospitalized
FAMILY MEDICAL HISTORY

Interpretation: His grandmother and grandfather from his father are still alive and well, same goes
with this grandmother and grandfather from his mother. His father and mother have no noted familial
disease, they also have no history of Diabetes Mellitus, Hypertension and Heart Disease.
PATHOPHYSIOLOGY