Acute Diffuse Glomerulonephritis (GNDA): Etiology, Epidemiology, Pathophysiology and Medical Treatment

Description:

Acute Diffuse Glomerulonephritis (GND) within this classification of the main diseases that affect diffusely and mainly the glomeruli of the kidneys, can be inflammatory or degenerative. Especially affects children, especially preschool age, however 90% of them have healing, 10% develop a chronic form and 1% can evolve rapidly and progressively.

Glomerulonephritis (GN) is the proliferation and inflammation of the glomeruli, secondary to an immunological mechanism, characterized by an anterior infectious episode, streptococcal or not, which triggers the clinical picture after a period of latency. In general, it resembles acute neuritic syndrome (ANS).

Etiology

Among the bacteria, what has most associated GN has been the beta hemolytic beta streptococcal group, while other streptococci (such as pneumococcus), staphylococcus, meningococcus, and Mycoplasma have been associated with acute glomerulonephritis.

Epidemiology

The probability that an individual develops NGVD in the presence of a streptococcal nephritogenic is 15%, being more frequent in children and adolescents, especially in the age group of 3 to 12 years of age. Less than 5% of cases are seen in children under 2 years of age and 5 to 10% occur in adults over 40 years of age. The disease is rarely repeated in the same individual, men are more affected than women in a ratio of 2 men and 1 woman.

Pathophysiology

In most cases, the NGVT arises from a case of streptococcal pharyngeal infection, in 2 to 3 weeks it can also continue with infections of the skin, the upper respiratory tract (mumps, varicella-zoster, hepatitis B, infection with the human immunodeficiency virus) in some patients may be foreign to the body for antigens (serum and drugs) in other cases, the kidney tissue itself serves as an antigen stimulator.

The decrease in glomerular filtration results in the renal retention of sodium and water, produces edema and often hypertension, which may have other factors besides the consequence of the retention of hydro salt and hypervolemia, hematuria and proteinuria are subsequent. It is due to the inflammatory process of glomerular capillaries, which allows the passage of red blood cells and protein in the urine.

Clinical manifestations

The clinical manifestations of GNDA appear after a latency period ranging from one to three weeks after the infection of the oropharynx, and an average of 21 days after the infection of the skin . During this period, it is asymptomatic, however, it is possible to identify microscopic hematuria and proteinuria in 30% of patients, when there is no latency period it should be alert to the possibility of exacerbation of the chronic disease.

The main aspect of GN is haematuria that has a sudden onset and may be microscopic, gross or gross proteinuria and is usually present due to the permeability of the cell membrane, the terms of serum creatinine and BUN may increase as cataracts of urinary output. There is a reduction in renal function, sodium and water retention, edema and various degrees of arterial hypertension (HA) is observed in approximately 75% of patients.

Complications

Complications to Acute Diffuse Glomerulonephritis is hypertensive encephalopathy (considered a medical emergency where it is necessary to reduce blood pressure without impairing renal function), heart failure and pulmonary edema. When the signs and symptoms of uremia are severe, dialysis begins. In patients with more severe forms may present headache, discomfort or pain in the side, confusion, drowsiness and seizures, are common in confused with neurological disorders.

Medical treatment

Medical treatment for NGTT consists mainly of treating the symptoms to preserve renal function and the treatment of immediate complications, since drug therapy depends on the cause of glomerulonephritis.

Treatment and nursing care

The majority of patients with complications of GN are treated as outpatients. In most children with NDT, the most effective treatment is the restriction of water, proteins, especially when urea is very high, as is the case of sodium in hypertension, edema and heart failure, the fluid balance must be measured and registered, the fluids administered must be calculated efficiently according to the loss and body weight.

Especially in patients treated with diuretics, weight, blood pressure should be monitored and should be carefully evaluated frequently in order to avoid worsening renal function due to possible hypovolemia.

Other nursing care consists of teaching the patient self-care, where the restrictions of the diet are clarified, in addition to being guided to obtain medical attention if symptoms such as fatigue, nausea, vomiting and decreased urine production occur , or the sign of any infection, the information that must be given verbally and in writing, and it is important to emphasize that the treatment should not be interrupted, even with signs of improvement.