Glomerulonephritis

Introduction to Glomerulonephritis

This article introduces glomerulonephritis. The three main points addressed in this article are:

1. Inflammatory changes to the glomeruli
2. Hematuria (cola-colored urine)
3. Fluid volume overload

Inflammatory Changes to the Glomeruli

The most common etiology of glomerulonephritis is a strep throat infection. There are also noninfectious etiologies that can lead to the development of glomerulonephritis, including lupus and Goodpasture syndrome. These etiologies will trigger an abnormal immune response within the kidneys.

During a strep throat infection, the body produces extra antibodies to fight the infection. The extra antibodies eventually settle in the glomeruli and cause inflammation. 

If the etiology is an immune system response, and that response can cause damage to the tissues. For example, lupus can cause the immune system to attack the kidneys, which damages the glomeruli.

Strep throat can lead to glomerulonephritis.

In glomerulonephritis, immunoglobulin G (IgG) and anti-IgG complexes are formed, but the body’s IgG fights the anti-IgG complexes, causing damage to the glomeruli. The damage causes the capillaries in the glomeruli to become very permeable. 

What happens when capillaries become permeable? Leakage. And in the case of glomerulonephritis, red blood cells and proteins leak out.

Read: Nephrotic Syndrome

Hematuria

Hematuria is the leakage of red blood cells into the urine. Hematuria presents as cola-colored or pink urine. Hematuria will be massive in glomerulonephritis, and it is one of the hallmark signs.

Glomerulonephritis is inflammation of the glomeruli.

Another sign of glomerulonephritis is proteinuria, which is when protein leaks into the urine. Proteinuria presents as foamy urine due to the proteins. The loss of protein is generally mild in glomerulonephritis unless the condition worsens.

Overall, the major complication with glomerulonephritis is hematuria, which presents as cola-colored urine.

Related Video – What is Glomerular Filtration?

Fluid Volume Overload

Why is fluid volume overload a presentation of glomerulonephritis? In glomerulonephritis, the patient is losing red blood cells and protein in the urine. When these substances are lost in the urine, they are no longer available in the vascular space. These substances must be in the vascular space to retain fluid.

In glomerulonephritis, fluids leak out of the vascular space and into the interstitium, causing edema.

Edema is one of the signs of fluid volume overload.

Patients present with massive amounts of edema. Because the fluid is outside the vascular space, the body has no way of eliminating it. The fluid must be in the vascular space to be filtered out by the kidneys.

Edema can also cause periorbital edema. That is edema that occurs underneath the eyes.

Fluid volume overload is targeted in patient intervention.

Related Video – Renin-Angiotensin-Aldosterone System (RAAS)

Assessments and Interventions

In treating glomerulonephritis, the provider must monitor:

• Lung sounds
• Airway, breathing, and circulation (ABCs)
• Blood pressure
• Pulse quality

The provider will consider administering several kinds of medications. For example:

• Medications like albumin help pull fluid back into the vascular space.
• Diuretics help eliminate the fluid through the kidneys.
• Corticosteroids calm the immune response that caused the glomerulonephritis.
• Antibiotics will be prescribed if the etiology of the glomerulonephritis was strep throat. 

While treating glomerulonephritis, remember these three key points: inflammatory damage to the glomeruli, hematuria or cola-colored urine, and focus assessments and interventions toward fluid volume overload.