References:
- Wong’s Nursing Care of Infants and Children, 11th Edition, ISBN 978-0-323-54939-4, by Marilyn J. Hockenberry, David Wilson, and Cheryl C. Rodgers (p. 795)
The majority of cases of renal glomerular disease are acute glomerulonephritis, minimal change nephrotic syndrome, and glomerulonephritis associated with systemic diseases. However, a few cases present a prolonged course and a poor ultimate prognosis. This diagnosis describes a variety of different disease processes that may be distinguished from one another by renal biopsy.
Pathophysiology
- Immunologic mechanisms can be implicated through direct attack on the kidney or secondary to the accumulation of immune complexes in the glomerular filter or fibrin deposition from previously damaged glomeruli.
- Either can contribute to further glomerular damage and can initiate chronic changes in the glomerular structure. These changes can go for years asymptomatically if it follows no history of acute glomerular disease, which is most cases.
- Eventually, kidney destruction produces marked reduction in renal function. Consequently, the disease is more common in adolescents than in younger children.
Clinical Manifestations
- Proteinuria or microscopic hematuria may be the only findings found early in the disease, often during a routine examination. Proteinuria may reach levels found in nephrotic syndrome.
- Laboratory findings may indicate decreased renal function.
- Other symptoms depends on the cause for the CGN. These may include hypertension, edema, intermittent gross hematuria, and other manifestations of chronic kidney disease.
Diagnostic Evaluation
Laboratory tests are the primary method of evaluation.
- Urinalysis: proteinuria with casts and red and white blood cells.
- Serology: elevated BUN, creatinine, and uric acid levels— evidence of decreased renal function.
- Electrolytes: metabolic acidosis, elevated potassium elevated phosphorus, and decreased calcium levels.
Therapeutic Management
Treatment is appropriate to the underlying disease and is largely symptomatic in most cases. Nursing efforts should be directed toward providing optimum conditions for the child’s physical, psychologic, and social development.
- As few restrictions as feasible should be imposed, and the child should be allowed to live as normal a life as possible for as long as possible.
- Marked hypertension is controlled with antihypertensive agents.
- Anemia may require recombinant erythropoietin and iron supplements.
- Dialysis or transplantation may be needed to restore relatively good health; however, these alternatives are reserved until renal failure is far advanced.
- Referral to centers specialized in renal disease is important, especially for cases of rapidly progressing glomerulonephritis.