Skip to main content

Glomerulonephritis Nursing Guide

This course is intended as a Quick Reference for glomerulonephritis and will cover an overview as well as nursing considerations utilizing the nursing process. 

Etiology and Epidemiology

Glomerulonephritis Definition

Glomerulonephritis (GN) is an alteration in kidney function from an injury to the glomeruli. GN falls into one of three categories: Primary, streptococcal infection, or secondary disease caused by a pre-existing condition. The glomeruli, which are responsible for ridding the body of harmful substances, can no longer prevent blood cells and proteins from filtering out through the kidneys. 

The exact cause of glomerulonephritis is not always evident or always related to kidney disease (DynaMed, 2018a). GN develops after an immunologic response in the body triggering inflammation and proliferation of glomerular tissue. The acute form of GN is the most serious and can lead to permanent glomerular damage. Acute GN progresses to chronic GN in approximately 30% of affected adults (DynaMed, 2018a). 

Glomerulonephritis usually appears after an infection or from another systemic disorder. Infection-related glomerulonephritis progresses to kidney failure in 15% of adults (DynaMed, 2018b). For GN caused by infective endocarditis, 32% of individuals have full recovery within 25 months. 

 

According to the Centers for Disease and Prevention (2021), GN can occur after a group A strep infection in adults and children. Some other conditions that increase the risk for developing glomerulonephritis are: 

  • Blood or lymphatic disorders 
  • Exposure to hydrocarbon solvents 
  • History of cancer 
  • Strep infections 
  • Viruses 
  • Heart infections 
  • Abscesses 
  • Amyloidosis 
  • Basement membrane disorder 
  • Focal segmental glomerulosclerosis 
  • Analgesic nephropathy syndrome 
  • IgA nephropathy 
  • Lupus nephritis 

Regardless of the cause of GN, the signs and symptoms are similar and include: 

  • Asymptomatic in early disease 
  • Sore throat or impetigo if cause is group A strep 
  • Pink, tea, or cola-colored urine 
  • Proteinuria 
  • Periorbital edema 
  • Edema of extremities 
  • Shortness of breath 
  • Fatigue 
  • Anorexia 
  • Hypertension 
  • Headache 
  • Joint or abdominal pain 
  • Azotemia 

 

The symptoms of acute poststreptococcal GN usually last for < 2 weeks. Renal function takes up to 3 months to improve, and hematuria lasts up to 6 months. The loss of protein or proteinuria lasts for as long as 10 years after GN is diagnosed and treated. 

Decreased kidney function, whether acute of chronic, is the main complication of GN (DynaMed, 2018a). Other complications that can arise are: 

  • End-stage renal disease 
  • Hypertension 
  • Hypertensive encephalopathy 
  • Seizures 
  • Heart failure 
  • Endocarditis 
  • Electrolyte and fluid imbalances 
  • Nephrotic syndrome 
  • Malnutrition 

 

Glomerulonephritis ICD-10 Code: N05. 2

  • Unspecified nephritic syndrome with diffuse membranous glomerulonephritis.

 

Glomerulonephritis (GN) Diagnosis 

Treatment for GN is dependent on the type of GN. In mild GN, there may be no symptoms and is often discovered through a routine urinalysis. For acute onset GN, infection should be suspected (DynaMed, 2018b). As GN advances, blood and protein are present in the urine. 

Tests often ordered when GN is suspected include a urinalysis and a creatinine blood test. A kidney ultrasound checks the shape, size, and flow of the kidneys. A kidney biopsy gives a definitive diagnosis of GN. 

When uncertain about diagnosis, a renal biopsy is needed to differentiate from other conditions (DynaMed, 2018a). The renal biopsy will show: 

 

Management & Treatment of GN 

The management of GN starts with preventing complications by adding certain medications such as: 

  • Antibiotics or antiviral medication 
  • Loop diuretics such as furosemide (Lasix®) 
  • Potassium replacement with potassium chloride (K-Dur® or Klor-Con®) 
  • Phosphate binding agents such as sevelamer (Renagel®) 

Managing conditions that cause GN is a vital factor in prevention. Minimizing risk factors such as hypertension or chemical exposures can also prevent GN. Some other considerations for managing GN include: 

  • Sodium restriction 
  • Corticosteroids 
  • Angiotensin-converting enzyme (ACE) inhibitors 
  • Dialysis for severe renal impairment 

 

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for glomerulonephritis are listed below. 

 

Assessment 

Assess signs and symptoms, such as: 

  • Vital signs 
  • Changes in urine output 
  • Protein in urine 
  • Hypertension 
  • Ability to perform activities of daily living 
  • Change in weight 
  • Fall risk 
  • Fluid intake 
  • Sodium intake 
  • Facial edema 
  • Extremity edema 
  • Increase in serum creatinine or BUN 
  • Weakness 
  • Dizziness or lightheaded 
  • Pallor 
  • Lethargy 
  • Irritability 

 

Nursing Diagnosis/Risk For 

  • Imbalanced nutrition, less than body requirements, as evidenced by (Phelps, 2021a): 
    • Proteinuria 
    • Electrolyte imbalance 
  • Excess fluid volume, as evidence by (Phelps, 2021b): 
    • Decreased renal regulation of fluid removal from the body 
    • The inability of the kidney to properly regulate sodium removal from the body 
  • Risk for electrolyte imbalance as evidenced by (Phelps, 2021c): 
    • Edema 
    • Renal dysfunction 

 

Interventions 

  • Offer small frequent meals with supplements as ordered 
  • Restrict fluids as ordered 
  • Limit dietary sodium 
  • Monitor vital signs 
  • Monitor daily weights 
  • Monitor blood sugar as ordered 
  • Monitor intake and output 
  • Administer medications as ordered 
  • Monitor serum chemistries as ordered 
  • Encourage activity as tolerated 
  • Encourage independence through activities of daily living 
  • Provide frequent rest periods 
  • Activate seizure precautions 
  • Monitor for signs and symptoms of heart failure: 
    • Distended neck veins 
    • Tachycardias 
    • Gallop rhythm 
    • Enlarged liver 
    • Crackles in lung bases 

 

Expected Outcomes 

  • Maintains current weight 
  • Communicates dietary requirements 
  • Self-monitors fluid and sodium intake 
  • Maintains normal serum electrolytes 
  • Verbalizes signs and symptoms to report to the healthcare provider 
  • Remains free of injury 

 

Individual/Caregiver Education 

  • Sodium and fluid restriction 
  • Signs and symptoms of electrolyte balance to report to the healthcare provider 
    • Irregular or racing heartbeat 
    • Shortness of breath 
    • Seizures 
    • Nausea or vomiting 
    • Lethargy 
    • Increased edema 
  • Disease process and proper body requirements for fluid, nutrition, and activity 
  • Recommended follow-up with healthcare provider 

Save 15% on Nursing Continuing Education Courses

Earn CEUs with Nurse.com's extensive course catalog. Use code CE15OFF at checkout to save 15% on your CE course

Save 15% Today!
View All Clinical Guides

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

 

Course Contributor 

The content for this course was revised by Kathleen Koopmann, RN, BSN, PCCN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner. 

 

Resources 

 

References