 Welcome to Nursing School Explained and today's video on chlomerular nephritis. If we look at the word again, chlomerular pertains to the chlomerulus of the kidney, nephro refers to the kidney itself, and then hiatus is inflammation or infection. So now this pertains to inflammation of the chlomerulus of the kidney. Let's look at how this happens. The most common cause for this condition is an infection of group A beta hemolytic strep, which is usually an acute infection and acute strep throat. And the symptoms of chlomerular nephritis start about one to two weeks after the strep throat infection, where an antigen antibody complex forms and because this is a large complex, it gets deposited and kind of clogs up the kidney. And because of this, the position of these complexes, the kidney gets inflamed and therefore it leads to this condition. Other conditions or causes that can cause chlomerular nephritis is infective endocarditis as well as a multitude of viral infections and then autoimmune disorders such as lupus and scleroderma. Now whatever we think about something that has to do with the kidney, this can be really significant and we always have to think about volume when we think about the kidney and those are signs and symptoms that the patient will be displaying. So first of all, initially the patient may present with periorbital edema, so just some minor swelling around the eyes, but eventually as the condition progresses, it leads to generalized edema because of the decrease in chlomerular filtration and the rate because of everything is clogged up. Now the decrease of the filtration rate leads to the accumulation of fluid in the patient's system which can then lead to hypertension because of this fluid volume excess. Also therefore because the filtration is decreased, there is going to be oliguria, so decrease in urine output because we are retaining so much fluid. And then there is hematuria and typically the color of the urine will be either tea colored, cola or bright red. So any kind of a reddish black or kind of a rusty tea colored kind of color. In addition, because of the chlomerular filtration that membrane being damaged, there can be protein that's spilled in the urine. And then the patient obviously will not be overall feeling well, so they'll have some anorexia and decreased appetite as well as all this edema with the hypertension can possibly lead to pulmonary edema. So you can see this is a pretty serious condition here. As for diagnostic tests, when we suspect that the patient has gloveronophritis, we're going to want to see if they have strep in their body. So we want to do an ASO which is an anti-streptolycin O-tider test. It's a blood test. And I also take a throat culture to detect if there's any strep throat in this patient. We certainly want to check the urine which will be positive for protein, blood and then hyaline casts which are some of these like sloughing off of the membrane. And then we're going to want to check a complete blood count and a comprehensive metabolic panel that most likely will show that the BUN and creatinine are increased as the filtration decreases and the kidney takes a toll. And then there will be some signs of inflammation or infection with an elevation in white count. H and H can be low because whenever the kidney is affected that can be something that happens. We have hemodilution because of the fluid volume excess that we're dealing with here. And then there will be low of human because we're spilling all that protein in the urine. ESR so inflammation will be increased and then certainly hyperkalemia can occur as we know can happen whenever there's damage to the kidney. So when the kidney is under aniburis. And then certainly we want to also check an ultrasound and a biopsy to see if there are any other causes of this condition and to maybe see what exactly is going on and determine any other reasons for this. In terms of treatment and nursing care, so these patients like I said they can be pretty significantly ill and that fluid volume excess is really the most significant causative agent so we need to check the vital signs very frequently and keep the blood pressure under control. In addition we always want to check their lung sounds because as we know with fluid volume excess it can lead to this pulmonary edema so we want to keep an eye on that probably more than once a shift maybe listen to them every four hours or so. The patient will need some rest to kind of get over this episode. In terms of the diet there will be decreased protein, decreased sodium and decreased fluid in their diet so there will be a fluid restriction to combat that problem with the fluid volume excess. For medications they'll need anti-hypertensives to keep the blood pressure within normal limits or within the defined parameters as well as diuretics to eliminate some of this extra fluid. And then the best practice however is that we teach our patients whenever they get prescribed a course of antibiotics to make sure that they finish the entire course because many times the patient even for a simple strep throat they feel better after three to five days when the course of the antibiotic was supposed to be ten days so they stop taking it after five days but that doesn't eliminate all the strep out of their system and some of that strep hangs around and then can cause this antigen antibody complex here to form leading to this complication of glomerular nephritis. So the most important part is that we teach our patients finish the full course of the antibiotics as it was prescribed even if you do feel better after a few days to make sure that all of the bacteria are eliminated out of their system. And then for complications, glomerular nephritis this acute post-infectious inflammation of the kidney can lead to chronic glomerular nephritis which then in turn can lead to end stage renal disease, chronic renal failure and our patients might end up on dialysis if it gets really severe. Now as you can see I have again highlighted here the most important things so glomerular nephritis caused mostly by group A beta hemolytic strep the edema is one of those real tell-tale signs that starts periorbital and then moves into generalized edema. The urine color T colored colo are bright red and that is in comparison to nephrodic syndrome which is a different condition that also affects the kidney and you can watch my separate video on that. And then the best practice to make sure that the patients finish their full course of the antibiotics. So thank you so much for watching this video on glomerular nephritis please also see the other video on nephrodic syndrome and the other renal disorders in the appropriate playlist. Give me a thumbs up if you enjoyed the video and I'll see you soon right here on Nursing School Explained. Thanks for watching.