I.

INRODUCTION
Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Eachkidney is composed of about 1 million microscopic filtering "screens" known asglomeruli that selectively remove uremic waste products. The inflammatoryprocess usually begins with an infection or injury (e.g., burn, trauma), then theprotective immune system fights off the infection, scar tissue forms, and theprocess is complete. There are many diseases that cause an active inflammation within the glomeruli.Some of these diseases are systemic (i.e., other parts of the body are involved atthe same time) and some occur solely in the glomeruli. When there is activeinflammation within the kidney, scar tissue may replace normal, functional kidneytissue and cause irreversible renal impairment. The severity and extent of glomerular damagefocal (confined) or diffuse(widespread)determines how the disease is manifested. Glomerular damagecan appear as subacute renal failure, progressive chronic renal failure (CRF); or simply a urinary abnormality such as hematuria (blood in the urine) or proteinuria (excess protein in the urine).

SIGN AND SYMPTOMS :

Common symptoms of acute glomerulonephritis include blood in the urine fever, nausea rash, leg swelling high blood pressure

EVALUATION : Physical findings in those with acute glomerulonephritis may include: Confusion Lethargy Excessive sleepiness Dry skin

Pale skin Loss of muscle tissue

 Muscles become smaller Leg swelling

Foot swelling Facial swelling Worse around the eyes Enlargement of the liver High blood pressure

TREATMENT : The treatment for acute glomerulonephritis depends on the underlying cause, as well as how poorly the kidneys are functioning. Mild cases of acute glomerulonephritis may resolve without treatment. Treatment is directed at the underlying cause, but also includes medications to control high blood pressure and a kidney diet to reduce the stress on the kidneys. Short-term kidney dialysis may be necessary for severe cases of glomerulonephritis that result in sudden kidney. failure. Treatment for acute glomerulonephritis may include:

Kidney disease diet:

o o o o o o o

Low calorie diet Low protein Low sodium diet Low potassium diet Low phosphorus diet Calcium supplement Vitamin B supplements

VI. ANATOMY AND PHYSIOLOGY :

A. RENAL VEIN This has a large diameter and a thin wall. It carries blood away from the kidneyand back to the right hand side of the heart. Blood in the kidney has had all itsurea removed. Urea is produced by your liver to get rid of excess aminoacids.Blood in the renal vein also has exactly the right amount of water and salts. Thisis because the kidney gets rid of excess water and salts. The kidney is controlledby the brain. A hormone in our blood called Anti-Diuretic Hormone (ADH for short) is used to control exactly how much water is excreted. B. RENAL ARTERY This blood vessel supplies blood to the kidney from the left hand side of theheart. This blood must contain glucose and oxygen because the kidney has towork hard producing urine. Blood in the renal artery must have sufficientpressure or the kidney will not be able to filter the blood.Blood supplied to the kidney contains a toxic product called urea which must beremoved from the blood. It may have too much salt and too much water.The kidney removes these excess materials ; that is its function. C. RENAL PELVIS This is the region of the kidney where urine collects. If you are very unlucky, youmay develop kidney stones. Sometimes the salts in the urine crystallise in the pelvis and form a solid mass which prevents urine from draining out of themedulla of the kidney.

D. URETER This one is easy peasy: the ureter carries the urine down to the bladder. It doesthis 24 hours per day, but fortunately the urine can be stored in a bladder so thatit is not necessary to wear a nappy! E. MEDULLA The medulla is the inside part of the kidney. It is shown in green in the diagram,but in real life it is a very dark red color. This is where the amount of salt andwater in your urine is controlled. It consists of billions of loops of Henl. Thesework very hard pumping sodium ions. ADH makes the loops work harder to pumpmore sodium ions. The result of this is that very concentrated urine isproduced.The opposite of an anti-diuretic is a "diuretic". Alcohol and tea are diuretics. F. Cortex The cortex is the outer part of the kidney. This is where blood is filtered. We callthis process "ultra-filtration" or "high pressure filtration" because it only works if the blood entering the kidney in the renal artery is at high pressure.Billions of glomeruli are found in the cortex. A glomerulus is a tiny ball of capillaries. Each glomerulus is surrounded by a "Bowman's Capsule". Glomerulileak. Things like red blood cells, white blood cells, platelets and fibrinogen stay inthe blood vessels. Most of the plasma leaks out into the Bowman's capsules.This is about 160 liters of liquid every 24 hours.Most of this liquid, which we call"ultra-filtrate" is re-absorbed in the medulla and put back into the blood. F. NEPHRONS NEPHROS is the Greek word for kidney. Your kidney doctor is called a NEPHROLOGIST because he treats kidney diseases. The tiny structures that do the work in your kidneys are called NEPHRONS. Each of your kidneys contains about one million nephrons. Each nephron has a small blood vessel that brings in unfiltered blood, a GLOMERULUS (glow-mareYule-us) that filters the blood, a tubule that caries away filtered waste materials in the urine, and a small blood vessel that returns filtered blood to the body.

G. Glomerulus and Bowman's Capsule This is where ultra-filtration takes place. Blood from the renal artery is forced intothe glomerulus under high pressure. Most of the liquid is forced out of theglomerulus into the Bowman's capsule which surrounds it. This does not workproperly in people who have very low blood pressure.

H. Proximal Convoluted Tubules Don't worry about remembering the name for your GCSE biology. Jolly goodthough if you can. Proximal means "near to" and convoluted means "coiled up"so this is the coiled up tube near to the Bowman's capsule. This is the place where all that useful glucose is re-absorbed from the ultra-filtrate and put back into the blood. If the glucose was not absorbed it would endup in your urine. This happens in people who are suffering from diabetes. I. Loop of Henl This part of the nephron is where water is reabsorbed. Kidney cells in this regionspend all their time pumping sodium ions. This makes the medulla very salty; youcould say that this is a region of very low water concentration. If you remember the definition of osmosis, you will realize that water will pass from a region of high water concentration (the ultra-filtrate and urine) into a region of low water concentration (the medulla) through cell membranes which are semi-permeable

J.

Distal Convoluted Tubules Don't worry too much about the name. Distal means "distant" so it is at the other end of the nephron from the Bowman's capsule. This is where most of the salts in the ultra-filtrate are re-absorbed.

K. Collecting Duct Collecting ducts run through the medulla and are surrounded by loops of Henl. The liquid in the collecting ducts (ultra-filtrate) is turned into urine as water andsalts are removed from it. Although our kidneys make about 160 liters of urine every 24 hours, we only produce about liter of urine. It is called a collectingduct because it collects the liquid produced by lots of nephrons. L. THE RENIN ANGIOTENSIN MECHANISM Decreased blood pressure stimulates the kidney to stimulates the kidney tosecrete renin. Renin splits the plasma protein angiotensinogen (synthesized by the liver) toangiotensin I. Angiotensin I is converted to angiotensin II by an enzyme (called convertingenzyme)secreted by the lung tissue and vascular endothelium. Angiotensin II : causes vasoconstriction stimulates the adrenal cortex to secrete aldosterone which maintainsnormal blood levels of sodium and potassium and contributes to the maintenance of normalblood pH, blood volume, and blood pressure.

II. OBJECTIVES :
-GENERAL OBJECTIVESThe general objective of this case presentation is to master and develop knowledge and skills in providing care and management to a patient with acute glomerulonephritis.

-SPECIFIC OBJECTIVES-

1. To define acute glomerulonephritis.

2. To know the clinical manifestation, nursing management and interventions or patient who this disease. 3. To know the different medications that needs to be taken including its side effects which can be harmful to the patient.

-SKILLS>To be able to obtain, document and present comprehensive medical history. >To perform initial physical examination such as general assessment to the patients appearance, position and degree of comfort. >To apply necessary skills in providing care or a client with acute glomerulonephritis.

-ATTITUDES-

>To learn how to establish rapport with the client and significant others.
>To be able to recognize the importance of patient and familial preferences when selecting among treatment option.

III. BIOGRAPHICAL DATA

NAME : Patient X AGE : 17 years old GENDER : female DATE OF BIRTH : October 27,1993 ADDRESS : San Antonio Alang-alang, Leyte RELIGION : Catholic CIVIL STATUS : Single NATIONALITY : Filipino NAME OF MOTHER : Mrs. I NAME OF FATHER : Mrs. A DATE OF ADDMISSION : September 26,2011 CHIEF COMPLAIN : swelling of face, upper and lower extremeties ADMITTING DIAGNOSIS : UTI t/o AGN PHYSICIAN : Dra. Y