Causes of Glomerulonephritis: Glomerulosclerosis (Nursing)

00:01 So we've looked at things to give our goal my realist problems.

00:04 They cause that "itis" in it.

00:06 We've talked about infections that can cause it, autoimmune diseases.

00:11 I want to talk now about conditions that actually scar the glomerulus.

00:15 Now when you think about that category, I know it seems pretty broad, But what I want you to focus on most is diabetes.

00:21 Because diabetes cause these micro vascular changes in the glomerular basement membrane.

00:27 Okay, Why do you care? Well basement membranes are really important.

00:31 They help keep contents where they're supposed to be and when you have diabetes you end up with micro tiny tiny tiny vascular changes in these basement membrane.

00:41 So you end up with this scarring in the glomerulus, which is called glomerulosclerosis.

00:48 That's what the scarring means.

00:50 Diabetic nephropathy is a huge problem in the United States.

00:53 It's one of the major causes of end stage renal disease.

00:57 So I wanted you have that framework that lens before we really broke it down.

01:02 Let's start back with the kidney and the blood supply because we know that diabetes causes problems with the microvasculature.

01:10 So let's look at the bigger vessels first.

01:12 Blood goes in the kidney through the renal artery it exits the kidney through the renal vein and then you've got the urine out through the ureter.

01:21 So let's look at a healthy glomerulus.

01:23 This is a patient who doesn't have diabetes and has no kidney disease.

01:27 You see the blood supply going in things circulating around in the glomerulus.

01:32 The filtrate goes through the rest of the Nephron the PCT the DCT and out as urine.

01:38 But now let's look at the difference in a diabetic kidney.

01:42 Remember we know there's a microvascular changes in their basement membrane they're scarring in the glomerulus because of their diabetic disease.

01:51 Now we have a problem with things not staying where they're supposed to.

01:55 Remember the basement membrane helps the right things they in the right places.

02:00 When this is damaged and scarred now we have issues with protein.

02:05 Have you ever wondered why we always check a diabetic patients urine for protein.

02:11 This is why.

02:12 When they have scarred glomerulus from their diabetic disease, Now they've got this problem the glomerulus where protein doesn't stay where it's supposed to it doesn't stay in the bloodstream where we need it.

02:24 It makes its way leaking out through those membranes and into the urine.

02:29 So when your In is diabetic.

02:31 We want to track their urine on a regular basis to screen for any problems with their kidneys as the protein levels increase in their urine that means the damage in their kidneys is getting worse.

02:44 So when you talk about conditions that are scarring the glomerulus and number one thought think about diabetes.

02:49 That's prevalent in the United States.

02:51 It's very common, but our job as healthcare professionals is to help slow that progression of damage.

02:58 Now there are some other things that Scar the glomerulus and none of these are really going to surprise yo.

03:02 Number 2 cause, we've got hypertension.

03:06 So hypertension is those kidneys remember that blood is being just beating the tar out of your kidneys and that's why hypertension can scar the glomerulus your kidneys are pretty cool.

03:19 I mean, they're amazing, but they are not meant to be high pressure all the time.

03:25 So when someone has uncontrolled hypertension the kidneys are going to take a major hit and I want you to think specifically about the glomerulus because uncontrolled hypertension can cause these arteries that supply the kidneys to become narrow.

03:41 Okay pause and think about that just for a minute.

03:43 This hypertension if it's not treated will make the vessels that actually supply the kidneys to become narrow.

03:50 They also getting weak or they can become hard? They just aren't as efficient.

03:54 So your kidneys themselves don't get adequate blood supply.

03:59 Now when the nephrons don't receive the oxygen and nutrients that they need to function well, that's another reason that they end up being damaged.

04:06 So when we're thinking about conditions at scar the glomerulus, we talked about diabetes, now we're breaking down why hypertension is a problem. Right? If it's uncontrolled those vessels become damaged.

04:18 They don't deliver enough blood and nutrients to the kidneys for the nephrons to work, and that's why we end up with problems.

04:26 So glomerulonephritis can also cause Hypertension.

04:31 What do you mean? Well hypertension can cause glomerulonephritis.

04:37 But if a patient also has glomerulonephritis from another reason that will cause a patient's blood pressure to be hypertensive also.

04:45 I know it sounds confusing but think back about what you know, if it's harder because of all the challenge in the kidneys where that blood to push it through that filter that will also raise a patient's blood pressure.