Rapidly Progressive Glomerulonephritis (Nursing)

00:00 Now hang on to your seats buckle up because we're talking about rapidly Progressive glomerulonephritis.

00:06 Now, this means loss of function over days to weeks.

00:10 This happens much quicker chronic over a period of years Rapidly Progressive.

00:15 We're talking about loss of function of your kidneys and just days to weeks.

00:20 Now I've got five causes up there for you.

00:22 Don't get overwhelmed by that.

00:23 We're going to take them one at a time because this is rapidly Progressive glomerulonephritis.

00:30 We got to look at what might be causing that inflammation in the glomeruli.

00:35 Well, sometimes it can be a complication of an infectious disease or some type of inflammatory response.

00:41 Remember those antibodies can get all clogged up in the kidneys and that can be a real problem causing the glomerulonephritis.

00:48 So first one, you might see it with an infectious disease or inflammatory injury.

00:53 So writing your notes immune system problem right in number 1.

00:58 Now can be a complication of a systemic disease.

01:00 He's like lupus or Scleroderma.

01:02 Whoo! autoimmune disease.

01:05 Okay. So number 1 is immune system response.

01:08 Number 2 is autoimmune number.

01:11 Number 3.

01:12 Yeah, that's a big word for we don't know.

01:15 Idiopathic disease like that just sounds real fancy, but we don't really know why.

01:20 Number 4.

01:22 I have a personal connection to, my dad was very sick with gallbladder.

01:27 So we were waiting for his gallbladder.

01:29 He's going to he had some lab done on friday and he was going to have the surgery on Monday.

01:34 So he was very dehydrated.

01:35 He been throwing up but my goodness he kept taking his NSAIDs non-steroidal anti-inflammatory drugs.

01:44 Now you may know them as ibuprofen or naproxen.

01:47 Those are examples of over-the-counter NSAIDs.

01:50 He was taking some higher powered ones that prescribed for him for his arthritis, and he was not going to miss taking those because he was extremely dehydrated from nausea and vomiting.

02:02 A baby was still having the arthritis pain.

02:04 He took the medication and he ended up with rapidly Progressive glomerulonephritis.

02:09 It threw him into an acute kidney injury or acute renal failure just because he was following what he thought was the best thing for his body.

02:19 So medications like NSAIDs and particularly fragile patients, like my dad who was elderly and is he was really dehydrated and his kidneys took a major hit.

02:30 This led to a lifetime following that on dialysis.

02:34 So that's how important it is that you understand the risks and dangers for all your patients so you can educate them.

02:41 Now rapidly progressing glomerulonephritis number 5 can also happen after a transplant and those are really involved.

02:50 You know, it's fantastic when a community gets behind a patient who needs a transplant for an organ and you have fundraisers and that's all great but life for a patient after a transplant patient.

03:00 A life for a patient after a transplant can be very complicated because they've got to say an immunosuppressive drugs.

03:06 They've got to keep all that together.

03:09 So sometimes this can happen the RPGN and that can really damage they're transplanted kidney but it makes sense. Doesn't it? Cause you've put something foreign into your body you're on a lot of immunosuppressive drugs to try and make sure the body doesn't attack it but you can still have some issues after the transplant.

03:26 Okay, so we've got five.

03:27 How are we going to look at these.

03:29 Well, 1 and 2, immune system or we know that's antibodies clogging things up.

03:35 2. autoimmune.

03:36 3. We don't know doesn't seem like a really need to remember that one, does it? Medications, please please please remember that one.

03:46 I wish I could go back and save my dad's kidney function and the fifth one after a transplant.

03:52 This is a risk for your patience.

03:55 Now clinical symptoms.

03:57 Yes.

03:58 Look, these are all looking very familiar.

04:00 These are just signs that the kidney struggling.

04:03 Protein in their urine, that shouldn't be there blood in their urine, that shouldn't be there, uremia that shouldn't be there, elevated BUN that's a sign of kidneys are struggling as an elevated creatinine and a decreased GFR.

04:18 That means that things are flowing through your glomerulus slower than we need them to.

04:23 So how do we treat it? Well, maybe you got to intervene quickly on this you want to address is there fluid volume overload.

04:29 We know the kidneys are supposed to get rid of excess water.

04:32 So if your kidneys are struggling they probably have extra fluid on board, which is going to lead to hypertension.

04:38 They've got extra waste in their urine as you got the uremia.

04:42 They can have an injury to the kidneys because there's some type of inflammatory response going on.

04:45 So we'll want to treat that.

04:47 Now here are some major treatments dialysis.

04:53 Yeah I'm talking about, usually can you do hemodialysis or peritoneal dialysis either one can be done but they can be done short termed.

05:01 Hopefully maybe get you over the hump.

05:04 Now for my dad his kidneys didn't really recover.

05:07 But some patients will be able to recover.

05:10 Look at plasmapheresis.

05:11 That's super cool.

05:13 Like take the blood out filter it through put it back in you can get rid of those damaging antibodies that are clogging things up.

05:20 Now if it goes really bad, you can also give a transplant but remember patients who have a transplant are also at risk for the rapidly Progressive glomerulonephritis.

05:29 So you just have to really watch be on the look out for those signs.

05:34 Now medications.

05:36 Consider corticosteroids or cytotoxic agents.

05:39 What? Why would we look at that? Well corticosteroids go after inflammation.

05:45 Well rapidly Progressive glomerulonephritis probably caused by some type of inflammation.

05:50 That's one of our issues right up there at number one.

05:53 So that might be a real issue.

05:54 Cytotoxic agents are going to suppress that immune system.

05:58 So that's why in this case will consider corticosteroids or cytotoxic agents depending on what the cause is of the glomerulonephritis.