OUR LADY OF FATIMA UNIVERSITY -VALENZUELA CAMPUS

COLLEGE OF NURSING

“Chronic Renal Failure secondary to Chronic Glumerulonephritis:

A Case Study”
A Case Study Presented to the Faculty of College of Nursing

Our Lady of Fatima University

Valenzuela City Campus

In Partial Fulfilment of the Requirements in NCMA 312

Related Learning Experience

For the Degree of Bachelor of Science in Nursing

Presented by:

BSN 3Y1 – 5A
 General
General objectives:
objectives:
This case study aims to provide a deeper understanding and a much more comprehensive
knowledge about a patient who is suffering from chronic renal failure secondary to chronic
glomerulonephritis
specific
specific objectives:
objectives:
- To discuss and analyze the anatomy and physiology of the renal system
- To understand the pathophysiology of glomerulonephritis to the progression of chronic kidney
failure
- To identify what medications are given and understand why it is given.
- To analyze and interpret the laboratory and diagnostic exam
- To enhance skills on how to provide proper care to patient who had peritonitis due to ingestion of
stinky tofu, whom at the same time diagnose with chronic renal failure secondary to chronic
 Patient’s
Patient’s profile:
profile:
Name: K.S.Y

Age: 37 years old

Height: 177 cm ( 5’10”)

Weight: 61 kg (134 lbs)

 case situation:
A 37 year old man with chronic renal failure who was secondary to chronic
glomerulonephritis had been on peritoneal dialysis for approximately 6 months without any
episode of peritonitis. In December 2019, he was admitted to the hospital for fever,vomiting,
abdominal pain, diarrhea, and cloudy dialysate several hours after eating stinky tofu.
The peritoneal effluent culture yielded Aeromonas Sobria. The patient was given
levofloxacin
for 10 days. The patient symptoms such as diarrhea, abdominal pain were relieved and
the cloudy effluent turned to be clear. Unfortunately, peritoneal dialysis catheter was
blocked
because of fibrin clot formation in the setting of inflammation, and finally it was removed.
INTRODUCT
 Chronic renal failure is a slow and progressive decline of kidney function. It is usually a result
of a complication from another serious medical condition such as diabetes, high blood pressure or
cardiovascular disease. Chronic renal failure is a condition in which normal kidney functions are
hampered. Three stages of chronic renal failure are reduced renal reserve, renal insufficiency and
end-stage renal disease (ESRD). Renal reserve (RR) is the kidney's ability to increase its basal
glomerular filtration rate (GFR) by at least 20% after a protein overload and a renal response lower
than that is considered a decreased one. Renal insufficiency is poor function of the kidneys that may
be due to a reduction in blood-flow to the kidneys caused by renal artery disease. End-stage renal
disease (ESRD) is a medical condition in which a person's kidneys cease functioning on a
permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant
to maintain life.
 Chronic glomerulonephritis, one of a group of kidney diseases characterized by long-term
inflammation and scarring of the glomeruli (microscopic structures in the kidney that filter blood
and produce urine). This form of kidney disease usually develops slowly (over years) and may not
produce symptoms at the outset. When symptoms and signs do appear, they typically include blood
in the urine (hematuria), swelling (edema), high blood pressure, foamy urine (due to protein
content), and frequent nighttime urination.

Peritonitis is a common cause of catheter removal and mortality in the patient undergoing
peritoneal dialysis (PD). Various pathogenic organisms have been identified as the etiology of pd-
related peritonitis, among which Aeromonas sobria is a rare one. Several studies have indicated
that Aeromonas sobria might be of particular clinical significance because of its enterotoxin
production. We here present a case of peritonitis due to Aeromonas sobria in a PD patient.
Anatomy and
Physiology
 Kidneys are two bean-shape organs, roughly the size of a large fists. It is located between T12 and L3,
and partially protected by floating ribs. Its function is to filter the blood, produce urine with the assistance of
the nephron, and to maintain a fine balance of water and electrolytes in the body and remove excessive
waste.
 Nephrons are the functional part of the kidneys
that filters the blood (renal corpuscle), reabsorbs
minerals/water and secretes waste (renal tubule), and
produces the substance called urine which will drain
down into the ureters, be stored in the bladder, and
voided out via the urethra. In the renal cortex and
medulla: parts of the nephron sit in the renal cortex,
specifically the glomerulus and Bowman’s capsule,
proximal convoluted tubule. It then dips down in the
renal medulla specifically the loop of Henle. Then the
distal convoluted tubule goes back up into the renal
cortex along with parts of the collecting tubule which
then goes back down into the renal medulla and
connects directly to the renal papilla and urine
excretion begins.
 How does the nephron receive its blood supply? From the afferent arteriole, the afferent arteriole
sends blood to the first part of the nephron called the glomerulus. Glomerulus is a collection of circular
capillaries that have extremely high pressure which help perform ultrafiltration. During this process the
blood will be filtered and filtrate will be created (which is a liquid consisting of the collection of fluid and
particles that came from the blood). These substances will “drip” down into a capsule that surrounds the
glomerulus called Bowman’s capsule (collects the filtrate).

What drips down? Water, Ions: sodium, chloride, calcium, potassium, magnesium, phosphate,
bicarbonate, amino acids, glucose, creatinine and urea (*not filtered blood cells or proteins)
PATHOPhysi
Pathophysiology of Glomerulonephritis to the progression of Chronic Kidney Failure

(A Disease-centered Approach)
Pathophysiology of Peritonitis in
relation to Patient’s Condition

(A Patient- Centered Approach)

Drug study
Nursing care
plans
LAboratory
and
 NORMAL VALUE RESULT INTERPRETATION
LAB TEST

● Complete blood 3,500-10,500 Increased WBC White blood cell count that is higher than
count normal might be an indication that you have
infection or an immune system disorder.
-WBC

● C-reactive protein 10 mg/L Increased A high level of CRP in the blood is a marker of
inflammation. It can be a wide variety of
conditions from infection.
urinalysis:
urinalysis: bun:
- (+) Blood - Increased in BUN (normal value
10-20 mg/dl)
- Proteinuria Mild to
moderate (<2.5 and >3.5g/24
hour)
creatinine
creatinine
- Specific gravity low (normal
- :: in creatinine (normal
Increased
value 0.6-1.1mg/dl)
1.02-1.025)

- Color yellow and hazy

Discharge
Planning
MEDICATION
➢ Informed the companion of choice and patient about the importance of medication.
➢ Informed the companion of choice to encourage the patient to comply with medication regimen.

1. Antibiotics should be taken by mouth ,once a day ,for 10 days

➢ Informed the companion of choice and patient to avoid taking medicines that is not prescribe by the
doctors.

EXERCISE
➢ Instructed the companion of choice and patient that doing exercise regularly may help lower the blood
pressure and keep it from further damaging the kidneys.

➢ Instructed the companion of choice and patient that exercise keeps the body strong and healthy.
TREATMENT
❖ Discussed the importance of strict adherence to medication regimen to the patient to ensure the patients
improvement from the current situation.
❖ Attend hemodialysis session 3 times a week lasting for 4 to 6 hrs.

HEALTH TEACHING
❖ Reminded the companion of choice to encourage the patient must always eat healthy food.
❖ Reminded the companion of choice to encourage the patient to do exercise regularly.
❖ Reminded the companion of choice to encourage the patient to follow the instructions of eating and
drinking given by the healthcare provider.
OUT-PATIENT
❖ Instructed the companion of choice, that patient should follow the schedule of follow-up check-up when
discharged.

DIET
❖ Discussed to companion of choice to encourage the patient to eat nutritious healthy diet with less protein,
salt.
❖ Restricted fluid intake.
❖ Discussed to companion of choice the importance of eating healthy foods for the patient.

SPIRITUAL
❖ Discussed to companion of choice to encourage the patient to strengthen faith and regularly pray to
communicate with God.