Nephritis is a inflammation of kidney . It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis. Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus . It is inflammation of lower urinary tract .

1. PRESENTED BY:RAKHI PANWAR
BSN 2nd YEAR
LUPUS NEPHRITIS AND
INTERSTITIAL
NEPHRITIS

2. LUPUS NEPHRITIS
CONTENT:

3. • Risk factor
• Pathophysiology
• Clinical manifestation
• Complication
• Diagnostic evaluation
• Nursing management
• Prevention
• Introduction to lupus
nephritis
• Lupus or SLE
• Meaning and
Definition
• Classification/stage
• Etiology and causes

4. INTRODUCTION
• Lupus nehritis : One of the most serious
manifestations of Systemic lupus erythematosus or
SLE
• Approximately 10 to 30% of patient with lupus
nephritis progress to end stage renal disease
(ESRD)
• May require hemodialysis or renal transplantation
if ESRD occur.

6. LUPUS OR SYSTEMIC LUPUS
ERYTHEMATOSUS (SLE) :
SLE Or systemic lupus erythematosus or
lupus is a autoimmune condition that causes
inflammation.
Body system affected : Joints, Skin, Lungs,
Heart,Kidneys, Brains,blood system .

7. MEANING/ DEFINITION :
LUPUS NEPHRITIS
•Lupus: systemic lupus erythematosus and
• nephritis: nephron :greek word, meaning
kidney and itis: inflammation
•Lupus nephritis is the inflammation of
kidney due to systemic lupus erythematosus
which is an autoimmune disease.

8. CLASSIFICATION AND
STAGES OF LUPUS
NEPHRTIS :
(ACCORDING TO WHO)

9. •Class 1: minimal mesangial glomerulonephritis
•class 2: mesangial proliferative lupus
nephritis
•class 3: focus glomerulonephritis
•class 4: diffuse proliferative nephritis
•class 5: membranous glomerulonephritis
•class 6: advanced Sclerosing lupus nephritis

10. ETIOLOGY AND CAUSES :
•Idiopathic
•Genetic predisposition

11. RISK FACTOR :
•GENDER: men are More at risk than women .
•AGE: It can occur at any age and time;
however cases are noted in people aged
between 15 and 45 years.
•ETHNICITY: Occur more frequently in
Asian, african-american and hispanics.

14. PATHOPHYSIOLOGY

15. • In a patient with lupus, process of phagocytosis is
too slow or performed incorrectly.
• Apoptic bodies are not consumed properly
• Bodies breakdown and leak out material into body
• Nuclear material(DNA) is present in apoptic bodies
and enters into extracellular matrix/space and
detected by immune system (as a foreign invader)

16. • Immune system creates antibody against it to attack nuclear
antigen
• Formation of immune complex takes place
• Immune complex deposition gets deposited in glomeruli of
kidney or basement membrane of Capillaries.
• Activation of complement system(type 3 hypersensitivity or
immune complex mediated hypersensitivity results in
• Neutrophile Infiltration,vasodilation and edema also activate
intrinsic pathway of coagulation system and microthrombi
form ; tissue ischmia and necrosis (fibrinoid necrosis).

17. CLINICAL
MANIFESTATIONS

18. NEPHROTIC SYNDROME
• Proteinuria(>3g/day )
• Hypoalbuminia (maitain and regulates oncotic
pressure )
• Edema
• Hyperlipidemia

19. NEPHRITIC SYNDROME :
• BUN increases
• GFR decrease
• Hematuria
• Oliguria
• Hypertension

20. FOAMY URINE

21. WEIGHT GAIN

22. MALAR RASH

23. EDEMA & SWELLING

24. HIGH BLOOD PRESSURE

25. •High creatinine level in blood
•Fever
• Nocturia
•Joint pain
•Muscle pain

26. DIAGNOSTIC EVALUATION :
•History
•Physical examination
•Urinalysis
•CBC
•Complement test (protein C3 nd C4) low
count

27. •Positive antinuclear antibody
•Positive anti-dsDNA
•High ESR.
•High C-reactive protein
•High serum cholesterol
•Low serum albumin
•High serum TAG

28. •Hematuria
•Anemia
•Low eGFR
•Low creatinine clearance
•High serum creatinine

30. • Kidney biopsy
• Ultrasound scan of kidney
• IOTHALAMATE CLEARANCE TEST: This is
done When kidney does not filter in correct way this
test is also use to assess the speed of Kidney
filtration more accurately. The test involve Injection
of radioactive iothalamate in blood then test the
duration how quickly it is excreted in urine.

31. COMPLICATION:
•Acute renal failure
•Chronic renal failure

32. MEDICAL MANAGEMENT :
The goal of management is :
•to decrease occurrence of flares,
•to Protects organs, joints and tissues from
damage, and
•to improve quality of live.

33. •Reduce symptoms or make symptoms
disappear (remission)
• Keep the disease from getting worse
•Maintain remission
•Avoid the need for dialysis or a kidney
transplant
-Belimumab:to decrease B Cell activity.

34. Drug regimens prescribed for lupus
nephritis include:
• mycophenolate mofetil (MMF),
cyclophosphamide + corticosteroids, and
the
immunesuppressant azathioprine with co
rticos-teroids.
• immunosuppressive drugs were better
than corticosteroids for renal outcomes

35. •MMF is safer than cyclophosphamide
with corticosteroids, with less chance
of causing ovarian failure, immune
problems or hair loss. It also works
better than azathioprine with
corticosteroids for maintenance
therapy.
•Hydroxichloroquine : Basic treatment

36. NURSING MANAGEMENT :
NURSING ASSESSMENT:
•Assess fluid status (daily weight monitoring ,
intake and output ,skin turgor, distension of
neck veins)
•Assess dietary/nutritional pattern (Diet
history , food preferences)

37. • Assess for edema (ankles, arm, feet, face,
eyes etc.)

38. NURSING DIAGNOSIS,
GOAL
AND
NURSING
INTERVENTION:

39. 1.Acute pain related to disease condition
GOAL:To reduce the level of pain
in client
NURSING INTERVENTION:

40. • Provide comfortable position to the client.
• Assess the location, characteristics, Onset,duration,
frequency,quality(sharp, dull) And severity(By using
pain scale eg wong baker pain scale) of pain via
assessment.
• Perform history assessment of pain(effectiveness of
Previous pain management etc)
• Determine factors that alleviate pain.
• Administered analgesics .

41. 1. Excess Fluid Volume Related to fluid
accumulation And decreased kidney
function.
GOAL :To reduce fluid volume in client

42. NURSING INTERVENTION:
• Daily weight monitoring of pt.
• Monitor intake output chart of patient
• Monitor vital signs(BP for Hypertension)
• Assess for edema (site,degree,type)
• Limiting the sodium intakes
• Limit the intake of fluid and water
• Administer diuretics as prescribed

43. PATIENT
TEACHING:

44. •Sodium restriction along with fluid restriction .
•Low fat diet (due to hyperlipidemia ) per MD
order.
•Low protein diet
•Avoid high potassium fruits and vegetables.
•Monitoring Phosphate intakes
•Educate patient about SLE.

45. INTERSTITIAL
NEPHRITIS

46. INTRODUCTION :
•Interstitial nephritis, also known as
tubulointerstitial nephritis, is
inflammation of the area of kidney
known as the interstitium, which consists
of a collection of cells, extracellular
matrix and fluid surrounding the renal
tubule.

48. DEFINITION:
•Interstitial nephritis is a kidney
disorder in which the spaces between
the kidney tubules become swollen
(inflamed). This can cause problems
with the way your kidneys work.

49. TYPES OF
TUBULOINTERSTITIAL
NEPHRITIS:
(A). ACUTE INTERSTISTIAL NEPHRITIS:
Has a rapid clinical onset and is characterized
histologically by interstitial edema, often
accompanied by leukocytic infiltration of the
interstitium or tubules and tubular injury.

50. (B). CHRONIC INTERSTITIAL
NEPHRITIS
There is infiltration with predominantly
mononuclear leukocytes, prominent interstitial
fibrosis,and widespread tubular atrophy.
ACUTE
• Edema
• Eosionphil
• Neutrophils
CHRONIC
• Fibrosis
• Tubular atrophy

51. CAUSES:
• INFECTIONS :
-acute/chronic bacterial pyelonephritis
-other infections(virus,bacteria)
• TOXINS
-drugs
-analgesics
-heavy metals(lead,cadmium)

52. • METABOLIC DISEASES:
-urate nephropathy (uric acid nephropathy)
-hypercalcemic nephropathy
-hypokalemic nephropathy
-oxalate nephropathy
• IMMUNOLOGIC RXN:
-lupus
-sjogren syndrome
• CHRONIC URINARY TRACT OBSTRUCTION

53. PATHOPHYSIOLOGY:

55. CLINICAL
MANIFESTATIONS :

56. CLASSIC TRIAD
OF SYMPTOMS :
1.Rash
2.Joint pain and
3.Increased
eosinophils in
blood
•Nausea
•Vomiting
•Anorexia
•Weight loss
•Pain with urination
•Flank pain

57. • BUN increases
• GFR decrease
• Non-oliguric AKI
• Hypertension (rare)
• Salt wasting

58. • Impaired ability to concentrate urine
(diluted urine)
• Diminished ability to excrete acids
(metabolic acidosis

60. DIAGNOSTIC
EVALUATION:

61. •Health history
•Physical examination
The health care provider will perform a
physical exam. This may reveal:
•High blood pressure

62. Common tests include:
•Blood chemistry
•BUN and blood creatinine levels
•Complete blood count
•Kidney biopsy
•Kidney ultrasound
•Urinalysis

63. MEDICAL
MANAGEMENT :
The goal of management is :
•Reduce symptoms
• Keep the disease from getting worse
•Avoid the need for dialysis or a kidney
transplant

64. •Removal of drug causing Condition
•cyclophosmide And Cyclosporine
(steroids)
• Immunosuppressive Therapy
• Kidney Transplant
• Dialysis
• corticosteroids

65. NURSING
MANAGEMENT:

66. NURSING ASSESSMENT:
• Assess vital signs (BP)
• Monitor intake output chart
• Assess for electrolyte imbalance
• Assess site and location of pain
• History of urine colour, frequency etc .
• Daily weight monitoring
• Assess for skin rashes

67. NURSING DIAGNOSIS,
GOAL
AND
NURSING
INTERVENTION:

68. 1. Deficit fluid volume related to vomiting.
GOAL: To maintain adequate fluid status
NURSING INTERVENTION:

69. • Monitor vital sign (especially BP and HR).
• Assess skin turgor and oral mucous membrane for
sign of dehydration .
• Assess Alteration in mentation/sensorium
(Confusion, slowed response)
• Monitor intake output chart .
• Apply cold/hot application to reduce client’s body
temperature.
• Provide plenty of fluid to rehydration therapy.

70. 1. Imbalanced nutrition pattern less than
body requirement related to anorexia.
GOAL: To achieve adequate nutritional
status.
NURSING INTERVENTION:

71. • Assess for the possible cause of Decreased
appetite Or GI discomforts.
• Monitor vital signs, intake output chart, body
weight,serum albumin.
• Provide diet consider patients like and dislikes
as far as possible.
• Provide frequent oral hygiene.
• Administered parenteral feeding as required.

72. PATIENT TEACHING:
• Stay well hydrated and increase (2500-3000ml )intake of
fluids .
• Restrict the use of over the counter medications.
• Restrict rich souce of oxalic acid (in oxalate
nephropathy)
• Restrict high protein diet (impaired kidney function)