The child with acute glomerulonephritis is under treatment in a ward. The nurse should look for the following as an indicator for acute renal failure?

1. A

   Polyuria

2. B

   Oliguria

3. C

   Hematuria

4. D

   Glycosuria

Appeared in: BHU NO - 2015

Explanation

• In acute glomerulonephritis (AGN), inflammation of the glomeruli severely reduces the kidney's filtering capacity.
• This reduction in glomerular filtration rate (GFR) directly leads to a decreased production of urine.
• Oliguria, defined in children as a urine output of less than 0.5 mL/kg/hr, is a hallmark sign of this significant drop in kidney function.
• Therefore, oliguria is a primary indicator that AGN is progressing to acute renal failure (ARF).

Why Other Options Were Wrong

• Option A: Polyuria is an excessive or abnormally large production of urine. This is the opposite of what occurs in acute renal failure, where urine production decreases.
• Option C: Hematuria (blood in the urine) is a characteristic symptom of acute glomerulonephritis itself, caused by damage to the glomeruli. While its presence confirms the disease, it does not specifically indicate the onset of acute renal failure.
• Option D: Glycosuria is the presence of sugar (glucose) in the urine. This is not a feature of glomerulonephritis or renal failure.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Monitoring for Acute Renal Failure in Acute Glomerulonephritis to guide bedside assessment, documentation, and the next nursing action.
• A nurse's primary role in caring for a child with AGN is vigilant monitoring for complications, with acute renal failure being the most severe.
• Accurate intake and output (I&O) measurement is a critical nursing intervention. For children, this includes weighing diapers and calculating hourly urine output (in mL/kg/hr).
• Any sign of oliguria must be reported to the healthcare provider immediately, as it may necessitate changes in fluid management, medications, or even dialysis.

How to Approach the Question

• First, identify the core concepts: The patient has acute glomerulonephritis (AGN), and the question asks for an indicator of acute renal failure (ARF).
• Recall the pathophysiology of AGN: Inflammation of the glomeruli.
• Think about the function of the glomeruli: They filter blood to make urine. What happens if they are inflamed?
• Connect the pathophysiology to the function: Inflamed filters work poorly, so less blood is filtered. This means less urine is produced.
• Evaluate the options based on this logic: 'Less urine' corresponds to oliguria. Polyuria is the opposite. Hematuria is a symptom of the initial disease, not necessarily the progression to failure. Glycosuria is related to blood sugar, which is irrelevant here.
• Select the option that directly reflects a critical decline in kidney function, which is a significant decrease in urine output.

Concept Tested & Keywords

• Concept Tested: Monitoring for Acute Renal Failure in Acute Glomerulonephritis
• Stem keywords: acute glomerulonephritis, child, acute renal failure, indicator
• Lead-in keywords: look for
• Clinical cues: Patient is a child with acute glomerulonephritis, a condition that puts them at risk for acute renal failure.
• Negative lead-in flag: false

Question ID

QDASXjBbk43OarxjM5B56k

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 489-491