Mya Watson

Staphylococcus Glomerulonephritis is an immune mediated disease that involves an antigen component derived from an infection agent. This  categorized into a hypersensitivity III response. Staphylococcus antigens enter the body and their antigens activate T cells to produce B cells. B cells then create and bind to antibodies IgA, IgG and IgM which creates an immune complex (IgA is most dominant). The immune complexes then circulate in the bloodstream. Problems arise when the antigen-antibody ratio favors the antigen, this is called a soluble immune complex. Soluble immune complexes are small enough to filter out of the bloodstream and into the organs, which in Ren’s case, into his Kidneys. Due to the accumulation of immune complexes within the glomerulus the classical pathway is initiated. This pathway causes inflammation through opsonization, chemotaxis and the membrane attack complex (MAC attack!) Proinflammatory cytokines and complement proteins arrive to the site of injury causing the Bowman’s capsule membrane to proliferate. This causes the membrane walls to thicken.  The thickening of the walls in the glomerulus limits the bodies ability to clear creatinine and other wastes from the body.  An increase in waste in the blood results in an increased vascular volume which causes edema and hypertension.

To diagnose a renal ultra sound, biopsy and electron microscopy can be used to help assess the size of the kidneys and visualize the inflammation. This can help diagnose the progression of disease.

Lab test such as renal function test, urine tests, BUN, C-reactive protein and GFR can tell the filtering rate of the kidneys and how efficient waste is at being released from the body. As the disease progresses, and the inflammation worsens these labs will change.

This disease can become chronic so early intervention is key. To get rid if the antigen an antibiotic can be used. Anti-hypertensives, diuretics and dietary restrictions are all important in managing this condition.

GN can be triggered by a variety of factors so tests are needed to help diagnose and prevent a variety of issues.

I love how we followed a case study of Ren throughout the podcast! It was a very fun and interactive way to incorporate the information! It was easy to follow and clear to understand! 

 I think an addition that could have been added is treatment of chronic GN and what happens when people progress through the stages. I am curious about what each stage looks like and the symptoms people may have as the disease progresses. I am assuming in the beginning people may not know they have a kidney condition but when do the symptoms appear?  I have learned through my sem 8 placement about dialysis, but I would have loved to hear why or when Ren may be put on that to help clear the waste from his body. Would Ren be a candidate for peritoneal dialysis or would he have to go straight to hemodialysis?  Could he potentially have a transplant in the future or is he not considered a candidate because it was from an infection?

I loved how the group described Ren at the beginning so I had a visual/idea of the patient. Using a common infection such as MRSA was awesome as I had no idea it could cause so much grief in the kidneys. Everyone spoke clearly and the sound was easy to hear through my computer speakers. The involvement of everyone was equal and I liked how someone would pop in and add more information as it was a new voice and the facts stuck with me. 

One teaching-learning strategy that was implemented that helped me learn was the summarization at the end. It brought the whole video together and was a quick recap of everything we learned. I find that summarizing material at the end helps learners (especially me) as I get so focused I may forget important information that was stated at the start, it also helps solidify the important information involved within the video. A summary at the end also may help clear up any muddy points that I may not have understood during the video. 

 If I could propose one change to this video, it would be more visual components. I am a visual learner so pictures and drawings help facilitate my learning. A visual component labelling the kidney, or a picture explaining  the stages of GN may have enhanced my learning further. I am curious about symptoms and how the disease progresses. Seeing the difference in wall thickness due to inflammation could have made me understand how the inflammation process occurs better.

I also love watching videos and videos made by peers are always the best so that could have been another option.

Overall, I felt this group’s video was very well done and I really enjoyed listening to it! 

I was unaware of how important the kidneys were to our daily lives until I was placed on the Renal floor for sem 8. Through patient research I noticed that a good portion of  patients had GN but wasn’t aware of how it occurred or the patho related. Weight, blood pressure, regular bloodwork and assessment questions such as “are you still producing urine?” , and “have you noticed any swelling?” would be linked to this case study of Ren. 

I will use this information in my future practice by ensuring I am aware of my patients renal function while sick with MRSA or other infections. Ins and outs, blood work, blood pressure checks and signs of edema are all cues to monitor. I should ensure that I am paying attention to fluid intake and that the patient is aware of why I need to monitor fluid intake. I would need to ensure the patient knew I needed to weigh their urine or insert a catheter to monitor urine output. I would also need to pay attention to their swelling/edema over my shift. Ensuring daily weights are being done in the morning to see weight gain would also be important to see if Ren is holding onto fluid.

Medication clearance from the body and certain medications should be used cautiously if the kidneys are unable to filter waste. I have learned through my renal placement that medications such as morphine and codeine are avoided in renal patients as they accumulate in the bloodstream as the kidneys are unable to filter it out. 

Being aware of my patient’s health literacy regarding their diagnosis is important. If they do not follow treatment or change their diet their disease may progress faster than if they followed their treatment plan. It would be important to bring in a team such as a social worker, dietician, pharmacist and nephrologist to help answer any questions that I may not be able to answer. If my patients need to change their diet and are unable to afford healthy food or have little access I would want to bring that up to the social worker and dietician to help navigate resources and alternative plans to have an optimal diet. I have seen patients on the renal unit at RIH advocate for themselves to talk to the social worker, nephrologist or pharmacist when they have a question, and the nurses are aware of their role and will refer to their team when needed.