Question

Patient in this case study is an elderly woman that is currently experiencing weakness accompanied by a fever of 100^oF. Historically, this patient has experienced hypertension, aortic thoracic graft, and GERD. Just 3 weeks prior to this case, she was treated for a UTI. Her physician admitted her to the hospital for a diagnostic workup.

Her lab results are as follows: Urinary results:  

Sodium	129 mmol/L		Color/Clarity	Yellow/Hazy
Potassium	3.7 mmol/L		Specific Gravity	1.015
Chloride	97 mmol/L		pH	5
Carbon dioxide	19 mmol/L		Blood	Large
BUN	52 mg/dL		Protein	2
Creatinine	3.2 mg/dL		Glucose	Negative
Hematocrit	25.6%		Ketones	Negative
Hemoglobin	8.5 g/dL		Nitrates	Negative
WBC	9,700		RBC	>25
			WBC	1-5
			Culture	Citrobacter spp.

The patient's condition continued to decline, and she ended up on dialysis. A renal biopsy was performed that showed rapidly progressive glomerulonephritis. She continued to decline, multiple organ involvement, requiring surgery and blood transfusions, which ultimately lead to being put on life support. Patient died after the removal the life support.

Questions:

1. Looking at the patient's urinalysis results, what is the significance of the results of 2+ protein and >25 RBCs?

2. What is the most likely cause of glomerulonephritis?

3. Why was the patient put on dialysis?

Answer 1

1.Protein is one of the substance identified during urine analysis.+2 protein indicates patient have proteinuria.Kidney are filters and they don't let protein to pass through.+2 protein indicates that patient have kidney disease.When kidney is damaged proteins like albumin may leaked in urine.

Patient has >25 rbc in urine means it is microscopic hematuria.Presence of blood can be sign of underlying infection or kidney disease.

2.Glomerulonephritis is the inflammation of glomeruli(tiny filters)in kidney.It can be Acute or chronic

Causes of Acute Glomerulonephritis:

1.Infections:In bacterial endocarditis there's infection of heart valve.Sometimes glomerular disease is associated with bacterial endocarditis.

Post streptococcus glomerulonephritis can develop after recovery from a streptococcus infection.

Viral infections like hepatitis B ,C can cause glomerulonephritis.

2.Immune diseases:

Glomerulonephritis occurs in Lupus disease.This chronic inflammatory disease affect kidney,heart, skin and lungs

.IgA nephropathy cause glomerulonephritis.

3.Vasculitis:

Wegener granulomatosis affect blood vessels in kidney,lungs.This can cause glomerulonephritis.

Polyarteritis nodosa is a disease where cell attack arteries.

Chronic glomerulonephritis can develop with no symptoms.This can cause kidney damage.Genetics play a role in this type of disease.

3.In this patient creatine level is 3.2mg/dl.This means kidneys are losing their functions and clearing creatine out of blood.Creatine level over 1.3 is high.In this case it is 3.2 and dialysis is necessary .High creatine levels tell that patient has impaired kidney function.This patient has lowlevel of sodium and can be caused by acute or chronic kidney disease.There is proteinuria and this also suggest kidney disease.Her kidney is not working properly and waste products are not cleared properly.Dialysis keeps the body in balance and remove all the waste ,salt ,water ,keep sodium, potassium in safe level and maintain blood pressure .