Transcript Case Study 31: Chronic Renal Failure

Case Study 31: Chronic Renal
Failure
Robyn Schwartz
V
Case Study 31: Chronic Renal
Failure
Robyn Schwartz
Past Medical history
• Went to ER 3 years ago
–
–
–
–
Coughing up blood for 6 hours
Difficulty breathing
Chills
Chest pain
• Recently had influenza A
• Lab results
– Elevated white blood cell count
– Iron deficiency
• Hepatosplenomegaly
– Enlarging of liver and spleen
• Crackles in the lung
Past Medical history
• ELISA test positive for GBM
• Elevated BUN
• Renal biopsy positive for IgG
– Immunoglobin antibody
• Goodpasture syndrome diagnosis
GoodPasture syndrome
• Rare
• Attacks lungs and kidneys
• Autoimmune disease
– Anti-glomerular basement membrane antigens (GBM) attack body
• Caused by immune hypersensitivity type II
– When antibodies of the immune system attach to antigens on the body’s own cells
– Antigens can be intrinsic or extrinsic
– Causes a B cell response
GoodPasture syndrome
• Rare
• Attacks lungs and kidneys
• Autoimmune disease
– Anti-glomerular basement membrane antigens (GBM) attack body
• Caused by immune hypersensitivity type II
– When antibodies of the immune system attach to antigens on the body’s own cells
– Antigens can be intrinsic or extrinsic
– Causes a B cell response
Treatment
•
Put on methylpredisolone
– Used to treat severe allergic reactions, blood disorders
– Decreases immune response
– corticosteroid hormone
•
Plasmapheresis
– 4 plasma exchanges of 1 L each daily for 2 weeks
– Cleans out blood
•
After 2 weeks symptoms resolved
•
Maintained on azathioprine
– Used to prevent rejection in kidney transplants
– Reduces the proliferation of immune cells
– Lowers autoimmune response
•
Also trimethoprim and sulfamethoxazole
– Antibiotics
– Reduce bacterial growth
Follow up 6 months later
• Urinalysis
– Low grade proteinuria and hematuria
• Presence of protein and blood in urine
– likely caused by the damage Goodpasture
syndrome did to his kidneys
• Serum creatinine levels increased over the past 3 years
• Very close to end-stage renal disease
• Creatinine clearance levels 15.5 mL/min
– End stage is 15 mL/min
• Suggested course
– Dialysis
– Kidney transplant
Physical exam
• Skin
– Dry and flaky
– Very pale
• Lungs
– Mild bibasilar crackles
– Likely caused by fluid in lungs
• Extremities
– Mild edema of hands and feet
• Neurological
–
–
–
–
–
Alert
CNs II-XII intact
DTRs 2+ throughout
Muscle tone 5/5
Positive Chvostek sign
• When the angle of the jaw is
tapped the mouth and face will
twitch
• Often associated with overactive
sodium channels
Lab results
Lab Results
Lab results