BrittanyHolocker11-11-17BruyereCase Study 31ChronicRenal Failure1.Which type of immune hypersensitivity reaction causes the destructiverenal changes in Goodpasture syndrome-type I, II, III, or IV?-Goodpasturesyndrome is a type II reaction.2.Why were methylprednisolone and azathioprine given to the patient?-Thegoal of treatment is to eliminate existing antibodies whilepreventing new ones from forming, which would lead to kidney failure.These drugs are immunosuppressants, and will aid in new antibodiesforming.
3. Why was trimethoprim and sulfamethoxazole prescribed withazathioprine for this patient?-Thesemedications are antibiotics, which will help destroy the existingantibodies in the patient’s body.4.What is the purpose of plasmapheresis?-Thepurpose of plasmapheresis is to help purify the blood.
It will takeout the patient’s “old” blood and replace it with a “cleaner”version.5.What is the pathophysiology behind the clinical signs of proteinuriaand hematuria in this patient?-Itis likely that the patient has progressed into chronic renal failure.The kidneys are no longer able to keep the GFR at an appropriaterate.6.Determine the approximate time to end-stage renal disease from thisvisit-Thepatient’s estimated GFR is 17%.
He will need a kidney transplant, andwill likely die soon without one.7.Determine the patient’s creatinine clearance from tests done threedays ago, indicate the stage of chronic renal failure to which thepatient has progressed, and identify an action plan.-Hiscreatinine clearance, which provide an approximation of the GFR, is17%. This places him at stage 4 of chronic kidney disease. Optionsfor the patient include dialysis and transplantation of one or bothkidneys.
8.What is a likely cause of the abnormal lung sounds here?-Thekidneys are shutting down and not filtering out fluids. This iscausing fluid overload, which can manifest as crackles in the lowerlung fields.9.Describe a positive Chvostek sign and suggest with which abnormallaboratory test below this clinical sign is significant.-TheChvostek sign can be described as a twitching of the cheek muscles asyou tap the facial nerves. It is a sign of hypocalcemia.
The normalcalcium range is 8.5-10.2, and the calcium level of this patient is6.
7.10.There are twenty abnormal laboratory tests above. Identify them andsuggest a brief pathophysiologic mechanism for each.-1)Na: 149 mEq/L : patient is unable to excrete excess sodium. -2)K: 5.
4 mEq/L: patient is hyperkalemic. ESRD leads to oliguria, whichreduces the amount of potassium able to be excreted.-3)Cl: 116mEq/L: this level is high- chloride generally increases anddecreases with sodium, to maintain a balance in the ECF-4)Ca: 6.7 mg/dL: hypocalcemic- due to impaired renal production ofcalcitriol(vitamin D3)-5)BUN: 143mg/dL: high due to decreased GFR-6)Cr:7.1mg/dL: high due to decreased GFR-7)Hb: 9.5 g/dL: low due to decreased production of erythropoietin,decreased production of RBCs-8)Hct: 30.
7%: low due to water retention, decreased RBCs-9)RBCs: 3.4million/mm3: low due to decreased production oferythropoietin-10)Alk Phos: 178IU/L: high-11)glucose: 152 mg/dL: high due to insulin resistance-12)Albumin: 2.9 g/dL: low due to increased urinary excretion-13)total protein: 5.0 g/dL- low due to proteinuria-14)Mg: 3.
8 mg/dL- high due to impaired regulation by the kidneys-15)PO4:5.9 mg/dL- high due to decreased renal phosphate excretion-16)protein in urine: +3- due to proteinuria-17)blood in urine: +3- due to damage to glomerular basement membraneleading to increased permeability-18)renal ultrasound: significant bilateral atrophy-19)chest x ray: bibasilar shadows: pulmonary edema-20)HCO3: 32mEq/L: high. Pulmonary edema leading to respiratory alkalosis