Brittany described as a twitching of the cheek muscles

Brittany
Holocker
11-11-17
Bruyere
Case Study 31
Chronic
Renal Failure

1.
Which type of immune hypersensitivity reaction causes the destructive
renal changes in Goodpasture syndrome-type I, II, III, or IV?
-Goodpasture
syndrome is a type II reaction.

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2.
Why were methylprednisolone and azathioprine given to the patient?
-The
goal of treatment is to eliminate existing antibodies while
preventing new ones from forming, which would lead to kidney failure.
These drugs are immunosuppressants, and will aid in new antibodies
forming.

3.
Why was trimethoprim and sulfamethoxazole prescribed with
azathioprine for this patient?
-These
medications are antibiotics, which will help destroy the existing
antibodies in the patient’s body.

4.
What is the purpose of plasmapheresis?
-The
purpose of plasmapheresis is to help purify the blood. It will take
out the patient’s “old” blood and replace it with a “cleaner”
version.

5.
What is the pathophysiology behind the clinical signs of proteinuria
and hematuria in this patient?
-It
is likely that the patient has progressed into chronic renal failure.
The kidneys are no longer able to keep the GFR at an appropriate
rate.

6.
Determine the approximate time to end-stage renal disease from this
visit
-The
patient’s estimated GFR is 17%. He will need a kidney transplant, and
will likely die soon without one.

7.
Determine the patient’s creatinine clearance from tests done three
days ago, indicate the stage of chronic renal failure to which the
patient has progressed, and identify an action plan.
-His
creatinine clearance, which provide an approximation of the GFR, is
17%. This places him at stage 4 of chronic kidney disease. Options
for the patient include dialysis and transplantation of one or both
kidneys.

8.
What is a likely cause of the abnormal lung sounds here?
-The
kidneys are shutting down and not filtering out fluids. This is
causing fluid overload, which can manifest as crackles in the lower
lung fields.

9.
Describe a positive Chvostek sign and suggest with which abnormal
laboratory test below this clinical sign is significant.
-The
Chvostek sign can be described as a twitching of the cheek muscles as
you tap the facial nerves. It is a sign of hypocalcemia. The normal
calcium range is 8.5-10.2, and the calcium level of this patient is
6.7.

10.
There are twenty abnormal laboratory tests above. Identify them and
suggest 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, which
reduces the amount of potassium able to be excreted.
-3)
Cl: 116mEq/L: this level is high- chloride generally increases and
decreases with sodium, to maintain a balance in the ECF
-4)
Ca: 6.7 mg/dL: hypocalcemic- due to impaired renal production of
calcitriol(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 of
erythropoietin

-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 membrane
leading 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

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