Case Study 31
Which type of immune hypersensitivity reaction causes the destructive
renal changes in Goodpasture syndrome-type I, II, III, or IV?
syndrome is a type II reaction.
Why were methylprednisolone and azathioprine given to the patient?
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
Why was trimethoprim and sulfamethoxazole prescribed with
azathioprine for this patient?
medications are antibiotics, which will help destroy the existing
antibodies in the patient’s body.
What is the purpose of plasmapheresis?
purpose of plasmapheresis is to help purify the blood. It will take
out the patient’s “old” blood and replace it with a “cleaner”
What is the pathophysiology behind the clinical signs of proteinuria
and hematuria in this patient?
is likely that the patient has progressed into chronic renal failure.
The kidneys are no longer able to keep the GFR at an appropriate
Determine the approximate time to end-stage renal disease from this
patient’s estimated GFR is 17%. He will need a kidney transplant, and
will likely die soon without one.
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.
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
What is a likely cause of the abnormal lung sounds here?
kidneys are shutting down and not filtering out fluids. This is
causing fluid overload, which can manifest as crackles in the lower
Describe a positive Chvostek sign and suggest with which abnormal
laboratory test below this clinical sign is significant.
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
There are twenty abnormal laboratory tests above. Identify them and
suggest a brief pathophysiologic mechanism for each.
Na: 149 mEq/L : patient is unable to excrete excess sodium.
K: 5.4 mEq/L: patient is hyperkalemic. ESRD leads to oliguria, which
reduces the amount of potassium able to be excreted.
Cl: 116mEq/L: this level is high- chloride generally increases and
decreases with sodium, to maintain a balance in the ECF
Ca: 6.7 mg/dL: hypocalcemic- due to impaired renal production of
BUN: 143mg/dL: high due to decreased GFR
7.1mg/dL: high due to decreased GFR
Hb: 9.5 g/dL: low due to decreased production of erythropoietin,
decreased production of RBCs
Hct: 30.7%: low due to water retention, decreased RBCs
RBCs: 3.4million/mm3: low due to decreased production of
Alk Phos: 178IU/L: high
glucose: 152 mg/dL: high due to insulin resistance
Albumin: 2.9 g/dL: low due to increased urinary excretion
total protein: 5.0 g/dL- low due to proteinuria
Mg: 3.8 mg/dL- high due to impaired regulation by the kidneys
5.9 mg/dL- high due to decreased renal phosphate excretion
protein in urine: +3- due to proteinuria
blood in urine: +3- due to damage to glomerular basement membrane
leading to increased permeability
renal ultrasound: significant bilateral atrophy
chest x ray: bibasilar shadows: pulmonary edema
HCO3: 32mEq/L: high. Pulmonary edema leading to respiratory alkalosis