Case Study 31: Chronic Renal Failure - Santa Monica College

Case Study 31: Chronic Renal Failure - Santa Monica College

Case Study 31: Chronic Renal Failure Robyn Schwartz me o r d n y s ure t s a p

d o Go 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 bodys 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 bodys 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

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