Week 5: Case Study
1. How would a pneumococcal infection lead to glomerulonephritis? How can glomerulonephritis result in nephrosis?
One of the causes of glomerulonephritis is from a pneumococcal infection. The antibodies that the body produces to fight off the bacterium binds to bacterial antigens and makes its way out into the capillary beds. This process causes an inflammation which then injures the glomerular capillary and basement membrane. The damage that is caused leads to glomerulonephritis.
The injured and defective glomeruli in the kidneys lead to the release of too much protein in the urine resulting in nephrosis.
2. Use JH’s laboratory values to determine if he is still experiencing nephrosis or if his condition is progressing to renal failure.
JH’s lab values indicate that the PaCO2, HCO3-, and Hct, and Na levels are all below normal limits. His potassium level was increased at 5.4 mEq/L. There was also an increase in JH’s BUN (58 mg/dl), creatinine (3.9 mg/dl), and albumin (2.0 g/dl) levels. Traces of protein were found in his urine suggesting that JH’s condition is progressing to renal failure.
3. What additional physical or laboratory findings would be helpful in determining JH’s degree of renal impairment?
Creatinine clearance is helpful in determining general kidney function. A level above 1.2 is reduced and indicates renal impairment. The kidneys' ability to handle creatinine is called the creatinine clearance rate, which helps to estimate the glomerular filtration rate (GFR). This rate will give a general overview of how the kidney is functioning.
Physical assessment findings of joint pain, tenderness, redness and swelling are all indicative of renal impairment from hyperuremia. Skin nodules, generalized itching/pruritus may be present upon assessment of the integument. Patient may also complain of flank pain. Decrease in urine