Acute Glomerulonephritis Case Study

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

Acute renal failure occurs quickly over a period of days or weeks with a reduction in GFR and elevation of BUN, plasma creatinine and crystatin C levels. Oliguria (urine output of < 30ml/hr or < 400 ml/day) is usually associated with ARF, although urine output may be normal or increased as well. Fluid is still filtered at the glomerulus but there is an alteration in tubular secretion or reabsorption. Most types of ARF are reversible if diagnosed and treated early (Perrin, 2009).

Medical History: A 57-year-old Caucasian male, with a history of end-stage renal disease, secondary to biopsy proven IgA nephropathy, history of liver cirrhosis secondary to alcohol abuse, hypertension, thrombocytopenia, leukopenia, who presented for evaluation for candidacy for a kidney transplant. The patient was evaluated at Tampa General Hospital. He went through a full medical work up. He was not listed due to lack of financial clearance per their center.

Acute renal failure is when the kidneys suddenly are unable to filter the blood of the waste products. Acute renal failure is alternatively called acute kidney failure or acute kidney injury. The causes of acute renal failure are divided into three categories based on their point of origin: prerenal, intrarenal, and post renal. The most common type of acute renal failure is prerenal, which can be described as a sudden drop in blood pressure or an interruption in blood flow to the kidneys. The common causes of prerenal AFR include hypovolemia, reduced renal perfusion, and septic shock. "Prerenal AFR is generally reversible when renal perfusion pressure is restored" (Liu, pg.98). Intrarenal, or intrinsic, acute renal failure is caused by acute tubular necrosis, renal artery obstruction, renal vein obstruction, interstitial nephritis, and glomerulonephritis. Postrenal occurs between the kidney and the urethral meatus. The major causes to postrenal AFR are tubular precipitation, urethral obstruction and bladder obstruction. Acute renal failure has four phases: onset, oliguria, diuresis and recovery. Onset begins with onset of the event and lasts for hours to days. The oliguria stage doesn't always occur in certain patients; however it lasts for 8-15 days. Oliguria deals with multiple acid-base balance diseases. The diuresis stage begins when the kidneys start to recover

Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).

Initial diagnosis of Streptococcal pharyngitis is determined by a point system awarding 1 point for each of the following; temperature greater than 38 C, absence of cough, tender anterior cervical lymph nodes, tonsillar swelling, age younger than 15, subtracting a point for age older than 45. If these symptoms are met, a rapid strep test will be performed before antibiotics are given, a precaution taken to prevent super-bugs from developing.

Diagnostic test would include, CBC with differential, ESR, platelet count, CRP, liver transaminases, gamma-glutamyltransferase (GGT), and urinalysis. CRP will be elevated but ESR is sometime normal. Blood, urine, cerebrospinal fluid, and group A beta-hemolytic streptococcus pharyngeal cultures may be collected to identify other sources of fever. Diagnostic test would be done to confirm or rule out the diagnosis of Kawasaki disease (Burns, Dunn, Brady, Starr & Blosser, 2013).

You are advised to consult your treating doctor for proper evaluation. You may need to undergo urine examination with culture and sensitivity tests.

Patients who are diagnosed with acute renal failure go through difficult times dealing with the disease. Their families too experience psychological difficulties, not knowing the degree of suffering their loved ones are going through. Therefore, in order to provide the best of care for the patient, nurses need to be knowledgeable about the problem, and find the best professional way to educate the patient and family so that the patient does not end up into the hospital for re-admission. Family members can best relate to the situation and understand what their loved ones are going through if they are included into the care of the patients. You get a better outcome when you treat patients as a whole. It is critical for nurses and other health care workers to provide patients and their family members with the necessary information in order for them to make informed decisions.

The most definitive method for testing beta-hemolytic streptococci is the latex-agglutination method. Alternatively identification can be made by the ability of S. pyogenes to hydrolyze the reagent PYR causing it to turn bright red. Rapid immunoassay testing is also available in detecting group A streptococci. This method identifies group A antigens from throat swabs and because they are so fast, they are usually used in clinics and physician offices. However, a throat swab for “strep” culture should be sent to a clinical microbiology laboratory is tests are negative and evidence of pharyngitis is

"Acute pyelonephritis involves acute tissue inflammation, tubular cell necrosis, and possible abscess formation" (Ignatavicius & Workman, 2013, p.1523). The

One of the major concerns associated with contrast administration is the risk for renal impairment known as contrast induced nephropathy (CIN). Furthermore, CIN is a serious complication effecting patient outcomes and health care costs. Studies agree, while the true number of CIN occurrences is difficult to attain, pre-existing health factors and conditions, such as, advanced age, kidney disease, congestive heart failure, hypertension, hyperuricemia, hypovolemia, non-steroidal anti-inflammatories, diabetes mellitus, and Glucophage are known to increase the risk potential (Schwab et al., 1989). In addition to CIN, other contrast reactions include contrast induced bronchospasm, and mild systemic contrast reactions. Therefore, identification

The success of (GABHS) as a pathogen relies on the production of multiple virulence factors involved in various aspects of host-pathogen interactions. GABHS Pharyngitis is most common in individuals aged 5-15 years, although adults may also acquire the disease (Tart et al., 2007 ; Alter et al., 2011). Streptococcal Pharyngitis seems to be very uncommon in children younger than 3 years with the exception of children with risk factors such as an older close or household contact with group A β-hemolytic Streptococci (GABHS) infection (Centor et al.,

Nephrotoxins, acute interstitial nephritis, glomerular damage, and vascular damage also correlate with intrarenal acute renal failure (Singh, Levy, & Pusey, 2013). Postrenal acute renal failure is usually a result of a urinary tract obstruction that affects the kidneys bilaterally, which causes the intraluminal pressure upstream from the site of the obstruction to increase with a progressive decrease in the glomerular filtration rate (McCance, Huether, Brashers, & Rote, 2014). A pattern consisting of several hours of anuria with flank pain followed by polyuria is typically found in individuals with postrenal acute renal failure (McCance, Huether, Brashers, & Rote, 2014).

Group A streptococcus (GAS) is an important human pathogen rank in the top ten of deadly infectious disease around the world despite being sensitive to most antibiotics that are used clinically. The major population will have suffered a group A streptococcus infection one time or another with non-life threating minor complications in the presence of antibiotic therapy but in some instances it goes on and causes several immune-mediated disorders associated with rheumatic fever affecting a diverse set of organs and tissues including the heart, kidneys, skin, joints, and brain. The propensity and degree to which Group A Streptococcus produces an invasive systemic infection is interrelated to its diverse virulence factor expression,