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.

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).

If a streptococcal infection such as pharyngitis or scarlet fever is left untreated, there is a small (~3%) chance that within approximately 20 days, the patient will present with rheumatic fever. After the first bout of rheumatic fever, if the host acquires a second untreated S. Pyogenes infection, the chance of coming down with rheumatic fever jumps substantially to ~50%. Most often this secondary disease will strike people aged 6-15 years old, roughly 20 days after the streptococcal infection, with a 2-5% mortality rate. One of the major diagnostic symptoms of this disease is Erythema Marginatum, snake- or ring-like eruptions covering the trunk, upper arms, and legs. Other symptoms include fever, arthritis (elbows, knees, wrists, and ankles), swollen joints, pain in the abdomen, nodules

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).

Streptococcal Pharyngitis is an upper respiratory infection caused by group A streptococci (GAS). This gram-positive bacterial group consists solely of Streptococcus pyrogens, the same bacterium responsible for many skin and soft tissue infections, such as impetigo, erysipelas, and acute bacterial endocarditis (Tortora, Funke & Case, 2013). Symptoms include sore throat, fever, Swollen, tender lymph nodes in the neck and inflammation of the middle ear. There are multiple ways of diagnosing Strep throat. Streptococcal Pharyngitis is most commonly diagnosed using enzyme immunoassay (EIA); which are hypersensitive and straightforward. Another way for diagnosing is using a sterile swab then rubbing it over the back of the throat and tonsils to

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

My diagnosis is post-streptococcal glomerulonephritis accompanied by hyperkalemia. This condition most likely arose due to the strep infection which was not killed entirely by the antibiotics and became stronger because the patient stopped taking them early, providing a chance for the pathogen to develop defenses against the antibiotics, reach the renal system and cause inflammation in the glomerulus. A sudden change in serum potassium levels would be a biological marker to confirm the diagnosis. This would be a distinguisher from other diseases because diseases such as sepsis, myocardial infarctions, and other illnesses do not increase serum potassium count.

The criteria for diagnosis entails a child that has a fever for 5 days plus four out of five of the other criteria: bilateral conjunctiva injection without exudate, polymorphous rash, inflammatory changes in the lips and oral cavity, changes in extremities (peripheral edema, erythema of palms and soles), and cervical lymphadenopathy that is usually unilateral, anterior cervical (Burns, Dunn, Brady, Starr, Blosser, 2013). Since the ER already performed cultures, a urine study, CBC, and CMP, which were all negative, the next blood work that would be beneficial is a CRP and ESR to check the extent of inflammation. The results of the CRP and ESR can help guide the management of the patient to see if treatment is necessary. The condition may only need to be monitored with a series of echocardiograms, or treatment with IVIG may become necessary depending on the results of the echocardiogram. No matter if IVIG treatment is needed, an echocardiogram should be performed as soon as a diagnosis is made, and at two weeks and six to eight weeks after the onset of the fever to evaluate coronary, myocardial, and pericardial inflammation (Burns, Dunn, Brady, Starr, Blosser,

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

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.,

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 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

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).

Glomerulonephritis (GN), or the inflammation of glomeruli, is a leading cause of renal failure worldwide. Inflammation is characterized by vascular fragility, infiltration of leukocytes, and edema. Glomerular disease may manifest by three major syndromes: nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis (RPGN). Nephritic syndrome consists of sudden onset of hematuria, non-nephrotic range proteinuria (1.5 g/24 h), active sediment with red blood cell (RBC) casts or dysmorphic RBCs, acute renal failure, and hypertension. Nephrotic syndrome is characterized by heavy proteinuria (>3.5 g/24 h), edema, hypoalbuminemia, and hyperlipidemia. RPGN is characterized by active sediment (RBC casts and dysmorphic RBCs) and rapid development of acute renal failure usually over a period of weeks to months. Glomerulonephritis accounts for the majority of progressive renal disease in many parts of the world.