10. A 78-year-old woman with a history of hypertension, aortic thoracic graft, a
ID: 1090073 • Letter: 1
Question
10. A 78-year-old woman with a history of hypertension, aortic thoracic graft, and esophageal reflux disease complained of fever (100oF) and weakness. She had been treated 3 weeks before at the hospital for a urinary tract infection. She was admitted to the hospital for a diagnostic workup and transfusion. Her laboratory results are below (left). Urine culture was positive for Citrobacter. UA results are listed below (right). The patient's renal function continued to decline, and she was put on hemodialysis. A renal biopsy was performed that showed end-stage crescentic glomerulonephritis. Two days later, the patient sustained a perforated duodenal ulcer, which required surgery and blood transfusion. Subsequently, she developed coagulopathy and liver failure. Her condition continued to deteriorate in the next few days, and she died following removal of life support. Color Specific gravity pH Blood Protein Glucose Ketones Ntrates RBC WBC Casts Hazylyellow 1.015 5 Large 120 mmoL Hct 25.6% 37mo b 8.5 g/dL mmolL 97 mmoVL 19 mmoVL 52 mg/dL Hgb WBC 9,700 BUN Creatinine 3.2 mg/d Negative 25 1-4 Granular, 1-4 a. Looking at the UA, what is the significance of the results of 2+ protein and greater than 25 RBCs? b. What is the most likely cause of glomerulonephritis? c. Why was the patient put on hemodialysis?Explanation / Answer
a)
The patients’s urine analysis shows protein 2+ and RMCs >25. She had proteinuria (presence of abnormal levels of protein in the urine). A normal person excretes <150 mg of proteins perday. 2+ means that more than 200 mg/dl of protein is excreted in the urine and the cause is kidney damage.
A normal person’s urine would have around 4 RBCs, but her urine had >25 RBCs and she had hematuria which was due to kidney injury or some kidney related damage.
b)
The most likely cause of glomerulonephritis for her would have been bacterial endocarditis. She already had aortic thoracic graft which might have have been infected.
The body’s response would have been produce large number od antibodies which would have lodged in the glomeruli causing glomerulonephritis.
c)
She was put on hemodialysis as she was obviously going into kidney failure or chronic kidney disease which was evident by
Creatinine 3.2 (normal 0.6 to 1.2)
Blood urea nitrogen 52 (normal 7 to 20)
Proteinuria
Hematuria
Her renal function continued to deline
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