Brittany Holocker
11-11-17
Bruyere Case Study 31
Chronic Renal Failure
1. Which type of immune hypersensitivity reaction causes the destructive renal changes in Goodpasture syndrome-type I, II, III, or IV?
-Goodpasture syndrome is a type II reaction.
2. Why were methylprednisolone and azathioprine given to the patient?
-The goal of treatment is to eliminate existing antibodies while preventing new ones from forming, which would lead to kidney failure. These drugs are immunosuppressants, and will aid in new antibodies forming.
3. Why was trimethoprim and sulfamethoxazole prescribed with azathioprine for this patient?
-These medications are antibiotics, which will help destroy the existing antibodies in the patient's body.
4. What is the purpose of plasmapheresis?…show more content… Describe a positive Chvostek sign and suggest with which abnormal laboratory test below this clinical sign is significant.
-The Chvostek sign can be described as a twitching of the cheek muscles as you tap the facial nerves. It is a sign of hypocalcemia. The normal calcium range is 8.5-10.2, and the calcium level of this patient is 6.7.
10. There are twenty abnormal laboratory tests above. Identify them and suggest a brief pathophysiologic mechanism for each.
-1) Na: 149 mEq/L : patient is unable to excrete excess sodium.
-2) K: 5.4 mEq/L: patient is hyperkalemic. ESRD leads to oliguria, which reduces the amount of potassium able to be excreted.
-3) Cl: 116mEq/L: this level is high- chloride generally increases and decreases with sodium, to maintain a balance in the ECF
-4) Ca: 6.7 mg/dL: hypocalcemic- due to impaired renal production of calcitriol(vitamin D3)
-5) BUN: 143mg/dL: high due to decreased GFR
-6)Cr: 7.1mg/dL: high due to decreased GFR
-7) Hb: 9.5 g/dL: low due to decreased production of erythropoietin, decreased production of RBCs
-8) Hct: 30.7%: low due to water retention, decreased RBCs
-9) RBCs: 3.4million/mm3: low due to decreased production of erythropoietin
-10) Alk Phos: 178IU/L:
