Assessment Practice
Clinical Case Studies
Glomerulonephritis
Look at this clinical case study and answer the questions
Case Study 2. Serena.(aged 12)
Diagnosis
- Serena and her mum visited their GP in considerable distress. Serena had been passing rusty coloured urine which was occasionally strangely 'frothy'. Mother suspected that the colour was due to blood in the urine.
- The GP wanted to know what else was happening, so she used a test strip to test a sample of Serena's urine. This revealed the presence of protein as suspected by the GP..
- She also thought Serena looked a little puffy around the face and took her BP. This revealed that Serena's blood pressure was on the high side.
- The GP also noticed that one of her partners had recently prescribed a course of antibiotics for a sore throat. This was very likely due to a streptococcal infection.
- The combined efforts of the antibiotics and Serena's immune system seemed to conquer the throat infection.
- The GP suspected some form of glomerulonephritis. This is a disease of the kidneys.
- A hospital visit was arranged and tests confirmed the Doctor's diagnosis. Blood tests suggested an autoimmune response had damaged part of the kidney nephrons.
Treatment
- Many cases of glomerulonephritis don't require any treatment, but patients must be carefully nursed and their blood pressure monitored, especially if the output of urine is very scanty. This is a danger sign.
- Immunosuppressive drugs and steroids may be necessary in more serious cases.
- Fortunately, Serena's condition cleared up after a few months.
Clinical questions:
- Why had the GP suspected that protein might be present in the urine?
- What does the presence of erythrocytes and protein in urine indicate is happening?
- Which part of the kidney nephron is affected here?
- What process normally takes place in this region of the nephron?
- What is an autoimmune response?
- What then might have triggered Serena's glomerulonephritis?
- Why is scanty urine 'a danger sign' in terms of blood pressure?
- Explain the drug treatment for 'more serious cases'.