Case Study 4A: Lawrence Based on the signs and symptoms presented in this case, 10 year old Lawrence appears to be suffering from acute glomerulonephritis (AGN).
A comprehensive term that refers to a collection of kidney related diseases in which there is an inflammatory response in the glomeruli, as evidenced in this case, AGN is usually preceded by a group A streptococcal infection of the throat (Smeltzer & Bare, 1996).Along with the history of a recent episode of pharyngitis or tonsillitis, fever is also common. As the disease progresses and becomes more severe, the patient may complain of general malaise, headache, facial edema and flank pain. As in Lawrence’s case, lethargy, anorexia and relentless flank pain are also common (Schacht, 2006), as is hypertension which can range from moderate to severe (Smeltzer ; Bare, 1996).
Lawrence’s diagnosis was most likely made upon the clinical findings of hematuria from red blood cells (RBC) in the urine and proteinuria, secondary to the increased permeability of the glomeruli. In addition, the RBC casts that were found in his urine are indicative of glomerular injury. Although not reported by his parents, Lawrence probably had a decrease in urine output as well, due to the fact that his urine specific gravity, blood urea nitrogen (BUN) and serum creatinine levels were all elevated (Smeltzer & Bare, 1996).
Medications prescribed in cases of AGN are often associated with the severity of symptoms. Since Lawrence’s hypertension leans more towards the moderate side, he would probably be assigned to bed rest, fluid restriction and treated with vasodilator drugs, such as nifedipine or hydralazine. Additionally, the administration of loop diuretics may be helpful to accelerate the resolution of his hypertension. If Lawrence is oliguric, as evidenced by the lab findings, this is usually transient and resolves on its own, therefore large doses of lasix or osmotic diuretics are contraindicated. A course of penicillin would also most likely be of benefit to Lawrence, however steroid treatment only becomes necessary if the disease is rapidly progressive (Schacht, 2006).While the ultimate prognosis of the disease depends upon the initial insult, for Lawrence, it is probably good.
Clinical manifestations of the disease usually do not recur after three months and recurrent episodes are rare (Schacht, 2006);;;;;;;;;;;;;;;;;;ReferencesSmeltzer, S ; Bare, B. (1996). Brunner and Sudarth’s Textbook of Medical Surgical Nursing. (8th Edition). Philadelphia, PA: Lippincott-Raven Publishers.
Schacht, R. M.D. (1996). Acute Poststreptococcal Glomerulonephritis. E-Medicine. (On-line).