Case Study 1: Urinary Function

Posted: June 8th, 2023

Urinary Function: 
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder. 

Case Study Questions

1 The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.

2 Create a list of risk factors the patient might have and explain why.

3 Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

Reproductive Function: 
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days. 
Microscopic Examination of Vaginal Discharge 
(-) yeast or hyphae 
(-) flagellated microbes 
(+) white blood cells 
(+) gram-negative intracellular diplococci 

Case Study Questions

1 According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.

2 Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?

3 Name the criteria you would use to recommend hospitalization for this patient

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Case Study 1: Urinary Function

The possible types of Acute Kidney Injury (AKI) that Mr. J.R. may have developed include:

a. Prerenal AKI: This type of AKI occurs due to decreased blood flow to the kidneys, leading to impaired kidney function. In this case, the clinical manifestations of fever, nausea with vomiting and diarrhea, weakness, dizziness, and pale and sweaty appearance can be attributed to dehydration and hypovolemia caused by gastroenteritis. The decreased blood volume reduces renal perfusion and contributes to prerenal AKI.

b. Intrinsic AKI: Intrinsic AKI refers to kidney damage that occurs within the renal tissue. The possible causes in this case could be acute tubular necrosis (ATN) caused by ischemia or nephrotoxicity. Ischemic ATN can result from decreased renal blood flow, as seen in prerenal AKI. Nephrotoxicity could be caused by substances present in the burritos or medications like Pepto-Bismol. The symptoms of metallic taste in the mouth and the use of Pepto-Bismol may indicate exposure to potential nephrotoxic agents.

c. Postrenal AKI: Postrenal AKI occurs due to obstruction of the urinary tract, preventing the normal flow of urine from the kidneys. While this is less likely in this case, it is still a possibility that needs to be considered. A detailed assessment, such as a renal ultrasound, would be necessary to rule out postrenal causes.

The risk factors that Mr. J.R. might have include:

a. Age: Advanced age can be a risk factor for kidney injury as kidney function naturally declines with age.

b. Dehydration: Prolonged vomiting, diarrhea, and poor fluid intake due to gastroenteritis can lead to dehydration, compromising renal blood flow and function.

c. Nephrotoxic exposure: The consumption of burritos from a local fast-food restaurant and the use of Pepto-Bismol are potential sources of nephrotoxic substances.

d. Coexisting medical conditions: Mr. J.R.’s medical history, not provided in the case study, could include comorbidities such as hypertension or diabetes, which are risk factors for kidney disease.

e. Medications: The use of medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can contribute to kidney injury, especially in the context of dehydration and reduced renal blood flow.

In chronic kidney disease (CKD), complications can arise in the hematologic system, including coagulopathy and anemia. The pathophysiologic mechanisms involved are as follows:

a. Coagulopathy: CKD disrupts the normal hemostatic balance, leading to a prothrombotic state. There is a decrease in the production of anticoagulant proteins like antithrombin III, protein C, and protein S, while procoagulant factors like fibrinogen and von Willebrand factor increase. Platelet dysfunction and vascular endothelial damage further contribute to coagulopathy in CKD.

b. Anemia: CKD often results in decreased production of erythropoietin (EPO), a hormone that stimulates red blood cell production in the bone marrow. Reduced EPO levels lead to decreased red blood cell production, resulting in anemia. Additionally, CKD can cause iron deficiency due to impaired absorption and increased losses, further exacerbating anemia.

Case Study 2: Reproductive Function

The most probable diagnosis for Ms. P.C. is pelvic inflammatory disease (PID). The clinical manifestations of lower abdominal pain, nausea, em