Question

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Please help to answer this question

A 6 year old girl had a recent diagnosis of streptococcus pharyngitis. This was treated after 5 days of pain. She has finished her antibiotics ten days ago and is now having increased fatigue, pink colored urine and some swelling to her face. Dad brings her to the clinic and you suspect acute glomerulonephritis.

Strep 1. What is the pathophysiology causing symptoms in APSGN (not how does strep cause it, but what is happening in the kidneys)?

Strep 2. What labs and medications would you anticipate being ordered for this girl? (labs, medications, fluids, diet, general orders)

Answer 1

1.The bacteria usually affects the nephrons and leaves a strain. A  strain on the nephrons will lead to damage and this will lead to alteration and loss of function .Once the nephrons are damaged it is irreversible and the filtration process is affected and causes RBC protein in the urine showing symptoms of hematuria,casts, cloudy urine,decreased urine output.The creatinine and protein levels in the blood are increased a d causing these symptoms.

2.Lab

• CBC: to get basic details
• ANA: to assess any autoimmune disorder
• Immunoglobulin A :is increased in APSGN
• Sr.Electrolytes:elevated creatinine
• Urine analysis:to assess specific gravity, casts,RBC,Leukocytes
• Renal profile

Medication

• Penicillin is the choice of drug to treat the infection

Fluid:

• Encourage to take adequate oral liquids
• Administer IV fluids

Diet

• Low sodium and low protein diet to be encouraged

General order

• Take medication as per order
• Regular screening and treatment until the renal profile is normal
• Follow infection control practices