Question

Patient’s Chief Complaint:

“I’ve been out of breath, I’ve had a cough, and I feel run down. I think that I may also have

a fever. This came on fast and it has been going on now for almost a full week.”

Physical Examination:

Vital Signs	Temp. = 101.9F oral BP = 130/87 mmHg HR = 90 beats/minute, normal rhythm RR = 30 breaths/minute Height = 6’2” Weight = 155 lbs
General	Thin, slightly anxious, acutely ill-appearing, young white male with tachypnea
HEENT	PERRLA Funduscopic exam of left eye reveals new fluffy, white retinal patches with focal hemorrhages consistent with CMV retinitis; right eye reveals no new lesions Ears and nose clear Sinuses nontender Oral cavity negative for thrush, erythema, exudates, or lesions
Neck, Lymph Nodes	Neck supple with no masses or bruits Slight cervical lymphadenopathy Thyroid normal
Chest and Lungs	Mild axillary lymphadenopathy Bibasilar crackles with auscultation
Heart	Normal sinus rhythm Normal S1 and S2 Negative for rubs, murmurs, or gallops
Abdomen	Soft and nondistended; Negative for pain or tenderness; Negative hepatosplenomegaly; Positive bowel sounds; mild-to-moderate inguinal lymphadenopathy
Genitalia/Rectum	Guaiac-negative stool; anal sphincter function normal; negative visible genital or anal lesions; prostate exam deferred
Musculoskeletal and Extremities	Neuromuscular intact; pedal pulses 2+; negative edema or wasting; nails normal; full ROM
Neurologic	Alert and oriented x 3; negative babinski reflex; negative cranial nerve abnormalities; normal DTRs; negal focal neurological signs

Serial Laboratory Values: Beginning nine months prior to the present visit

	9 months ago	6 months ago	3 months ago	This Visit
General
Weight (lbs)	167	167	162	155
BP (mmHg)	125/72	120/65	120/72	130/87
Hematology
Hb (g/dL)	13.6	13.5	11.5	10.9
Hct (%)	38.9	38.0	33.4	32.0
Platelets (x10^3/mm^3)	376	390	287	260
WBC (x10^3/mm^3)	3.8	4.1	3.3	3.8
Lymphs (%)	24.7	32.0	36.4	18.2
Monos (%)	14.5	14.1	10.2	11.4
Eos (%)	2.5	2.4	3.7	1.5
Basos (%)	1.0	0.6	1.0	1.1
Neutros (%)	57.3	50.9	48.7	67.8
HIV Markers
CD4 Cells (%)	18	27	26	15
CD4 cells/mm^3	163	353	359	119
CD8 Cells (%)	33	37	35	29
CD8 cells/mm^3	307	470	350	214
HIV RNA (copies/mL)*	>750,000	<500	<500	67,600
Chemistry
Na (mEq/L)	141	140	135	136
K (mEq/L)	4.2	4.0	3.5	4.3
Cl (mEq/L)	107	107	103	108
BUN (mg/dL)	7	8	7	10
Cr (mg/dL)	0.9	0.9	0.7	0.9
Glu, fasting (mg/dL)	95	90	104	115
T Bili (mg/dL)	0.5	0.6	1.2	0.5
T Prot (g/dL)	6.3	6.5	6.0	6.1
Alb (g/dL)	3.2	2.9	3.0	2.7
AST (IU/L)	25	30	28	34
ALT (IU/L)	50	55	54	51
Ca (mg/dL)	8.8	8.6	8.9	7.8
Phos (mg/dL)	3.5	3.1	3.9	3.8
Mg (mg/dL)	1.9	1.9	1.8	2.0

*determined with reverse transcriptase-polymerase chain reaction assay

Other Tests:

• Sputum specimen obtained with inhalation of 3% saline by ultrasonic nebulizer

• Methenamine silver stain positive (consistent with Pneumocystis infection)

• Monoclonal antibody with immunofluorescence: for Pneumocystis

Case Study Questions:

1. Direct HIV infection of renal cells may result in clinical manifestations of kidney disease. Do laboratory tests indicate that HIV has affected kidney function? Explain your answer.

2. Discuss the clinical presentation of a client with acute HIV infection.

Answer 1

ANSWER- Having HIV may have a greater chance of getting kidney disease.If any person is having HIV the chances of getting kidney disease is more .The laboratory test that indicate are-

• have a high viral load (having large amount of HIV in blood)
• have a low CD4 count
• family history of kidney disease
• age more than 60years
• excessive intake of medications or medications taken for long years which damages the kidney such as NSAIDS(Non steroidal anti-inflammatory drugs) and other pain killers.
• high blood pressure
• having diabetes
• hepatitis
• urine test
• kidney function test (KFT)
• Glomerular filteration rate test

HIv harm the nephrons in the kidney. The filteration process of kidney do not work well .HIV infects the cells of the kidney. The medications which is used to treat the HIV can also damage the kidney.

2) Clinical presentation of client with acute HIV infection

• rashes
• fever with chills
• headache
• fatigue
• weakness
• sore throat
• night sweating
• loss of apetite
• ulcers that appear in mouth, esophagus , genitals
• swollen lymph nodes
• muscle pain
• dirrhoea
•