1. Case Study 31: Chronic Renal Failure
Robyn Schwartz

2. Case Study 31: Chronic Renal Failure
Goodpasture syndrome + V
Case Study 31: Chronic Renal Failure
Robyn Schwartz

3. Past Medical history Went to ER 3 years ago Recently had influenza A
Coughing up blood for 6 hours
Difficulty breathing
Chills
Chest pain
Recently had influenza A
Lab results
Elevated white blood cell count
Iron deficiency
Hepatosplenomegaly
Enlarging of liver and spleen
Crackles in the lung

4. Past Medical history ELISA test positive for GBM Elevated BUN
Renal biopsy positive for IgG
Immunoglobin antibody
Goodpasture syndrome diagnosis

5. GoodPasture syndrome Rare Attacks lungs and kidneys Autoimmune disease
Anti-glomerular basement membrane antigens (GBM) attack body
Caused by immune hypersensitivity type II
When antibodies of the immune system attach to antigens on the body’s own cells
Antigens can be intrinsic or extrinsic
Causes a B cell response

6. GoodPasture syndrome Rare Attacks lungs and kidneys Autoimmune disease
Anti-glomerular basement membrane antigens (GBM) attack body
Caused by immune hypersensitivity type II
When antibodies of the immune system attach to antigens on the body’s own cells
Antigens can be intrinsic or extrinsic
Causes a B cell response

7. Treatment Put on methylpredisolone Plasmapheresis
Used to treat severe allergic reactions, blood disorders
Decreases immune response
corticosteroid hormone
Plasmapheresis
4 plasma exchanges of 1 L each daily for 2 weeks
Cleans out blood
After 2 weeks symptoms resolved
Maintained on azathioprine
Used to prevent rejection in kidney transplants
Reduces the proliferation of immune cells
Lowers autoimmune response
Also trimethoprim and sulfamethoxazole
Antibiotics
Reduce bacterial growth

8. Follow up 6 months later Urinalysis
Low grade proteinuria and hematuria
Presence of protein and blood in urine
likely caused by the damage Goodpasture syndrome did to his kidneys

9. Serum creatinine levels increased over the past 3 years
Very close to end-stage renal disease
Creatinine clearance levels 15.5 mL/min
End stage is 15 mL/min
Suggested course
Dialysis
Kidney transplant

10. Physical exam Skin Lungs Extremities Neurological Dry and flaky
Very pale
Lungs
Mild bibasilar crackles
Likely caused by fluid in lungs
Extremities
Mild edema of hands and feet
Neurological
Alert
CNs II-XII intact
DTRs 2+ throughout
Muscle tone 5/5
Positive Chvostek sign
When the angle of the jaw is tapped the mouth and face will twitch
Often associated with overactive sodium channels

11. Lab results

12. Lab Results

13. Lab results