Chronic Renal Failure
Answer the questions in paragraph form in a discussion paper, 350 word minimum, APA format.
Be sure to include a title page, at least one reference required
Case Study: Chronic Renal Failure
History of Present Illness:
Mr. M.A. is a 27-year-old white male, who is visiting his primary healthcare provider to discuss recent
blood tests. He has been feeling fatigued and weak lately. Past Medical History Three years ago, the
patient presented to the emergency room with a six-hour history of coughing up blood. He also
complained of difficulty breathing, chills, and chest pain. He had recently suffered a two-week episode
of influenza A.
Laboratory tests revealed an elevated white blood cell count and iron deficiency anemia. A physical
exam revealed moderate hepatosplenomegaly and inspiratory crackles at the base of each lung. He was
hospitalized for a thorough clinical workup. An ELISA test was positive for anti-glomerular basement
membrane (GBM) antibodies in the blood, but serum complement levels were within normal limits.
Immunofluorescence of the renal biopsy was positive for IgG and complement lining the glomerular
membranes.
A diagnosis of Goodpasture syndrome was made. The patient was educated about Goodpasture
syndrome (that it is a disease in which the immune system attacks the kidneys and lungs) and that a
potential serious complication is chronic renal failure. The patient was immediately placed on
methylprednisolone (1 mg/kg/d po divided Q 6–12 hrs) and plasmapheresis was conducted (four plasma
exchanges of 1 L each daily for two weeks). After two weeks, the patient’s symptoms resolved and
serum anti-GBM antibodies were no longer detectable. The patient was maintained for six months on
azathioprine (2 mg/kg/d po QD) and 160 mg trimethoprim plus 800 mg sulfamethoxazole 3 /week.
Patient Case Question 1. Which type of immune hypersensitivity reaction causes the destructive renal
changes in Goodpasture syndrome—type I, II, III, or IV?
Patient Case Question 2. Why were methylprednisolone and azathioprine given to the patient?
Patient Case Question 3. Why was trimethoprim and sulfamethoxazole prescribed with azathioprine
for this patient?
Patient Case Question 4. What is the purpose of plasmapheresis?
During a follow-up visit with a nephrologist in six months, a urinalysis revealed a lowgrade proteinuria
and hematuria.
Patient Case Question 5. What is the pathophysiology behind the clinical signs of proteinuria and
hematuria in this patient?
With each patient visit at every six-month interval, proteinuria and hematuria became more severe.
