Renal PBL

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Questions and Answers

What does the increased interstitial fluid around Ms. Williams' eyes and lower extremities indicate?

Decreased serum potassium levels

Changes in capillary permeability and low serum albumin (correct)

Increased urinary output

Elevation in serum oncotic pressure

What significant change in renal function is noted in Ms. Williams' condition?

Complete resolution of hematuria

Substantial drop in GFR (correct)

Normal serum albumin levels

Increase in urine output

What is a notable symptom that indicates potential damage to the kidney in Ms. Williams?

Increased serum calcium

Elevated bicarbonate levels

Presence of RBCs in urinalysis (correct)

Decreased platelet count

What is the main proposed mechanism by which magnesium sulfate works in Ms. Williams' treatment?

Vasorelaxation and altering neuromuscular transmission Signup and view all the answers

What potential diagnosis is suggested by the combination of renal involvement and neurological symptoms in Ms. Williams?

Preeclampsia or lupus flare Signup and view all the answers

What condition immediately threatens Ms. Williams' life post-delivery?

Hyperkalemia Signup and view all the answers

What is a primary consequence of immune complex deposition in the glomerular capillaries in lupus nephritis?

Alteration of the glomerular capillary permeability Signup and view all the answers

What abnormal finding in Ms. Williams' ECG suggests changes due to hyperkalemia?

Peaked T-waves Signup and view all the answers

Which symptoms initially presented by Ms. Williams may indicate a connection to autoimmune disorders?

Photosensitivity and joint pains Signup and view all the answers

What is the expected outcome of delivery in cases of preeclampsia?

Immediate improvement in condition Signup and view all the answers

Which laboratory finding indicates a significant loss of kidney function in Ms. Williams?

Urine protein levels at 4+ Signup and view all the answers

What is the most likely effect of lupus nephritis on the glomerular filtration rate (GFR)?

GFR decreases due to inflammation Signup and view all the answers

Which of the following treatments is typically given to Ms. Williams to manage her blood pressure?

Magnesium sulfate Signup and view all the answers

In the context of the differential diagnosis, which condition shares similar late pregnancy symptoms with lupus nephritis?

Preeclampsia Signup and view all the answers

The joint effusions observed in Ms. Williams could be attributed to which of the following causes?

Autoimmune disease-related inflammation Signup and view all the answers

What aspect of lupus nephritis treatment is crucial for preventing kidney failure?

Immune system suppression Signup and view all the answers

Which laboratory finding is most indicative of lupus nephritis in pregnant women?

Increased protein levels in urine Signup and view all the answers

What distinguishes the rash associated with systemic lupus erythematosus from other differential diagnoses?

It has a distinct 'butterfly' distribution on the face Signup and view all the answers

What is a potential consequence of untreated lupus nephritis?

Reduction in kidney function and need for dialysis Signup and view all the answers

How can joint effusions in Ms. Williams be differentially diagnosed from other potential causes?

Through joint aspiration and analysis of fluid Signup and view all the answers

What does a negative rheumatoid factor indicate in the context of suspected autoimmune disease?

It indicates that the autoimmune process is likely not rheumatoid in nature. Signup and view all the answers

Which physiological change during pregnancy contributes to decreased blood viscosity?

Increased plasma volume exceeding red blood cell volume. Signup and view all the answers

Why is close monitoring necessary for the new presence of protein in Ms.Williams' urine?

It may indicate worsening renal function. Signup and view all the answers

Which mechanism primarily causes vasodilation during Ms.Williams' pregnancy?

Decreased vascular responses to angiotensin II. Signup and view all the answers

What does a decrease in eGFR during pregnancy usually indicate?

Normal physiological adaptation to pregnancy. Signup and view all the answers

What common symptom experienced by Ms.Williams at 36 weeks gestation suggests increased intracranial pressure?

Papilledema and blurred vision. Signup and view all the answers

How does pregnancy affect potassium levels in Ms.Williams' body?

Potassium declines as it is incorporated into fetal cells. Signup and view all the answers

What is the significance of an increase in T regulatory cells (Tregs) during pregnancy for Ms.Williams?

They promote maternal tolerance of the fetus. Signup and view all the answers

Why is Ms.Williams advised to follow up in a high-risk obstetrics clinic?

She is at high risk for complications during pregnancy. Signup and view all the answers

Which hormone's threshold is reset at a lower osmotic level during pregnancy leading to lower serum sodium levels?

Antidiuretic hormone. Signup and view all the answers

What is the role of calcium gluconate in the context of metabolic acidosis?

It increases the threshold potential. Signup and view all the answers

Which medication acts as a beta agonist to promote intracellular potassium movement?

Albuterol Signup and view all the answers

What finding is most indicative of nephrotic syndrome in terms of proteinuria?

Proteinuria greater than 3 mg/d Signup and view all the answers

What type of renal injury is indicated by crescent formation in Bowman's space?

Lupus nephritis class IV Signup and view all the answers

Which immunosuppressive medication inhibits the proliferation of T and B lymphocytes?

Cyclophosphamide Signup and view all the answers

What is the primary mechanism of action of mycophenolate mofetil?

It inhibits inosine monophosphate dehydrogenase preferentially in T and B lymphocytes. Signup and view all the answers

What is the purpose of using an angiotensin converting enzyme inhibitor in the treatment of lupus nephritis?

To lower blood pressure and decrease proteinuria Signup and view all the answers

Which drug is a monoclonal antibody that binds to B-lymphocyte stimulator?

Belimumab Signup and view all the answers

What urinary findings are commonly seen in patients with glomerular damage in lupus nephritis?

Presence of RBC and granular casts Signup and view all the answers

Why is it advised for a patient with lupus nephritis to avoid breastfeeding?

Medications needed for treatment could be harmful to the infant. Signup and view all the answers

Study Notes

M1 Renal PBL - R2 Document: Patient Case Study

Goal: Investigate a pregnant woman's case, focusing on blood pressure, kidney function, and electrolytes.
Case: Lupus nephritis class IV diagnosed.
- Characterized by glomerular damage from autoimmunity.
- Immune complex deposits lead to altered glomerular permeability causing proteinuria (protein in the urine).
- Lowered glomerular filtration rate (GFR) due to reduced surface area.
- Untreated, can lead to kidney failure and dialysis.
- Clinically similar to preeclampsia, making diagnosis challenging in late pregnancy.
Patient (Ms. Williams): Initial visit with subtle symptoms.
- Photosensitivity, joint pain (knees, wrists).
- Possible iron deficiency anemia and oral contraceptives plausible causes.
- Key Physical finding: Malar rash (butterfly appearance). Knee Effusions (fluid in joints).
Differential Diagnosis for rash: Various possibilities, including SLE, erysipelas, rosacea, pellagra, dermatomyositis, including cellulitis.
Autoimmune Disease Suspicion: Family history of rheumatoid arthritis and presence of malar rash.
Initial Lab Results to Support Autoimmune Disease: Positive antinuclear antibody (ANA) test. Negative rheumatoid factor. Normal complement levels. Mild Anemia but normal iron levels.
Follow-Up Visit #1 (12 weeks pregnant):
- Increased plasma volume, but decreased hematocrit.
- Cardiac output increases, while systemic vascular resistance decreases.
- Lower blood pressure.
- Increased nitric oxide.
- Rise in estrogen and progesterone.
- Increased T regulatory cells (Tregs) helping maternal tolerance of the fetus.
- Raised eGFR (glomerular filtration rate), a normal response to pregnancy.
- Lower sodium and potassium levels, lower bicarbonate (mild hyperventilation).
- Mild proteinuria noted which must be monitored.
Follow-Up Visit (36 weeks pregnant):
- Increased intracranial pressure indicated by headache, blurred vision, papilledema, and elevated blood pressure and edema.
- Increased urine protein excretion to 4+.
- Blood cell abnormalities (RBCs in the urine, fragmented RBCs/schistocytes).
- Worsening GFR, suggesting further kidney damage. Reduced hemoglobin concentration/hematocrit suggests blood loss.
- Lower bicarbonate.
Diagnosis Considerations:
- Preeclampsia.
- Lupus flare with neural and renal involvement.
Treatment: Magnesium sulfate given to lower blood pressure and prevent seizures.
Delivery: Delivers baby, condition doesn't improve. Worsening hyperkalemia, edema, and worsening GFR noted post-delivery. Increased intracranial pressure. Severe renal symptoms.
Kidney Biopsy Results: Crescent formation in Bowman's space. Immunofluorescence positive for immune complexes.
-Indicative of lupus nephritis. Proliferative and crescentic nature suggests highly severe lupus nephritis (class IV).
Postpartum Course: Kidney function doesn't improve fully post-delivery.
- Further treatment requires immunosuppresants such as corticosteroids, cyclophosphamide, mycophenolate mofetil, and/or Belimumab given to adjust immune dysfunction.
Prognosis: Requires close monitoring for kidney function recovery, as kidney function may not return to normal levels, and potential for long term complications.

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Description

Explore the complex case of a pregnant woman with Lupus nephritis class IV. This quiz focuses on the diagnosis and management of kidney function, blood pressure, and electrolytes in the context of pregnancy. Delve into differential diagnoses and clinical presentations associated with this condition.