Mr. J.R.’s Case (Acute Kidney Injury and Chronic Kidney Disease)

Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.Case Study Questions The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.Create a list of risk factors the patient might have and explain why.Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.Reproductive Function:Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.Microscopic Examination of Vaginal Discharge(-) yeast or hyphae(-) flagellated microbes(+) white blood cells(+) gram-negative intracellular diplococciCase Study Questions According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?Name the criteria you would use to recommend hospitalization for this patient Share on Facebook Tweet Follow us Sample Answer     Mr. J.R.’s Case (Acute Kidney Injury and Chronic Kidney Disease) Possible Types of Acute Kidney Injury (AKI): Based on Mr. J.R.’s symptoms (nausea, vomiting, diarrhea, fever), the possible types of AKI include: Prerenal AKI: This occurs due to decreased blood flow to the kidneys. Dehydration from gastroenteritis can lead to prerenal AKI. Symptoms like weakness and dizziness upon standing support this possibility. Intrinsic AKI: This type of AKI involves direct damage to the kidneys themselves. Gastroenteritis can cause inflammation that damages the kidneys (tubulointerstitial nephritis). Full Answer Section       Linking Clinical Manifestations: Dehydration: Vomiting, diarrhea, and fever contribute to dehydration, leading to decreased blood flow to the kidneys (prerenal AKI). Nausea and vomiting: These can be symptoms of both gastroenteritis and AKI. Weakness and dizziness: These symptoms can be caused by dehydration (prerenal AKI) or electrolyte imbalances (intrinsic AKI). Risk Factors for Mr. J.R.: Age: The risk of AKI increases with age. Dehydration: Severe gastroenteritis can lead to significant fluid loss, increasing the risk of AKI. Underlying medical conditions: Uncontrolled diabetes or hypertension could worsen AKI. (The case doesn’t mention these, but it’s a good practice to consider) Chronic Kidney Disease (CKD) Complications: Hematologic System: Anemia: Damaged kidneys can’t produce enough erythropoietin, a hormone that stimulates red blood cell production. This can lead to anemia, causing fatigue and shortness of breath. Coagulopathy: Kidney disease can affect platelet function and protein production, increasing the risk of bleeding problems. Pathophysiology: Anemia: Decreased erythropoietin production leads to a decrease in red blood cell production. This reduces the oxygen-carrying capacity of the blood. Coagulopathy: Kidney disease can affect the production of proteins responsible for blood clotting, leading to an increased risk of bleeding. Ms. P.C.’s Case (Gonorrhea) Diagnosis: Ms. P.C. most likely has gonorrhea. Here’s why: Symptoms: Lower abdominal pain, nausea, vomiting, and malodorous vaginal discharge are all classic symptoms of gonorrhea. Microscopic Examination: The presence of white blood cells suggests inflammation, and gram-negative intracellular diplococci are characteristic of gonorrhea bacteria (Neisseria gonorrhoeae). Sexual History: Unprotected sex with a new partner increases the risk of sexually transmitted infections (STIs) like gonorrhea. This question has been answered. 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