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Patient case: Rapidly Progressive Nephritic Syndrome

Patient case: Rapidly Progressive Nephritic Syndrome

Discussion

A 35-year-old woman presents to the emergency department with a sudden onset of severe fatigue, swelling in her legs and face, and blood-tinged urine over the past two weeks. She reports a recent history of flu-like symptoms, including fever and sore throat, which resolved without treatment. Over the past few days, she has noticed decreased urine output and increasing shortness of breath.

On examination, her blood pressure is elevated at 170/100 mmHg, and there is significant periorbital and peripheral oedema. Laboratory tests show an elevated serum creatinine of 3.8 mg/dL, a BUN of 65 mg/dL, and urinalysis reveals haematuria with red blood cell casts, proteinuria, and moderate pyuria. A renal biopsy confirms crescentic glomerulonephritis, indicating rapidly progressive nephritic syndrome (RPGN).

The patient is started on high-dose corticosteroids and immunosuppressive therapy to address the underlying autoimmune process, with plans for possible plasmapheresis. She is monitored closely for worsening renal function, as urgent intervention is critical to prevent irreversible kidney damage.

Questions
1. What is the most likely trigger for the patient’s rapidly progressive nephritic syndrome (RPGN)?

a) Bacterial endocarditis

b) Recent flu-like illness

c) Urinary tract infection

d) Dehydration

2. Which of the following findings on urinalysis is most characteristic of nephritic syndrome?

a) Fatty casts

b) Red blood cell casts

c) Crystals

d) Bacteria

3. What did the renal biopsy confirm in this patient’s diagnosis?

a) Membranous glomerulopathy

b) Crescentic glomerulonephritis

c) Diabetic nephropathy

d) Tubulointerstitial nephritis

4. What is the most important aspect of the patient’s initial treatment plan for RPGN?
  1.  a) Antibiotic therapy
  2. b) High-dose corticosteroids and immunosuppressants
  3. c) Dialysis initiation
  4. d) Blood pressure reduction with diuretics
Reveal answers

Answers

 

 

Answer Key:

  1. b) Recent flu-like illness
  2. b) Red blood cell casts
  3. b) Crescentic glomerulonephritis
  4. b) High-dose corticosteroids and immunosuppressants