Answer Happy

J.H. is a 12-year-old boy diagnosed several months ago with nephrotic syndrome following postinfectious glomerulonephritis secondary to an episode of pneumococcal pneumonia. He has been coming to the clinic to have his condition monitored and therapies adjusted as needed. At his latest clinic visit, a decrease in urine output, increasing lethargy, hyperventilation, and generalized edema are noted. Trace amounts of protein are detected in J.H.'s urine by dipstick. Blood is drawn for laboratory analysis, and the results are as follows: pH = 7.36 PaCO, 33 mm Hg PaO₂ = 100 mm Hg HCO, −= 18 mEq/L Het = 30% Na - 130 mEq/L K-5.4 mEq/L BUN-58 mg/dl creatinine = 3.9 mg/dl albumin = 2.0 g/dl 1. How would a pneumococcal infection lead to glomerulonephritis? How can glomerulonephritis result in nephrotic syndrome? (6 points: Explain the pathophysiology of how pneumococcal infection leads to glomerulonephritis. Explain the pathophysiology of how glomerulonephritis results in nephrotic syndrome.) 2. Use J.H.'s laboratory values to determine if he is still experiencing nephrotic syndrome or his condition is progressing to renal failure. (5 points: Analyze these laboratory values and list those that are abnormal. Discuss whether or not these laboratory values show evidence of nephrotic syndrome or progression to renal failure.) 3. What additional physical or laboratory findings would be helpful in determining J.H.'s degree of renal impairment? (4 points: List at least 4 additional physical findings/symptoms or laboratory tests that would be helpful in determining the degree of renal impairment.) 4. What would the treatment regimen include if J.H. has progressed to renal failure? (5 points: List 5 interventions for managing renal failure.)