Question

78-year old woman with a history of hypertension, aortic thoracic graft, and esophageal reflux disease complained of fever (100 o ) and weakness. She had been treated 3 weeks before at the hospital for a urinary tract infection. She was admitted to the hospital for a diagnostic workup and transfusion. Her laboratory results are listed below:

Na+ 129 mmol/L Hct 25.6%
K+ 3.7 mmol/L Hgb 8.5 g/dL
Cl- 97 mmol/L WBC 9,700
CO2 19 mmol/L
BUN 52 mg/dL
Creatinine 3.2 mg/dL
Urine culture was positive for Citrobacter.
Urinalysis results are listed:
Color Hazy/yellow
Specific gravity 1.015
pH 5
Blood Large
Protein 2
Glucose Negative
Ketones Negative
Nitrates Negative
RBC >25
WBC 1–4
Casts Granular, 1–4
The patient’s renal function continued to decline, and she was put on hemodialysis. A renal biopsy was performed that showed end-stage crescentic glomerulonephritis. Two days later, the patient sustained a perforated duodenal ulcer, which required surgery and blood transfusion. Subsequently, she developed coagulopathy and liver failure. Her condition continued to deteriorate in the next few days, and she died following removal of life support.
1. Looking at the urinalysis, what is the significance of the results of 2+ protein and >25 RBCs?
2. What is the most likely cause of glomerulonephritis?
3. Why was the patient put on hemodialysis?

Answer 1

1. The significance of 2+ proteins and high RBC indicates severe decrease in renal function. These two things should not be present in urine in a healthy individual

2. Maybe the UTI could be the cause of the glomerulonephritis. Patient has a history of GERD and so treatment with Proton Pump Inhibitors can sometimes lead to interstitial nephritis which may have been the case here.

3. Patient was put on dialysis due to decreased renal function