Module 4 Discussion: Urinary Function
Reply to Tiffany
Module 4 Discussion: Urinary Function
Link the clinical manifestations described to the different types of Acute Kidney injury.
Per the case, Mr. J.R. might be suffering from prerenal, intrinsic renal, or postrenal AKI (Acute kidney injury). Nausea, vomiting, and diarrhea, among other symptoms, can be observed. Thus, we can conclude that the reason may be pre-renal AKI caused by volume depletion and diminished renal perfusion (Jacob et al., 2020). The first step in pre-renal AKI is the fall in effective blood flow to the kidneys, and therefore there is lower filtration and blood flow in the glomeruli due to a decrease in glomerular filtration rate (GFR) without injury to the renal parenchyma. The kidney failure as a result of this type of AKI is often reversed if the root cause is treated immediately.
By contrast, the patient might get a peculiar taste of the metal, showing that the uremia was inherent and, therefore, the kidneys were damaged. Implicit AKI means that a particular part of the kidney, be it the tubules, glomeruli, or interstitium, suffers damage, and thus, there is a fall in GFR (Glomerular Filtration Rate (Kwiatkowska et al., 2023). One of the most common adverse effects of NSAIDs is AKI, and after that, chronic kidney dysfunction may occur that can require more intricate therapy.
If we rule out the possibility of post-renal AKI, which is caused by obstructing the urinary tract. In that case, we can say that this given case would be less likely due to the fact that the patient doesn’t present any symptoms such as flank pain, hematuria, or reduced urine output. Nevertheless, an all-out elimination of it is not demanded until further investigation can be conducted.
According to the assessment based on the clinical symptoms, the foremost possible etiology of this condition is pre-renal AKI associated with volume depletion secondary to gastroenteritis. The symptoms of vomiting and diarrhea mean a loss of fluids and electrolytes in the body, which has led to decreased renal perfusion and a strain on kidney function. Intrinsic renal injury is, by definition, impossible to exclude without proper follow-up examinations.
Create a list of risk factors the patient might have and explain why.
Mr. J.R.’s multiple risk factors escalate his chances of having AKI. At 73 years of age, he may have been having problems with kidney function, which had started to get worse with age and the age-related changes in renal structure and function. The renal failure episodes, caused by the ongoing occurrence of vomiting and diarrhea, are due to the loss of volume of the body. If, as indicated, Mr. JR. is presently administering some nephrotoxic medicines, such as NSAIDs, to suppress his fever, they may be the reason for the AKI development in addition to underlying diseases. Coming to the age of 80 years, Mr. J.R. may be susceptible to acute kidney injury. Ultimately, if Mr. J.R.’s gastroenteritis is based on a bacterial infection, his chances of developing sepsis with sepsis-associated AKI are high.
Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Mr. J.R.’s AKI might come to a point of deterioration into chronic kidney disease (CKD). This situation can also lead to the development of hematologic complications, such as coagulopathy and anemia. Coagulopathy in CKD is fundamentally associated with the amassment of uremic toxins that disrupt platelet function, thus decreasing their aggregation ability and adherence to the walls of blood vessels. The platelets’ dysplasia and activation abnormalities result in a more prolonged bleeding time and a higher risk of bleeding problems.
Anemia is another common blood disorder in CKD, mainly because the damaged kidneys produce less erythropoietin (EPO). EPO is an endocrine hormone that accelerates the activity of the bone marrow to produce red blood cells, and its deficiency causes a decrease in red blood volume and the development of anemia. Anemia of chronic renal failure is directly proportional to the level of the underlying renal dysfunction, almost inevitably.
Module 4 Discussion: Reproductive Function
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.
Concerning Ms. P.C.’s presenting symptoms and the results of the microscopic examination of her vaginal discharge, the possible diagnosis must be the Neisseria gonorrhoeae cervicitis. She presents the typical secrete of gonococcal disease, which is observed in a suffocated, yellow, and bad-smelling vaginal discharge just a few days after unprotected and risky sex (Nsuami et al., 2020).
Granulocytes (white blood cells) and gram-negative intracellular diplococci, seen under microscopy, help diagnose cervicitis caused by gonococci. The presence of leukocytes instead of erythrocytes suggests an ongoing inflammatory reaction that is similar to the occurrence of an infectious condition. Detecting intracellular gram-negative diplococci in specimens is a definitive laboratory test for gonorrhea. Besides these, other possible causes of Ms. P.C.’s symptoms, like chlamydia, trichomoniasis, and vaginal candidiasis, are less likely or have less evidence to support them compared to the others based on the current information.
Based on the vaginal discharge described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
The gram-negative intracellular diplococci visualized under the microscope suggest Neisseria gonorrhoeae as the responsible strain of the bacterial disease in Ms. P.C.’s case. N. gonorrhoeae is a prominent sexually transmitted agent that can affect the cervix, urethra, rectum, and pharynx. In women, the typical outcome of Neisseria gonorrhoeae infection may be purulent cervicitis, as manifested in Ms. P.C. The bacteria bind to, invade, and elicit an inflammatory response from the cervical epithelial cells. This leads to the presence of neutrophils (white blood cells) in the cervical.
Name the criteria you would use to recommend hospitalization for this patient.
Most simple gonococcal cervicitis cases usually respond well to outpatient medication consisting of oral and/or intramuscular antibiotics (Wihlfahrt et al., 2023). Nevertheless, for the situations where Ms. P.C. and other patients with suspected gonococcal cervicitis, hospitalization can be expected, it may be advised. Another time is during the onset of severe nausea, vomiting, or abdominal pain that may result in the impossibility of taking medications in the oral form. Such circumstances may necessitate the placement of patients in in-patient management where suitable treatment can be guaranteed.
Another probable scenario that could lead the patient towards hospitalization is when the patient’s presentation is more resembling of pelvic inflammatory disease (PID). PID is a severe complication of untreated cervicitis, especially when the pathogens causing it are N. gonorrhoeae or C. trachomatis. In these cases, the infection spreads and causes infection of the epithelial cells of the uterus, fallopian tubes, or other organs. Should some of the symptoms of PID occur in Ms. P.C., she will be admitted to the hospital for stronger I.V. antibiotics therapy.
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