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A case of a patient

with tea-colored
urine
PGI Elizabeth Jeremmie L.
Reyes
General Data
N.L.
9 y.o.
Male
Filipino
Catholic
Born on 9/9/!!"
#esidin$ at %an$an$daan& Bisi$ n$ 'a(ataan& Caloocan
)
st ad*ission at MC+
,ast Medical -istory
.
/01 ,ri*ary 2u(erculosis 3 co*pleted 4
*os of treat*ent
.
/-1 Asth*a
.
/-1 Aller$ies
.
/-1 -eart disease
-istory of ,resent
5llness
.
wee6s ,2A -------fe7er 2 89.:C&
associated with throat pain& sou$ht consult
at a health center and was $i7en
A*o;icillin tsp e7ery 9 hours;" days
which a<orded relief
.
= days ,2A ------ tea colored urine& no
*edications& no consultation
-istory of ,resent
5llness
.
days ,2A ---- still with tea colored
urine& sou$ht consult at >,D& urinalysis
was done
.
Few hours ,2A -----patient ca*e for
follow up with urinalysis result and was
ad7ised ad*ission
,ast Medical -istory
.
/01 ,ri*ary co*ple; 3 treated at a
pri7ate clinic
.
/01 chic6enpo;
.
/01 *u*ps
.
/-1 aller$y
.
/-1 asth*a
.
/-1 pre7ious hospitali?ation
Fa*ily -istory
.
/01 hypertension 3paternal
.
/-1 heart disease
.
/-1 dia(etes
.
/-1 cancer
.
/-1 asth*a
,ersonal/%ocial
.
,renatal@ re$ular prenatal chec6-up& no
infections& no e;posure to infectious
diseases
.
Natal@ preter*& N%D& "l(s
.
,ostnatal@ spontaneous cry& intu(ated
for ) day due to respiratory distress
,ersonal/%ocial
.
Father@ 84y.o.& door installer
.
Mother@8)y.o.& housewife
.
Grade " pupil
.
Diet@ hotdo$& noodles& Aun6 foods&
softdrin6s& does not eat 7e$eta(les
,ersonal/%ocial
.
5**uni?ation -istory@ co*pleted B,5 at
health center
,hysical B;a*ination
.
General@ awa6e& conscious&
con7ersant& a*(ulatory& not in distress
.
Cital si$ns@ B, )!/9! ,# 9) ## )9 2
84.9
Dt 896$
.
%6in@ /01 crusted lesions on lower
e;tre*ities
,hysical B;a*ination
.
-BBN2@ s6ull is round& hairs (lac6
eEually distri(uted& anicteric sclera&
pin6 palpe(ral conAuncti7a& no
nasoaural dischar$e& no
tonsillopharyn$eal con$estion
.
Nec6@ supple& no ly*phadenopathies
,hysical B;a*ination
.
Chest/Lun$s@ sy**etric chest
e;pansion& no retractions 7esicular
(reath sounds
.
-eart@ adyna*ic precordiu*& nor*al
rate& re$ular rhyth*& no *ur*urs
.
A(do*en@ $lo(ular& nor*oacti7e (owel
sounds& soft& nontender
,hysical B;a*ination
.
B;tre*ities@ $rossly nor*al& full and
eEual pulses& /01 (ipedal ede*a
.
Ner7ous %yste*@ awa6e& oriented to 8
spheres& intact *e*ory
At the B#
Subjective Objective Assessment Plan
/01 reddish colored urine Dt 89 6$
2 84.9
B,@ )!/9!
##@)9
-#@ 9)
/01 (ipedal ede*a
+rinalysis@ ,MN )-!/hpf
#BC@ 2N2C
Acute
Glo*erulonephr
itis
Dia$nostics@
CBC with A,C& A%>&
%eru* electrolyte& urine
culture and sensiti7ity&
B+N& Crea& '+B ultrasound
At the B#
Subjective Objective Assessment Plan
/01 reddish colored urine CBC@
)!./!.8/)."/
!.:=/!.!4/!.):/
!.!/8:8
B+N@ =."
**ol/L /.9-
9.1
Crea@ :8." u*ol/L
/=8-)!41
Na@ )8=.9 /)8=-)"91
'@".8) /8.=-=.81
Cl@ )!8.: /99-)!:1
Ca@ ."= /.8-.91
A%>@ 9!!5+/*l
Acute
Glo*erulonephr
itis
Ad*it
Low fat& low salt
diet
5nsert heploc6
,enicillin G ).
M FuG e7ery 4 hours
/-1 AN%2
2otal Huid restriction
Course in the Dard@ )
st
hospital day
Subjective Objective Assessment Plan
/01 tea colored urine B, ))!-)8!/9!-)!!
CA# 9!-)!
## !s
2 3 8:.9 C
Awa6e& co*forta(le& not in
distress
/01 (ipedal ede*a
'+B ultrasound@ Nor*al
sono$ra* of 6idneys and
urinary (ladder
Acute Glo*erulonephritis 2herapeutics@
Furose*ide 89 *$/5C e7ery
) hours
Nifedipine = *$/cap %L E"
I)"!/9!
,araceta*ol =!/= 3 : *L
for fe7er I8:.9C
Non-therapeutic@
Dei$h patient daily and
record

Course in the Dard@ nd
hospital day
Subjective Objective Assessment Plan
/-1 tea colored
urine
2 8:.9C
B,@ )!-9!/4!-
)!!
))!/9!
)!/9!
/01 (ipedal
ede*a

Fe7er ,araceta*ol
=!*$/=*l :.=
*l e7ery " hours
Dei$h patient daily
Course in the Dard@ 8rd
hospital day
Subjective Objective Assessment Plan
/-1 tea colored
urine
No su(Aecti7e
co*plaints
Dt@ 846$
+>@ ).!4cc/hr
B,@ 9!-)!!/4!-9!
CA#@ 9!-9!s
## 3 !s
/01 (ipedal ede*a
Acute
Glo*erulonephritis
Fluid li*it J ))44
*l
4a*-p*@ "9! *l
-)!p*@ =84 *l
)!p*-4)*@ )=!*l
Course in the Dard@ "th
hospital day
Subjective Objective Assessment Plan
/-1 tea colored
urine
No su(Aecti7e
co*plaints
Dt@ 89 6$
+>@ 8 cc/hr
B,@ 9!-))!/4!-9!
CA#@ 9!-9!s
## 3 !s
/01 *ini*al (ipedal ede*a.
Lower e;t
Acute
Glo*erulonephritis
Continue present
care and *ana$e*ent
,lan for dischar$e if B, is
controlled
Course in the Dard@ =
th
hospital day
Subjective Objective Assessment Plan
/-1 tea colored
urine
No su(Aecti7e
co*plaints
Dt@ 846$
+>@ ).9 cc/hr
B,@ 9!-)!!/4!-9!
CA#@ 9!s
## 3 !s
afe(rile
Awa6e& co*forta(le& N5D
/-1 (ipedal ede*a
%CB& clear B%
A,& N###
Full pulses
Acute
Glo*erulonephritis
MG-@
Furose*ide 8" *$/paper
ta( >D for *ore days
Co-A*o;icla7 "=:/= 3 = *L
B5D ; )!d
Captopril =*$/ta( 3 K ta(
>D for d *ore
For +rinalysis
Follow-up after 8 days w/
results
La(oratory and
5*a$in$
.
CBC w/ A,C@ )!./8/)."/:=/):/8:8
.
%B@ )8=.9/".8/)!8.:/."=
.
A%>@ 9!! iu/*L /01
.
C8@ ! /9:!-)=:41
.
+rine C%@ No $rowth after days of incu(ation
.
'+B@ Nor*al
.
B+N@ =." Crea@ :8."
Discussion
Btiolo$y
.
follows infection of the throat or s6in (y
certain Lnephrito$enicM strains of GA%
.
9:N in less-de7eloped countries
.
MC@ =-) y/
.
%trep pharyn$itis 3 cold weather *onthsO
,yoder*a 3 war* weather *onthss
.
2hroat /serotype )1O %6in /serotype "91
,atholo$y
.
'idneys appear sy**etrically
enlar$edO
.
Glo*eruli appear enlar$ed and
relati7ely (loodless showin$ di<use
*esan$ial cell proliferation w/ increase
in *esan$ial *atri;
.
5**unoHuorescence *icroscopy@ LLu*py-(u*pyM
deposits of i**uno$lo(ulin and co*ple*ent on the
$lo*erular (ase*ent *e*(rane and *esan$iu*
.
Blectron *icroscopy@ electron dense
deposits or Lhu*psM o(ser7ed on the
epithelial side of the GBM
,atho$enesis
.
Mediated (y i**une co*ple;es
/anti(ody-anti$en co*ple; or 2ype 555
hypersensiti7ity1
Clinical
Manifestations
.
De7elops )- w6 after an antecedent streptococcal
pharyn$itis or 8-4 w6 after streptococcal pydoer*a
.
'idney in7ol7e*ent@ asy*pto*atic *icroscopic
he*aturia w/ nor*al renal function to $ross
he*aturia w/ acute renal failure
. Bde*a& hypertension and oli$uria can de7elop
. #are@ heart failure& encephalopathy
.
Acute phase@ resol7es w/in 4-9 w6
.
+rinary protein e;cretion and hypertension usually
nor*ali?e (y "-4 w6 after onset
.
Microscopic he*aturia can persist for )- yr after
initial presentation
Dia$nosis
. +rinalysis@ #BC casts& proteinuria& ,MN
. B+N& Creatinine& %eru* electrolytes 3 esti*ate GF#
. CBC@ *ild nor*ochro*ic ane*ia
. C8@ decreased /I9!N1
.
A%> titer& B%#@ ele7ated /only in pharyn$itis1
.
2hroat culture
. Dnase B le7el /anti-deo;yri(onuclease1@ (est sin$le
anti(ody titer for cutaneous infection
.
%trepto?y*e screen
.
CP#/M#5
. #enal (iopsy
Co*plications
.
-ypertension@ 4!N
.
-ypertensi7e encephalopathy@ )!N /re7ersi(le1
.
-yper6ale*ia& -ypocalce*ia
.
Acidosis
.
%ei?ures
.
+re*ia
.
Acute renal failure
2reat*ent
.
%odiu* restriction
.
Diuresis /5C Furose*ide1
.
Control of hypertension /Ca-channel
anta$onists& 7asodilators& ACB
inhi(itors1
.
)!-day anti(iotic therapy with
penicillinQQQ
,ro$nosis
.
Co*plete reco7ery in I9=N
.
#ecurrences e;tre*ely are
.
RN leads to $lo*erulosclerosis and
chronic reenal disease