Question

A 46 year old woman, Susan Grey, was seen by a physician and diagnosed with a moderate case of strep-throat. She was prescribed 1000mg amoxicillin daily to be taken for 12 days. After 6 days she felt better and stopped taking her antibiotics. Nine days later she was hospitalized with the following symptoms: severe headache, mild delirium, accelerated and “fluttery-feeling” heartbeat, brown cola-colored urine, and massive edema of the legs. Clinical diagnostic tests revealed the following:

Body Temperature	37°C
Heart Rate	110 BPM
Blood Pressure	190/110
Serum Potassium Concentration	6.5 mEq/L
Serum Sodium Concentration	160 mEq/L
Estimated Urine Output	300 mL/day

In addition, ECG analysis displayed an arrhythmic heartbeat with a peaked T-wave, depressed ST segment, weak P-Wave, and a widened QRS complex. Urinalysis showed proteinuria (4g/day), presence of red blood cells, and presence of renal tubular cells.

What is your diagnosis for this patient (be specific)?

How does this condition arise?

What biological marker would you look for to confirm your diagnosis?

Given the severity of this patient’s symptoms, what are the best treatment options?

What is the likely prognosis for this patient? Will she be required to make any long-term dietary or lifestyle changes?

Answer 1

The provisional diagnosis is of nephrotic syndrome

All the typical features

-Proteinuria >3.5g per day

-Tachycardia and high bp

-electrolyte imbalance ( normal Na-135-140meq,K -5.5meq)

oliguria,cola coloured urine(gross hematuria)

Proteinuria is caused due to goomerular pathology due to many causes,but here in the question it suggests towards Drug induced nephrotic syndrome(dur to Nsaids,pencillamine) -as patient has history of taking drugs to streptococci

Drug induced nephrotic syndrome usually causes membranous nephropathy on histology and few biological markers are-anti AR antibodies,NAG,anti-PLA2R

Also i would recommend you to watch armando hasudungan video on nephrtic disease to get a basic idea .