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Acute kidney injury, formerly known as acute renal failure, is a sudden decrease in renal functions, which develops within a short time and is rapidly progressing. It is marked by a severe reduction in urine output, with an increase in the serum levels of creatinine and some electrolytes. Acute kidney injury is categorized depending on the part of the kidney which is affected. Therefore, it can be classified into tubular, glomerular, interstitial, or vascular, with acute tubular necrosis being the most common type among the hospitalized patients (Praga et al., 2016). The case presented depicts different clinical manifestations which cut across various classes. For acute tubular necrosis, the clinical manifestations which pointed to this were nausea and vomiting, weakness, and dizziness. The clinical manifestation, which means a glomerular type of kidney injury, is fever. Clinical manifestations which point towards interstitial nephritis are fever, nausea, vomiting, and weakness. In the case of vascular type of acute kidney injury, the clinical features, in this case, included fever, nausea, and vomiting.
The various risk factors which might have predisposed the patient to the condition are old age, as most cases are shared with advancing age. The second risk factor is atherosclerosis of the renal vessels, as this may reduce renal blood flow, causing injury to the kidney. The other risk factors for acute kidney injury are infections since infection can cause inflammation of the kidney parenchyma (Ronco et al., 2019). Preexisting autoimmune conditions such as lupus can also cause damage to the kidney due to the deposition of immune complexes in the kidney, followed by inflammation in response to the complexes, thereby causing injury to the kidney. The other risk factor is obesity.
The hematological system is adversely affected by chronic kidney diseases. The first complication is anemia—kidney functions in erythropoietin production, which is essential in erythropoiesis involved in chronic renal failure. With kidney failure, such processes are reduced; therefore, the red cell indices are reduced, including the hemoglobin levels. Such patients will consequently present with symptoms of anemia such as fatigue, dyspnea, easy fatigability, palpitations, and pallor, among others (Ronco et al., 2019). The second hematological aspect affected is the coagulation cascade. Kidney failure results in the loss of protein in the urine. Such proteins also contain coagulation factors which are essential in the stoppage of bleeding. With their increased losses and reduced level, therefore, the patient is at risk of bleeding disorders. Chronic renal failure consequently results in cardiovascular diseases and neglect, which further present with more hematological symptoms.
Case Study 2: Reproductive Function
The most like diagnosis of Ms. PC is a sexually transmitted infection (STI). The reasons for this diagnosis are from the patient’s clinical presentation and the history is taken. She presents with a history of lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge which are classical for STIs and urinary tract infections, UTIs. Her history of unprotected sex eight days ago with her partner, who has been away for some time, makes the likelihood that the partner had an infection that he transmitted to her during the sexual intercourse (Martín-Sánchez et al., 2020). It is confirmed that she presents to the clinic just a few days after the intercourse. The microscopic examination reveals no flagellated microbes, thereby ruling out the possibility of a urinary tract infection from the gut by E. coli.
Based on the vaginal discharge and the microscopic examination of the sample, the most likely organism, in this case, is Neisseria gonorrhea. The criteria I would use to recommend hospitalization for this patient are, first, if she cannot tolerate outpatient oral antibiotic regimen if the illness is severe, if the patient is pregnant, and when the diagnosis is uncertain. I will use the other criteria if the patient is immune deficient and fails to improve clinically after 72 hours of outpatient therapy.
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