Peer Responses

history is positive for strep throat previously treated. Her work up revealed severe abnormal lab
values. Her final diagnosis is post streptococcal glomerulonephritis.
What specific lab values would you suspect are abnormal? Defend your answer.
Children with strep throat may develop post streptococcal glomerulonephritis within two weeks of
having the infection and some children can develop it after six weeks after a bacterial skin infection called
impetigo (Rawla et al., 2021). Symptoms include oliguria, hypertension, edema, hematuria, and proteinuria
which are very similar to nephritic syndrome (Rawla et al., 2021). This condition causes an overactive
immune response causing kidney inflammation impairing its function. This reaction will cause elevated
BUN and creatinine level and decreased glomerular filtration rate (GFR) (Rawla et al., 2021). Due to the
inflammatory reaction causing complement 3 (C3) consumption these level will also be low (Rawla et al.,
2021). Urinalysis would also show so RBS casts, macro or microscopic hematuria, mild proteinuria, or in
rare cases if nephritic syndrome and the kidneys are impaired there may be extensive proteinuria (Rawla
et al., 2021).
What is the significance of a positive strep infection?
Strep causes a type III hypersensitivity inflammatory reaction within the body which can greatly impair
kidney function (Rawla et al., 2021). Specifically, nephrogenic streptococci, a group A beta-hemolytic
strep, damage the glomeruli and small blood vessels in the kidneys (Rawla et al., 2021). Some literature
suggests that the body creates a strep antigen immune complex with a “human antibody” and that this
immune complex is the cause of the disorder (Rawla et al., 2021).
Compare and contrast acute vs chronic glomerulonephritis.
Acute glomerulonephritis occurs when there is a sudden onset of damage that temporarily malfunctions
the kidneys but this damage can be reversed quickly when the underlying cause is treated (Haskell, 2020).
For example, administering IV fluids for dehydration, removing nephrotoxins, or stat dialysis if its fluid
overload and electrolyte imbalance causing injury (Haskell, 2020).
Chronic glomerulonephritis is considered if kidney impairment continues over a long period of time or
there is over 3 months of decreased GFR (Haskell, 2020). The damage is no longer reversible. This chronic
condition has a gradual onset of symptoms that are caused by chronic diseases like diabetes or
hypertension but it can also be inherited (Haskell, 2020).
Does glomerulonephritis resolve? Defend your answer.
There is a chance that acute glomerulonephritis can be reversed as long as the cause of the injury is
identified and resolved quickly. The damage in chronic glomerulonephritis is not reversible but there is
treatment to slow down its deterioration.
References
Haskell, R. (2020, January 31). Acute kidney injury and chronic kidney disease – What's the difference.
Lippincott Nursing Center. https://www.nursingcenter.com/ncblog/january-2020/acute-kidney-injury-and-
chronic-kidney-disease

Rawla, P., Padala, S., & Ludhwani, D. (2021). Poststreptococcal glomerulonephritis. In StatPearls
[Internet]. StatPearls Publishing.

Travis LeGrand

When people with celiac disease eat foods that contain gluten, their
immune system is activated and launches an allergic reaction on the gluten
and the small intestine. Celiac disease is a T cell mediated immune disorder
characterized by the loss of oral tolerance to dietary gluten and the licensing
of intraepithelial lymphocytes to kill intestinal epithelial cells, leading to
villous atrophy” (Kim et. al. 2015). T cells have receptors that recognize
antigens. Once the antigen is recognized, and in this case this antigen it
gluten, it activates the T cells. As a result of this activation and the attack on
the small intestines, sometimes malabsorption can be the result of this
immune response. This means the body is no longer able to get the nutrients
it needs via the small intestine. Celiac disease is described by patients who
suffer from it as a severe discomfort of the digestive system and can be quite
painful. Patients who are diagnosed with celiac disease are strongly advised
to adhere to gluten-free diet and this be a life long change. Foods that are
intensely avoided are wheats, barleys and ryes.
One major symptom of celiac disease is diarrhea. Among other
symptoms are anemia and osteoporosis. In many cases, adults suffer for
many years before receiving their diagnosis of celiac disease. “Gliadin
ingestion results in the activation of gladin-reactive T cells in the intestine.
These celiac disease T cells are hypothesized to provide immunologic help to
B cells to produce TG autoantibodies, in addition to promoting a favorable
cytokine milieu to help drive the celiac disease process. Gliadin ingestion is
also directly toxic to the enterocytes, resulting in IL-15 release and
subsequent upregulation of MIC-A on the enterocyte surface" (Barker & Liu
2008).

References:

Barker, J. M., & Liu, E. (2008). Celiac disease: pathophysiology, clinical
manifestations,
and associated autoimmune conditions. Advances in pediatrics, 55,
349–365. https://doi.org/10.1016/j.yapd.2008.07.001

Kim, S. M., Mayassi, T., & Jabri, B. (2015). Innate immunity: actuating the
gears of
celiac disease pathogenesis. Best practice & research. Clinical
gastroenterology, 29(3),
425–435. https://doi.org/10.1016/j.bpg.2015.05.001

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