A 7-year-old boy was brought to his pediatrician because he had developed hematuria, which required hospitalization. Approximately 6 weeks before his admission, he had a severe sore throat but received no treatment for it. Subsequently, he did well except for complaints of mild lethargy and decreased appetite. Approximately 3 weeks before admission, he had a temperature of 101° F daily for 7 days. He complained of minimal bilateral back pain. Physical examination revealed a well-developed young boy with moderate bilateral costovertebral angle (CVA) tenderness. The remainder of the physical examination results were negative. His blood pressure was 140/100 mm Hg in both arms and legs.
Studies Results Urinalysis, p. 956 Blood +4 (normal: negative) Protein +1 (normal: negative) Red blood cell casts Positive (normal: negative) Specific gravity 1.025 (normal: 1.010-1.025) Color Red-tinged (normal: amber-yellow) Urine culture and sensitivity (C&S), p. 973 No growth after 48 hours Blood urea nitrogen (BUN), p. 511 42 mg/dL (normal: 7-20 mg/dL) Creatinine, p. 190 1.8 mg/dL (normal: 0.7-1.5 mg/dL) Creatinine clearance test, p. 193 64 mL/min (normal: approximately 120 mL/min) Renal ultrasound, p. 866 No tumor; kidneys diffusely enlarged and edematous Intravenous pyelogram (IVP), p. 1057 Delayed visualization bilaterally; enlarged kidneys, no tumor; no obstruction seen Renal biopsy, p. 751 Swelling of glomerular tuft, along with polymorphonuclear leukocyte infiltrates in Bowman’s capsule (findings compatible with glomerulonephritis); immunofluorescent staining, positive for IgG Anti-DNase-B (ADB) titer, p. 79 200 units (normal: ≤170 units) Total complement assay, p. 172 33 units/mL (normal: 75-160 units/mL)
Case Studies 2
The blood, protein, and RBC casts in the boy’s urine indicated a primary renal disorder. The elevated creatinine and BUN levels indicated that the problem was severe and markedly affecting his renal function. Both kidneys were probably equally impaired. Intravenous pyelogram (IVP) was helpful only in ruling out Wilms tumor or congenital abnormality. Normally an IVP would not be performed in light of this patient’s impaired renal function. It is presented here for demonstration of the information it can provide. Renal ultrasound is a much safer test to visualize the kidney to exclude neoplasm. The ultrasound findings were compatible with an inflammatory process involving both kidneys. Renal biopsy was most helpful in suggesting glomerulonephritis. The history of recent pharyngitis, fever, the positive ASO titer, the positive ADB titer, and the finding of immunoglobulin IgG antibodies on the immunofluorescent stain all suggested poststreptococcal glomerulonephritis.
The patient was placed on a 10-day course of penicillin. He was given antihypertensive medication, and his fluid and electrolyte balance was closely monitored. At no time did his creatinine or BUN level rise to a point requiring dialysis. After 6 weeks, his renal function returned to normal (creatinine, 0.7 mg/dL; BUN, 7 mg/dL). His antihypertensive medications were discontinued, and he remained normotensive and returned to normal activity.
Critical Thinking Questions
- At what point would the BUN and creatinine have signified the need for dialysis? 2. What was the cause of the patient’s hypertension? 3. What would you do if this patient had developed a swollen mouth and neck after the IVP? APA style 2 reference.
One of the biggest problems with children of alcoholics is that they tend to be more prone to mental illnesses. Many children struggle with hyperactivity problems, anxiety, depression, low self esteem, and psychosomatic reactions (Christensen, 2000 p.219). These emotional problems are a result of their parent’s actions. These children grow up seeing their parent in situations that create added stress for them. The parent may or may not be abusive, or may be absent for important things. Maybe the parent even argues with their children over certain matter that influence less support (Barerra, 1993 p. 603). This can lower the child or childrens’ self esteem. Low self esteem leads to or can lead to real mental health problems such as depression or anxiety. These children are much more likely to have substance abuse problems early in life. Some of the reasoning behind that is the genetics of mental health disorders, such as alcoholism, but some of it is because children with anxiety and depression can turn to drugs and alcohol to cope (Puttler 1998, Serec 2012, Vernig 2011). Children of alcoholics’ mental health problems create issues for them not only during childhood, but also later in life (Vernig 2011, Serec 2012, Puttler 1998, Eiden 2009, Sher 2007). Their adulthoods often include some form of substance abuse often caused by their mental health problems. Alcoholics typically also have depression or anxiety of some form (Eiden 2009). Children of alcoholics feel neglected because their parent or parents do not always pay attention to them, or they have to give up being a child in order to replace the support of their alcoholic parent. The oldest child steps up, while the younger children begin to feel neglected and ignored. These children act out and develop these mental problems as a result of the little attention they are paid. In early stages of development these children need more attention and care and often do not receive it. This causes anxiety, depression, and hyperactivity disorders (Eiden 2009, Vernig 2011, Puttler 1998). Physical illnesses are common in children of alcoholics just as the mental illnesses are. Children in these situations tend to become more prone to illnesses, especially in earlier childhood stages like infants, toddlers, preschool age, and middle school ages. These children need a lot of support, love, and help from their parents and lack of their basic needs causes more physical illnesses to occur. They need to be taken care of and given lots of attention. Studies show that alcoholic parents possess lower quality parenting skills than those of nonalcoholic parents (Eiden 2009). Children in preschool or of preschool age are 65% more likely to come down with illnesses such as colds and coughs more than other children. They are also more likely to have allergies and anemia or to be over or under weight (Serec, 2012). Due to the poor parenting skills of alcoholic parents, children at young stages are more at risk to be hospitalized for their illnesses or injuries. They are more likely to spend more days in the hospital, need more medical treatment, and get more injuries than children without alcoholic parents (Serec, 2012). These children are not treated properly at home, or not as well as they should be taken care of. Physical illnesses occur in the children in adolescence as well, but are more common in those of the younger children. Aggravation of alcoholic parents towards their children is more likely than that of nonalcoholic parents, so that is possibly an aspect of why children tend to become sicker when their parents are alcoholics. Children of all ages try to get attention from their parent or parents when one or both of them are alcoholics. It is natural for the human body to need (or crave) love and attention. Younger children often need more love and attention as their brains develop, learn, and grow. Children cann>