Patient A, a man 27 years of age, presents to an outpatient clinic complaining of two days of facial and

hand swelling. He first noticed swelling around his eyes, along with difficulty putting on his wedding ring
because of swollen fingers. Around the same time, he began to notice that his urine appeared reddish-
brown. He reports having less urine output over the past several days. He has no significant medical
history. His only medication is ibuprofen, which he took more than one week ago for fever and sore
throat that have since resolved. On examination, he is afebrile, with a heart rate of 85 beats per minute
and a blood pressure of 172/110 mm Hg. Patient A has periorbital edema; his funduscopic examination
is normal, without arteriovenous nicking or papilledema. His chest is clear to auscultation. His heart
rhythm is regular, with a nondisplaced point of maximal impulse, and he has no abdominal masses or
bruits. The patient also has edema of his feet, hands, and face. A dipstick urinalysis in the clinic shows
specific gravity of 1.025 with 3+ blood and 2+ protein, but is otherwise negative. A fresh-spun urine
specimen is positive for red blood cell casts.

The physician diagnoses acute (likely poststreptococcal) glomerulonephritis. This condition is most likely
to affect children with a history of upper respiratory infection or a history of strep throat one to three
weeks earlier, although adults may also be affected. Patients present with edema, hypervolemia,
hypertension, hematuria, and oliguria. Red blood cell casts on urinalysis verify the diagnosis. Systemic
lupus erythematosus is another possible cause, but this patient has no signs or symptoms indicating this
etiology.
Treatment of poststreptococcal glomerulonephritis focuses on managing hypertension and edema.
Patient A is placed on a low-salt diet and liquid intake is restricted. If the edema was more severe, loop
diuretics would be prescribed. However, the edema begins to resolve and his blood pressure begins to
lower with conservative management. Additionally, Patient A is prescribed oral penicillin G at a dosage
of 250 mg four times per day for 7 to 10 days to eradicate the nephritogenic strain. The patient is
instructed to rest and avoid vigorous physical activity for a day or two.

Source: https://www.netce.com/casestudies.php?courseid=2066

 Note: one of the risk factor for glomerulonephritis is Regularly taking more than the
recommended dose of non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, aspirin or naproxen

ADDITIONAL NOT FROM THE SEARCHED CASE STUDY:

- Grade 2 edema on arms and legs (mag edema lang guro ta guys para naa tay loop diuretics nga
tambal)
- Grade 2 periorbital edema
-foamy urine (caused by too much protein in urine)

DEMOGRAPHIC:

 -pwede include ang mga s/s sa sore throat sa past med hx (Pain or a scratchy sensation in the
throat,Pain that worsens with swallowing or talking, Difficulty swallowing, Sore, swollen glands in
your neck or jaw, Swollen, red tonsils, White patches or pus on your tonsils, A hoarse or muffled
voice.

DRUGS:

-furosemide- for the edema

-angiotensin-converting enzyme (ACE) inhibitors (ACEIs)- for the HTN

*note: pwede unta ta mag prednisone kay for the inflammation but di nalang guro para less complicated
since Some cases of glomerulonephritis can get better on their own. If you had strep throat that led to
glomerulonephritis, your glomeruli might recover on their own after you take an antibiotic to treat the
strep infection. So pwede rajud di nalang ta magprednisone kay naa naman sad tay furosemide para
maka-less sa edema.

-penicillin

LABS:

-UA

-CBC (bun and crea elevated)

-ultrasound (https://radiopaedia.org/cases/post-infective-glomerulonephritis)