Posted: January 26th, 2023

Mr. J.R. is a 73-year-old man

Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study 1 Questions:

The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented, name the possible types of Acute Kidney Injury.
Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage to J.R.’s kidney became irreversible and he is now diagnosed with Chronic Kidney Disease (CKD). Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study 2 Questions:

According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probable diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
Based on the vaginal discharge described and the microscopic examination of the sample, could you suggest which would be the microorganism involved?
Name the criteria you would use to recommend hospitalization for this patient.

Possible types of Acute Kidney Injury (AKI) for Mr. J.R. are prerenal, intrinsic, and postrenal AKI.

Clinical manifestations described such as vomiting, nausea, fever, weakness, dizziness, and decreased urine output can be linked to prerenal AKI which is caused by decreased renal perfusion due to dehydration or decreased cardiac output. Intrinsic AKI can be caused by direct damage to the kidney and may be linked to symptoms such as fever and a metallic taste in the mouth. Postrenal AKI can be caused by obstruction in the urinary tract and may be linked to decreased urine output.

Risk factors for Mr. J.R. could include: advanced age, dehydration, poor cardiovascular function, underlying kidney disease, and exposure to nephrotoxic substances or medications.

In Chronic Kidney Disease (CKD), patients may experience coagulopathy (abnormal blood clotting) and anemia due to decreased production of erythropoietin and vitamin K-dependent clotting factors. These complications occur due to damage to the kidneys, which limits their ability to produce these substances and maintain normal hematologic function.

The most probable diagnosis for Ms. P.C. is a bacterial vaginosis (BV) based on the description of the abnormal vaginal discharge and the microscopic examination findings. BV is characterized by a thick, malodorous discharge with elevated white blood cells and gram-negative intracellular diplococci.

The microorganism most likely involved in this case is Gardnerella vaginalis, a gram-negative anaerobic bacterium commonly associated with BV.

Criteria for hospitalization for this patient could include: severe abdominal pain, fever, dehydration, inability to tolerate oral medications, or pregnancy (to ensure prompt treatment and monitoring).

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