Predisposing Factors: Gender: male Age: 9 yrs.

Old Family history: Kidney related disease Unhygienic habits Frequent consumption of high sodium food

Precipitating factors: Habit of holding back urine

Accumulation of urine in the bladder

LEGEND: Signs and Symptoms Disease Process Precipitating Factors Predisposing Factors Medical Management
Ascending infection takes place in the renal parenchyma Release of antigen-antibody complexes in the circulation Prolong storage of urine in the bladder Invasion of certain kind of bacteria in the body Ultrasound showed Acute Renal Parenchymal Disease

Paracetamol (Biogesic) 500 mg 1/2 tab PO every 4 hours

Entrapment of exogenous bacteria in the endothelial lining of the glomeruli

Abnormal increase of body temperature of 38. 7C

Immune complex reaction in the glomerular capillary 1. Amikacin (amikacide) 125mg q 8h 2. Penicillin G 1m l "u" IV q 6

Abnormal increase of WBC of 18,000 and segmenters of 80 and abnormal decrease of lymphocytes of 17.

Proliferation of epithelial cells lining glomerulus & cells between endothelium & epithelium of capillary membrane Inflammatory response Vasodilation of the renal arteries supplying the glomeruli

Impairment to release erythropoeitin Decrease RBC: 4.59 Inability to stimulate red bone marrow to increase production of RBC Hgb; 10.8 Hct: 33.0 Pale skin and conjunctivae

1. Hydrocortisone (soluocrtef) 50mg IVTT every 6 hours 2. prednisolone (Prelone) 20mg/5ml IVTT BID

Increase perfusion of blood going to the glomeruli Urinalysis showed pus cells of 0 2 cells and revealed few bacteria in the urine Swelling capillary membrane & infiltration with leukocytes

Insufficient tissue perfusion going to the kidneys Ultrasound showed Acute Renal Parenchymal Disease

Reduction of glomelular membranes capacity for selective permeability 1. Increase abdominal girth of 26cm. 2. Ultrasound showed minimal ascites. 3. Chest X-ray 1. anasarca Results showed 2. bipedal edema; MINIMAL TO pitting Grade 1 MODERATE PLEURAL EFFUSION

Decrease urine output and frequency

Occlusion of the capillaries of the glomeruli vasospasm of afferent ventrioles Leakage of large and small particles such as RBC and protein. Urinalysis showed protein (+4) and RBC (14 cells) in the urine

Decrease glomerular filtration rate Decrease ability to form filtrate from glomeruli plasma flow

Third-space fluid shifting from intravascular to interstitial compartment in the peritoneal cavity

Retention of water and waste products

1. Furosemide (Lasix) 40mg 1tab BID 2. spironoloactone (Aldactone) 25mg 1 tab PO BID