Carolina Sanchez was a 24-year-old woman who was working toward a Political Scie
ID: 81424 • Letter: C
Question
Carolina Sanchez was a 24-year-old woman who was working toward a Political Science degree at the University of California at Davis. In February of 2014 she developed a case of acute pharyngitis. Her symptoms included a 101*F fever and an intense sore throat, which she described a day later to her physician as a feeling of sharp knives in her throat. She also had an irritating headache and vague abdominal pain. When she presented to her physician, he noted that both her throat and tonsils were inflamed and covered with patches of pus. The clinician diagnosed strep throat based on her symptoms and what he described as telltale signs of strep throat. He told Carolina that after having practiced medicine for 40 years he could differentiate bacterial and viral throat infections based upon clinical symptoms and smell. She was given a prescription for erythromycin because, as a child, she had exhibited an allergic reaction to penicillin. In spite of her physician's assurance that she would not suffer any adverse reactions to the antibiotic, she did not fill the prescription and fully recovered on her own within three days. Eleven days after her initial pharyngitis, she woke up in the morning with relatively puffy eyes and ankles that were so swollen that it hurt her to walk. When she went to the bathroom, she noticed that her urine was tinged with blood. She visited her physician the same day. He noted that, in addition to the symptoms she described, she had hypertension (elevated blood pressure) and other symptoms indicative of a dysfunctional kidney. The physician ascertained that she had not taken the antibiotic he had prescribed and he told her that she was experiencing acute glomerulonephritis, a disease normally found in children. He stressed that had she taken her prescription, she probably would not have contracted this additional disease because the antibiotic is prescribed not only to cure the pharyngitis, but also to prevent any additional related diseases. Carolina responded by telling him that she had not taken the antibiotic partly because of her previous bad experience with penicillin, but also because she was not convinced that she had strep throat based on what she perceived as his shoddy diagnostic method. The end result was the progression of kidney damage, which is more common in young adults and adults than it is in children. What precedes acute glomerulonephritis and what symptoms occur? What have histopathologic studies indicated when examining cases of glomerulonephritis? When do most cases of pharyngitis appear? In general, what causes the pathogenesis of acute glomerulonephritis? What is the frequency of glomerulonephritis? Is there a difference in clinical presentation of disease depending on what type of primary infection the individual had? How is acute glomerulonephritis normally treated? What is the difference between acute and chronic glomerulonephritis? For those who develop renal failure, how are they treated?Explanation / Answer
Q1. Infection by group A ß-hemolytic streptococci usually precedes acute glomerulonephritis.