Tuberculosis (TB) is a disease that causes millions of death worldwide. Caused by Mycobacterium tuberculosis, TB affects the entire body but usually attacks the lungs. The cases of TB in the past decades have decreased dramatically. However, certain factors caused the resurgence of the disease. One of these is the onset of AIDS epidemic. Knowing that AIDS makes a person’s immune system weak, it allows the Mycobacterium tuberculosis to thrive in the human body causing tuberculosis.
AIDS also increases the risk of activation in people with latent tuberculosis as well as the possibility of having subsequent TB episodes due to exogenous reinfection. Another contributing factor to the continuous rise in cases of tuberculosis is the resistance of certain strains to drugs that cure TB. As the strains become resistant, the chance for curing TB is getting lower because there is the need to find new means in combating the new strains of microorganism.
Other factors would include the limitation of new control measures as well as the development of improved vaccine. Poverty together with poor ventilation and crowded environment contribute to this increase of TB cases. Changes in the health care system regarding its context on TB elimination are different as what it is in the past decades. Poor detection and lack of access to medical services indeed affects the trend of TB cases. 2. Eddie presented a condition known as acute poststreptococcal glomerulonephritis (APSGN), an archetype of acute glomerulonephritis or AGN.
AGN is an inflammation of the glomeruli, whose primary function is to remove wastes on the blood and release it out of the body in the form of urine. Most cases of glomerulonephritis are the result of trapped circulating antigen antibody complexes within the glomerulus. Complexes form as a result of activation of body’s defense to combat the invading microorganisms. Its source may be classified as exogenous (such as poststreptococcal infection), or endogenous (such as systemic lupus erythematosus).
With Eddie’s case, Group A beta hemolytic streptococcal microorganisms are the main culprit of his streptococcal infection. As the complexes continue to lodge on the glomeruli, pathologic changes may occur and inflammatory response may be activated. The swelling caused by the inflammatory process increases the permeability of the membrane resulting to a decrease in glomerular filtration rate (GFR). As GFR decreases, so is the ability of the kidney to concentrate urine resulting to low pH and high specific gravity.
It also impairs the filtering ability of the urine allowing urea and creatinine to build up on the blood, resulting to an increase in BUN and creatinine in urinalysis. Glomerular swelling from the inflammatory process leads to distention of the renal capsule, which then triggers receptors found on the kidney. As the receptors are triggered, the client experiences flank pain or abdominal pain. On the other hand, an increase in permeability of the membrane allows components such as blood and proteins to escape in the urine resulting to manifestations of gross hematuria and proteinuria.
The client may also manifest hypertension because of the disregulation of the RAAS found on the kidneys whose function is to maintain blood pressure and fluid balance. It causes sodium retention, which then results to water accumulation leading to hypertension. The pediatrician will ask for hospitalization especially if the client manifest symptoms like edema, oliguria and elevated urea and creatinine. Treatment for acute glomerulonephritis aims to eliminate antigens, to strengthen the immune system, to prevent further kidney damage, and to return normal kidney function.
An antibiotic therapy (penicillin for streptococcal infection) may be prescribed to treat predisposing infection. Corticosteroids are given to relieve symptoms of the disorder. Hypertension is treated with prescriptions of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. A diet low in sodium and protein is usually ordered during the acute phase, when edema and hypertension are present. Because of its immune-related cause, plasmapheresis is found to reduce the inflammation of the kidneys.