Question

An adolescent is hospitalized with acute glomerulonephritis. Which aspect of the client's history is most significant to her diagnosis? A. Immunization with VZIG after exposure to varicella B. Experiencing a bout of cystitis within the past year C. Having an untreated sore throat two weeks ago D. Sitting next to a student with mononucleosis

Short answer

Answer: C. Having an untreated sore throat two weeks ago

Step-by-step solution

A. Immunization with VZIG after exposure to varicella

VZIG (Varicella Zoster Immune Globulin) is given to patients after exposure to varicella (chickenpox) to decrease the severity of the infection. This option may not be directly related to acute glomerulonephritis, as there isn't a strong association between varicella infection and acute glomerulonephritis.

B. Experiencing a bout of cystitis within the past year

Cystitis is the inflammation of the bladder, usually caused by a bacterial infection. Although urinary tract infections can sometimes involve the kidneys, the relation between cystitis and acute glomerulonephritis is not strong, especially if it occurred a year ago.

C. Having an untreated sore throat two weeks ago

An untreated sore throat is often caused by a bacterial infection, especially Streptococcus infection. This option is the most significant in the history, as there is a strong association between streptococcal throat infections and acute glomerulonephritis. The untreated infection can lead to the development of an autoimmune reaction, causing inflammation in the glomeruli of the kidneys.

D. Sitting next to a student with mononucleosis

Mononucleosis, commonly known as "mono," is caused by the Epstein-Barr virus (EBV). Although mono can cause an immune response in the body, it's not typically associated with acute glomerulonephritis. From the analysis of each option, the most significant aspect of the client's history to her diagnosis of acute glomerulonephritis is:

Answer

C. Having an untreated sore throat two weeks ago

Key concepts

Streptococcal Infection

A streptococcal infection, often referred to informally as "strep," is a common type of bacterial infection. The bacteria responsible for this infection, called Streptococcus, can cause a variety of illnesses, ranging from minor ailments like sore throats to more serious conditions.
Streptococcal infections can be contagious and are typically spread through respiratory droplets when an infected person coughs or sneezes.

• Types of Illnesses: Villainous strains like *Streptococcus pyogenes* are responsible for conditions such as strep throat, impetigo, and even scarlet fever.
• Diagnosis: Usually, a rapid strep test or throat culture is performed to identify this bacterial presence.
• Treatment: Most strep infections are treatable with a course of antibiotics, such as penicillin or amoxicillin, which help to eliminate the bacteria and prevent complications.

The crucial part to remember is that untreated streptococcal infections, especially sore throats, can sometimes lead to complications that stress the body's immune response.

Immune Response

The immune response is an essential defense mechanism of our body. When the immune system detects harmful invaders like bacteria or viruses, it reacts swiftly to protect the body.
This response involves a series of complex actions designed to recognize, attack, and eliminate the threat.

• Recognition: The body identifies harmful substances, which can be bacteria, viruses, or foreign materials.
• Activation: Once identified, immune cells are activated to attack these invaders.
• Attack and Elimination: Antibodies attach to and neutralize the harmful agents, while other immune cells "eat" them.
• Memory: The immune system remembers the invaders for faster response in the future.

However, problems can occur when the immune system overreacts or targets its own tissues, leading to conditions such as acute glomerulonephritis. Here, the immune reaction to a streptococcal infection mistakenly damages the kidney's filtering units.

Kidney Inflammation

Kidney inflammation, medically known as nephritis, can be triggered by various factors, including infections or autoimmune reactions.
In the case of acute glomerulonephritis, the inflammation occurs in the glomeruli, which are tiny structures in the kidney crucial for filtering blood.

• Symptoms: Symptoms can include blood in the urine, increased blood pressure, and swelling of certain body parts (like the face or feet).
• Causes: This condition often follows an infection, notably streptococcal infections, due to the immune system's inappropriate attack on kidney tissues.
• Treatment: Addressing glomerulonephritis generally involves managing symptoms, treating the underlying infection with antibiotics, and sometimes utilizing medication to control inflammation and blood pressure.

Understanding the relationship between an untreated strep infection and kidney inflammation helps clarify why it is so critical to seek timely medical intervention if one suspects a possible streptococcal infection.