00:01
All right,
o how do we diagnose this?
Really unusual thing
only happens rarely.
00:07
What are the ways
that Healthcare Providers
will diagnose this condition.
00:11
While they look at labs in
the patient's risk factors.
00:14
They look at the patient's
clinical assessment.
00:16
They look and see for signs of
lung Hemorrhage or proteinuria
or blood in their urine.
00:21
When they diagnosed it
and they confirm it.
00:24
They noticed the presence
of anti GBM antibody
in the blood or in the kidney.
00:30
Now it takes a tissue
biopsy to do that.
00:33
Okay.
So here's a pretty good list,
but I don't want to
speak through it.
00:37
I want to go back
because look at the
role you play in this.
00:40
All right assessment of labs
and patients risk factors.
00:43
You can get a lot of the
patient's risk factors
on a good patient history.
00:48
So when you're doing
an admission assessment
you want to make sure that you
ask these types of questions
you want to do a very thorough
assessment on your patient.
00:56
Now you look for signs
of lung Hemorrhage
and proteinuria or
blood in the urine.
01:02
Now we don't automatically jump
to someone has blood in
their urine to good pressure.
01:06
Right?
That wouldn't be a
logical conclusion.
01:09
Remember diagnosing
you're part of the team
you're bringing important
information to the table
to help the healthcare provider
make an accurate diagnosis.
01:17
You do know that protein
in the urine and kidneys
that are putting
blood in the urine.
01:23
There is a problem that
needs to be followed up on.
01:26
Now we can actually
confirm the diagnosis
with a specific test
that looks for those
Antibodies in the blood
or even more specific you
can do a kidney biopsy
and I'm giving you that face
because that's not
comfortable for your patients.
01:40
They literally go
in and snip off
a part of the kidney and take
it back out for examination.
01:45
So you can imagine why
that would not be fun.
01:48
But based on what you
know about antibodies,
you know that they
can live in your blood
you solve it in her bloodstream
or be deposited in tissues,
and that's why a tissue
biopsy may be helpful.
02:00
Well not pleasant
for your patience.
02:03
So let's talk about
some good news.
02:04
Let's talk about how you
can treat this disease.
02:07
Now, there's two options here.
02:08
We're going to try
to either get rid
of the antibodies that you have
and we're gonna try to
prevent new ones from forming.
02:15
All right,
that's the overall
plan for treatment
get rid of the
antibodies you have
and stop new ones from forming.
02:22
So how do we get rid
of the ones we have?
Plasmapheresis.
02:26
So you take that out you
remove those antibodies
and that will help
with the inflammation.
02:31
- how do we stop new
ones from forming?
We've got to suppress
that immune system
two options corticosteroids
or cyclophosphamide Okay.
02:41
So we've got these two
options that can be used.
02:44
That's what will stop further
antibodies from forming
because if I suppress
that immune system
stop the binding
and those antibody
to the basilar membrane,
you get the picture.
02:56
So when you're thinking
about treatment,
get rid of the
antibodies you have
Stop the new ones from forming.
03:02
Plasmapheresis,
and then corticosteroids
or cytotoxic drugs
like cyclophosphamide.
03:08
Now, what do you do with
this patient after discharge?
We talked earlier new
patients die from this
the answer is usually not some
do from pulmonary Hemorrhage,
but usually they don't,
but they need to get
acute treatment quickly.
03:22
We need to figure out
what their factors are
and help them get rid of those
the environmental factors
and then they need
proper follow-up care.
03:30
So after discharge,
the patient needs regular
visits for follow-up
for a long period of time
have to keep an eye on
their kidney function
and want to make
sure they keep taking
their immunosuppressive therapy.
03:41
We also want to see
if they're having any
of those side effects
from immunosuppressive therapy
and help them address those.
03:47
Now the patient
might need dialysis
if the damage was really severe,
it might need to start
on some dialysis and
continued indefinitely.
03:56
If that can't
resolve the problem
then they may even consider
a kidney transplant.
04:01
So after discharge,
they need great follow-up care.
04:04
We need to keep a
really close eye
on that immunosuppressive
therapy and kidney function
and then watch of the patient
may progress to need dialysis
or even a kidney transplant.
04:15
Now we talked about
helping them in the middle.
04:17
We want to help them identify
those environmental factors
and get rid of them.
04:21
So smoking is one of
the more obvious ones
you want to give that
patient support encouragement
and education about how they
can stop smoking without.
04:30
any form of judgment.
04:32
So if you're not a smoker,
you don't have any right to
be self-righteous with them
be understanding all of
us have coping mechanisms
and smoking is definitely
a coping mechanism
and really difficult to stop.
04:47
So be kind, don't judge just
help the patient take a step
toward a healthier life.
04:54
So this patient is exposed
to any other type of impossible
environmental factors
that have to work together
to help them recognize that
and eliminate or minimize
them from your life.