George, a 26-year-old patient, presents to the Emergency Department (ED) with fever, chills, headache, stiff neck (nuchal rigidity), pain in the back, abdomen and extremities, as well as nausea and vomiting. George lives in a commune with many people in close quarters. He has been diagnosed with meningitis. What is meningitis? Which of the following would be most concerning regarding George's living situation and risk for meningitis? (Select all that apply, all. some or none)

A. Clinical manifestations: hematuria (urine is smoky, brown tinged): Hematuria is a hallmark sign of acute glomerulonephritis. The smoky or cola-colored urine results from red blood cells leaking through the damaged glomeruli, often seen in post-infectious cases.

B. Clinical manifestations: oliguria: Decreased urine output is common due to impaired glomerular filtration. Oliguria reflects reduced kidney function, which contributes to fluid retention, hypertension, and accumulation of waste products.

C. Treatment: Antibiotics, corticosteroids, cytotoxic agents, anticoagulants: Depending on the cause and severity, treatment may include antibiotics for infection, corticosteroids or cytotoxic agents for inflammation, and anticoagulants if there's risk of thrombosis due to nephrotic syndrome features.

D. Treatment: Prescription dose ibuprofen: NSAIDs like ibuprofen are generally avoided in glomerulonephritis because they can reduce renal perfusion and worsen kidney injury, especially in patients already experiencing compromised kidney function.

E. Clinical manifestations: Proteinuria that exceeds 3–5g/day with albumin: This level of proteinuria is characteristic of nephrotic syndrome, not acute glomerulonephritis. While proteinuria may be present, it is typically moderate and not in the nephrotic range.

A. Glomerulonephritis: This is an immune-mediated condition involving inflammation of the glomeruli and typically presents with proteinuria, hematuria, hypertension, and edema rather than urinary frequency, burning, or foul-smelling urine. The presence of E. coli and leukocytes does not support this diagnosis.

B. Kidney calculi: Kidney stones may present with flank pain, hematuria, and sometimes nausea or vomiting, but are not usually associated with urinary frequency, burning, or bacterial growth on urine culture. Randi’s symptoms point more toward an infectious etiology rather than a structural obstruction.

C. Lower UTI: cystitis (bladder infection) and possibly lower ureters: The burning, itching, frequent urination, and foul smell are classic signs of cystitis. The absence of flank pain and only a slightly elevated temperature further supports a lower tract infection rather than an upper one.

D. Upper UTI (pyelonephritis): Pyelonephritis typically presents with fever over 101°F, chills, nausea, vomiting, and significant costovertebral angle (CVA) tenderness or back/flank pain. Since Randi denies back pain and has only a mild temperature elevation, an upper UTI is unlikely.