A 10 y/o male present to his pediatrician as a follow-up to a strep throat infec
ID: 123723 • Letter: A
Question
A 10 y/o male present to his pediatrician as a follow-up to a strep throat infection two weeks earlier. The Px shows no signs of the strep infection, however, the physician notes pitting edema in the lower extremities. Continuing the physical exam, the physician found the Px’s BP was 154/86 with a heart rate of 82. A urine sample was taken and the urine was amber colored and frothy with visible sediment. The physician admitted the Px to the hospital and blood and urine tests were run.
Blood
Urine (24 hr collection)
[Na+]p
126 mEq/L
pH
5.0
[K+]p
4.3 mEq/L
Glucose
0
[HCO3-]p
25 mEq/L
RBC
7 p/hpf*
[Cl-]p
89 mEq/L
Protein
4g/24hr
Glucose
84 mg/dL
creatinine
485 mg/dL
pH
7.4
volume
800 mL
PCO2
39 mmHg
PAH
485 mg/dL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
* p/hpf = cells per high powered field
(use cellular mechanisms and diagrams)
a) From these data, what part of the nephron do you think is most affected? Defend your answer. (20pts)
b) What is your diagnosis and what is the cause of this pathology? (10pts)
c) Why is the Px exhibiting high blood pressure? (15 pts)
d) How would you treat this Px? (5pts)
Blood
Urine (24 hr collection)
[Na+]p
126 mEq/L
pH
5.0
[K+]p
4.3 mEq/L
Glucose
0
[HCO3-]p
25 mEq/L
RBC
7 p/hpf*
[Cl-]p
89 mEq/L
Protein
4g/24hr
Glucose
84 mg/dL
creatinine
485 mg/dL
pH
7.4
volume
800 mL
PCO2
39 mmHg
PAH
485 mg/dL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
Explanation / Answer
a) Damage to the glomeruli. As the rate of protein is high in the urine around 4g/24hour. For a 24hour urine collection the normal value should be less than 80mg.
b) Glomerulonephritis-It is a kidney condition that involves damage to glomeruli.,
Pathology:
Infection of streptococci produces Immune complex, antigens which activates compliments recruitment of leucocytes. Leads to inflammation of glomeruli causing damage to glomerular membrane and causes symptoms like hematuria, protenuria and RBC casts. Cytokinesis produced during inflammation leads to proliferation of MC and EC which causes blockage of renal capillaries and decreased Glomerular filtration rate which can caude edems, hypertension, heart failure, Renal Failure.
C) The kidney has pivotal role in regulating blood pressure. Glomerulonephritis can cause hypertension because of damage to kidney function.
d) The goal is to reduce tge symptoms and prevent further kidney damage.
Hypertension is treated by anti hypertensive medications.
Bacterial infection treated with antibiotics.
To suppress the immune system use of corticosteroids.
To increase urine output diuretics are given.
Vitamins and ns and mineral supplements given.
Rest
Restrictions in fluid.
Last Dialysis.
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