1. A 10 y/o male present to his pediatrician as a follow-up to a strep throat in
ID: 3476466 • Letter: 1
Question
1. 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
12.88 mg/mL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
* p/hpf = cells per high powered field
What is the diagnosis and what is the cause of this pathology? Explain. (use cellular mechanisms and diagrams)
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
12.88 mg/mL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
Explanation / Answer
1. The main symptoms are HYPERTENSION, EDEMA and PROTEINURIA.
2. The above symptoms and biochemical changes point towards the diagnosis of NEPHROTIC SYNDROME .
3. NEPHROTIC SYNDROME is defined as the presence of NEPHROTIC RANGE PROTEINURIA, EDEMA and HYPOPROTEUNEMIA.
4. NEPHROTIC SYNDROME mainly occurs due to pathology of podocytes as a result filtration barrier disrupts and PROTEINURIA occurs. This decreases oncotic pressure and leads to edema.
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