. A 10 y/o male present to his pediatrician as a follow-up to a strep throat inf
ID: 3476467 • Letter: #
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
12.88 mg/mL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
* p/hpf = cells per high powered field
Why is the Px exhibiting high blood pressure? 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. From the biochemical analysis , it is clear that this patient has HYPONATREMIA which means decreased blood sodium.
2. This leads to decreased flow of Na through kidneys.
3. As a result a decreased load of Na is sensed by DISTAL CONVULATED TUBULES.
4. As a result RENIN ANGIOTENSINOGEN CYCLE GETS STIMULATED.
4. This leads to increase formation of ANGIOTENSINOGEN II
5. It causes VASOCONSTRICTION, stimulation of ALDOSTERONE
6. These changes lead to HYPERTENSION
4.
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