Morris is a 52-yr old man with a history of 10 years type 2 Diabetes. His serum
ID: 219024 • Letter: M
Question
Morris is a 52-yr old man with a history of 10 years type 2 Diabetes. His serum creatinine is 0.9 mg and his blood pressure is 130/90. Morris is overweight and does not exercise regularly. His glomerular filtration rate (GFR) was measured and was recorded to be 98ml/min. His 24-hour urine shows a significant increase in microalbuminuria from 100 mg/24 hours last year to the current 200 mg/24 hours. According to these investigations, his doctor informed Morris that he has stage 1 chronic kidney disease (CKD) indicating kidney damage. Answer the following questions 1. Is his GFR at a normal rate? 2. What would you expect the GFR values to be in end stage kidney failure? 3. What lead to microalbuminuria in this case? .Explain the pathophysiologyof microalbuminuria 5. Is his serum creatinine at a normal level? 6. What does a high serum creatinine indicate? 7. What is the prognosis of this case? 8. How can Morris be treated?Explanation / Answer
1. Answer is YES.
The patients with Stage 1 chronic kidney disease will have normal glomerular filtration rate, usually above 90 ml/min ( normal GFR ranges from 90-120 ml/min/1.73m2).
2. At end stage kidney failure GFR will be less than 15 ml/min
3. The presence of Mircroalbumin in urine is due to type 2 diabetes associated renal damage
4. Microalbuminuria can be as a result of increased intraglomerular capillary pressure, damage in glomerulai that changes glomerular barrier filtration, normal reabsorption of filtered albumin is not being functional or hereditary vascular endothelial dysfunction
5. he has serum creatinine level within normal range for an adult male (0.6- 1.2mg/dL of blood)
6. High serum creatinine level indicate renal damage
7. The kidneys will be unable to clear creatinine (which is formed as a result of muscle activity in the first place) through urine, and it will remain in the blood and concentrate.
8. By having a healthy life style and eating healthy foods including vegetables and fruits plus regular checking of serum creatinine level, blood pressure, urine protein level etc and taking medicines that a physician recommended, on time.
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