A 10 y/o male present to his pediatrician as a follow-up to a strep throat infec
ID: 3476468 • 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
12.88 mg/mL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
* p/hpf = cells per high powered field
How to treat this Px? Explain
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 urine analysis and biochemical changes point towards NEPHROTIC SYNDROME.
2. The initial treatment plan is GLUCOCIRTICOIDS. it is mainly used as an antiinflammatory agent.
3. DIURETICS such as FUROSEMIDE is given to reduce edema
3. ANTIHYPERTENSIVES such as ACE inhibitors are given to treat hypertension
4. CALCINEURIN INHIBITORS are given to children who are resistant to steroids.
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