A 10 y/o male present to his pediatrician as a follow-up to a strep throat infec
ID: 3476477 • 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
Show cellular mechanisms and diagrams
a) From these data, what part of the nephron do you think is most affected? Explain.
b) What is your diagnosis and what is the cause of this pathology?
c) Why is the Px exhibiting high blood pressure?
d) How would you treat this Px?
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
A. The part to be effected mostly is GLOMERULI. this leads to the loss of proteins through filtration barrier in GLOMERULI which is made by pedicures.
B. The patient is suffering from NEPHROTIC SYNDROME most probably MINIMAL CHANGE NEPHROTIC SYNDROME. Scientists are yet to determine what actually leads to minimal change disease. There may be some AUTOIMMUNAL MECHANISMS. This disease is characterized by THICKENING OF GLOMERULUS DUE TO ANTIBODY DEPOSITION.
C. loss of plasma sodium decreases the SERUM OSMOLARITY as a result of which compensatory MECHANISMS get stimulated such as ANTI DIURETIC HORMONE and RENIN ANGIOTENSINOGEN CYCLE. ADH expands plasma volume and Renin cycle forms ANGIOTENSIN 2 which leads to vasoconstriction and aldosterone secretion. Taken together these MECHANISMS increase the blood pressure.
4. Initial line of treatment is GLUCOCORTI COIDS which reduce inflammation, LOOP DIURETICS to remove excess fluid, ACE INHIBITORS to treat high blood pressure.
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