This 71yearold woman was transferred from a rural hospital complaining of SOB an

Question

This 71yearold woman was transferred from a rural hospital complaining of SOB and showing evidence of pulmonary edema. There was no history of chest pains, nausea, vomiting or diaphoresis. Her admission diagnosis was CHF (acute exacerbation), MI (subendocardial), DM, and HTN. Medications included Lasix, morphone, nitroglycerin, and Procardia.

Laboratory tests were significant for increased CK, 544 U/L (21215) with a CKMB of 29.2 ng/ML (0 4), which is a relative index of 54. During the first few days of her hospital stay, blood glucose ranged from 201 to 365 mg/dL (70110); creatinine ranged from 1.7 to 1.9 mg/dL (0.61.0); and BUN ranged from 46 to 49 mg/dL (525).

Admission urinalysis was significant for:

glucose 100 mg/dL

blood moderate

protein >300 mg/dL

WBCs 25/HPF

RBCs 1020/HPF

epithelials/LPF few squamous, few renal

casts/LPF 510 granular, rare WBC

After aggressive treatment of the CHF, her condition improved moderately with Cardizem (then Procardia), Nipride, and Cardura. She received intravenous nitroglycerin and insulin. The discharge diagnosis was status postsubendocardial MI, triplevessel cardiac disease, CHF, HTN, DM, and a renal condition. She was scheduled to return to the hospital eventually for triplevessel coronary bypass.

Case Questions:

1. What renal condition do the urinalysis data suggest? Explain.

2. What is the pathophysiology behind the renal condition in question 1? Explain.

Explanation / Answer

Laboratory tests were significant for increased CK, 544 U/L (21215) with a CKMB of 29.2 ng/ML (0 4), which is a relative index of 54. During the first few days of her hospital stay, blood glucose ranged from 201 to 365 mg/dL (70110); creatinine ranged from 1.7 to 1.9 mg/dL (0.61.0); and BUN ranged from 46 to 49 mg/dL (525)

What renal condition do the urinalysis data suggest? Explain.

Chronic glomerulonephritis is a kidney diseases characterize by long-term inflammation and scarring of the glomeruli

Now based on the urinalysis test results of the patient, there is a high level of protein called proteinuria and glucose level, a modest amount of blood is called hematuria has been also find accompany by granular and cellular cast. In which these findings are assumed to be the primary urinalysis test result of this renal condition.

What is the pathophysiology behind the renal condition in the first question? Explain

Pathophysiology of chronic glomerulonephritis:

Creatinine

Laboratory tests for serum creatinine provide an indicator or glomerular filtration rate (GFR). When the GFR is damaged a reduced amount of creatinine is being emit by the the glomerulus that causes the serum

creatinine levels to increase.

BUN

reflects the GFR, because the urea is being filtered to glomerulus, when the BUN elevates the GFR drops, becausethe urea is being reabsorbed by the blood through thepermeable tubules, the BUN rises in chronic renal failure

Casts

Casts (accumulations of cellular precipitates) originate in the renal tubules, from which they take their shape. They are cylindrical with distinct borders. All casts have a precipitated micro protein matrix and arise primarily from the ascending limb of the distal tubule. Granular Cast, indicates that the patient occur glomerulo nephritis. The type of cast identified suggests the disease process occurring in the kidney.

WBC

White blood cells (WBCs) in the urine (a condition termed pyuria) are primarily indicative of urinary tract infection,particularly when bacteria are present. Glomerulonephritisand nephrotic syndrome also may demonstrate pyuria, but usually in combination with proteinuria, red cells, and casts. The finding of WBC casts reflects a kidney infection, because these casts are not formed in the bladder or prostate .

Chronic glomerulo nephritis usually causes only very mild or subtle symptoms, it goes undetected for a long time in most people. Edema mayoccur. High blood pressure is common. The disease may progress tokidney failure, which can cause itchiness, fatigue, decreased appetite, nausea, vomiting, and difficulty breathing.

Creatinine

Laboratory tests for serum creatinine provide an indicator or glomerular filtration rate (GFR). When the GFR is damaged a reduced amount of creatinine is being emit by the the glomerulus that causes the serum

creatinine levels to increase.

BUN

reflects the GFR, because the urea is being filtered to glomerulus, when the BUN elevates the GFR drops, becausethe urea is being reabsorbed by the blood through thepermeable tubules, the BUN rises in chronic renal failure

Casts

Casts (accumulations of cellular precipitates) originate in the renal tubules, from which they take their shape. They are cylindrical with distinct borders. All casts have a precipitated micro protein matrix and arise primarily from the ascending limb of the distal tubule. Granular Cast, indicates that the patient occur glomerulo nephritis. The type of cast identified suggests the disease process occurring in the kidney.

WBC

White blood cells (WBCs) in the urine (a condition termed pyuria) are primarily indicative of urinary tract infection,particularly when bacteria are present. Glomerulonephritisand nephrotic syndrome also may demonstrate pyuria, but usually in combination with proteinuria, red cells, and casts. The finding of WBC casts reflects a kidney infection, because these casts are not formed in the bladder or prostate .

Chronic glomerulo nephritis usually causes only very mild or subtle symptoms, it goes undetected for a long time in most people. Edema mayoccur. High blood pressure is common. The disease may progress tokidney failure, which can cause itchiness, fatigue, decreased appetite, nausea, vomiting, and difficulty breathing.

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