A 10 year old, 75 lb male is presented at the ER due funny colored urine and gen
ID: 97520 • Letter: A
Question
A 10 year old, 75 lb male is presented at the ER due funny colored urine and general achiness. During the history, he said the urine had been cloudy and he rarely has an urge to mitriculate. He had a sore throat about 2 weeks ago, but recovered normally. He has periorbital edema and pitting edema of the ankles. Evaluate the following by using arrows to indicate any values that are abnormal. ie. High Low or N (See the appendix in the book or the internet for normal values.)
PE 101.2 F, HR 70 R 16 BP 130/95 BUN 55 mg/dl Creatinine 3.0 mg/dl. K+ 5.8 mEq pH 7.32
Hct 35% WBC 11,500 UA = Urine Analysis: Sp Grav. 1.015 RBCs 4+ Protein 4+ Protein casts
Is the blood likely from a lower urinary tract infection (Post-renal problem in the bladder)? Yes No
Given your work so far, do the values suggest this is Pre, Renal or Post-renal problem? ____________
Strep throat can trigger a hypersensitivity, with Antibody-Antigen binding, what type of reaction is that?
_________________________________________________________
What test could be performed to confirm he had strep throat 2 weeks ago? ______________________
What cells or molecules contributed to the 4+ protein in the UA? ___________________________
What are those proteins doing to his glomeruli and how does that relate to oligouria and his edema?
_________________________________________________________________________________
_________________________________________________________________________________
Why would body weight and blood pressure be monitored?_________________________________
List treatments for acute renal failure, including dietary changes for this case:_________________
________________________________________________________________________________
Explanation / Answer
PE 101.2 F
HR 70
R 16
BP 130/95
BUN 55 mg/dl (high)
Creatinine 3.0 mg/dl (high)
K+ 5.8 mEq (high)
pH 7.32
Hct 35% (low)
WBC 11,500 (pretty high)
UA = Urine Analysis
Sp Grav. 1.015 (normal)
RBCs 4+ (normal)
Protein 4+ (high)
Is the blood likely from a lower urinary tract infection (Post-renal problem in the bladder)?
Yes
Given your work so far, do the values suggest this is Pre, Renal or Post-renal problem?
Post-renal problem because of the increased BUN and the creatinine values
Strep throat can trigger a hypersensitivity, with Antibody-Antigen binding, what type of reaction is that?
Type II hypersensitivity reaction/molecular mimicry
What test could be performed to confirm he had strep throat 2 weeks ago?
Rapid antigen test from a swab from the throat.
What cells or molecules contributed to the 4+ protein in the UA?
Increased endocytosis of protein by renal tubular cells.
What are those proteins doing to his glomeruli and how does that relate to oligouria and his edema?
These protein cause glomerular hyperfiltration. Oliguria and proteinuria are common symptoms which occur in patients with nephrotic syndrome.
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