Angela was a 24-year-old female felt swollen, weak, and fatigued for several mon
ID: 3474134 • Letter: A
Question
Angela was a 24-year-old female felt swollen, weak, and fatigued for several months. She suddenly noticed her urine had a red-brown discoloration and was low in volume. She went to the emergency room of a nearby hospital and the following data were obtained upon examination and testing:
Hematology:
Serum sodium 124 mEq/L
Serum potassium 6 mEq/L
Serum creatinine 2.5 mg/dL
BUN 24.0 mg/dL
pH (arterial) 7.31
Hematocrit 25%
Urinalysis:
Appearance Red to brown
Specific gravity 1.025
Blood Positive
Glucose Negative
Protein Mild
Renal Function Tests:
GFR (glomerular filtration rate) 40 mL/min
RBF (renal blood flow) 280 mL/min
1.A. What was Angela's disorder?
B. What could cause this disorder?
2.Define hyponatremia and hyperkalemia.
3.What is the cause of the hyponatremia and hyperkalemia?
4.Why is there blood in Angela’s urine?
5.How do Angela’s renal function tests compare to normal?
6.What caused the swollen feeling?
Explanation / Answer
Angelas disorder is chronic renal failure, because Angela feel swollen week and fatigue since last few months.
1A- Angela having chronic renal failure with renal azotemia, mainly uremia.
B- the cause of chronic renal failure are mainly acute tubular necrosis and causes of renal azotemia or uremia is the chronic renal failure.
2 - hypokalemia is defined as serum potassium level more than 5 milliequivalent per litre.
Hyponatremia is defined as serum sodium level is less than 135 meq.per litre.
3 - due to the acute tubular necrosis as well low gfr , there there will be less amount of sodium will be observed from proximal convoluted tubule and distal convoluted tubule so that more sodium will be washed out from body into the urine.
And when sodium is reabsorbed Potassium is excreted through Sodium Potassium exchanger but due to loss of sodium into urine Potassium is no longer secreted into the Tubular fluid and potassium will remain high in blood producing hyperkalemia and hypo natremia.
4- blood is present in the urine of Angela because in chronic renal failure there will be damage to the glomerular capsule so that RBC leaked out and hematuria will occur.
The renal function test of the Angela are abnormal because the blood urea nitrogen is elevated and serum creatinine is also elevated.
The BUN to serum creatinine ratio is less than 15 so the most probable cause is renal azotemia due to intrinsic renal cause like acute tubular necrosis.
The swelling is more prominent over the eyes and face it occurs due to the loss of protein into the urine which cause decrease in the plasma proteins lead to decrease osmotic pressure and edema occurs.