Case-1: Patient History J.H. is a 12-year-old boy diagnosed several months ago w
ID: 91781 • Letter: C
Question
Case-1: Patient History
J.H. is a 12-year-old boy diagnosed several months ago with nephrosis following postinfectious glomerulonephritis secondary to an episode of pneumococcal pneumonia. He has been coming to the clinic to have his condition monitored and therapies adjusted as needed. At his latest clinic visit, a decrease in urine output, increasing lethargy, hyperventilation, and generalized edema are noted. Trace amounts of protein are detected in J.H.’s urine by dipstick. Blood is drawn for laboratory analysis, and the results are as follows:
pH = 7.36
PaCO2 = 33 mm Hg
PaO2 = 100 mm Hg
HCO3 – = 18 mEq/L
Hct = 30%
Na+ = 130 mEq/L
K+ = 5.4 mEq/L
BUN = 58 mg/dl
creatinine = 3.9 mg/dl
albumin = 2.0 g/dl
Analyze this case study and answer the next four questions that follow.
Case-1: Question-3
What additional physical or laboratory findings would be helpful in determining J.H.’s degree of renal impairment? (select all that apply)
A) Physical findings would include dehydration and hypotension.Explanation / Answer
JH’s lab values indicate that the PaCO2= 33 mm Hg,
HCO3= 18 mEq/L and
Hct= 30% , and
Na+ = 130 mEq/L ,
These all levels are all below normal limits.
** And His potassium level was increased at 5.4 mEq/L.
*"There was also an increase in JH’s
-BUN (58 mg/dl),
-creatinine (3.9 mg/dl),
-and albumin (2.0 g/dl) levels.
**Traces of protein were found in his urine suggesting that JH’s condition is progressing to renal failure.
***"laboratory findings would be helpful in determining J.H.’s degree of renal impairment are:
D)*Creatinine clearance is helpful in determining general kidney function.
*A level above 1.2 is reduced and indicates renal impairment.
Here in the test it is given that creatinine = 3.9 mg/dl , which is above1.2.
B)**urine test is.helpful to idtefy -release of too much protein in the urine resulting in nephrosis.
Reason for release of protein in urine:
-One of the causes of glomerulonephritis is from a pneumococcal infection.
-The antibodies that the body produces to fight off the bacterium binds to bacterial antigens and makes its way out into the capillary beds.
-This process causes an inflammation which then injures the glomerular capillary and basement membrane. The damage that is caused leads to glomerulonephritis.
-The injured and defective glomeruli in the kidneys lead to the release of too much protein in the urine resulting in nephrosis.
**""physical findings would be helpful in determining J.H.’s degree of renal impairment are:
*C)Physical findings would include edema, pruritus, and hypertension