Question

Frances Jenkins, 63 year old female with a 15 year diagnosis of Diabetes, presents in the clinic. She also has a 10 year history of hypertension. Her diabetes and hypertension has been only moderately controlled. Today she reports edema in her hands, face, and feet. She reports that she is tired and "just doesn't seem to have any energy". Her blood sugar is within acceptable limits. Her urine is positive for blood and protein. What complication of diabetes might you suspect? Deana Lewis, a 43 year old housewife, complains of "not feeling well", edematous hands and feet, and smoky-colored urine. She reports that she had strep throat 3 weeks ago. Her vitals are within normal limits except that her blood pressure is 142/100. She states that her BP generally runs around 130/80. What renal problem do you suspect? A 17 year old female presents to the primary care clinic complaining of nausea, vomiting, and diarrhea for the past three days. She reports that she is very fatigued and last night she was woken up with muscle cramps in her legs. Labs: normal kidney function, Na 149, K 3.0. What is your primary concern?

Answer 1

1) Diabetes is a metabolic disorder characterized by elevated blood glucose level. It commonly occurs secondary to excess intake of carbohydrates or lack of insulin secretion from Pancreatic cells. Type 1 diabetes also called as insulin dependent diabetes it is most common during childhood. Type 2 diabetes terms as non insulin dependent diabetes. Gestational diabetes appears during gestational period. Hypertension also refers to elevated blood pressure.HT increases the risk factor of cardiovascular diseases. Untreated hypertension act as a life threatening conditions. In the given scenario Ms Jenkins urine report reveals presence of protein and blood indicates a complication of diabetic nephropathy. Diabetic nephropathy commonly occurs when the patient with diabetes have hypertension. It occurs after a marked kidney damage. Early detection is essential to prevent further dame of the nephrons. Treating patient with blood pressure control drugs like ACE inhibitors prevents further detonation of kidney function.

2) Post streptococcal glomerulonephritis is the diagnosis for the present condition. Since the patient suffered from strep throat before 3 weeks it may be a contributing factor. The inflammatory mediators formed as a result of inflammatory response got deposited in the glomeruli leading to decline in renal function. Treating with loop diuretics, anti hypertensive medications,immunosuppresive therapy helps to prevent rapid declining  of renal function.

3) The serum sodium level of 149 indicates hypernatremia , that commonly occurs due to increased water loss. This happens secondary to nausea,vomiting and diarrhea for three days. Administration of oral rehydration therapy and intravenous fluid therapy with 5 % dextrose and half normal saline stabilizes the condition.