Question

Case #4 Mr. Ali, is a seriously ill 42-year-old male with a history of several episodes of microscopic hematuria in the past 20 years. Until recently the macroscopic hematuria had spontaneously reverted to a symptomatic microscopic hematuria. Significant lab results include a BUN of 80 mg/dl (N:8-23 mg/dl), serum creatinine of 4.5 mg/dl (N:0.6-1.2 mg/dl), creatinine clearance of 20 ml/min (N:107-139 ml/min), serum calcium of 8.0 mg/dl (N: 9.2-11.0 mg/dl), serum phosphate of 6.0 mg/dl (N:2.3-4.7 mg/dl), and an elevated level of serum IgA. • Results of UA are: Microscopic exam: • >100 RBC/ hpf-many are dysmorphic • 8-10 WBC/ hpf • 2-4 hyaline casts/ Ipf 0-2 waxy casts/Ipf • 1-5 granular casts/Ipf 0-1 broad granular casts/ Ipf

Answer 1

1.The laboratory results and the history suggests for renal disease. This seems to be the injury to the glomerulus over a coarse of time in the patient .The symptoms are closely associated to Glomerulonephropathy

2.The following lab test helps in the diagnosis

• Hematuria
• Dysmorphic RBC
• Casts in urine
• Protein in urine
• Leukocytes in urine
• Cloudy urine
• Elevated Sr.creatinine

3.The additional diagnosis which can be suggested from his current condition are

• Acute renal failure (due to elevated BUN,Creatinine, Phosphate, decrease in creatinine clearance rate,sr.Calcium)
• Berger's disease (due to elevated IgA levels with other results)

4.The positive urine glucose tests means excretion or expulsion of glucose through urine.This can happen when the glucose level is in increased level in the blood ,the renal system excretes the excess glucose by the filtration process.This can happen if patient is diabetic.