Question

Question Explain the cause of Maya’s swollen and edematous feet?

Renal filtration is complex and the way the kidney excludes proteins from urinary loss is based on a protein’s size as well as its aggregate charge. Podocytes within the glomerulus play a pivotal role in maintaining the filtration membrane and their injury can lead to profound urinary protein. The loss of osmotically important proteins from the blood results in changes in the hemodynamic balance leading to fluid exiting the vascular space in many parts of the body, and thus producing tissue swelling. Maya is an eight-year-old little charmer. Observant and smart, she loves the outdoors and plans to become a veterinarian. A few weeks ago she had what her doctor thought was the flu, but she recovered fine. Then she began feeling sick again. She had a low grade fever, was achy and out of energy. She noted that her feet were swollen such that she could hardly get her shoes on and even her eyelids were puffy. Another oddity was that her urine foamed like meringue. References Case StudyA Young Child with Fever and Foamy Urine
Strategy Case 1 Symptoms and Cause Read the report and answer all questions. In the doctor’s office Maya’s observations were confirmed. She had significant pedal edema (excess fluid in the soft tissues of her feet) that even extended part of the way up her legs. She also had edema of the soft tissue of her back (she had been lying down prior to being brought to the doctor’s office) and swelling of her face, most notably around the eyes. She did not have respiratory symptoms and was breathing easily. She had a low grade fever of 99.6 deg F. Indeed, when she produced a urine sample, there was over an inch of foam on top. A dipstick urinalysis showed that her urine was loaded with protein (normally there is just a trace). All other parameters were normal. Maya’s kidneys were indeed losing protein at an alarming rate. The loss of albumin in particular decreased intravascular solute (oncotic) pressure resulting in movement of water from the vascular system into the tissue space, leading to her edema. What had gone wrong with Maya’s kidneys centers around the glomerulus and specifically the podocytes.   

Answer 1

The Renal system plays the major role in filteration process. The podocytes are one of the layer of the Bowman's capsule which filtrates the larger molecules like protein. When there is a defect in it the proteins cannot be filtered and as a result will be eliminated through the renal system through micturation. The albumin is one of the protein which will be decreased as a result change in osmotic pressure occurs causing fluid to retain from the blood vessels into the surrounding tissue resulting in edema especially in the feet.