Question

CLINICAL CHEMISTRY - RENAL FUNCTION CASE STUDY II

A 30-year old woman with a history of systemic lupus erythematosus was admitted to the hospital for renal function testing. The following results were obtained on her laboratory tests.

Na 142 mmol/L

K 4.9 mmol/L

BUN 37 mg/dl

Creatinine 3.9 mg/dl

Urine Protein 4+ (by reagent strip)

Also, oval fat bodies were observed microscopically and the urine appeared very milky.

1. Are any of the above results abnormal?

2. What is the patient’s BUN/Creatinine ratio? Is this within normal limits? What can you tell from this result?

3. Are there any other tests that should be ordered?

4. With the results that are given, what is a likely diagnosis?

Answer 1

1.The abnormal reports are

• BUN:Increased (7 to 20 mg/dl
• Creatinine :Increased (0.6 to 1.2mg /dl most of the values till 1.5 mg/dl are considered to be in normal range)
• Urine protein :4+ indicates presence of protein in urine (normal:negative)
• Appearance:milky (pale yellow and clear )
• Presence of oval fat bodies in the urine
• 24 hour urine analysis

2.The normal BUN/Creatinine ratio is 10:1 or 20:1.Increased BUN and Increased creatinine ration is an indicator of a renal disease. The patient has an increased BUN/Creat ratio.

3.The other test which can be ordered are

• GFR :To assess the filtration rate of kidney
• Serum Electrolyte :a abnormal levels can be noted when there is a kidney disease
• USG :To assess any structural abnormalities
• Albumin creatine ratio
• CBC

4.The above results suggests that the patient's likely diagnosis is acute kidney injury