Question

A 10 year old, 75 lb male is presented at the ER due funny colored urine and general achiness. During the history, he said the urine had been cloudy and he rarely has an urge to mitriculate. He had a sore throat about 2 weeks ago, but recovered normally. He has periorbital edema and pitting edema of the ankles. Evaluate the following by using arrows to indicate any values that are abnormal. ie. High          Low or N (See the appendix in the book or the internet for normal values.)

PE 101.2 F,   HR 70   R 16   BP 130/95    BUN 55 mg/dl   Creatinine 3.0 mg/dl.   K+ 5.8 mEq    pH 7.32

Hct 35%   WBC 11,500    UA = Urine Analysis: Sp Grav. 1.015    RBCs 4+    Protein 4+    Protein casts

Is the blood likely from a lower urinary tract infection (Post-renal problem in the bladder)?   Yes     No

Given your work so far, do the values suggest this is Pre, Renal or Post-renal problem? ____________

Strep throat can trigger a hypersensitivity, with Antibody-Antigen binding, what type of reaction is that?

_________________________________________________________

What test could be performed to confirm he had strep throat 2 weeks ago? ______________________

What cells or molecules contributed to the 4+ protein in the UA? ___________________________

What are those proteins doing to his glomeruli and how does that relate to oligouria and his edema?

_________________________________________________________________________________

_________________________________________________________________________________

Why would body weight and blood pressure be monitored?_________________________________

List treatments for acute renal failure, including dietary changes for this case:_________________

________________________________________________________________________________

Answer 1

PE 101.2 F

HR 70

R 16

BP 130/95

BUN 55 mg/dl (high)

Creatinine 3.0 mg/dl (high)

K+ 5.8 mEq (high)

pH 7.32

Hct 35% (low)

WBC 11,500 (pretty high)

UA = Urine Analysis

Sp Grav. 1.015 (normal)

RBCs 4+ (normal)

Protein 4+ (high)

Is the blood likely from a lower urinary tract infection (Post-renal problem in the bladder)?

Yes

Given your work so far, do the values suggest this is Pre, Renal or Post-renal problem?

Post-renal problem because of the increased BUN and the creatinine values

Strep throat can trigger a hypersensitivity, with Antibody-Antigen binding, what type of reaction is that?

Type II hypersensitivity reaction/molecular mimicry

What test could be performed to confirm he had strep throat 2 weeks ago?

Rapid antigen test from a swab from the throat.

What cells or molecules contributed to the 4+ protein in the UA?

Increased endocytosis of protein by renal tubular cells.

What are those proteins doing to his glomeruli and how does that relate to oligouria and his edema?

These protein cause glomerular hyperfiltration. Oliguria and proteinuria are common symptoms which occur in patients with nephrotic syndrome.