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Renal Case Study 4




uestions regarding Renal case study at the end of the document attached.;Attachment Preview;Renal Case Study 4 Biol 1120.doc Download Attachment;Renal Case Study 4;Biology 1120 Anatomy and Physiology;Chief Complaint: Dark Urine;Clinical History: Nathan S. was a 10 year old boy who was brought by his mother to a;community health clinic in a remote part of west Texas. The nearest physician was 80;miles away. When the physician assistant (PA) asked the reason for the visit, the boys;mother said, referring to his urine, His water looks like Coca- Cola. She went on to say;that she thought it might have been discolored the night before, but the light was poor and;she couldnt be sure. This morning she notice the toilet water was discolored after he;urinated. She gave him juice and water and waited to observe for herself on his next;bathroom trip about two hours later. Hes not making much water, she added.;The PA asked the usual systems review questions. Specific questioning abuts drug;abuse, over the counter medicines, and exposure to toxins revealed nothing suspicious.;Nathan was not taking any prescribed or over the counter medicines. When asked about;any recent health problems, his mother revealed that he had been a picture of good health;and vigor except for a cold and a bad sore throat a few weeks earlier.;Physical Examination and Other Data: Vital signs were: Temperature 98.5F, heart rate;88, respirations 16, and blood pressure 145/92. Nathan was quiet and not in distress and;appeared to be of average height and weight. He did not appear anemic or jaundiced but;his face looked round and puffy. When asked abut his face, his mother said shed noticed;it but thought it was because he was tired from staying up too late the last few nights with;his father, working on the farm where they lived. The remainder of the physical;examination was unremarkable. He had no rash, enlarged lymph nodes, or abdominal;masses.;The PA gave Nathen a big glass of water and collected some blood for the few;basic tests that could be done by the office assistant on clinical equipment. Hematocrit;was low (34mmHg) and blood glucose was normal. Sodium and potassium were normal.;BUN and creatinine were slightly increased. After two hours, Nathan passed a small;amount of dark brown transparent urine which tested strongly positive for both protein;and hemoglobin by routine dipstick tests. Urinary sediment was concentrated by;centrifugation. A moderate number of RBCs and a few red cell casts were noted, but they;didnt seem enough to account for the strongly positive hemoglobin. No crystals or;WBCs were present.;Clinical Course: The PA was puzzled. The pieces didnt seem to fit together, so she;called the hospital that managed the clinic and spoke to a pediatrician who said, This is a;classic case of acute glomerulonephritis. I havent seen one in several years. The;pediatrician outlined a treatment plan of salt restriction and therapy with diuretics and;antihypertensive medication with carefully monitoring of urine output. The PA dispensed;the drugs from the limited supply on hand and gave his mother a calibrated, disposable;urine cup, instructed her to measure Nathans urine output and call daily with the results.;His urine output was how initially but began to improve on the third day. Mother and son;returned a week later. His daily urine volume had returned nearly to normal, urine;hemoglobin and protein were less positive, and most of his facial swelling has;disappeared. On the follow up visit a week later, his blood pressure was near normal. A;blood specimen was collected and sent to the hospital to be tested for antistreptococcal;antibodies which were previously detected in high concentration.;Case Notes;Questions;1. Other than water and waste, name some important substances Nathan excreted in his;urine. (1points);2. Nathans blood pressure was elevated. What structure and or hormones in his kidney;played a role in increasing his blood pressure? (3 points);3. Nathans hematocrit was low, what is the norm range and why was his low? (3 points);4. What were the principal nitrogenous wasted compounds in Nathans urine? (2points);5. Did Nathan have proteinuria? Why? (2points);6. His urine contained RBC casts, Of what importance was his finding? (3 points);7. Why was Nathans face swollen? (2 points);8. What caused the glomerulonephritis? (5 points);9. Would the GFR be up or down? Why (4points)


Paper#16646 | Written in 18-Jul-2015

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