Question

A 23-year-old felt puffy, weak, and tired for several months. She suddenly noticed her urine had a red to brown discoloration and the volume was minimal. She went to the emergency room of a nearby hospital and the following data were obtained upon examination and testing: Hematology: Serum sodium 125 mEq/L Serum potassium 6 mEq/L Serum creatinine 2.6 mg/dL BUN 24.0 mg/dL pH (arterial) 7.32 Hematocrit 25% Urinalysis: Appearance Red to brown Specific gravity 1.025 Blood Positive Glucose Negative Protein Mild Renal Function Tests: GFR (glomerular filtration rate) 40 mL/min RBF (renal blood flow) 280 mL/min 5. How do the renal function tests for this individual compare to normal? 6. What caused the puffy feeling? 7. What type of treatment does this person need? 8. Is this person a candidate for kidney dialysis? Explain your answer.

Answer 1

5) Hematology :-

Serum sodium - 125mEq/L ( low) ( Normal level :- 135-145mEq/L)

Serum Potassium - 6mEq/L ( High)( Normal :- 3.7 - 2 mEq/L)

Serum Creatinine - 2.6 mEq/L ( High)( Normal :- 0.8-1.4mEq/L)

pH( arterial) - 7.32( slightly low)( Normal :- 7.35- 7.45)

Hematocrit - 25% ( low) ( Normal : 45%)

Urinalysis :-

Appearance - Red to Brown ( Normal :- Yellow)

Specific Gravity - 1.025 ( Normal :- 1.001- 1.035)

Blood - Positive ( Normal :- Negative)

Glucose - Negative ( Normal :- Negative)

Protein - Mild ( Normal :- Negative)

Renal function test :-

GFR - 40 ml/ min ( low) ( Normal :-120ml/ min)

RBF - 280ml/ min ( low) ( 1000- 1200ml/ min)

6) Puffy indicates fluids. It is due to loss of protein, most likely albumin. With loss of albumin the osmotic gradient shifts and this causes fluids to be retained in the tissues leading to edema and feeling of puffiness / swelling.

7) Clinical treatment of this patient for Renal failure are as follow :-

- Healthy eating, physical activity, maintaining a healthy weight , quiting smoking and managing stress.

- Water intake should be controlled to maintain a serum sodium of 135- 145 mEq/ L .

- Sodium should be restricted or permitted, depending on whether the individual is accumulating or losing sodium.

- Angiotensin - converting enzyme ( ACE) inhibitors and angiotensin receptor blockers ( Arabs)

- Beta blocker and a diuretic

8) The cause of Chronic Renal failure needs to be determined first and then treated specifically. Meanwhile, dietary and fluid intake need to be monitored. Reduced dietary protein ( to reduce nitrogenous waste production) with sufficient carbohydrates and fat to meet energy requirements and prevent ketosis or muscle wasting is recommended. Water intake should be controlled to maintain a serum sodium of 135-145 mEq/L. Sodium should be restricted or permitted, depending on whether the individual is accumulating or loading sodium.

Fluid and dietary control may be adequate to support this individual through the diagnosis and treatment. If not, intermittent dialysis may be necessary.