What is your diagnosis and what is the cause of this pathology?
A 10 y/o male present to his pediatrician as a follow-up to a strep throat infection two weeks earlier. The Px shows no signs of the strep infection, however, the physician notes pitting edema in the lower extremities. Continuing the physical exam, the physician found the Px’s BP was 154/86 with a heart rate of 82. A urine sample was taken and the urine was amber colored and frothy with visible sediment. The physician admitted the Px to the hospital and blood and urine tests were run.
Blood
Urine (24 hr collection)
[Na+]p
126 mEq/L
pH
5.0
[K+]p
4.3 mEq/L
Glucose
0
[HCO3-]p
25 mEq/L
RBC
7 p/hpf*
[Cl-]p
89 mEq/L
Protein
4g/24hr
Glucose
84 mg/dL
creatinine
485 mg/dL
pH
7.4
volume
800 mL
PCO2
39 mmHg
PAH
485 mg/dL
[creatinine]
4.1 mg/dL
Uosm
525 mOsm
PAH
0.013 mg/mL
* p/hpf = cells per high powered field
(use cellular mechanisms and diagrams)
a) From these data, what part of the nephron do you think is most affected? Defend your answer. (20pts)
b) What is your diagnosis and what is the cause of this pathology? (10pts)
c) Why is the Px exhibiting high blood pressure? (15 pts)
d) How would you treat this Px? (5pts)