|
Re:Questions 1 Month, 1 Week ago
|
Karma: 0
|
|
Q#20
Hi Stephanie!!!
What would be the renal biopsy like in Alport syndrome???
whats causes it????
|
|
nnavam
Mighty Nephron
Posts: 105
|
|
|
|
|
Re:Questions 1 Month, 1 Week ago
|
Karma: 11
|
|
nnavam wrote:
Q#21
A 46-year-old man is hospitalized for severe necrotizing pancreatitis. He has a history of alcoholism, hepatitis C, and chronic liver disease. He was given nothing by mouth overnight and received 6 L of normal saline. Twenty-four hours after admission, his abdominal pain worsens and nasogastric suction is initiated. He continues to have nothing by mouth. At this time, his sodium level is 145 mmol/L.
Over the next 24 hours, his urine output increases and isotonic saline is continued at 100 mL/h. Total parenteral nutrition is initiated with a total volume of 2 L, 120 mmol of sodium, and a high amino acid content. Findings of chemistry and urine studies 48 hours after admission are listed.
Laboratory studies on admission:
Sodium 138 mmol/L, Potassium 3.4 mmol/L, Chloride 103 mmol/L, Bicarbonate 22 mmol/L,
Blood urea nitrogen 8.93 mmol/L, Creatinine 123.79 μmol/L, Urine output 45 mL/h.
Laboratory studies 48 hours after admission:
Sodium 153 mmol/L, Potassium 3.0 mmol/L, Chloride 112 mmol/L, Bicarbonate 24 mmol/L,
Blood urea nitrogen 17.5 mmol/L, Creatinine 97.26 μmol/L, Urine output 200 mL/h, Urine sodium 50 mmol/L, Urine potassium 50 mmol/L, Urine osmolality 620 mmol/kg H2O.
Which of the following is the most likely cause of this patient's polyuria?
1)Solute diuresis
2)Central diabetes insipidus
3)Postobstructive diuresis
4)Nephrogenic diabetes insipidus
Answer: 1. The urine osmolality is high, ruling out diabetes insipidus.
|
|
|
|
|
|
|
Re:Questions 1 Month ago
|
Karma: 0
|
|
HI!!
A 45 yr male with history of hypertension,poorly controlled DM on OHA presents with bilateral leg edema and generalised weakness for 2 months.
His labs are Cr of 172,Urine protein of 4.8 g/24 hrs, urine albumin to cr ratio is 1324.
urinalysis under microscopy is bland.
His HBA1C is 8.5%
HeA B,HepB,HepC neg.
E ANA,SMA,ENA neg.
Whats the next step in management??
|
|
nnavam
Mighty Nephron
Posts: 105
|
|
|
|
|
Re:Questions 1 Month ago
|
Karma: 11
|
|
Statistically, this is diabetic nephropathy. However, these numbers don't add up. An ACR of 1300 would predict over 10 grams of protein per day.
Nevertheless, one could argue that a highly nephrotic diabetic patient should have a kidney biopsy to exclude other causes of GN. The cutoff for when biopsy should be performed is not clear but a generally accepted on is 5 grams / day.
|
|
|
|
|
|
|
Re:Questions 4 Weeks, 1 Day ago
|
Karma: 0
|
|
Thanks.
So,The next step would be Nephro consult for biobsy and possible RRT????
|
|
nnavam
Mighty Nephron
Posts: 105
|
|
|
|
|
Re:Questions 4 Weeks, 1 Day ago
|
Karma: 11
|
|
Biopsy yes. A little early for RRT
|
|
|
|
|
|
|
