A 10 yo male present to his pediatrician as a followup to a

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

[HCO^3-]_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

P_CO2

39 mmHg

PAH

12.88 mg/mL

[creatinine]

4.1 mg/dL

Uosm

525 mOsm

PAH

0.013 mg/mL

            * p/hpf = cells per high powered field

How to treat this Px? Explain

Solution

1. The urine analysis and biochemical changes point towards NEPHROTIC SYNDROME.

2. The initial treatment plan is GLUCOCIRTICOIDS. it is mainly used as an antiinflammatory agent.

3. DIURETICS such as FUROSEMIDE is given to reduce edema

3. ANTIHYPERTENSIVES such as ACE inhibitors are given to treat hypertension

4. CALCINEURIN INHIBITORS are given to children who are resistant to steroids.