Case1 Patient History JH is a 12yearold boy diagnosed severa

Case-1: Patient History

J.H. is a 12-year-old boy diagnosed several months ago with nephrosis following postinfectious glomerulonephritis secondary to an episode of pneumococcal pneumonia. He has been coming to the clinic to have his condition monitored and therapies adjusted as needed. At his latest clinic visit, a decrease in urine output, increasing lethargy, hyperventilation, and generalized edema are noted. Trace amounts of protein are detected in J.H.’s urine by dipstick. Blood is drawn for laboratory analysis, and the results are as follows:
pH = 7.36
PaCO2 = 33 mm Hg
PaO2 = 100 mm Hg
HCO3 – = 18 mEq/L
Hct = 30%
Na+ = 130 mEq/L
K+ = 5.4 mEq/L
BUN = 58 mg/dl
creatinine = 3.9 mg/dl
albumin = 2.0 g/dl

Analyze this case study and answer the next four questions that follow.

Case-1: Question-2

Use J.H.’s laboratory values to determine if he is still experiencing nephrosis or his condition is progressing to renal failure. (select all that apply)

Solution

Answer: Option B and Option D

Explanation:

As seen from the laboratory information of the patient, the PaCO2 of 33 mmHg is low (Normal value: 35-45 mmHg ), HCO3 of 18mEq/Lis low(Normal value: 22-26 mEq/L) , Hct of 30% is very low(Normal value: 40-54% ), Sodium ions of 130 mEq/L is low (Normal value: 135-145 mEq/ L), K+ ions of 5.4 mEq is slightly high (Normal value: 3.5-5.3), BUN of 58 mg/dl is very high (Normal value: 7-25 mg/dl ), creatinine of 3.9 mg/dl is vey high (Normal value: 0.6-1.2 ) and albumin level of 2 g/dl is very low (Normal value: 5.5 g/dl )

The low HCO3- values is suggestive of metabolic acidosis and hyperventilation is seen as a respiratory compensation fro metabolic acidosis.

Option A cannot be true as all the above said symptoms like low albumin and hyponatremia are clearly indicating nephrosis.

Based on these abnormal lab values elevated BUN, creatinine, compensated metabolic acidosis, elevated K+ levels low hemotocrit and traces of protein clearly indicates that patient is still experiencing renal failure. Hence, Option B is correct answer.

Option C is incorrect, as the patient is experiencing the renal failure as seen from the laboratory data.

Option D is correct as low albumina and hyponatremia are clearly indicating nephrosis in the given patient. Hence, option D is also correct answer.