STUDENT WITH RENAL DISEASE Q1. Edema can be defined as increased fluid in the interstitial tissue spaces or body cavities. It may be localized or systemic. It usually results from increased hydrostatic pressure, reduced plasma colloid oncotic pressure or obstruction of lymphatic drainage. Since the major determinant of plasma oncotic pressure is the plasma proteins, hence; a decrease in the level of plasma protein will result in edema. High level of protein in Haddi’s urine and low level of albumin and sodium retention in her blood is consistent with the edema she’s having.
Q2. The pathophysiology of ascites, azotemia and hematuria can be explained by the excessive glomerular permeability that occurs in nephrotic syndrome. The permeability allows leakage of plasma proteins leading to proteinuria. The proteinuria subsequently leads to hypoalbuminaemia, then resultant loss of colloid osmotic pressure of the blood. The loss of colloidal osmotic pressure will lead to accumulation of fluid in the interstitial spaces, hence the ascites. Edema that accompanies hypoproteinaemia is usually of the generalized type.
Hematuria and azotemia are classical signs seen in patients with nephritic syndrome. The hematuria is as a result of the disruption of the glomerular basement membrane and also bleeding from any part of the renal tract. There is also deposition of immunoglobulin on the glomerular basement membrane, all resulting in the hematuria Haddi’s is presenting with. The azotemia is as a result of transient renal failure which accompanies the nephritic syndrome. This is because the kidney fails to adequately excrete all the excess urea and other nitrogenous waste that ought to be excreted when it filters the blood.
Q3 Haddi can be encouraged to get insecticides or mosquito nets so as to prevent mosquito bites hence preventing parasitic infection from the malaria parasites. Q4. Mannitol is a diuretic which is usually administered intravenously. Its aim is to supplement other forms of diuretics. It has an osmotic effect which it exerts to reduce edema by drawing water out of the interstitial spaces and also help prevent renal damage. It will increase the daily urinary output of the patient and cause increase in sodium urinary output. Since the hypertension of the patient is volume dependent, Mannitol will subsequently help reduce the blood pressure.
Q5. Most diuretics normally induce hypokalemia because there loss of potassium via urine when the drugs are being administered. The loss is as a result of potassium trying to maintain a balance between the electrolytes which is lost as a result of the effects of diuretics. The potassium sparing diuretics will therefore prevent the loss of potassium in urine hence increasing the potassium level in the blood. This when happens we tend to have hyperkalemia. Q6. Cystitis: retrograde pyelography. This allows me to view the architecture of the kidney involve and also the location of the lesion.
Pyelonephritis: urine culture. I will like to do a urine culture because it will allow me to identify the organism involve such E. coli or klebsiella spp. Diabetes mellitus: chemical urinalysis. This will allow me to determine the level of glucose in the urine whether it is high or not. Nephritic syndrome: chemical urinalysis. This test will allow me to do microscopic, macroscopic and chemical analysis of the urine so as to determine the level of the markers that is seen nephrotic syndrome.
Reference Kumar, V. Abbas, F. , Nelson, F. (2005). Pathology Basis of Disease. Elsevier Saunders.