What type of renal failure is pw likely developing

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Reference no: EM133363215

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

Discussion Questions

1. How would a pneumococcal infection lead to glomerulonephritis? How can glomerulonephritis result in nephrosis?

2. Use J.H.'s laboratory values to determine if he is still experiencing nephrosis or his condition is progressing to renal failure.

3. What additional physical or laboratory findings would be helpful in determining J.H.'s degree of renal impairment?

4. How will J.H.'s therapy changes if his condition has progressed from nephrosis to uremia?

Case 2

P.W. is 23 years old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.'s vital signs and hematocrit suggest that he has had a blood loss of about 2500 ml. A urinary catheter is inserted to monitor urine output, and fluid
resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium.

Discussion Questions:

1. What type of renal failure is P.W. likely developing? What data support this conclusion?

2. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?

3. In addition to urine output, what laboratory data should be monitored to assess changes in P.W.'s renal function?

4. If P.W.'s renal function does not return to normal, but continues to be diminished, what are the subsequent stages of his renal disorder and what clinical problems do they present?

Reference no: EM133363215

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