A 27 year old female was seen by medical personnel at an after-hours clinic. She complained of nausea and weakness. Physical examination showed the patient had some edema. Since the patient's medical record showed a history of diabetes, her family physician was notified. Further patient history revealed the patient had been treated 2 weeks prior for a recurring urinary tract infection with two types of antibiotics. However, over the past week, the patient's urine output began to decrease markedly (oliguria). Alarmed by this information, the family's physician ordered several series of blood tests STAT and asked the patient's husband to transport her to the hospital for admission and further evaluation.
The following tests were ordered:
Complete blood chemistry
Urinalysis (Be sure to view the photos of the cells and casts at this site.)
urine clearance test to test for glomerular filtration rate
In addition to the links below, review the urinary system, kidney anatomy, and the nephron in the workbook.
View Kidney Disease video and The Functional Unit of Kidney video and answer the following questions:
- 1. What are the 3 important functions of the kidney?
- 2. What things can cause a change in the structure or function of the kidney, causing kidney disease?
- 3. List symptoms that may be present if the kidneys are failing?
- 4. What treatment method will be used if kidney function can't be restored?
This patient's symptoms may well indicate the serious and life-threatening condition know as acute renal failure.
The broad definition certainly means the loss of kidney function to some degree and is usually of sudden onset. At the kidney level, this means a loss in the glomerular filtration rate. The link above presents a good overview of the key points of renal failure and links to basic kidney function. In this case study, we will focus on acute tubular necrosis (ATN) as a toxic side-effect of the antibiotics administered previously.
Fron the link "acute kidney failure" answer the following questions:
- 5. Define acute renal (kidney) failure.
- 6. What symptoms may occur in acute kidney failure?
- 7. What is prerenal acute renal failure and what might cause this? (Prerenal is something that is stopping blood flow to the kidneys)
- 8. What is postrenal acute renal failure and what might cause this? (Postrenal is a condition that's blocking urine from leaving the kidneys)
- 9. What causes intrarenal acute renal failure? (Intrarenal is direct damage to the kidneys)
From the link "acute tubular necrosis" and the video below "Intrarenal Acute Kidney Injury" answer the following questions:
- 10. Define acute tubular necrosis
- 11. What are risks that may lead to ATN? From the video, what happens to the glomerular filtration rate (GFR) in ATN? What symptoms does this lead to?
Initial Significant Laboratory Blood Chemistry Results and Key Urinalysis Values
Case questions 12-20 can be found by linking to blood chemistry results and key urinalysis results