PMBC01 Presentation.pptx on clinical case

Clinical presentation on renal case

1. PMCB01 Clinical Biochemistry Group Presentation Group 1 - Case Study A 2004231 | 2346385 | 2357170 | 2354140 | 2358130

2. Topic Question An elderly male, who had a long history of high blood pressure was brought to the hospital in a drowsy state. Biochemical investigation revealed the following: Blood urea – 124mg% Serum Creatinine – 6.8mg% Serum Uric Acid – 8.8mg% Serum inorganic phosphorus – 6.2mg%

3. Q1. Diagnosis - Part 1 Normal Levels Serum Urea = 10-40 mg% Serum Creatinine = <1.5 mg% Serum Uric Acid = <7 mg% Serum inorganic phosphorus = 3-4.5mg% REFERENCE NEEDED***

4. Q1. Diagnosis – Part 2 Probable diagnosis is renal failure, as a result of either acute kidney injury (AKI) or chronic kidney disease (CKD.) We know this because, after comparison with normal values, the patients’ serum; NPN substance levels are elevated (urea, uric acid and creatinine) Phosphorus levels are elevated Renal failure can be caused by a variety of factors, in this case the patients’ history of high blood pressure (hypertension) has caused hypertension neuropathy (Wiederkehr M, et al. 2007) which reduces the kidneys ability to filter waste products, resulting in a retainment of NPNs and phosphorous, seen in the patients serum samples. As a result of the kidney dysfunction, there is a build up of toxins and a decrease in the ability to secrete erythropoietin, for the bone marrow to produce red blood cells (Davey et al., 2019) this causes anemia and therefore drowsiness, presented as a symptom by the patient.

5. Q2. Urinary Output Average urinary output is approximately 800 – 2000mL per day (Mercado et al., 2019) Factors affecting urinary output Age Sex Body size Metabolic rate Health status Urinary output provides valuable information about kidney function and overall health Significant deviations from the average range should be investigated further as it may indicate an underlying health condition

6. Q3. What is Oliguria? Defined as a urine output of 400mL per day in adults and is a symptom rather than a disease itself (Haider & Aslam, 2020) Causes Prerenal Postrenal Neurogenic Medications/toxins Can be a sign of AKI or CKD, prompt evaluation is required once symptoms present. Laboratory tests and imaging studies are used to determine underlying cause ( Ronco et al., 2019) Treatment involves addressing underlying condition, diuretic therapy or dialysis (Kellum et al., 2021)

7. Q4. Importance of the creatinine clearance test Evaluation of renal functions by glomerular filtration rate ( Shabaz & Gupta 2023) Detection of kidney disease (Patel et al., 2013) Monitoring kidney disease and its treatment/progression (Sandilands et al., 2013) Assessment of drug clearance and dosage ( Kyriakopoulos & Gupta, 2023)

8. References Davey, C. H., Webel , A. R., Sehgal, A. R., Voss, J. G., & Huml , A. M. (2019). Fatigue in Individuals with End Stage Renal Disease.  Nephrology Nursing Journal : Journal of the American Nephrology Nurses’ Association ,  46 (5), 497–508. https:// www.ncbi.nlm.nih.gov / pmc /articles/PMC7047987/ Haider, M. Z., & Aslam, A. (2020).  Oliguria . PubMed; StatPearls Publishing. https:// www.ncbi.nlm.nih.gov /books/NBK560738/ Kyriakopoulos, C., & Gupta, V. (2024).  Renal Failure Drug Dose Adjustments . PubMed; StatPearls Publishing. https:// pubmed.ncbi.nlm.nih.gov /32809347/ Mercado, M. G., Smith, D. K., & Guard, E. L. (2019). Acute Kidney Injury: Diagnosis and Management.  American Family Physician ,  100 (11), 687–694. https:// pubmed.ncbi.nlm.nih.gov /31790176/ Parving , H.-H., Andersen, S., Jacobsen, P., Christensen, P. K., Rossing , K., Hovind , P., Rossing , P., & Tarnow, L. (2004). Angiotensin receptor blockers in diabetic nephropathy: renal and cardiovascular end points.  Seminars in Nephrology ,  24 (2), 147–157. https:// doi.org /10.1016/j.semnephrol.2003.11.003 Patel, S. S., Molnar, M. Z., Tayek , J. A., Ix , J. H., Noori, N., Benner, D., Heymsfield , S., Kopple, J. D., Kovesdy , C. P., & Kalantar -Zadeh, K. (2012). Serum creatinine as a marker of muscle mass in chronic kidney disease: results of a cross-sectional study and review of literature.  Journal of Cachexia, Sarcopenia and Muscle ,  4 (1), 19–29. https:// doi.org /10.1007/s13539-012-0079-1 Ronco , C., Bellomo , R., & Kellum, J. A. (2019). Acute kidney injury.  The Lancet ,  394 (10212), 1949–1964. https:// doi.org /10.1016/s0140-6736(19)32563-2 Sandilands, E., Dhaun , N., Dear, J., & Webb, D. (2013). Measurement of renal function in patients with chronic kidney disease.  British Journal of Clinical Pharmacology ,  76 (4), n/a-n/a. https:// doi.org /10.1111/bcp.12198 Shahbaz, H., & Gupta, M. (2023).  Creatinine Clearance . PubMed; StatPearls Publishing. https:// www.ncbi.nlm.nih.gov /books/NBK544228/ Vassalotti , J. A., Stevens, L. A., & Levey, A. S. (2007). Testing for Chronic Kidney Disease: A Position Statement From the National Kidney Foundation.  American Journal of Kidney Diseases ,  50 (2), 169–180. https:// doi.org /10.1053/j.ajkd.2007.06.013