Accumulated

Renal & Urinary System


Step 1: View Clinicals

A 30-year-old man with an intellectual disability presents with left-sided weakness and dysarthria for two days, in a background of anorexia and nausea for one week.


His medical history is significant for stage IV chronic kidney disease secondary to uncorrected posterior urethral valves. He has been poorly adherent to treatment and is not on any medications right now, including over-the-counter drugs or herbal preparations.

His surgical and family histories are unremarkable. He does not drink, smoke, or use illicit substances. There are no known allergies. He has never been employed. He is a single child and currently lives with his widowed, elderly father.

A complete blood count is only significant for a hemoglobin level of 10.7 mg/dL (normal: 11 - 18). His leukocyte count is 6,500/mm3, with normal differentials.


Step 2: Order Relevant Investigations

1. Comprehensive metabolic panel

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Glucose: 145 mg/dL (<200)

Sodium: 141 mEq/L (135 - 145)

Potassium: 4.2 mEq/L (3.6 - 5.2)

Chloride: 101 mEq/L (95 - 105)

Calcium (total): 6.5 mg/dL (8.5 - 10.2)

Phosphorus: 3.4 mg/dL (2.5 - 4.5)

BUN: 56.2 mg/dL (7 - 20)

Creatinine: 3.20 mg/dL (0.7 - 1.3)


ALT: 34 U/L (9 - 51)

AST: 21 U/L (13 - 40)

ALP: 80 U/L (34 - 122)

Bilirubin (total): 0.3 mg/dL (0.1 - 1.1)

Albumin: 4.2 mg/dL (3.5 - 5.5)

2. Arterial blood gases

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pO2: 90 mmHg (>70)

pCO2: 39 mmHg (35 - 45)

pH: 7.30 (7.35 - 7.45)

HCO3: 22 mmol/l (22 - 26)

saO2: 99%

3. MRI Brain

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T2-weighted images show bilateral hyperintensities of the periventricular white matter, basal ganglia, and internal capsule, suggestive of cytotoxic edema. There is no evidence of ischemia, hemorrhage, or mass lesions.

4. Lumbar puncture

clear

You realize that lumbar puncture is not indicated currently.

Step 3: Select Appropriate Management

1. Hemodialysis

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2. Calcium supplementation

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3. Sodium Bicarbonate

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4. Anticoagulation

clear