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"Aiman had low urine output", Nur Zarifah Binti Mohd Zaki PBL…
"Aiman had low urine output"
symptoms
puffiness of face, particularly around eyes, first noted in the morning
puffiness lessen in the afternoon
Low volume and frequency of urine
History
history of skin infection involving legs
Streptococcus infection
streptococcus produce a toxic enzyme (Streptolysin O)
Body produce antibody (Antistreptolysin O) against Streptolysin O
antigen-antibody complexes deposit in the glomerular basement membrane (GBM)
induce inflammatory cells
cause microvascular damage
renal ischemia
1 more item...
produce proteases and oxidants
cause damage to GBM and GBM become leaky
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ESR after 1 hour: high
produce membrane attack complex
attack podocytes and mesangial cells
Antistreptolysin O titre (ASOT): high
General physiscal examination
High BP
Blood test
Urine test
Appearance: dark yellow
Protein: high
cause low protein in the blood (hypoalbuminemia)
decrease oncotic pressure of the blood
increase blood hydrostatic pressure
water driven out from blood
RBC: high
normal 4 RBC
Leukocytes: high (pyuria)
normal <5
Microscopic examination: Red cell cast
Treatment
Loop diuretic
e.g: Furosemide
act on NKCC2 symporter in the thick ascending limb of Loop of Henle
inhibit sodium, potassium and chloride ion reabsorption
decrese osmolality of renal medulla
decrease water reabsoption in nephron
increase urine output
decrease blood pressure
salt and water restriction
water: to decrease blood volume
decrease edema
salt: to decrease blood osmolality
decrease blood pressure
Nur Zarifah Binti Mohd Zaki
PBL URS 1