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AIMAN HAD LOW URINE OUTPUT - Coggle Diagram
AIMAN HAD LOW URINE OUTPUT
Blood investigations
ESR after 1st hour
Aiman's result is high which is 25 mm/hour. This means that the erythrocytes settle at the bottom of test tube at a faster-than-normal rate, indicating inflammation in his body.
blood urea
Aiman has high blood urea level which is 7.0 mmol/L. The causes of this high result maybe can caused by decreased filtration and glomerular filtration rate because urea are free filtered across the glomerulus. This will results in the build up of blood urea.
Corticosteroid intake also causing increase breakdown of protein which results in increase in urea formation.
serum creatinine
Serum creatinine is one of chemical compound that leftover from energy produced from the muscles. Normally, serum creatinine will exit as a waste product in the urine. As Aiman's result is high in serum creatinine which is 65 umol/L, this means that there is an accumulation of the serum creatinine in the blood which is indicates that he has a kidney disease.
serum potassium
Potassium is an important element in cell metabolism, and it’s important in maintaining the balance of fluids and electrolytes in the body. Aiman has high level of serum potassium which is 6.2 mmol/L which is indicates that he has hyperkalemia. This happens when kidney can't get rid of enough potassium through urine.
Antistreptolysin O titre (ASOT)
anti-streptolysin O is the antibody made against streptolysin O, an immunogenic, oxygen labile streptococcal hemolytic exotoxin produced by most strains of group A
Signs, symptoms
hypertension
When there is decrease in renal perfusion, renin will be released by the kidney. It will cause conversion of angiotensinogen to angiotensin I. Further conversion of angiotensin I to angiotensin II by ACE. When there is activation of angiotensin II, it will cause arteriolar vasoconstriction. In which, it will results in increased of blood pressure.
puffiness less in afternoon than in the morning
Associated with postural changes. Lying down (sleep) causes fluid to rest and collect in the face, hence causing puffiness of face worse in the morning. In the afternoon, when Aiman spends time in upright position, this fluid goes to the lower limbs due to gravity, hence lessen the puffiness of face.
volume and frequency of urination has reduced
Maybe caused by dehydration where when water intake is low, plasma osmolality will increase. This will lead dry mouth and also throat. When this happen, it will stimulate osmoreceptor and also thirst center. This sensation will be stimulated. Thus, decrease urine output.
no ankle oedema
This suggests that the oedema is only mild, not severe enough to cause ankle oedema
Urine examination
Appearance: Dark yellow
Due to reduced urine output and elevated level of red blood cell in urine
Glucose : Negative
normal blood glucose level
Protein : ++
Due to structural damage to the glomerular barrier such as podocytes and basement membrane that allows passage of more and larger molecules. The filtration slit between podocytes and normal podocytes architecture, interdigitating podocytes foot processes are critical to maintaining a barrier to protein loss into the urinary space
RBCs : 20-30/HPF
As the glomerulus wrapped with blood cells. So, if there is an inflammation on it, it will cause glomerulus to loss its shape. This will lead to leak of blood cells and proteins in the tubules or kidney or urine.
Leucocyte : 4-5/HPF
normal which 5 WBCs per high power field (wbc/hpf).
Microscopic examination : Red cell casts