Cardiac_Markers_and_Renal_Function

Cardiac_Markers_and_Renal_Function - Interpretation of...

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1 Interpretation of Laboratory Tests: A Case-Oriented Review of Clinical Laboratory Diagnosis Roger L. Bertholf, Ph.D. Associate Professor of Pathology University of Florida Health Science Center/Jacksonville
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2 Case 1: Oliguria and hematuria
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R. Bertholf American Society of Clinical Pathologists 3 Case 1: Oliguria and hematuria A 7-year-old boy was brought to the pediatrician because of vomiting and malaise. On physical examination he was slightly flushed, and had some noticeable swelling of his hands and feet. The patient was uncomfortable, and complained of pain “in his tummy”. He had a slight fever. Heart was normal and lungs were clear. His past medical history did not include any chronic diseases. The mother noted that he had a severe sore throat “about two weeks ago”, but that it had cleared up on its own. The child was not taking any medications. There were no masses in the abdomen, and lymphadenopathy was not present. The child had some difficulty producing a urine specimen, but finally was able to produce a small amount of urine, which was dipstick-positive for blood and protein.
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R. Bertholf American Society of Clinical Pathologists 4 Questions. . . What is the differential diagnosis in this case? What laboratory tests might be helpful in establishing the diagnosis?
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R. Bertholf American Society of Clinical Pathologists 5 What do the kidneys do? Regulate body fluid osmolality and volume Regulate electrolyte balance Regulate acid-base balance Excrete metabolic products and foreign substances Produce and excrete hormones
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R. Bertholf American Society of Clinical Pathologists 6 The kidneys as regulatory organs “The kidney presents in the highest degree the phenomenon of sensibility, the power of reacting to various stimuli in a direction which is appropriate for the survival of the organism; a power of adaptation which almost gives one the idea that its component parts must be endowed with intelligence.” E. Starling (1909)
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R. Bertholf American Society of Clinical Pathologists 7 Review of Renal Anatomy and Physiology The kidneys are a pair of fist-sized organs that are located on either side of the spinal column just behind the lower abdomen (L1-3). A kidney consists of an outer layer (renal cortex) and an inner region (renal medulla). The functional unit of the kidney is the nephron ; each kidney has approximately 10 6 nephrons.
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R. Bertholf American Society of Clinical Pathologists 8 Renal anatomy Cortex Medulla Pelvis To the bladder Capsule
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R. Bertholf American Society of Clinical Pathologists 9 The Nephron Renal artery Glomerulus Bowman’s capsule Proximal tubule Distal tubule Collecting duct Henle’s Loop Afferent arteriole
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R. Bertholf American Society of Clinical Pathologists 10 Glomerular filtration Glomerlular capillary membrane Vascular space Bowman’s space Mean capillary blood pressure = 50 mm Hg BC pressure = 10 mm Hg Onc. pressure = 30 mm Hg Net hydrostatic = 10 mm Hg 2,000 Liters per day (25% of cardiac output) 200 Liters per day GFR 2245 130 mL/min
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R. Bertholf
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This note was uploaded on 09/18/2011 for the course MED 6566 taught by Professor Staff during the Summer '11 term at University of Florida.

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Cardiac_Markers_and_Renal_Function - Interpretation of...

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