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A woman aged 80 presents with severe weakness, disorientation hypertensive, extreme weakness and tachycardia to the emergency department.
The lady had been suffering with Type 2 Diabetes mellitus over 10 years.
The pathology department provided the following test results.
Parameter Result Range
Urea 13.8 mmol/L 1.8.3 mmol/L
Ferritin 273.1 Ug/L 4.6–204 ug/L
What is the most likely diagnosis for you?
Each biochemical finding should be discussed and the clinical implications outlined.
The lady provided a 24-hour urine sample of 1950ml. She had a plasma creatinine level of 168umol/L. Her urine creatinine was 8.3mmol/L. Calculate the creatinine clearance, and comment on it.
Discuss the impact of age, sex, and diet on the production of serum creatinine.
Discuss the advantages of using cystatin C to measure renal function.
According to the case study, the woman was 80 years old. She is also suffering from various illnesses.
The most likely diagnosis is chronic kidney disease.
The patient has had type two diabetes mellitus for over 10 years.
The patient is now at high risk for developing chronic kidney disease.
According to her medical records, the levels of potassium and creatinine as well as HbA1c are extremely high.
Gillett and colleagues found that HbA1c should be between 19-40 mg/Mol.
According to the results, the women’s HbA1c level is 51 mmol/Mol.
The woman is therefore at very high risk.
Tachycardia is another problem for women.
This could be a side effect from high risk type 2 diabetes.
Chain and Gregory (2016) note that creatinine’s normal level is between 48 and 80 umol/L.
It was found that creatinine levels are much higher than expected, at 168 Umol/L.
The level of creatinine is higher at 13.8mmol/L, than the usual range of 1.7-8.3mmol/L.
The biochemical findings can be derived from the results of each diagnostic test.
Due to the risk of type two diabetes mellitus, the patient developed serious health issues such as hypertension, disorientation, tachycardia and severe weakness.
The patient’s potassium levels rose by 5.7 mg/L. This is in contrast to the normal range of 3.7-5.4 mmol/L.
The patient could be attacked by chronic renal disease and kidney disease.
A patient can also be at risk for renal failure.
To determine the glomerular filtration rate, the mdrd calculation test is used.
The eGFR rate is 27 ml/min/1.73 sq.m.
The normal range for e-GFR is >90 mg/min/ 1.73 square.m.
The result is therefore lower than the normal e-GFR.
The patient is suffering from the 4th stage chronic kidney disease. His kidney function is severely impaired.
The ferritin concentration is 273.1 mg/L.
(Kelkitli and al.
A patient might have chronic anemia due insufficient production red blood cells.
Potassium plays a vital role in nerve and muscle cell function. It also helps regulate the heart rate.
The hyperkalemia occurs when the potassium level in the blood rises above the normal range.
Plasma ferritin is a measure of the total iron stored in the body.
Iron deficiency anemia is characterized by a deficiency or insufficient ferritin.
Higher levels of urea may lead to impaired homoeostasis, and chronic kidney disease-related electrolyte impairment.
Additionally, the patient will experience an increase in the protein catabolism rate and may develop acute glomerulonephritis.
An increase in creatinine levels is an indicator of poor kidney health. This is because creatinine is a byproduct from muscle metabolism (Wang, et al.
Logue and colleagues.
(2013). Creatinine is the byproduct of normal muscle break down.
The kidney filters creatinine in blood from urine and reabsorbs very little creatinine.
If the reabsorption rate rises, there may be problems in the kidney or damage to the kidney.
GFR rate is dependent on gender, age, race, and body size.
The creatinine clearance is the best estimate of the glomerular filtration rate.
(2014) concluded that sample collection for the creatine clearing test is crucial and essential.
A wrong sample collection could result in a different creatinine clearance testing result.
The interpretation of this result and its interpretation shows that the creatinine clearance result of the patient, a woman aged 80 years old, is normal.
The other parameters indicate that the patient is more at risk of developing renal disease or kidney failure.
Clearance on Creatinine = UxV/ PmL / Min
V= Urine flow rate in m L / min (L/24h/1.44)
UxV= 8300x50ml /1.44mL/ min=8300×1.354.1= 11238.2
This test is used to check the accuracy and function of the kidneys.
It is used to detect kidney problems and blood flow.
It is used to diagnose diabetes mellitus type 2 and check for kidney problems.
The test will also be used to determine the effect of toxic drugs on kidney function.
Logue and colleagues.
(2013). The normal creatinine clearance rate is 120 mL/min and the body surface area is 1.73m2.
BSA can be used to determine the amount of body fat.
It is possible to identify health issues such as diabetes, heart problems, malfunction of the kidneys, shock, chronic kidney disease and dehydration if creatinine clearance rates fall below their normal levels.
(2016). The rate of serum creatinine formation is affected by age, sex, and diet.
You should eat less protein and carbohydrate.
As the renal function declines, water should be limited.
The kidney function decreases with age.
Patients should adopt a modified diet.
Additionally, the patient may have hypertension or tachycardia. Accordingly, potassium and sodium intake should be limited.
The serum creatinine sensitivity to early detection of kidney disease is low and does not provide a reliable predictor of how old people will be.
People with normal renal function and higher muscle mass may experience falsely increased serum creatinine levels.
Modified diets may contain cystatin C with a lower molecularweight.
This basic protein is used to filter out and metabolize tubular absorption using a small amount excreted urine.
Creartinine levels in older people and women are lower than those of younger people and men.
However, production rates vary from person to person and between people of different ages.
The serum creatinine rate is unaffected by age or sexual activity due to the fact that this protein is used.
The benefits of using this basic protein include age and sex.
Tuot and colleagues found that body mass index and body fat are key factors in determining the rate of serum creatinine production.
The calculation of the waist hip to hip ratio is required in order to determine the body fat.
The body weight should equal the amount of serum creatinine that decreases with increasing age.
The problem with renal function is exacerbated by the rising rate of serum creatinine.
It is important to use the mid-urinary serum creatinine collection period sample in order to avoid any errors in calculation.
A low serum creatinine level can be used to diagnose impaired glomerular filtration.
The diagnosis of renal dysfunction can be made easier by CystatinC.
It doesn’t depend on your age, sex, and diet.
The body fat and body weight index are also not important for those who use cystatin C to make their basic protein.
Cystatin C is encoded in the CST3 genes.
CST3 is used by physicians primarily to determine kidney function (Mindikoglu, et al.
However, it can be very expensive and takes a lot of time to use.
Cystatin C has a very low molecular mass.
The cystatin C is filtered out of the blood stream during glomerular filtration.
The doctors sometimes use cystatin C to detect diabetes early.
Cystatin C works best for seniors.
This is the most sensitive marker for glomerular filtration. It also helps in early indication of impaired kidney function.
Cystatin C measurement alone is not enough to assess the kidney function.
Woo et.al. (2014) found that body composition has an impact on the cdystatin C. cancer. Thyroid dysfunction may also have an effect on the function of cystatin C.
(2014) noted that kidney dysfunction can increase the risk of death and cardiovascular disease.
The function of the kidneys is linked with the cardio-vascular system.
A renal problem can cause problems in the cardio-vascular system, which may lead to heart failure.
Cystatin C may cause death if it is increased at an excessive rate.
It should not be taken in excess to reduce the chance of death.
This would not impact the kidney function.
BMI can have an impact on cystatin C. However, other factors such as the liver disease or kidney disease cannot affect cystatin C.
Cystatin C can be used to determine the presence of microalbumin.
Dosing medication can not be stopped by the kidney.
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