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Limiting the progression of renal failure!

5K views 17 replies 8 participants last post by  achistikbenny 
#1 ·
A 6-year-old girl is brought to the physician because of a 4-week history of headache, fatigue, and decreased appetite. During this period, she has had nausea and vomiting. At the age of 4 years, she was diagnosed with post-streptococcal glomerulonephritis. She is at the 15th percentile for height and the 10th percentile for weight. Examination shows no abnormalities. Her serum urea nitrogen (BUN) level is 50 mg/dL. Which of the following is most likely to limit progression of this patient's renal failure?

A) Increased potassium and sodium bicarbonate intake
B) Decreased sodium and daily calorie intake
C) Low-protein diet
D) Strict fluid restriction
E) Dialysis
 
#7 ·
Dialysis will only help excrete the nitrogenous waste products currently in her system producing her uremia. Although this will decrease/eliminate her symptoms, it will not correct her kidney function and once you stop dialysis, her BUN is likely to climb and she will become uremic all over again.
Therefore I say the answer is low protein diet. The NH3 group in amino acids is the main contributor to the nitrogenous waste products, so if she decreases her protein intake, she greatly decreases the build up of these products therefore her BUN won't be as high.
 
#13 ·
Actually, I was just thinking... Even in renal failure, unless you're end stage, you can still excrete a certain amount of nitrogenous waste products. You're just doing so at a decreased rate. This patient only has uremia or mild renal impairment. So I think if you decrease her protein intake, her BUN will drop. It's a dynamic system with NH3 constantly being ingested, and constantly being excreted. So if we decrease the amount being taken in, it will decrease the currently high BUN without the need for dialysis. Does that make sense to anyone?
 
#15 ·
I dont know the right ans thats is why i posted it . so we should reason togather. This is a standard nbme question that one could possibly see in exam.

May be strict low protein intake may be the ans but am still not convinced about how the uremia will be taken care of .
 
#16 ·
Let's say a normal person, like you or I, takes 10 NH3 groups in our diet, and we excrete 10 NH3 groups from our kidneys, so we have 0 net NH3 groups and no uremia. In this patient, her renal function is impaired, so she takes in 10 NH3 groups, but she can only excrete 8 NH3 groups, so she's left with a net +2 NH3 groups ok? So she's uremic ie azotemia (increased blood NH3 groups) with symptoms. So now let's say we decrease her protein intake, to 8NH3 groups ok? So she takes in 8 NH3 groups, and excretes 8 NH3 groups and voila, she's back to net 0 NH3 groups just like me and you! So if she maintains her low protein diet, it doesn't matter if she's renally impaired, she will not be uremic! If her renal impairment gets worse, then she just has to decrease her protein intake more! SIMPLE AS DO RAY MEE
 
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