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  #1  
Old 02-25-2012
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Kidney Limiting the progression of renal failure!

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
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  #2  
Old 02-26-2012
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I think the true answer is " Low protein diet " ?
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  #3  
Old 02-26-2012
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I think the patient has uremia bcos of the nausea and vomiting with elevated BUN/CR . so i think Dialysis will come first then when the renal function has normalized she can now go on low protein diet
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Old 02-26-2012
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he's asking what will limit the "progression" so i think it's low protein diet
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Old 02-26-2012
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D) Strict fluid restriction
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  #6  
Old 02-26-2012
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i will go with dialysis. whats the ans?
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  #7  
Old 02-26-2012
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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.
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  #8  
Old 02-26-2012
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with high BUN it shud be dialysis.
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  #9  
Old 02-26-2012
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If u reduce her protein intake what will happen to the already elevated BUN/CR level. how do u correct the already renal impairement?
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  #10  
Old 02-26-2012
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That's a good question. I think you could be right there! Maybe the answer is dialysis then...
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  #11  
Old 02-26-2012
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I think the question is wrong , because he didn't ask me for urgent intervention or ttt ..
He ask me with limit long progression, for me it's logic the best thing is dialysis, but dialysis used in renal failure !!! why he ask me to prevent progress failure ??
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Old 02-27-2012
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please tell the ans
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  #13  
Old 02-27-2012
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Quote:
Originally Posted by achistikbenny View Post
If u reduce her protein intake what will happen to the already elevated BUN/CR level. how do u correct the already renal impairement?
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?
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  #14  
Old 02-27-2012
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Quote:
Originally Posted by angelovd View Post
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?
according to your logic thinking , also the question doesn't mention urgent or better intervention, the question ask for long time management ,so for me also I prefer restrict protein intake
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  #15  
Old 02-27-2012
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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 .
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  #16  
Old 02-27-2012
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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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  #17  
Old 02-28-2012
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low-protein diet??




Quote:
Originally Posted by achistikbenny View Post
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
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  #18  
Old 02-28-2012
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Hmmmmmmmmm! i think ur make a lot of sense in ur explanation . i dont know the ans either but any more explanation will be helpful.
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