Question

Patient A is a 43 year old woman, with a 15-year history of type 2 diabetes, hypertension, and hyperlipidemia and a 20-year history of smoking.

She had been referred to a diabetes clinic for intensive diabetes self-management education and training over this period. She presents in the office with shortness of breath, pruritus (itching), and edema of bilateral extremities.

Her blood pressure is 165/92 mm Hg, heart rate 94 beats per minute (regular rate and rhythm), and respiration 26 breaths per minute. She is 5 feet 3 inches tall and weighs 202 pounds (BMI: 35.8). Blood is taken and sent to the laboratory for analysis, which reveals some abnormal findings.

LABORATORY ANALYSIS

Blood Test Patient A's Results Target Range

Hemoglobin 8.7 g/dL 11.0–12.0 g/dL

Creatinine 2.2 mg/dL 0.6–1.2 mg/dL

GFR 49 mL/min/1.73 m 290–120 mL/min/1.73 m2

Serum albumin 3.3 g/dL ≥4.0 g/dL

Glucose(random) 186 mg/dL <140 mg/dL

Calcium 10.0 mg/dL 8.4–9.5 mg/dL

Phosphorus 5.0 mg/dL 2.7–4.6 mg/dL

Plasma PTH 77pg/mL 35-70 pg/ML

   

Discuss how this patient's pre-existing conditions are affecting her urinary system.  

Please include in your discussion:

State of Blood Creatinine, Albumin, Glucose. What does it indicate?

Why might her plasma PTH be elevated? What concerns do you have?

What does the GFR tell you and what are your concerns?

What may be causing the high blood pressure and high respiratory rate?

What might you expect to see in this patient's urinalysis?

Why is this patient put on a low protein diet? What other dietary restriction might you recommend? Other treatment?

Answer 1

thanks