RFT Charts

CASE 1
A 50-year-old patient was admitted for treatment of sore throat and pneumonia. He
had poorly controlled diabetes mellitus and on admission blood urea was 140
mg/dL and serum creatinine was 2.8 mg/dL. He received 2.0 L fluid, but blood
urea increased to 160 mg/ dL and serum creatinine to 3.0 mg/dL. Urine output
which was initially good dropped to 500 mL over a 24hours period. Next day, he
developed shortness of breath and lower extremity edema. Blood urea rose to300
mg/dL and serum creatinine to 6.3 mg/dL.
1. What is the probable diagnosis? (1 mark)
Ans : The patient is suffering from acute renal failure (ARF),also referred to as
acute kidney injury (AKI).
2. Name any three intrarenal causes for your diagnosis. (3 marks)
Ans: Acute Glomerulonephritis,Rapidly progressive cresentric
Glomerulonephritis ,Acute tubular necrosis,Acute Pyelonephritis,drug induced
acute interstitial nephritis,Malignant Hypertension,Polyarteritis Nodasa,Sickle cell
disease,Systemic lupus erythematosus,transfusion reactions,myeloma
nephropathy,crush injuries and papillary necrosis.
3. Name any two tests done to measure tubular dysfunction.(2 marks)
Ans : Dilution test ,Urine concentration test,Vasopressin (ADH) test,Urine
acidification test and Phenolsulphonephthalein test
4.What is the microscopic cast seen in the urinary sediment in your diagnosis ?
(1 mark)
Ans : Renal tubular epithelial cell cast./Myoglobin cast
5. What is the triad of presentation seen in hemolytic uremic syndrome ? ( 3
marks)
Ans: Hemorrhagic diarrhea, Microangiopathic hemolytic anemia and rapidly
progressive renal failure.
6.What is the normal reference range for BUN (blood urea Nitrogen)
Ans: 7-18 mg/dl
CASE 2
A 50-year-old man was admitted with loss of appetite, nausea, vomiting, difficulty
of breathing and fatigue. History revealed that he had similar symptoms 5 years
back and was diagnosed with hypertension and kidney failure. On examination,
temperature was 36.8°C, respiratory rate was 22/min, pulse rate 64/min, BP was
170/100 mm Hg, marked pallor was present, chest and lungs showed bilateral basal
rales, abdomen was soft, flat and tender. No other abnormality was detected.
Patient was an occasional alcoholic, and a chronic smoker. Laboratory
investigations showed—Blood urea 65 mg/dL, serum creatinine 2.4 mg/dL, serum
calcium 6.4 mg/dL, serum potassium 4.9 mg/dL, and serum sodium 139 mmol/L.
Urine examination results were – Color straw colored, pH 5.0, specific gravity
1.020, appearance turbid, volume 900 mL/24 h, albumin 3+, sugar negative, pus
cells 1-3/HPF, RBC – 1-2/ HPF, and epithelial cells rare.
1. What is the probable diagnosis? (1 mark)
Ans: The patient is suffering from chronic renal failure (CRF), also known as
chronic kidney disease (CKD).
2. What type of anemia usually is represented in your case? (1 mark)
Ans : Normocytic normochromic
3.Name any three risk factors in your diagnosis .( 3 marks)
Ans: Diabetes mellitus, hypertension, glomerular nephritis, urinary tract infection,
autoimmune disease and kidney stones
4.What are the diagnostic markers for your diagnosis? (4 marks)
Ans: Serum creatinine, estimated GFR, microalbumin and Cystatin C
5. What is the microscopic cast seen in the urinary sediment in your diagnosis?
(1mark)
Ans : Waxy Cast
6.What are the tests to measure glomerular filtration rate?
Ans : Inulin clearance, Endogenous creatinine clearance & Urea clearance
7.What is estimated glomerular filtration rate (eGFR) can be used for?
Ans : eGFR can be used for staging of patients with chronic kidney disease.
8. What is Creatinine Coefficient?
Ans : Creatinine co-efficient is the urinary creatinine expressed in mg/kg body
weight. The value is elevated in muscular dystrophy. Normal range is 20–28 mg/kg
for males and 15–21 mg/kg for females
9. What are Non Protein Nitrogen substances?
Ans : Non-protein Nitrogen includes urea, creatinine and uric acid. Minor
components of NPN are urobilinogen, indican, ammonia and amino acids
10.Name few renal causes showing increase in blood urea.
Ans: Acute glomerulonephritis Nephrosis Malignant hypertension and Chronic
pyelonephritis
CASE 3
A 10 year old patient presented with swelling in the face and legs which develoed
after a sore throat. Patient also complaints of severe headache and passing rusty
colored urine.
O/E:
Pulse – 100/min
B.P. – 140/90 mmHg
Temperature – normal
Haemoglobin – 12.3gm/dl
WBC ,TC– 22,000
DC-Neutorphil – 83%, Lymphocytes – 12.3%, eosinophil -0.1%, basophil -0.2%
Platelet – 2, 28,000
ESR – 74mm/hr
Urine dipstick test – protein - +, Blood - ++++
Urine microscopy – RBC cast
Serum Creatinine – 2.3mg/dl
Urea – 52.3 mg/dl
C- reactive protein – 11.2 mg/dl
1.What is the probable diagnosis?
Ans : Acute post infectious glomerulonephritis
2.Name the main clinical features of this disease?

Ans : Hematuria, Protienuria, Azotemia, hypertension
3.What is the etiology of the above condition?

Ans: Group A beta haemolytic streptococci
4.Diagnostic lab investigation for the above condition?

Ans: Increased ASO (antistreptolysin titre) and decreased complement C3 levels
5.Typical electron microscopic finding in this condition?

Ans: Subepithelial humps of antigen antibody complex
6.Factors reducing Serum creatinine level?

Ans : Low muscle mass, females, malnutrition
7.What are the methods of estimation of serum creatinine level?

Ans: Jaffe s reaction and enzymatic methods
8.What is the formula to calculate GFR (glomerular filtration rate)
Ans: UV/P (U- concentration of substance in urine in mg/dl; V- volume of
urine excreted in ml/min and P- concentration of substance in plasma in
mg/dl)
9.What are the properties of agent used to measure GFR?

Ans: a) it should be physiologically inert and endogenous
b) Should be freely filtered by glomeruli, neither be reabsorbed nor
secreted by renal tubules
c) it should not bind to plasma proteins and should not be metabolised by
kidney
d) it should be excreted only by kidneys

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CASE 1

2.Name the main clinical features of this disease?

3.What is the etiology of the above condition?

4.Diagnostic lab investigation for the above condition?

5.Typical electron microscopic finding in this condition?

6.Factors reducing Serum creatinine level?

7.What are the methods of estimation of serum creatinine level?

9.What are the properties of agent used to measure GFR?

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