BOF: 46
A 26-year-old male presents with swelling of his body. He
is found to have 4+ proteins in his urine
Further investigations reveal
Sodium 117 mmol/L
Potassium 5.3 mmol/L
Urea 4.6 mmol/L
Glucose 4.8 mmol/L
Plasma osmolality 286 mOsm/kg
Albumin 19 g/L
24-hour urinary protein 7.4 g
In this patient which one of the following tests would
you arrange to determine the cause of his hyponatraemia?
a)
Lipid profile
b)
Urine osmolality
c)
Urinary excretion of sodium
d)
Short synacthen test
e)
TSH level
Answer: a)
The clinical features and the high urinary protein and
low albumin would suggest the patient has nephrotic syndrome.
The calculated osmolality of blood is 254, the measured
osmolality is 286. Hence the osmolar gap is > 10 mmol/L suggesting that there
is another substance in the blood accounting for the remainder of the
osmolality.
In nephrotic syndrome cholesterol is high and with marked
hypoalbuminaemia elevation of triglycerides may occur as well.
Revision Tip
Revise nephrotic syndrome KEYS
to SUCCESS in Medicine page 319-321
