ЗАДАЧА 1

Patient S., 22 years old, worker. I went to the doctor with complaints of pain in the
lumbar region, swelling on the face, a decrease in the amount of urine removed to 400 ml
/ day, the appearance of red urine, thirst, headache, and weakness. According to the
results of the examination, a diagnosis of glomerulonephritis was made. The results of the
survey:
Blood count Urinalysis
Hb 116 g/l Quantity 50,0 ml
Er 3,6*1012/l Color Dark red
9
LEU (WBC) 12,5*10 /l transparency ………
ESR 25 mm/h Reaction Slightly acid
Leukocytes

Trb 305*109/l Specific gravity 1032

color index 0,95 Protein 2,1 g/l
(WBC count)

Eos 3 Bens Jones Protein negative

%

Bas 1 Sugar negative

formula,

stab neutrophils 2 Bilirubin negative

segmented 61 Ketone bodies negative
neutrophils
Lymph 25 Urine sediment microscopy
Mon 8 Epithelium Flat 0-1 in field of view
Round 1-2 in field of view
Leu 10-15 in field of view
Er 80-100 in field of view
Cylinders hyaline and granular 5-6
in field of view
Salt -
Bacteria -

Blood chemistry
Total bilirubin 14,5 mkmol/l Residual nitrogen 16,3 mmol/l
Total protein 75 g/l Creatinine 98 mmol/l
Albumin 45 g/l (60%) Urea 6,5 mmol/l
Globulin: 40% Uruc acid 260 mkmol/l
– α1 2% Potassium 3,7 mmol/l
– α2 6% Sodium 138 mmol/l
– ß 4% Calcium 2,4 mmol/l
– γ 28% Magnesium 1,0 mmol/l
Cholesterol 4,8 mmol/l Chlorine 98 mmol/l

QUESTIONS:
1. Identify and justify the urinary syndrome present in the patient, and indicate its
diagnostic value.
2. Identify and explain changes in the general analysis of blood, biochemical analysis
of blood.
3. What will be the transparency of urine according to the general analysis of urine,
explain these changes.
4. What additional methods of instrumental examination are indicated to the
patient? What changes do you expect to get from this patient?
TASK 2
Patient S., 32 years old. At the age of 5, kidney disease was detected. Over the past
year, his health worsened, he began to complain of a constant headache, the amount
of urine being discharged decreased, nausea, an unpleasant taste in his mouth
joined, appetite disappeared, in the mornings vomiting, and loose stools bothered.
Results of the survey:
Blood count Urinalysis
Hb 85 g/l Quantity 50,0 ml
Er 2,1*1012/l Color watery
LEU (WBC) 12,5*109/l transparency Cloudy
ESR 25 mm/h Reaction Slightly acid
Trb 300*109/l Specific gravity 1010
Leukocytes

color index 0,8 Protein 1,1 g/l

(WBC count)

2 3 Bens Jones Protein negative

formula, %

1 1 Sugar negative
2 2 Bilirubin negative
70 61 Ketone bodies negative
20 25 Urine sediment microscopy
85 г/л 8 Epithelium Flat 1-2 in field of view

Leu 4-6 in field of view

Er 5-10 in field of view
Cylinders hyaline and granular 2-3
in field of view

Blood chemistry
Total bilirubin 14,5 mkmol/l Residual nitrogen 120,5 mmol/l
Total protein 60 g/l Creatinine 786,5 mmol/l
Albumin 30 g/l (50%) Urea 35,6 mmol/l
Globulin: 50% Uruc acid 402 mkmol/l
– α1 4% Potassium 5,6 mmol/l
– α2 8% Sodium 126 mmol/l
– ß 9% Calcium 2,0 mmol/l
– γ 19% Magnesium 1,0 mmol/l
Cholesterol 5,0 mmol/l Chlorine 90 mmol/l
 Urinalysis according to Zimnitsky
Fluids taken per day - 1200 ml
Serving hours Relative Density Urine Amount in ml
No.
1 6-9 - -
2 9-12 1011 50
3 12-15 1009 50
4 15-18 - 50
5 18-21 1011 -
6 21-24 1012 50
7 0-3 - 50
8 3-6 1009 -
Daytime Diuresis 150
Night Diuresis 100

Sample Reberg-Tareev
Creatinine clearance 15 ml / min

Tubular reabsorption 39%

Cockcroft formula glomerular filtration rate: 20 ml / min / 1.73 m2

Pict. 1. Ultrasound of kidney
With longitudinal scanning, the kidneys are visualized
as echo-negative formations with clear oval
contours, with multiple cysts of different sizes, the
size of the kidneys on both sides is 18x11x9 cm. The
cortical substance is located in areas.
Fig. 2. Excretory urography
The kidneys are enlarged on both
sides, the pyelocaliceal system is
enlarged and deformed. Slowed down
contrast on both sides
QUESTIONS:
1. Based on the results of the examination, evaluate the functional ability of the
kidneys in the patient, indicate the diagnostic value of the revealed changes.
2. Identify and explain changes in the general analysis of blood and the general
analysis of urine, and indicate the diagnostic value of the revealed changes.
3. Indicate the diagnostic capabilities and diagnostic value of the instrumental
examination methods used in this patient.
4. What clinical syndrome can be assumed in the patient?