Clinical cituation 5

The man, 27 years old, he is complained on the weakness, sweat, headache, rise of temperature, pains in joints and in cardiac region.

The biochemical test serum of blood :

Total protein – 110 g/l Alpha-globulin’s – 16.2%

Gamma-globulin’s – 34.5%

C-reactive protein – the reaction is positive.

Diphenylic test – 12 mmol/l (5.8-6.6mol/l)

Fibrinogen – 6.8 g/l (in normal – 2-4 g/l)

(carbohydrates components of glycoproteins)

Sialic acids – 3.8 mmol/l (in normal – 2.0-2.33 mmol/l)

General analysis of blood:

Leukocytes – 11.0*10⁹ g/l (neutral shift to the left)

Erythrocytes – 4*10¹² g/l

Hemoglobin – 90.5 g/l

ESR – 28 mm/hour

Analysis of urine:

Diuresis – 1.9 l

Color – straw-yellow

Specific gravity – 1.027

pH is– slightly -acidic

Protein – is present in the form of trace

The formed elements – single erythrocytes in visual field.

At what kind of pathology such changes are observed in analyses of blood and urine?

Call these changes, explain the reasons of their appearance.

The answer to a task 1

At the patient the leukocytosis with neutrophilic shift to the left thrombocytopenia, decrease in the contents of hemoglobin (hypochromic anemia), acidosis, are marked. The increase in the basic components of rest nitrogen of blood are observed: urea, a uric acids, creatinine, the contents of calcium is reduced, the contents of phosphates and magnesium is increased. The urine analysis point out on decrease of diurnal diuresis, (diurnal urine exertion), low specific gravity of urine, its alkaline reaction.

The specified changes are observed in chronic renal insufficiency which is a final stage of the long-term pathological process resulting in destruction of parts of neurons. Infringement of secretary functions of kidneys lead to a delay of nitrogenous slogs: urea, uric acid, creatinine. As response to their toxic action is developed leukocytes with neutral shift to the left, a thrombocytopenia and hypochromic anemia. The same reason causes a nausea, vomiting, loss of appetite. Last is caused also by disorder in synthesis of erythropoietin in kidneys (erythropoietin stimulates formation of hemoglobin). Reduction of quantity of trombocyts leads to infringement of blood coagulation of blood, and, hence, to a bleeding and hemorrhage. Excretion of nitrogenous slogs through skin, stomach and intestines, and sedimentation of uric acid in the in articulate bags leads to a painful skin itch, pains in joints.

Loss by kidneys of ability to secretion protons in a lumen of tubular and to return components of buffer systems in blood leads to metabolic acidosis, alkaline reaction of urine, development of the big noisy breath, hypokaliemia, muscular weakness. It is broken reabsorption of calcium, develops hypocalcemia. Therefore for the account of compensatory mechanisms amplified (strengthened) production of parathyroid hormone, parathormon secondary hyperparathyroidism begins. So the bone tissue is broken its alkaline components pass in blood and participate in maintenance of acid-alkaline balance. Because of destruction of a bone tissue develops osteoporosis osteopenia. The quantity of phosphates in blood increases owing to infringement of secretary function of kidneys. Extra renal ways of excretion of phosphates from and organism are absent.