76b. Renal Disease – Paediatric Case StudyThe course content the following article will help you complete the case study (Reading Renal 5).Jacqui, aged 5 years, presented to her general practitioner with moderate generalised pain in her abdominalregion, a high temperature (41°C) and chills, frequent and painful urination, proteinuria and haematuria. Hergeneral practitioner advised Jacqui’s parents to take Jacqui to Emergency Department at their local hospitalbecause she might need intravenous antibiotics, and then phoned to advise the senior medical officer inadvance of their arrival. On presentation at the Emergency Department, Jacqui’s pain had worsened, her bloodpressure was 120/80 mmHg and pulse 120 beats per minute.Reducing her pain was the initial priority and Jacqui was prescribed intravenous morphine and oralparacetamol. Further questioning of her parents revealed that Jacqui had previously had a urinary tractinfection, had been ‘difficult to toilet train’, still wets her bed reasonably frequently and occasionally has somedaytime urine leakage particularly if she cannot go to the toilet regularly.After her pain subsided further tests were arranged. An investigative ultrasound examination revealed minor renalswelling and ureteral dilatation. Jacqui was admitted to hospital and commenced on intravenous gentamicin.Jacqui was encouraged to drink plenty of water and her fluid intake and urine output were monitored.Jacqui’s blood and urine test results are outlined below (with age-specific reference range): Biological variablePatient resultsNormal rangeWhite blood cell count15 x 109/L4.5 – 12 x 109/LHaemoglobin120 g/L113 –145 g/LHaematocrit0.45 %0.33 – 0.42 %Mean cell volume75 fL74 – 87 fLSodium145 mmol/L135 –145 mmol/LPotassium5.2 mmol/L3.5 – 5.3 mmol/LSerum creatinine118 µmol/L25 – 70 µmol/LMicroalbuminuria45 mg/L
