A 35-year-old woman with a personal history of cholestasis gravidarum and early ovarian failure. She lives in an urban environment, worked as a…

  

A 35-year-old woman with a personal history of cholestasis gravidarumand early ovarian failure. She lives in an urban environment, worked as a housewife, does not smoke or drink, she does not follow chronic treatments, nor does she have known drug allergies.She went to the emergency service due to progressive swelling of both lower limbs, one week in progress, and which in recent days is accompanied by predominantly eyelid facial edema. The clinical history by organs and apparatus highlighted, approximately 10 days before the onset of the edema, the presence of symptoms compatible with upper respiratory infection (odynophagia, low-grade fever, unproductive cough, bilateral pleuritic pain) that was resolved satisfactorily by means of symptomatic treatment with paracetamol. In the rest of the anamnesis, the patient denied cardiorespiratory, digestive, genitourinary, neurological or musculoskeletal symptoms. The patient had a good general condition and adequate coloring and hydration. Her vital signs were: blood pressure 156/95 mmHg; heart rate 85 beats per minute; 98% oxygen saturation breathing ambient air; temperature 36.5º. In her lower limbs, a soft, perimalleolar and pretibial edema with pitting + / +++ was evidenced.The hemogram showed a hemoglobin of 11 g / dL, a mean corpuscular volume of 89 fL, 110,000 platelets / mL, and 4,120 leukocytes / mL, with a normal formula. In the biochemistry, a creatinine of 1.42 mg / dL, urea 93 mg / dL, LDH 457 IU / L and CRP 1.8 mg / dL stood out, with total proteins, ions and liver profile within normality. In the urine sediment, red cells ++, hematic casts and proteins ++ were detected, while in the 24-hour urine study there were 900 mg of proteins. The coagulation study and the electrocardiogram were normal. 1. Considering the data provided, what do you think is the most accurate diagnosis? Nephrotic syndrome or nephrotic syndrome. Indicate which clinical parameters allow you to make this decision.2. Why does the patient have edema? (describe the pathophysiology of this process)3. Why is it necessary to determine blood creatinine and urea levels when evaluating a patient with kidney disease? (justify)4. What mechanism explains the hypertension suffered by the patient? (justify)5. What blood marker would you measure to confirm your diagnosis? or do you think that the diagnosis should not be confirmed with new tests? (justify briefly) Biology Science Physiology PSYCHOLOGY 110

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