A 40-year-old Woman who

has been Feeling Lethargic

PROTEIN
Gayam, Glydenne Glaire P.

Case Problem
Judy, a 40-year-old woman with a past
history of kidney infections, was seen by
her physician because she had been
feeling lethargic for a few weeks. She also
complained of decreased frequency of
urination and a bloated feeling. The
physician noted periorbital swelling and
general

edema,

including

swollen

Laboratory Results:
Urinalysis
Microscopic

Macroscopic
Color

Yellow

Appearance

Cloudy or frothy

Specific Gravity 1.022

pH

7.0

Protein
Glucose

3+
(500mg/dL)
(SSA: 4+)
Neg

Ketones

Neg

Bilirubin

Neg

Blood

Neg

Urobilinogen

Normal

Nitrite

Neg

Leukocyte
Esterase

Neg

WBCs

0-3/HPF

RBCs

0-1/HPF

Epithelial
Cells

Rare squamous/HPF
Rare renal tubular
epithelial/HPF
0-3 Hyaline/LPF
1. Renal Tubular
epithelial/HPF
2. Granular/LPF
3. Waxy/LPF
0-1 Fatty/LPF

Casts

Other

Occasional oval fat

bodies

Laboratory Results: Chemistry

Reference Range
6.0-8.4 g/dL

Protein

5.0 g/dL

Albumin

2.4 g/dL

3.5-5.0 g/dL

Cholesterol

370 mg/dL

<200 mg/dL

BUN

33 mg/dL

7-24 mg/dL

Creatinine

2.1 mg/dL

0.5-1.2 mg/dL

1.What type of disease or

condition
would
be
characterized
by
the
urinalysis
and
chemistry
results?
Nephrotic syndrome
marked proteinuria and lipiduria
(oval fat bodies and fatty casts) in
urinalysis
Hypoalbuminemia and

2.

Discuss the physiological cause of

edema.

Edema
caused by hypoalbuminemia
which
leads
to
reduced
plasma
osmotic
pressure
(allows fluid to leak from
blood vessels to the intestinal
spaces).

3.

What is Judys albumin:globulin (A:G)

ratio? Is it within the reference range? Is
it consistent with the probable diagnosis?

Judys A:G ratio is 0.92, which is below

the reference range (1.5-3.5). Normal
albumin levels are 60% of the total
protein. A low A:G ratio is consistent with
Total Serum Protein = Albumin + Globulin
diagnosis
of nephrotic syndrome.
G =a TP
-A
G = 5.0 g/dL 2.4 g/dL = 2.6 g/dL
A:G = 2.4 g/dL : 2.6 g/dL
A:G = 0.92

4. Describe what you would expect

to see in this patients protein
electrophoresis.
Nephrotic Syndrome SPE

markedly increase in 2- and globulins

markedly decrease albumin and
-globulins, especially IgG