Mr. Wu is a patient with kidney disease who presents to your clinic for monitoring. You notice on his chart that his GFR was estimated through inulin administration to be about 35 ml/min. What does this tell you about the health of his kidneys? Mr. Wu is taking a medication that is normally excreted from the body in the urine. You order blood work and find that the concentration of this medication in his plasma is much higher than normal. How does his decreased GFR explain the elevated level of medication in his plasma?

Video transcript

Hi, everybody. Here's our next problem, Missus Patel, a 65 year old woman with a history of hypertension and diabetes visits the clinic for her regular check up. Her blood pressure has been well controlled with medication and her blood glucose levels are within the target range. However, her recent lab results indicate that her glom glomerular filtration rate. GFR is 15 mL per minute indicating a significantly low GFR, what immediate action could be recommended for her? A increase her water intake. B integrate more salt into her diet. C administration of insulin or d undergo dialysis. Well, the key here is that although her two chronic conditions, her hypertension and her diabetes are well controlled, she's got a very, very severe issue with her kidneys, 15 mL per minute is, as our problem says, significantly low, the average rate for comparison uh for GFR is 125 mL per minute. So this is a really key or really crucial, crucial situation. And the immediate problem is that her kidneys are in severe danger of essentially failing. So that is going to go straight to choice. D undergo dialysis, dialysis is needed when there's advanced kidney disease as this low GFR indicates and it can perform the functions of or some of the functions of the kidney, such as those key functions of removing waste products and excess water from the blood. When we look at the other answer, choices, choice, a increased water intake, although increased water intake is good for kidney function, this is not sufficient with such a drastically low GFR. And in fact, it can make water's matters worse because when the kidneys are functioning at such a low level, they can't eliminate water. And if you're taking in more water, that will cause increased fluid retention. So choice A is just not going to be a sufficient treatment and in fact, could make things worse. Choice. B integrate more salt into her diet. Well, this would be something you'd recommend if someone was, were having hypotension, low blood pressure. Um but this can make hypertension worse if you don't want to cause a problem with something that had been a problem in the past, also increased salt will cause increased fluid retention, which again, if her kidneys aren't eliminating water, that will cause more problems. So choice B would also not be a good choice for an immediate action. And then finally, choice C administration of insulin. Well, this would be recommended if her blood glucose were high. But we see in our problem that her blood glucose is within the target range, there's no reason to ami insulin. Her diabetes is probably the cause of damage, the damage to her kidneys that's causing this uh essentially kidney advanced kidney disease. But administering insulin would only be for the sake of reducing blood glucose. It's not going to reverse the damage to the kidney or increase the GFR. So choice C administration of insulin is not the immediate action you'd want to take here. So again, when you have such a drastically low GFR, the immediate action you would recommend is choice D undergo dialysis. See you in the next video.