You are completing your medical school rotation in renal physiology. Your attend
ID: 3512134 • Letter: Y
Question
You are completing your medical school rotation in renal physiology. Your attending physician, Dr. Brown, asks you to review the charts of the patients you examined in the previous week. You made the summary chart above, in order to discuss each case more efficiently.
A. For all patients, list the factors that are outside of normal range and specify whether they are higher or lower than expected.
B. Match the patients with their most likely diagnosis. Choose between the following conditions: normal, type 2 diabetes, respiratory alkalosis, respiratory acidosis, diabetes insipidus, high blood pressure, low blood pressure, lack of aldosterone. Support your answers.
C. Based on Derek’s condition, what would be the appropriate response of the afferent and efferent arteriole diameter to normalize his glomerular filtration rate? Explain your answer.
D. What would happen if you treated Justin with physiological doses of anti-diuretic hormone (ADH)? Describe the possible changes in urine characteristics and what would change in the nephron.
GFR (ml/min) Urine volumeFasting (mL) Urine glucose Urine (mM) plasma potassium mEa/L 35 50 110 75 86 lucose 8.2 Stephanie Kate Justin Yusri Derek 125 123 120 112 253 125 150 300 132 165 4.9 5.0 4.8 4.3 0 0 0 0 Blood pH Urine H Urine concentration (mOsm) Urine HCO3 Arterial PCO2 800 300 15 400 700 Normal Normal Normal Decreased Normal Normal Normal Normal Elevated Normal 40 40 40 32 40 Stephanie Kate Justin Yusri Derek Normal GFR: 100-125 ml/min Normal urine volume: 100-150 mL Normal plasma glucose: 3.5-6.0 mM Normal urine concentration: 50-1200 mOsm Normal blood pH: 7.35-7.45 Normal urine potassium: 25-125 mEq/L 7.38 7.41 7.40 7.69 7.38Explanation / Answer
Answer of part A is as follows
Name of patients list the factors that are outside of normal range
1. Stephanie fasting plasma glucose 8.2mM - Higher than expected
Urine glucose level 4.3mM - higher than expexted
2.Justin urine concentration 15mosm -Lower than expexted
3. yusri Blood pH 7.69 - higher than expected
Urine H+ - decreased
Urine HCO3- - elevated
4.Derek GFR 253 -Higher than expected
Urine volume 165mL - higher than expected
Answer of part B is as follows...
1.Stephanie Type2 diabetes - as having both plasma glucose and urine glucose higher than expected
2. Kate Normal - as every given test is normal
3.Justin diabetes insipidus - as the urine concentration is lower than expected
4.yusri Respiratory alkalosis - as the blood ph is higher than expected
5. Derek high blood pressure - as GFR is higher than expected
anwer of part c is as follows...
the increased blood volume with its higher blood pressure will go into afferent arteriole and into the glomerulus, which results in increased GFR.
decreaseing both Affrent and efferent arteriole diametre will normalize the GFR.
answer of part d is as folllows.....
If we treat justin with doses of ADH it will eliminate the increase of urination.
if level of ADH is increased there is possibility of nephrogenic diabetes insipidus.
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