You are completing your medical school rotation in renal physiology. Your attend

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 7.38

Explanation / Answer

Question A. For all patients, list the factors that are outside of normal range and specify whether they are higher or lower than expected.

Answer-

Stephenie- FBS and Urine glucose outside normal limit, FBS is elevated and urine glucose present

Kate- Everything is Normal

Justin- Urine Volume is increased, and normal Urine concentration is decreased

Yusri- Blood Ph is Raised ( alkalosis), Urine H+= decreased, Urine Hco3= Increased, Arterial Pco2= Decreased.

Dereck- GFR is Increased, Urine Volume is increased.

Question 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.

Answer-

Question 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.

Answer- To normalize his GFR, the afferent arteriole should constrict, thereby decreasing the GFR,and the efferent arterile should Dilate , so that more fluid is removed from glomerulus thereby decreasing GFR.

Question 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.

Answer- justin sufferring fron Diabetes insipidus. ADH will treat the Condition. ADH will increase the solute free water reabsorption back into the circulation from the filterate in the kidney tubules hence normalizing the urine volume and the concentration.

In Nephrons- ADH constricts the arterioles which increases the peripheral vascular resistence and raises arterial blood pressure.

Stephenie Type 2 Diabetes Mellitus ( Increase in FBS and posite urine glucose) Kate Normal Justin Diabetes Insipidus ( increase in urine volume and decrease in urine concentration) Yusri Respiratory alkalosis with metabolic Compensation ( Blood Ph alkaline means alkalosis, and blood pco2 is decreased means respiratory, and once Hco3 is secreted in urine means metabollic compensation is occuring in body.) Dereck Lack of aldosterone, Low BLood presuure. ( GFR and Urine volume is Incresed)

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