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Kidney Function Case Study

Kidney Function Case Study

Description:

Through completing this case study, you will learn and be able to:

  1. Identify the three processes that are involved with urine formation-filtration, reabsorption and secretion-and identify the places in the nephron where they happen.
  2. Outline the main mechanisms by which the kidney regulates pH in the body, and discuss the roles of specific transporters for H+ and HCO3- in pH regulation.
  3. Discuss the inter-related roles of the nervous system, the respiratory system and the renal system in regulation of pH in the body.
  4. Outline the mechanisms by which the kidney regulates plasma electrolyte concentrations, with special emphasis on plasma Ca++, including the pertinent hormones involved.
  5. Identify disturbances in plasma electrolytes and pH, given appropriate reference values.
  6. Identify possible causes of these disturbances

In this case study, you will be using your understanding of acid-base balance and kidney/nephron function to solve the problem of the grandmother's stomach problems. Your answers will be assessed using the rubric posted on this tutorial.

An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. 

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Tutorial

Grandma’s TUM-my Trouble: A Case Study in Renal Physiology and Acid-Base Balance

You will be using this Case Study which requires an understanding of both kidney function and blood buffering systems.  It also gives you the opportunity to learn more specific details about some of the transport mechanisms in the distal and proximal convoluted tubules.

This case study was written by Ann T. Massey (Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA) and is posted on the Buffalo University National Center for Case Study Teaching in Science. Please go to the site: http://sciencecases.lib.buffalo.edu/cs/collection/detail.asp?case_id=731&id=731  and download the case study from there.

Source: Ann T. Massey, Nell Hodgson Woodruff School of Nursing, Emory University National Center for Case Study Teaching in Science

Rubric for Kidney Function Case Study

This is the rubric that will be used to grade your answers to this case study. The relevant case study questions are sorted as to KU, TI, A and C. Notice that the Thinking/Inquiry is distinguishes between Process and Strategic Thinking.

Full Screen

Source: M. O'Mahony

NIH - Diabetes, Digestive and Kidney Diseases

http://www.niddk.nih.gov/health-information/Pages/default.aspx

This page from the National Institutes of Health (US) is a good resource for information about kidney problems relevant to the case study.

Source: NIH: Diabetes, Digestive and Kidney Disorders

Useful Pictures

I found the figures in the case study to be a little bit confusing.  It shows the cell that would be part of the proximal and distal tubule walls.

Here are some figures that I found useful understanding which way the ions were being transported - and what they were being transported into and out of.

http://www.zuniv.net/physiology/book/images/25-9.jpg

http://en.wikivet.net/Reabsorption_and_Secretion_Along_the_Proximal_Tubule_-_Anatomy_%26_Physiology

http://www.pathwaymedicine.org/proximal-tubule-transport

https://www.google.ca/search?q=sodium+reabsorption+in+the+proximal+convoluted+tubule&sa=G&biw=968&bih=543&tbm=isch&imgil=lfg-bMP1zaGkwM%253A%253BC2Y_SvOfQMiGeM%253Bhttp%25253A%25252F%25252Fintranet.tdmu.edu.ua%25252Fdata%25252Fkafedra%25252Finternal%25252Fpharmakologia%25252Fclasses_stud%25252Fen%25252Fpharm%25252Fprov_pharm%25252Fptn%25252FPharmacology%25252F3%2525252520year%25252F15%2525252520Diuretics%2525252520Stimulants%2525252520and%2525252520relaxants.htm&source=iu&pf=m&fir=lfg-bMP1zaGkwM%253A%252CC2Y_SvOfQMiGeM%252C_&usg=__caNP-4z2IQ7CQJ47PtxcRKqGA78%3D&ved=0CCkQyjc&ei=j6ADVd-ZM7TLsAST7IDIAQ#imgrc=lfg-bMP1zaGkwM%253A%3BC2Y_SvOfQMiGeM%3Bhttp%253A%252F%252Fbasic-clinical-pharmacology.net%252Fchapter%25252015_%252520diuretic%252520agents_files%252Fimage007.gif%3Bhttp%253A%252F%252Fintranet.tdmu.edu.ua%252Fdata%252Fkafedra%252Finternal%252Fpharmakologia%252Fclasses_stud%252Fen%252Fpharm%252Fprov_pharm%252Fptn%252FPharmacology%252F3%252520year%252F15%252520Diuretics%252520Stimulants%252520and%252520relaxants.htm%3B413%3B438

http://o.quizlet.com/FHkL-yaQIVK5Fs1WeEZoaw_m.png

http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam%204/sec.act.transport.antiporter-x.jpg

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/calcium.html

http://www.nature.com/nrrheum/journal/v8/n11/images/nrrheum.2012.157-f3.jpg

http://upload.wikimedia.org/wikipedia/commons/5/5c/1817_The_Role_of_Parathyroid_Hormone_in_Maintaining_Blood_Calcium_Homeostasis.jpg

 

Source: given above