Download Rodeo with Renal Issues

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HAPS-I Course: Advanced Renal Biology 2008
Title: Rodeo with Renal Issues
Draft/revision date: June 26, 2008
Author Information
Author Name: Paula Curbo
Institution: Hill College
Department: Biology
Address: 112 Lamar Drive
City: State: Hillsboro, TX
CountryZip (postal) Code: 76645
Email: [email protected]
Phone: Fax: (254) 582-7591
Learning Object Information:
Description of object: Case Study on Inhibition of ADH and Renal Trauma
Appropriate uses of object: Anatomy & Physiology class or laboratory
Key Words: (Please select key words from list)
__ Absorption
__ Acid-base
__ Action potential
__ Adrenal
__ Aging
__ Acclimatization
__ ACTH
__ Adaptation
__ Adult
__ Air
__ Airway
__ Biosynthesis
__ Altitude
__ Bladder
__ Alveoli
__ Blood
__ Amino Acid
__ Blood-brain barrier
__ Ammonia
_X_ Blood pressure
__ Anemia
__ Bone
__ Anesthesia
__ Brain
__ Angiogenesis
__ Breathing
_X_ Angiotensin
__ Bronchus
__ Antibiotics
__ Buffer
__ Aorta
__ Apoptosis
__ Artery
__ Arteriole
__ Asthma
__ Atherosclerosis
__ Artificial
__ ATP
__ ATPase
__ Atrial
__ Auditory
__ Autonomic
__ Autonomic regulation
__ Axon
__ Bacteria
__ Baroreceptor
__ Behavior
__ Bile
__ Biofeedback
__ Biography
__ Biological rhythm
__ Calcium
__ Calory
__ Capillary
__ Carbohydrate
__ Carbon dioxide
__ Cardiac
__ Cardiac muscle
__ Cardiac output
__ Cardiovascular
__ Cell
__ Central motor system
__ Central nervous system
__ Cerebral
__ Chloride
__ Cholesterol
__ Chronobiology
__ Circulation
__ Cold
__ Colon
__ Connective tissue
__ Contractility
__ Contraction
__ Control of breathing
__ Coronary
__ Culture
__ Cytokine
__ Cytoskeleton
__ Dendrite
__ Development
__ Diabetes
__ Diet
__ Diffusion
__ Differentiation
__ Digestion
__ Disease
__ DNA
__ Drug
__ Ear
__ Electrical
__ Electrocardiogram
__ Electro-encephalogram
__ Electrolyte
__ Electrophysiology
__ Endothelial
__ Energy
__ Epilepsy
__ Epinephrine
__ Epithelial
_X_ Erythrocyte
__ Estrogen
__ Excitation
__ Excitation-contraction
__ Exercise
__ Expiratory
__ Extracellular
__ Eye
__ Fat
__ Feedback
__ Female
__ Fetal
__ Fever
__ Fluid
__ Free radical injury
__ Gallbladder
__ Ganglia
__ Gas exchange
__ Gastrointestinal
__ Gender
__ Gene
__ Gene expression
__ Gene regulation
__ Gene therapy
__ Genetic
__ Gene transfer
__ Gestational biology
__ Gland
__ Glomerular filtration rate
__ Glomerulus
__ Glucose
__ Gravitational
__ Growth
__ Growth factor
__ Heat
__ Heat shock
__ Hemodynamics
__ Hibernation
__ High throughput
screening
__ History - disease
__ History - general
__ History–physiological
process
__ Hormone
_X_ Homeostasis
_X_ Hypothalamus
__ Hypothermia
__ Hyperthermia
__ Hypertension
__ Hypoxia
__ Hydrogen
__ Ischemia
__ Ion channel
__ Intracellular
__ Intestine
__ Integrative
__ Insulin
__ Instrumentation
__ Inspiratory
__ Inorganic
__ Imaging
_X_ Inhibition
__ Illium
_X_ Kidney
__ Knockout models
__ Neonatal
__ Nerve
__ Neural control
__ Neural mechanism
__ Neuromodulator
__ Neuromuscular
__ Neuron
__ Neurotransmitter
__ Lipid
__ Nitric oxide
__ Liver
__ Nitrogen
__ Lipid
__ Norepinephrine
__ Lung
__ Nose
__ Lymph
__ Nucleus
__ Lymphocyte
__ Obesity
__ Organ culture
__ Magnetic resonance
imaging
__ Male
__ Mathematical model
__ Mechanics
_X_ Membrane
__ Metabolism
__ Microarray
__ Microcirculation
__ Model
__ Model organism
__ Model system
__ Motility
__ Motor
__ Muscle
__ Myocardial
__ Organic
__ Osmoregulation
__ Osmosis
__ Oxidative
__ Oxygen
__ Pain
__ Pancreas
__ Parasympathic
__ Parathyroid
__ Parenchyma
__ Pathway
__ Pathophysiology
__ Peripheral
__ pH
_X_ Pituitary
__ Plasma
__ Platelets
__ Polarity
__ Potassium
__ Pregnancy
__ Pressure
__ Prostaglandin
__ Protein
__ Pulmonary
__ Pulse
__ Receptor
_X_ Red blood cell
__ Reflexes
_X_ Regulation
__ Regulatory
_X_ Renal
_X_ Renin-angiotensin
system
__ Reproduction
__ Respiration
__ Respiratory control
__ RNA
__ Second messenger
_X_ Secretion
__ Senses
__ Sensory system
__ Shivering
__ Shock
__ Signaling
__ Signal transduction
__ Skeletal muscle
__ Skin
__ Sleep/wake states
__ Small intestine
__ Smooth muscle
__ Sodium
__ Spleen
__ Stomach
__ Stress
__ Surfactant
__ Sympathetic
__ Synaptic transmission
__ Systems analysis
__ Taste
_X_ Teaching material
_X_ Teaching method
__ Temperature
__ Testosterone
__ Thalamus
__ Thrombosis
__ Thyroid
__ Tissue
__ Tissue engineering
__ Transport
__ Transporter
__ Transmitter
__ Transgenic animal
__ Transgenic model
__ Tubule
__ Tumor
__ Urea
__ Urine
__ Vascular
__ Vascular smooth
muscle
__ Vasoactive
__ Vasoregulation
__ Veins
__ Ventilation
__ Ventricular
__ Vessel
__ Vitamin
_X_ Volume
_X_ Water
__ White blood cell
Other suggested key words not listed:
Renin, Antidiuretic Hormone, binge drinking, collecting ducts, osmolality, hematuria, proteinuria,
dehydration, trauma, lacertion, glomerulus, alcohol
Cultural Aspects:
__X_None
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Cultural (specify cultures):
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Format: txtdoc
URL address of file: (if applicable) : N/A
Special technical requirements for this object: None
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Educational Information
Learning resource type: (select all that apply)
Auditorium Multimedia
__ animation
__ audio
__ video
__ diagram
__ digital presentation
(PowerPoint)
__ graph/chart
__ table
__ 35mm slide
__ image
__ simulation
__ illustration
__ map
__ photograph
_X_ application
_X_ discussion group/
listserv
__ webcast
Reading Room
__ meeting
presentation
__ proceedings
__ book
__ book chapter
__ journal
__ journal article/issue
__ thesis/dissertation
__ report
__ abstract
__ memo
__ newsletter
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__ pamphlet/brochure
Classroom
__ teaching strategies
& guidelines
__ course syllabus
__ lesson plan
__ lecture/lecture
outline
__ laboratory exercise
__ laboratory manual
_X_ assignment/activity
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__ assessment: tool
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with answer key
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_X_ assessment: other
__ fieldtrip guide
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Intended end user role:
_X_ Teacher __ Author__ Learner __ Manager __ Other:
Grade level: (select all that apply)
__ Preschool (0-4 yr)
__ High School - upper div (Grades 11-12) (16-18 yr)
__ Primary Elementary (K-2) (5-8 yr)
_X_ Undergraduate - lower div (Grades 13-14) (Adult)
__ Undergraduate - upper div (Grades 15-16) (Adult)
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_X Professional (degree program) (Adult)
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_X At grade level
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Typical learning time:
__ <1 hour_X_ 2-3 hours __ 4-6 hours__ 6-9 hours__ >9 hours
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Teaching Strategies
Broad Teaching Strategies
__ Other instructional technology use
__ Active learning/discovery learning
__ Bicultural/bilingual education
Additional Teaching Strategies
_X_ Cooperative learning/small group instruction
__ Block time teaching
_X_ Critical analysis/Critical thinking
_X_ Case-based instruction/Case study approach
__ Hands-on learning
_X_ Class/group discussion
_X_ Inquiry-based learning
__ Data analysis, collection, interpretation
__ Large-group instruction
__ Demonstrations
__ Parent involvement
__ Field laboratory experience/Field trips
__ Student-centered instruction
__ Hypothesis testing
__ Teacher-centered instruction/traditional instruction
_X_ Independent study
_X_ Tutorial or self-directed instruction
__ Laboratory experiment
__ Learning centers
Use of Instructional technology
__ Learning cycles
__ Computer-assisted learning
__ Peer teaching
__ Multimedia/audiovisual instruction
__ Problem sets/word problems
_X_ Problem-based learning
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Authentic & Alternative Assessment
__ Peer evaluation
__ Performance-based assessment
__ Portfolios
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Tests & Testing
__ Cognitive tests
__ Computer-assisted testing
__ Essay tests
__ Group testing
__ Multiple-choice test
__ Norm referenced tests
__ Objective referenced tests
__ Open book tests
__ Standardized tests
__ Testing techniques
__ Timed-tests
__ True-false tests
__ Verbal tests
Grading
_X_ Non-graded student evaluation
_X_ Pass-fail/Pass-no credit/Pass-no record grading
__ Rubrics
_X_ Ungraded classes
Rodeo with Renal Issues
Learning Objectives
The student will be able to explain/identify the:
•
Role of the antidiuretic hormone (ADH).
•
Effect of an inhibitor such as alcohol on ADH.
•
Role of renin in maintaining blood pressure.
•
Consequences of dehydration.
•
Role of the filtration membrane.
•
Hematuria and proteinuria.
•
Relationships between the endocrine, cardiovascular, and urinary systems.
Part One
Rusty, a student at a central Texas college, is a member of the college rodeo team.
The night before a scheduled rodeo, he attended a party during which he drank
alcohol excessively. He urinated copiously every 20-30 minutes throughout the night.
Rusty finally went home about 3:00 a.m. to sleep. He woke up at noon with a
headache and extreme thirst. Rusty drank water and ate lunch before making
preparations to ride with a friend to the rodeo.
Questions
1. Why did Rusty urinate every 20 - 30 minutes?
2. Where is ADH synthesized? Which gland secretes ADH?
3. What is the effect of ADH on the kidney?
4. How is blood pressure affected from this loss of water?
5. Why did he experience extreme thirst upon waking?
6. Plasma renin activity (PRA) increases after binge drinking. What is PRA?
7. Had Rusty not replenished lost fluids by drinking water, what could be some
potential serious consequences?
Answers
1. Why did Rusty urinate every 20 - 30 minutes? Alcohol inhibits the antidiuretic
hormone (ADH) and prevents water reabsorption by the renal collecting ducts.
2. Where is ADH synthesized? Which gland secretes ADH? ADH is synthesized in
the hypothalamus in response to an increase in ECF osmolality. ADH is stored in
and released from the posterior pituitary.
3. What is the effect of ADH on the kidney? ADH targets renal collecting ducts and
prevents aquaporins from inserting into the luminal membranes of the principal
cells. Thus, water is not reabsorbed and is lost from the body as dilute urine.
4. How is blood pressure affected from this loss of water? Large amounts of water
loss reduces blood volume which in turn reduces blood pressure.
5. Why did he experience extreme thirst upon waking? Rusty experienced
extreme thirst because his hypothalamic thirst center was activated by an
increase in plasma osmolality.
6. Plasma renin activity (PRA) increases after binge drinking. What is PRA? PRA
refers to levels of renin in the plasma. Renin, an enzyme released from granular
cells in the kidney, act on the plasma protein angiotensinogen to produce
angiotensin I which is then converted to angiotensin II. Angiotensin II is a
hormone that elevates mean arterial pressure and functions to prevent water
loss.
7. Had Rusty not replenished lost fluids by drinking water, what could be some
potential serious consequences? As Rusty’s state of dehydration continued,
hypovolemic shock and hypernatremia could occur. Hypovolemic shock occurs
when blood volume is insufficient to maintain blood pressure. Hypernatremia
occurs when plasma concentration of Na+ exceeds 145mEq/L. With extreme
water loss from the body, sodium concentration increases above the normal
value of 140mEq/L if water is not replenished.
Part Two
Before arriving at the rodeo, Rusty and his friend stopped for an early supper. His
headache that he woke up with was gone. At the rodeo, he prepared for his bareback riding event. Rusty was thrown from the horse two seconds into the event. As he
hit the ground the front right hoof of the horse kicked Rusty’s right upper lumbar region.
Rusty felt intense pain in his back but decided to drive home and see if the pain would
go away. After sleeping uncomfortably throughout the night, he woke up and noticed
that his urine was slightly dark red when he urinated. The pain in his right upper lumbar
region was still present.
Questions
1. Should Rusty go to the doctor or should he wait and see if the color of urine
returns to normal in a few days? Explain why or why not.
2. Urine is normally a pale yellow. What could be a possible explanation for the red
color of his urine?
Answers
1. Should Rusty go to the doctor or should he wait and see if the color of urine
would return to normal in a few days? Explain why. Rusty should go to the
doctor immediately; the red color of urine suggests possible trauma to the
kidney.
2. Urine is normally a pale yellow. What could be a possible explanation for the
dark red color of his urine? Filtration membranes are located in the glomeruli of
nephrons and are the site of blood filtration. Large substances such as blood
cells and large proteins typically are not filtered. Since the horse’s hoof landed
on his right upper lumbar region, the filtration membrane is probably damaged
allowing erythrocytes to appear in the urine.
Part Three
Rusty decided to go to the hospital. As a result of the initial examination, the doctor
ordered a urinalysis and computed tomography (CT). The urinalysis indicated
hematuria and proteinuria . CT results indicated laceration in the lower pole of the right
kidney. Rusty was given a blood substitution and underwent embolization, which is a
procedure to stop blood flow. The bleeding was immediately controlled following the
embolization procedure. He remained in the hospital. Within 5 days, urinalysis results
indicted Rusty’s urine was negative for hematuria and proteinuria. All other values
were also normal. Rusty was released from the hospital.
Questions
1. What is hematuria?
2. What is proteinuria?
3. Explain why both red blood cells and proteins were in Rusty’s urine.
Answers
1. What is hematuria? Hematuria is the presence of red blood cells in the urine
which can be brought on by trauma to the kidney that Rusty most likely
experienced.
2. What is proteinuria? Proteinuria is the presence of protein (usually albumin) in
urine. Large proteins typically are too large to be filtered by the nephron.
3. Explain why both red blood cells and proteins were in Rusty’s urine. Trauma to
Rusty’s kidney at the rodeo damaged the filtration membrane, thus allowing red
blood cells and proteins to be present in the filtrate.
References
Print:
• Kee, Joyce LeFever. Handbook of Laboratory and Diagnostic Tests with Nursing
Implications. 3rd ed. Stamford: Aplleton & Lange, 1998.
• Marieb, Elaine N. and Katja Hoehn. Human Anatomy & Physiology. 7th ed. San
Francisco: Pearson Benjamin Cummings, 2007.
• Saladin, Kenneth. Anatomy & Physiology The Unity of Form and function. 4th ed.
New York: McGraw Hill, 2007.
• Tierney, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis, eds.
Current Medical Diagnosis & Treatment. 39th ed. New York: Lange Medical
Books/McGraw-Hill, 2000.
Internet:
• Dinkel, Hans-Peter, Jansjorg Danuser, and Jurgern Triller. “Blunt Renal Trauma:
Minimally Invasive Management with Microcatheter Embolization-Experience in
None Patients.” Radiology 2002;223:723-730©RNSA, 2002
http://radiology.rsnajnls.org/cgi/content/full/223/3/723
• Geehan, Douglas M. and Richard A Santucci. “Renal Trauma.” eMedicine. 12
Jun 2006
http://www.emedicine.com/MED/topic2853.htm
• Nieminen, M. M. “Renin-aldosterone axis in ethanol intoxication during sodium
and fluid repletion versus depletion.” Int J Pharmacol Ther Toxicol. 1983
Nov;21(11):552-7.
http://www.ncbi.nlm.nih.gov/pubmed/6360917