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Learning Object Course Project Cover Sheet 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 Historical (specify eras): Cultural (specify cultures): Geographical (specify regions/countries): Technical Data Information Format: txtdoc URL address of file: (if applicable) : N/A Special technical requirements for this object: None (e.g., Macromedia flash required) 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 __ non-journal article __ pamphlet/brochure Classroom __ teaching strategies & guidelines __ course syllabus __ lesson plan __ lecture/lecture outline __ laboratory exercise __ laboratory manual _X_ assignment/activity (non-laboratory) __ assessment: tool __ assessment: exam with answer key __ assessment: exam w/o answer key _X_ assessment: other __ fieldtrip guide Reference Room __ bibliography __ index __ dataset __ dictionary/glossary __ thesaurus __ discussion group/listserv archive __ manual __ scientific standards and guidelines __ review 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) __ Graduate (Adult) _X Professional (degree program) (Adult) __ General Public (All ages) __ Informal Education (All ages) __ Continuing Education (Adult) __ Intermediate elementary (Grades 3-5) (8-11 yr) __ Middle School (Grades 6-8) (11-14 yr) __ High School - lower div (Grades 9-10) (14-16 yr) Difficulty: __ Under grade level (e.g., Learning Center) _X At grade level __ Above grade level (e.g., honors, Advanced placement) __ Considerably above grade level (e.g., gifted/talented) Typical learning time: __ <1 hour_X_ 2-3 hours __ 4-6 hours__ 6-9 hours__ >9 hours Pedagogical Entry: (select all that apply) 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 Assessment Authentic & Alternative Assessment __ Peer evaluation __ Performance-based assessment __ Portfolios __ Self-evaluation 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