AP2
Dr. Halstead
Unit 8 case studies
Tricia Kanipe
The Case of the Man with the Swollen Kidneys
Mr. Newman is a 49 year old male who has hematuria, fever and severe flank pain. He also has bilateral lumbar tenderness, bilateral renal enlargement, liver enlargement, ankle and facial edema, skin pallor, and lung sounds suggest pulmonary edema. His vital signs are as follows: BP 172/100, heart rate 92 beats per minute, and a temperature of 102.2 F. There have been some labs done. His red blood count is 3.1 million cells, white blood count is 22,000 cells, potassium is 5.4 mEq/L, calcium is 6.8 mg/dL, phosphate is 4.3 mEq/L, urea is 37 mg/dL, creatinine 2.0 mg/dL, albumin is 2.9 mg/dL, and pH is 7.29. With labs like these, more testing was done. A chemistry panel which showed protein 1.7 gm/24 hours, glomerular filtration rate of less than 30 ml/minute, and his urine sediment showed presence of gram negative bacilli, presence of white blood cells, presence of red blood cells, and granular and waxy casts.

Mr. Newman had a genetic screening that showed a mutation on Chromosome 16. This mutation results in the formation of abnormal membrane protein called polycystin. It is inherited from one of his parents. The mutation takes place in 1 to 2 homologous chromosomes. With him only have one copy; it has stayed latent for many years. Now he has two abnormal polycystin genes. Polycystin genes act as receptors for extracellular growth.

Cystic lesion has formed in Mr. Newman’s kidney. Cyst forms when cells in any region of the nephron divide rapidly. Proximal tubule cells have divided. Dilated segment fill with glomerular filtrate. The dilated segments grow until it eventually separates from the nephron; after it separates the cyst forms. A cyst has formed and it continues to grow. Cysts begin to secrete calcium and chloride ions into the lumen.

Mr. Newman’s kidney weighs 4 kilograms. It has multiple cysts of varying size and shapes. Some of the cysts are infected causing him to have lumbar tenderness, fever, and urine sediment changes. Other cysts are hemorrhagic. As the cysts rupture, they are excreted in the urine causing him to have blood in his urine. Very little normal renal tissue exists. No obvious regions of renal cortex or renal medulla can be identified. The hilus and entire collecting system are severely disrupted. His is kidney is non-function and needs to be removed.

Cysts exert pressure causing destruction of nearby tissue. Loss of nephrons results in the inability to maintain normal solute balance, excrete wastes such as urea and creatinine, secretes erythropoietin causing severe anemia. The pressure on blood vessels interferes with renal blood flow causing hypertension.

Mr. Newman’s disease has resulted in a number of organ system defects. He has a reduced glomerular filtration, which causes accumulation of water that result in pulmonary edema. He has anemia and reduced platelet function that causes subcutaneous bruising. Also due to anemia, he has an elevated blood urea level that can lead to bleeding disorders. Due to his increased blood urea levels, he may have trouble getting an erection. Cysts destroy normal renal tissue in the kidneys. The cysts could cause hepatic enlargement, abdominal pain, and reduced hepatic function. Increased urea levels may cause pericarditis. Effects of increased urea levels in blood may cause encephalopathy resulting in coma or death. Berry aneurysms may rupture resulting in hemorrhage or even death.

The answers to the question are as follows. Polycystic kidney disease is what best explains Mr. Newman’s clinical signs and symptoms. Cysts form in the kidneys as a result of multiple genetic mutations. The normal function of this protein is regulation of cellular differentiation and proliferation. Red blood count is decreased due to decreased erythropoietin secretion. Mr. Newman’s urine sediment analysis results are hematuria due to ruptured cysts. The event illustrated is an apoptosis. Urinary protein concentration, red blood cells count, BUN concentration, and blood creatinine concentration indicate severe renal disease. Image shown describes multiple cysts. Complications result from uremia or excessive urea levels in the blood are pericarditis and encephalopathy. Decreased glomerular filtration rate is most associated with pulmonary edema.
The Case of the Thirsty Woman
This case study is about a woman named Mrs. Anderson. Mrs. Anderson’s current condition has produced effects in numerous body organs. Her clinical presentation showed symptoms of polydipsia, polyuria, and nocturia. Her medical history includes a long history of manic depression illness treated with Lithium. Mrs. Anderson is asymptomatic when she is allowed to drink massive volumes of water. She has been recently moved to a supervised care facility where her water intake has been drastically limited. Upon physical exam Mrs. Anderson’s skin is wrinkled, shows dry mucous membranes, disorientation, lethargy and confusion.
Mrs. Anderson’s vital signs included a blood pressure of 70/55, heart rate of 124 beats per minute. Her blood plasma osmolality is 380mOsm/kg, sodium of 152 mEq/L, BUN of 36mg/dL, creatinine of 2.1mg/dL and a lithium level of 1.9mEq/L. Her urinalysis revealed a urine output in 24 hours of 17 liters, specific gravity of 1.001, urine osmolality of 154 mOsn/kg, positive protein and positive red blood cells in her urine. Mrs. Anderson body has resulted in chemical defects that have affected her different body systems in a negative way. The lithium that Mrs. Anderson has been taking as created pathologic changes in her kidneys. These changes have occurred gradually over many years.

The answers to the questions in the exercise are as follows. Diabetes insipidus, best describes her medical condition. Her renal tubules are atrophic that create tubular interstitial fibrosis. The lithium therapy resulted in the absence of water membrane proteins. The inability of principal cells in the collecting ducts to respond to ADH results in symptoms of polyuria. Her urine sample showed the presence of red blood cells, a condition that results in glomerular filtration membrane damage. Mrs. Anderson’s low blood pressure measurement is due to her excessive water intake. The substance recycled back and forth is Urea. Mrs. Anderson’s urinary specific gravity measurement is excessive water in the urine, and Mrs. Anderson’s confusion is caused by severe dehydration.

References:
Disruptions to Homeostasis. The Case of the Man with the Swollen Kidneys. (n.d.). Retrieved November 3, 2015, from http://www.wiley.com/college/interactions/Balancing/content/Balancing/hi2a/frameset2.htm

Disruptions to Homeostasis. The Case of the Thirsty Woman. (n.d.). Retrieved November 3, 2015, from http://www.wiley.com/college/interactions/Balancing/content/Balancing/hi1a/frameset2.htm