Biology 1120 Anatomy and Physiology

Chief Complaint: Dark UrineClinical History: Nathan S. was a 10 year old boy who was brought by his mother to acommunity health clinic in a remote part of west Texas. The nearest physician was 80miles away. When the physician assistant (PA) asked the reason for the visit, the boy’smother said, referring to his urine, “His water looks like Coca- Cola.” She went on to saythat she thought it might have been discolored the night before, but the light was poor andshe couldn’t be sure. This morning she notice the toilet water was discolored after heurinated. She gave him juice and water and waited to observe for herself on his nextbathroom trip about two hours later. “He’s not making much water, “she added.The PA asked the usual systems review questions. Specific questioning abuts drugabuse, over the counter medicines, and exposure to toxins revealed nothing suspicious.Nathan was not taking any prescribed or over the counter medicines. When asked aboutany recent health problems, his mother revealed that he had been a picture of good healthand vigor except for “a cold and a bad sore throat” a few weeks earlier.Physical Examination and Other Data: Vital signs were: Temperature 98.5F, heart rate88, respirations 16, and blood pressure 145/92. Nathan was quiet and not in distress andappeared to be of average height and weight. He did not appear anemic or jaundiced buthis face looked round and puffy. When asked abut his face, his mother said she’d noticedit but thought it was because he was tired from staying up too late the last few nights withhis father, working on the farm where they lived. The remainder of the physicalexamination was unremarkable. He had no rash, enlarged lymph nodes, or abdominalmasses.The PA gave Nathen a big glass of water and collected some blood for the fewbasic tests that could be done by the office assistant on clinical equipment. Hematocritwas low (34mmHg) and blood glucose was normal. Sodium and potassium were normal.BUN and creatinine were slightly increased. After two hours, Nathan passed a smallamount of dark brown transparent urine which tested strongly positive for both proteinand hemoglobin by routine dipstick tests. Urinary sediment was concentrated bycentrifugation. A moderate number of RBCs and a few red cell casts were noted, but theydidn’t seem enough to account for the strongly positive hemoglobin. No crystals orWBCs were present.Clinical Course: The PA was puzzled. The pieces didn’t seem to fit together, so shecalled the hospital that managed the clinic and spoke to a pediatrician who said, “This is aclassic case of acute glomerulonephritis. I haven’t seen one in several years.” Thepediatrician outlined a treatment plan of salt restriction and therapy with diuretics andantihypertensive medication with carefully monitoring of urine output. The PA dispensedthe drugs from the limited supply on hand and gave his mother a calibrated, disposableurine cup, instructed her to measure Nathans urine output and call daily with the results.His urine output was how initially but began to improve on the third day. Mother and sonreturned a week later. His daily urine volume had returned nearly to normal, urinehemoglobin and protein were less positive, and most of his facial swelling hasdisappeared. On the follow up visit a week later, his blood pressure was near normal. Ablood specimen was collected and sent to the hospital to be tested for antistreptococcalantibodies which were previously detected in high concentration.Case Notes:Questions1. Other than water and waste, name some important substances Nathan excreted in hisurine. (1points)2. Nathans blood pressure was elevated. What structure and or hormones in his kidneyplayed a role in increasing his blood pressure? (3 points)3. Nathans hematocrit was low, what is the norm range and why was his low? (3 points)4. What were the principal nitrogenous wasted compounds in Nathans urine? (2points)5. Did Nathan have proteinuria? Why? (2points)6. His urine contained RBC casts, Of what importance was his finding? ( 3 points)7. Why was Nathans face swollen? (2 points)8. What caused the glomerulonephritis? (5 points)9. Would the GFR be up or down? Why (4points)