ADEGOKE ADEGBITE

KIDNEY AND URINE EXPERIMENT

Patient 5 Patient 6
Glucose Negative Negative
Bilirubin Negative Negative
Ketones Negative Negative
Specific gravity 1.020 1.030
Blood Negative Negative
PH 6.5 6.0
Protein ++++ Negative
Urobilinogen Negative Negative
Nitrite Negative Negative
Lipids positive Negative

5. What is possibly wrong with patient 5? Explain the physiologic basis for the
result.

- Nephrotic syndrome- (presence of protein ++++ and upper limit of specific

gravity)
- Nephrotic syndrome is a spectrum of kidney diseases, including minimal
change damage, focal segmental nephrosclerosis, and membranous
nephropathy. In nephrotic syndrome, there is increased permeability to the
glomerular epithelial cell, glomerular basement membrane, or podocytes which
normally filters substances selectively by size and charge, including proteins. The
membrane of this increased permeability is not clearly understood, but a number
of mechanisms have been described, including immune responses that lead to
damage to the glomerular epithelial cells and glomerular basement membrane,
and loss of negatively charged glycoproteins on the surfaces of these structures
which usually repel proteins. Consequently, there is loss of proteins in high
quantity ( > 3g in 24hours), leading decrease in plasma protein, majorly albumin.
The presence of lipid in the urine results from concomitant loss of steroid binding
hormones that help to transport plasma protein in circulation.

6. What is possibly wrong with patient 5? Explain the physiologic basis for the
result
- In patient 6, the specific gravity is at the upper limit of normal (1.030- normal
range is 1.005- 1.030). The causes of elevated SG include
dehydration( inadequate water intake or volume depletion from excessive
vomiting and diarrhea), diabetes milletus, and congestive cardiac failure. In
dehydration and CCF(reduced cardiac output),there is reduced renal perfusion,
leading to the activation of the renin-angiotension-aldosterone system; the
release of vasopressin and aldosterone help to reabsorb as much fluid as
possible to maintain the arterial blood pressure, and consequently, there is
reduced fluid excretion relatively to solute and hence, increased urinary specific
gravity. In DM, as a result of the elevated plasma glucose, renal threshold for
glucose reabsorption is exceeded, and this results in glucose excretion in urine.
Consequence of which is elevated urinary specific gravity.