Explain how the management of this disease/disorder alterations in renal and urinary function and relates to the pathophysiology. Are any new treatment options on the horizon? Please explain.

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vincent040899Lv1

13 Sep 2023

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Elin HesselLv2

17 Dec 2019

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Pathophysiology:

A 53-year-old woman has hypertension, which is unstable, and she is currently on several medications for this. She is required to have monthly blood work and urine tests for renal function assessment because many of her pills have an effect on her kidneys.

a. How does the kidney impact on or influence the circulatory system in relation to the womanâs case?

b. What aspects of monitoring renal function should be explored?

Question 1: Why do you think that the adding of sodium acetoacetate resulted in a 50% decrease in renal ammonia production?

Question 2: Explain how ketone bodies depress renal ammoniogenesis by preventing the transformation of glutamine and glutamate into Î±-ketoglutarate in the mitochondria of the renal tubular cell.

Excerpt:

Infusion of ketone bodies to ammonium chloride-loaded acidotic dogs was found to induce significant reduction in urinary excretion of ammonia. This effect could not be attributed to urinary pH variations. Total ammonia production by the left kidney was measured in 25 animals infused during 90 min with the sodium salt of D,L-Î²-hydroxybutyric acid adjusted to pH 6.0 or 4.2. Ketonemia averaged 4.5 mM/liter. In all experiments the ammonia content of both urine and renal venous blood fell markedly so that ammoniogenesis was depressed by 60% or more within 60 min after the onset of infusion. Administration of equimolar quantities of sodium acetoacetate adjusted to pH 6.0 resulted in a 50% decrease in renal ammonia production. Infusion of ketone bodies adjusted to pH 6.0 is usually accompanied by a small increase in extracellular bicarbonate (3.7 mM/liter). However infusion of D,L-sodium lactate or sodium bicarbonate in amounts sufficient to induce a similar rise in plasma bicarbonate resulted in only a slight decrement in ammonia production (15%). The continuous infusion of 5% mannitol alone during 90-150 min failed to influence renal ammoniogenesis.

Infusion of pure sodium-free Î²-hydroxybutyric acid prepared by ion exchange (pH 2.2) resulted in a 50% decrease in renal ammoniogenesis in spite of the fact that both urinary pH and plasma bicarbonate fell significantly. During all experiments where ketones were infused, the renal extraction of glutamine became negligible as the renal glutamine arteriovenous difference was abolished. Renal hemodynamics did not vary significantly. Infusion of Î²-hydroxybutyrate into the left renal artery resulted in a rapid decrease in ammoniogenesis by the perfused kidney. The present study indicates that ketone bodies exert their inhibitory influence within the renal tubular cell. Since their effect is independent of urinary or systemic acid-base changes, it is suggested that they depress renal ammoniogenesis by preventing the transformation of glutamine and glutamate into Î±-ketoglutarate in the mitochondria of the renal tubular cell.

orangeguinea-pig426

Hello can someone help me with my case study and critical thinking questions please... appreciate it.

A couple that met at a Cystic Fibrosis Society support group is contemplating having children. They both had brothers who developed cystic fibrosis and they are concerned about the likelihood of having sons who have the disease. As a counselor, you are to answer the following two genetic counseling consult questions in addition to the five critical thinking questions that are listed below.

Genetic Counseling Consult Questions (To Answer)

What is the likelihood that any of their children (sons and/or daughters) will be born with the disorder?

What is the likelihood that any of their children (sons and/or daughters) will be carriers of the disorder?

Critical Thinking Questions (To Answer)

What are the main presenting issues? Include why they may have arisen. (Noteâin this case, you are to assume that they have a child who presents with cystic fibrosis.)

Identify and use at least one website that you used to learn more about the issues and potential solutions; briefly explain what was found at the website(s).

What is (are) the potential disease or disorder? Include (a) a justification for your decision, (b) the causal agent, and (c) the mode of transmission.

What is the recommended treatment for the most likely disease or disorder you identified?

What is the prognosis for the disease or disorder (a) without treatment and (b) with treatment?