13 Questions
What is the physiological principle of the inulin clearance test to measure GFR?
Inulin is freely filtered by the glomerulus but is not reabsorbed at all, so the amount of inulin in the urine relative to the urine flow rate can be a direct determination of how fast the filtration rate is.
Are Mr R's values of GFR normal? What does this indicate for his renal function?
No, Mr. R's GFR values are not normal. The presence of albumin in the urine indicates kidney damage, likely in the silent stage of renal failure.
Comment on Mr R's blood pressure and predictions over time.
Mr. R's blood pressure is relatively normal at 155/92mmHg. Given his age, health information, and the presence of high blood pressure on medication, prediction over time should consider the impact of his conditions and aging on his blood pressure control.
What is the fundamental cause of Type 1 Diabetes Mellitus from an endocrine standpoint?
autoimmune self-destruction of pancreatic B-cells that make insulin
How is diabetes mellitus, specifically Type 1 DM, confirmed?
Fasting blood sugar test or A1C hemoglobin test or autoantibody tests
Define the differences between Type 1 and Type 2 Diabetes Mellitus.
Type 1: Insulin not produced, rapid onset | Type 2: Insulin resistance, slow onset, mostly in older individuals
Define the hyperglycaemic 'polys' associated with diabetes.
Polyuria, Polydipsia, Polyphagia
Calculate the missing pH value for Mr. R's blood test table.
7.145
What is Mr. R's acid-base status at the time of the blood test?
Metabolic acidosis
What treatment and maintenance schedule would a 12-year-old Mr. R have been placed on?
Insulin therapy, controlled diet, continuous glucose monitoring, exercise
What are the consequences of hyperglycaemia and hypoglycaemia on the human body?
Hyper: increased thirst, urination; Hypo: unconsciousness, confusion, coma
Define the 'pathies' associated with Chronic Diabetes Mellitus.
Neuropathy, Nephropathy, Retinopathy
Define RBF, ERPF, and GFR in the context of kidney function.
RBF (Renal Blood Flow), ERPF (Effective Renal Plasma Flow), GFR (Glomerular Filtration Rate)
Study Notes
Case Study: Mr. R
Background
- Mr. R is a 61-year-old man diagnosed with diabetes at the age of 12.
- He has a long-standing sequential history, with his grandfather also having diabetes.
- He has a history of smoking and drinking alcohol in his teenage years, but has quit since the age of 23.
Physical Examination (Age 61)
- Height: 168cm
- Weight: 55kg
- BMI: 19.5 (bottom normal)
- Blood Pressure: 135/85mmHg (mildly high)
- Heart Rate: 75BPM (normal)
- Respiratory Rate: 16 breaths/min (normal)
- GFR: 55mL/min (low)
- BUN: 19 mg/dL (high)
- Plasma Creatinine: 1.5 mg/dL (high)
- Hematocrit: 40% (high)
- Blood Glucose: 126mg/dL (high)
- HB1Ac: 6.0% (slightly high)
- Urine protein: Trace (proteins found in the urine)
Type 1 Diabetes
- Fundamental cause: autoimmune destruction of pancreatic B-cells, leading to no insulin production.
- Method of confirmation: Fasting blood sugar test, finger prick test, and A1C hemoglobin test.
- Characteristics: Not produced, onset in early childhood, and 10% of diabetic population.
Differences between Type 1 and Type 2 Diabetes
- Endogenous insulin production: Not produced in Type 1, produced but not responsive in Type 2.
- Onset speed: Rapid in Type 1, slow in Type 2.
- Typical age of onset: Early childhood in Type 1, mostly over 45 in Type 2.
- Percent of diabetic population: 10% Type 1, 90% Type 2.
- Body habitus: Extreme hunger, weight loss, and fatigue in Type 1, excess body fat in Type 2.
- Treatment: Insulin therapy, diet control, and exercise in Type 1, diet, weight, exercise, medication, and insulin therapy in Type 2.
Hyperglycaemic "Polys"
- Polyuria: Excess urine production due to excess glucose in the urine.
- Polydipsia: Excessive thirst due to excess urine and high plasma osmolarity.
- Polyphagia: Extreme hunger due to insulin resistance and high blood glucose levels.
Acid-Base Status (Age 12)
- pH: 7.145 (very low)
- Diagnosis: Metabolic acidosis, compensated by respiratory system.
- Treatment: Insulin therapy, controlled diet, and continuous glucose monitoring.
Consequences of Hyper and Hypoglycemia
- Hyperglycemia: Increased thirst and urination, sweating, shaking, and brain damage.
- Hypoglycemia: Unconsciousness, moodiness, hunger, shakiness, tremors, confusion, and death.
Retinopathy and Nephropathy (Age 30)
- Mr. R presents with acute retinopathy leading to retinal detachment in his right eye.
- Ultrasound and MRI imaging of his kidneys show no abnormalities.
- Inulin clearance test and urine analysis results:
- RBF: 1050mL/min
- ERPF: 620mL/min
- Haematocrit: 41% (normal)
- Urine flow rate: 1.5 mL/min
- Plasma inulin: 0.55 mg/mL
- Urine inulin: 42 mg/mL
- Blood glucose: 8.2 mmol/L
- Urine albumin excretion: 5mg/day
GFR and Renal Function
- GFR: 115mL/min (lower than normal)
- Indication: Renal function impairment, possibly in the silent stage of renal failure.
Blood Pressure and Predictions
- Blood pressure: 155/92mmHg (on antihypertensive medication)
- Predictions: Increased risk of cardiovascular disease and further renal damage.
Additional Information (Age 45)
- Mr. R notices occasional puffiness in his feet and lower legs.
- He has had to give up table tennis due to declining vision and 2 wrist fractures.
- Blood test results:
- Na+: 130 mmol/L (low)
- K+: 5.2 mmol/L (high)
- PO4: 1.8 mmol/L (high)
- Urea: 30 mg/dL (high)
- Creatinine: 2.2 mg/dL (high)
Prepare for the Week 9 tutorial with pre-reading worksheets and resources from Topics 6, 7, and 9. Includes a practice group quiz with 10 MCQs.
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