Question

Robert was diagnosed with hypertension at the age of 39. In taking better care of himself., Robert a former college athlete found himself eating poorly, consuming too much alcohol, smoking, and spending too much time sitting in front of the TV since graduating. His personal habits have also caused him to gain a significant amount of weight. Robert is now on two high blood pressure medications to try and control his blood pressure. He also modified his lifestyle to include regular exercise, stopping smoking and moderate alcohol consumption and a sodium diet.

Robert’s, father had died earl from renal failure due to hypertension he took his lifestyle changes seriously. Robert now 56, is a triathlon athlete and very competitive and strived to first in his age group. In order to gain the edge, he needs, he hired a certified clinical trainer, Carmen. Robert was experiencing dehydration and fatigue while exercising, so he wanted help to find a way to drink enough fluids while training.

Carmen designed a way for Robert to assess his physiological status (PS)before, during, and after his workouts. A urinalysis was done before, right after, and six hours after a two-hour training run to determine his renal status a measure of his PS.

The table below shows Robert’s urinalysis data.

Time	Color	Specific Gravity	Protein	Glucose	pH
Before	pale yellow	1.010	absent	absent	6.3
Immediately after	dark yellow	1.044	small amount	absent	4.4
Six hours post	yellow	1.032	absent	small amount	5.2

Questions

1. Trace glucose that was found in Robert’s urine six hours after his exercise, this concerned Carmen, however, Robert had a large meal an hour before the urinalysis. How could this affect the glucose in Robert’s urine?

2. Intense exercise can cause lactic acid to accumulate. How can Carmen tell Robert’s kidneys are trying to prevent acidosis? Describe this mechanism.

3. After reviewing Robert’s urinalysis data, do you think he should drink more water prior to starting his training to make sure he stays adequately hydrated? Explain your answer.

4. One of the medications the Robert takes to control his blood pressure is called an angiotensin converting enzyme inhibitor (ACE inhibitor), which inhibits the activation of angiotensin II. What are two of the mechanisms by which angiotensin II targets the kidneys to increase extracellular fluid volume, there are several?

Answer 1

1. As robert had taken a large meal 1hour prior to urinalysis so which caused a rise in the blood gucose level and which ultimately got exreted showing a glucose intolerance kind of state and he must be careful and try to prevent Diabetes Mellitus which he had risk factors of smoking, alcohol intake etc.

2. During exercise a lot of lactic acid are produced which is released in the blood stream ultimately causing acidosis. In order to prevent the adversities of these acidosis, kidneys causes excretion of this acids by conserving bicarbonate ions. So the pH of his urine was also acidic immediately after exercise.

3. As during exercise the metabolism hastens up so the water is used rapidly as well as more is exrceted during sweating. The dark urine with relatively more specific gravity shows the relative state of dehydration of Robert. So it is advised to consume water before exercise in order to remain hydrated.

4. Angiotensin 2 causes release of aldosterone from adrenal gland which ultimately cause conservation of Na and exretion of K from the tubules and ultimately expanding extracellular volume.

Angiotensin 2 helps in release of ADH from pitiotary which conserves water from collecting duct and so prevents dehydration

All the best mate. Cheers