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POLONIManipal Academy of Higher Education - MAHE

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Science1Information Technology1Algebra4Engineering2Calculus3Biology8Chemistry1
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It took the diagnosis of high blood pressure (hypertension) at theage of 45 to shock Max into taking better care of himself. A formercollege football player, he had let himself go, eating too muchjunk food, drinking too much alcohol, sitting on his chubby bottomfor the majority of the last two decades, and even indulging in thefrequent habit of smoking cigars. Max's physician had to prescribetwo different antihypertensive medications in order to get hisblood pressure under control. She also prescribed regular exercise,a low-salt diet, modest alcohol intake, and smoking cessation. Maxwas scared, really scared. His father had hypertension at a youngage as well, and ended up on dialysis before dying fromcomplications of kidney failure.

Fortunately for Max, he took his doctor's advice and began adramatic lifestyle change that would bring him to his present-daysituation. Now, at the age of 55, he was a master triathlon athletewho routinely placed among the top five tri-athletes of the sameage group in the country. Max's competitive spirit had been ignitedby this, but at the same time he wanted to be first among his peers. To that end, he hired Tracey, aCertified Clinical Exercise Specialist, to help him gain the edgehe needed to win at the end of the race. His most immediate concernwas that he was experiencing problems with dehydration and fatiguebecause he hadn't found an effective way to drink enough fluidswhile exercising.

Tracey showed Max an impressive array of assessment tools forquantifying and analyzing his physiological state before, during,and after his workouts. One of the tools was urinalysis, which Maxfound a bit odd, but he dutifully supplied urine samples on aregular, prescribed basis. Tracey explained that Max's hydrationstatus was tricky due to the medication he took to control hishypertension, and that renal status (as measured in the urinalysis)was one of the tools she could use to evaluate his physiologicalstate.

Tracey logs the following results of Max's urinalysis immediatelyafter, and six hours after, a rigorous 2-hour run.

Time Color Specific Gravity Protein Glucose pH
Before exercise pale yellow 1.002 absent absent 6.0
Immediately after exercise dark yellow 1.035 small amount absent 4.5
Six hours after exercise yellow 1.035 absent small amount 5.0

Short Answer Questions

  1. What does the color of Max's urine tell Tracey about howconcentrated or dilute it is? How does Max's urinecolor/concentration compare to the urine specific gravity at thesame time?
  2. Based on the urine color and specific gravity, what might Traceyconclude about the hydration status of Max's body at the threedifferent times?
  3. Antidiuretic hormone (ADH) regulates the formation of concentratedor dilute urine. In which time period is Max's body secreting itshighest amount of ADH? Explain your answer.
  4. Tracey knows that proteinuria (protein in the urine) after intenseexercise is physiological (normal). However, protein is typicallynot present in urine. Why is that?
  5. Tracey had been slightly concerned about the trace glucose that wasfound in Max's urine six hours after his exercise until shediscovered that he had eaten an entire large pizza an hour beforethe urinalysis. Explain why glucose might show up in Max's urineafter a particularly heavy meal.
  6. Lactic acid accumulation can be a consequence of intense exercise.Tracey notes that Max's kidneys are working to defend his bodyagainst acidosis. How can she tell? Describe this mechanism.
  7. Based on Max's urinalysis data, should he drink more water prior toexercise to ensure that he doesn't dehydrate during intenseactivity? Explain your answer.
  8. Max's regular exercise regimen has reduced his high blood pressure,allowing him to achieve normal blood pressure on a singleantihypertensive medication. The medication he takes is called anangiotensin converting enzyme inhibitor, or ACE inhibitor,which blocks the activation of angiotensin II. Describe at leasttwo mechanisms by which angiotensin II targets the kidneys toincrease extracellular fluid volume and, therefore, increase bloodpressure.
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