The Case of the Man with the Swollen Kidneys
Mr. Newman is a 49 year old male who has hematuria, fever and severe flank pain. He also has bilateral lumbar tenderness, bilateral renal enlargement, liver enlargement, ankle and facial edema, skin pallor, and lung sounds suggest pulmonary edema.
His vital signs are as follows: BP 172/100, heart rate 92 beats per minute, and a temperature of 102.2 F. There have been some labs done. His red blood count is 3.1 million cells, white blood count is 22,000 cells, potassium is 5.4 mEq/L, calcium is 6.8 mg/dL, phosphate is 4.3 mEq/L, urea is 37 mg/dL, creatinine 2.0 mg/dL, albumin is 2.9 mg/dL, and pH is 7.29. With labs like these, more testing was done. A chemistry panel which showed protein 1.7 gm/24 hours, glomerular filtration rate of less than 30 ml/minute, and his urine sediment showed presence of gram negative bacilli, presence of white blood cells, presence of red blood cells, and granular and waxy casts.
Mr. Newman had a genetic screening that showed a mutation on Chromosome 16. This mutation results in the formation of abnormal membrane protein called polycystin. It is inherited from one of his parents. The mutation takes place in 1 to 2 homologous chromosomes. With him only have one copy; it has stayed latent for many years. Now he has two abnormal polycystin genes. Polycystin genes act as receptors for extracellular growth.
Cystic lesion has formed in Mr. Newman’s kidney. Cyst forms when cells in any region of the nephron divide rapidly. Proximal tubule cells have divided. Dilated segment fill with glomerular filtrate. The dilated segments grow until it eventually separates from the nephron; after it separates the cyst forms. A cyst has formed and it continues to grow. Cysts begin to secrete calcium and chloride ions into the lumen.
Mr. Newman’s kidney weighs 4 kilograms. It has multiple cysts of varying size and shapes. Some of the cysts are infected causing him to have lumbar tenderness, fever, and...
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