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An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. The case was developed for use in a physiology or human anatomy and physiology course, but it might be used in undergraduate nursing courses as well (e.g., pharmacology, pathophysiology).

This case study describes the daily osmotic struggle for survival faced by hummingbirds. The narrative is written from the viewpoint of a human observer who sees an Anna's hummingbird feeding on flowers outside of her window.  She notices that the birds mostly feed early in the morning and again in the evening at dusk; midday encounters are rare.  The case raises questions about floral nectar production, how this correlates to feeding bouts, and how this in turn correlates to the daily osmotic challenges faced by these nectarivorous birds and their allies (sunbirds). Students will learn about renal adaptations for survival and how they operate. Finally, since hummingbirds have a high metabolic rate and cannot feed overnight they undergo torpor during this time, an energy saving physiologic state.  Students read journal articles to answer case questions, which should lead them to a better understanding of the related physiological processes of osmoregulation, metabolic rate and torpor.

Loss of species richness is often due to anthropogenic activity. The global decline of amphibians is one such example. This case study examines the impact of road deicing agents on amphibians living near bridges and roads treated heavily with salt during the winter months. Concepts explored in this case include changes to the aquatic environment as a result of road deicing applications, bioaccumulation, osmoregulation in amphibians living in clean freshwater, and the impact of increased aquatic salinity levels on the ability of amphibians to adequately osmoregulate in an environment for which they are not adapted. Three short videos created by the author can be shown in class or assigned for viewing in advance for a "flipped" classroom approach. Originally developed for a general education/introductory biology course, the case could also be used with introductory level animal anatomy and physiology courses as part of a deeper exploration of the renal system.

This case study synthesizes students' knowledge of the central dogma and cell structure by examining a rare health disorder in order to understand protein targeting and its medical consequences. Students first identify the molecular alteration in affected members of a family with renal Fanconi syndrome as reported in the New England Journal of Medicine (2014). Students then use an online bioinformatics tool to analyze the wildtype and mutant proteins and examine their subcellular localization. Finally, students use this information to explain the symptoms of affected family members. The case is delivered with a PowerPoint presentation that includes a selection of brainstorming prompts and "clicker questions." Students complete a worksheet (included in the teaching notes) before class, making the activity suitable for a flipped classroom. A second worksheet (also included in the teaching notes) is completed during class. The case is written for an introductory biology course for majors, but could also be used as a unit capstone in a non-majors human biology course; the case is also scalable to upper division courses in physiology that specifically explore kidney function.