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Chronic kidney disease, in its later stages, may cause hyperphosphatemia. Hyperphosphatemia promotes the bone resorption and tend to increase the amount of calcium in vessels and increases the risk of vascular calcification. Parathyroid hormone also increases in chronic kidney disease which also promotes bone resorption, hypercalcemia, and vascular calcification. Vitamin D 3, if given in a patient who has hyperphosphatemia, may actually promote bone resorption and vascular calcification if PTH is more than 100. So if there is hyperphosphatemia, vitamin D should be given along with a phosphate binder such as sevelamer if the calcium-phosphate product is more than 55. If Calcium phosphate product is more than 55, it means you shouldn't give calcium-based phosphate binders such as calcium acetate, instead start the patient on Sevelamer. But if Calcium phosphate product is less than 55 then give patient calcium acetate as a phosphate binder. Decide the dose of vitamin D based on PT...

A 35-year-old male presented to Emergency department of PIMS hospital complaining of intermittent hematuria, lower abdominal pain, and dysuria. Blood complete picture, Urine routine examination, and renal function tests were ordered along with an X-Ray KUB. X-Ray KUB revealed a Big Stone in the Urinary Bladder. The patient was referred to urology for further management. A Large stone in the urianry bladder. Courtesy of Dr. Adil Ramzan, MBBS, MD Internal Medicine A large stone in urinary bladder. Courtesy of Dr. Adil Ramzan MBBS, MD Internal Medicine, Pakistan Institute of Medical Sciences, SZABMU, Islamabad Pakistan Dr. Adil Ramzan, MBBS, MD Internal Medicine Pakistan Institue of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical Univeristy Islamabad Pakistan

Medullary Sponge Kidney: Medullary Sponge Kidney a benign disorder is presented at birth and is not diagnosed until fourth or fifth decade. Kidneys have a marked irregular enlargement of the medullary and interpapillary collecting ducts. This is associated with medullary cysts that are diffuse giving a “Swiss cheese” appearance in these regions.   Clinical features of Medullary Sponge Kidney Medullary Sponge Kidney presents in 50s or 60s with following symptoms. Hematuria: gross or microscopic (red/dark colored urine) Recurrent UTI,(increase urinary frequency, burning micturation, pain during urination, flank or abdominal pain) Renal stone formation and nephrocalcinosis. (flank pain, blood in urine, pus in urine, urinary retention, supra-pubic pain) Distal renal tubular acidosis Decreased urinary concentrating ability. (large amount of colorless colored urine)     Investigations of Medullary Sponge kidney Intravenous pyelography (...

Nephritic Syndrome Acute nephritic syndrome indicates an inflammatory process causing renal dysfunction over days to weeks that may or may not resolve. In severe cases it may cause more than 50% loss of nephron function over the course of just weeks or months. It affect the process of glomerular filtration and renal tubular reabsorption . It is characterized by the abrupt onset of: Hematuria with RBC casts or dysmorphic RBCs typically seen on urine microscopy. Proteinuria (usually non-nephrotic range). Renal impairment: manifesting as oliguria, uremia, raised urea and creatinine. Hypertension due to salt and water retention. Edema (usually periorbital, leg or sacral) due to salt and water retention. ACUTE NEPHRITIC SYNDROME Clinical Presentation Hematuria ( micro or macroscopic) Proteinuria Hypertension Edema Oliguria , Uremia   Glomerual diseases with nephritic presentation Diseases of glomerulus may present clinically...

Watery Vaginal Discharge after Pelvic/Cervical Surgery/Operation (Ureter Ligation During Radical Hysterectomy): Today My paying guest came to me and said her aunt has some problem. I took her history and she said, patient has under gone Pelvic surgery a month ago for some pelvic cancer.  Operative notes were saying “radical hysterectomy performed, Cervix was barrel shaped and removed, uterus and ovaries are removed. Uterine artery ligated, Lymph nodes were normal in size shape and consistency. Specimen is sent for lab examination. Then i read the specimen examination report, it said, “Stage II Cervical Cancer”. I didn’t find any other abnormality in lab reports except slightly raised serum creatinine and urea Then i saw Intravenous Urogram where i clearly noticed dilated pelvis of right kidney, left kidney was normal and bladder was normal in size shape and contour no filling defect seen. Then i asked about her current symptoms, she said that she has fever, pain in right...

Urinary infection  Many women have the habit of going to the bathroom to take. And that's a problem, because when you retain urine in the bladder for a long time, bacteria are also there, which increases the risk of them adhere to the wall of the organ and cause urinary tract infection, drink at least 1.5 litres of water a day is essential to avoid the problem. Using pants that tighten and choke the genital region is a habit that can facilitate genital infections. And these, in turn, can also cause urinary infections. When you have an inflammation of the vagina, there are changes that eventually PH facilitating the creation of an enabling environment for bacteria that can cause a urinary problem, "he explains. According to doctors, men can also have the problem, but it is more common among women. This is because they have the urethra - raceway urine, leaving the bladder and ends in sex organ - shorter than that of men. In women, the bacteria in the vagina and per...

Tubular reabsorption: occurs as filtrate flows through the lumens of proximal tubule, loop of Henle, distal tubule, and collecting ducts. Following Processes are used in reabsorption: Diffusion Facilitated diffusion Active transport Co-transport Osmosis Reabsorbed substances are transported to interstitial fluid and reabsorbed into peri tubular capillaries. •The luminal cell membranes are those that face the tubular lumen (“urine” side) •The basolateral cell membranes are those are in contact with the lateral intercellular spaces and peritubular interstitium (“blood” side) •The term transcellular refers to movement of solutes and water through cells •The term paracellular refers to movement of solutes and water between cells •Epithelial cell junctions can be “leaky” (proximal tubule) or “tight” (distal convoluted tubule, collecting duct)   Types Of Transport Processes: •Passive transport (simple diffusion) •Facilitated diffusion •Primary active transport •...