Channel Your Enthusiasm
A chapter by chapter recap of Burton Rose's classic, The Clinical Physiology of Acid Base and Electrolyte Disorders, a kidney physiology book for nephrologists, fellows, residents and medical students.
Episodes
Chapter Twenty-Two: Introduction to Disorders of Osmolality
ReferencesThis is the famous Edelman equation from JCI in 1958 by Isodore Edelman! Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water (not to be confused by Isildur House of Isildur - Tolkien GatewayJoel mentioned his slide deck on Edelman: https://pbfluids.com/wp-content/uploads/2023/04/QN_III-The-Ed
Chapter Twenty: Respiratory Acidosis
ReferencesBiff Palmer! Respiratory Acidosis and Respiratory Alkalosis: Core Curriculum 2023Josh what is sensed- pCO2 or pH and some exploration suggests that it is not settled! Sensing, physiological effects and molecular response to elevated CO2 levels in eukaryotes - PMC and this one with catchy title: Out of thin air: Sensory detection of oxygen and carbon dioxide - PMCIf anna does VOG on Halda
Chapter Twenty One: Respiratory Alkalosis
ReferencesChapter 19, Part 3 August 30, 2023Biff Palmer’s Ted Talk-Why not? Biff Palmer at TEDxSMU 2013Anna mentioned this issue of lactic acidosis in a panic disorder: The Lactic Acid Response to Alkalosis in Panic Disorder | The Journal of Neuropsychiatry and Clinical NeurosciencesReminder of important clinical lesson: Lactate: panicking doctor or panicking patient? - PMCMelanie regaled the grou
Chapter Nineteen: Metabolic Acidosis, part 3
ReferencesChapter 19, Part 3 August 30, 2023Joel and Roger mentioned the most common cause seems to be Sjögren’s syndrome for an acquired distal RTA. We mentioned this in an earlier episode and referenced this example of an absence of the H+ ATPase, presumably from autoantibodies to this transporter. Here’s a case report: Absence of H(+)-ATPase in cortical collecting tubules of a patient with Sjog
Chapter Nineteen: Metabolic Acidosis, part 2
ReferencesChapter 19, Part 12Metabolic acidosis June 14, 2023ReferencesChapter 19, Part 2Roger mentioned MELAS syndrome MELAS syndrome: Clinical manifestations, pathogenesis, and treatment optionsJosh mentioned this blog on lactate- Understanding lactate in sepsis & Using it to our advantageWe discussed the Warburg effect The Warburg Effect: How Does it Benefit Cancer Cells? - PMC and he
Chapter Eighteen: Metabolic Alkalosis, part 2
ReferencesPart 2, March 1, 2023The alkaline tide phenomenon in studies that measured both the alkaline tide and acid secretion, the bicarbonate accumulation increased in linear fashion with the acid secretion. Melanie thought this was first recognized in the 60’s but later found this manuscript from 1939 in JCI! ALKALINE TIDES - PMCMelanie mentioned this old study that explores the respiratory res
Chapter Nineteen: Metabolic Acidosis, The Show, part 1
ReferencesChapter 19, Part 1 Metabolic acidosis June 14, 2023American Society of Nephrology | Medical Students - Kidney TREKS this is the program that Josh mentioned at Mount Desert Island! Effects of pH on Potassium: New Explanations for Old Observations - PMC here’s the review melanie from Peter Aronson that clarifies the fact that there are no H+-K+ antiporters outside the kidne
Chapter Eighteen: Metabolic Alkalosis, part 1
We are a bit slappy at the beginning of the episode since we had just recorded our conversation with the Glaucomfleckens. ReferencesChapter 18 Metabolic alkalosis! Part 1 February 23, 2023It is chloride depletion alkalosis, not contraction alkalosis classic review by Galla and Luke, the metabolic alkalosis mavens who review the role of chloride.On the mechanism by which chloride corrects meta
Chapter Seventeen: Introduction to Simple and Mixed Acid-Base Disorders
ReferencesI said I used MDCalc but I was mistaken I use MedCalX which is nice but getting dated. We talked about this out of print book that we love: Cohen, J. J., Kassirer, J. P. (1982). Acid-base. United States: Little, Brown.Josh mentioned this article that looked at over 17,000 samples with simultaneous measured and calculated bicarbonate and found a very small difference. Comparison of M
Chapter Sixteen: Edematous States, part 2
ReferencesWe talked about winning the 2022 ASN innovation contest and here’s a link to our promo video https://www.dropbox.com/scl/fi/g4osnf0nradsfryyo51fi/ASN-Education-Contest-Channel-Your-Enthusiasm-Podcast.mp4?rlkey=pnso45x07nr3pane9y8cux8yg&e=1&dl=0We wondered about “permissive hypercreatinemia” and Josh referenced the DOSE trial: Relevance of Changes in Serum Creatinine During a Hear
Chapter Sixteen: Edematous States, part 1
ReferencesCapillary Hemodynamics Insights into Salt Handling and Blood Pressure | NEJMAmy mentioned about the 3 phases of the interstitiumAre the precapillary sphincters and metarterioles universal components of the microcirculation? An historical review - PMCSafety factor?Renal Function during Recovery from Minimal Lesions Nephrotic Syndrome - Abstract - Nephron 1987, Vol. 47, No. 3 - Karge
Chapter Fifteen: Clinical Use of Diuretics, part 2
ReferencesProximal Tubule-Specific Deletion of the NHE3 (Na+/H+ Exchanger 3) in the Kidney Attenuates Ang II (Angiotensin II)-Induced Hypertension in Mice Melanie is in love with this paper that shows that sodium retention Bumetanide and furosemide in heart failure everyone agreed that we love this classic paper from Craig Brater on diuretics (and the source of figure 15-6). Lety referen
Chapter Fifteen: Clinical Use of Diuretics, part 1
Outline Chapter 15 — Clinical Use of Diuretics- Among most commonly used drugs- Block NaCl reabsorption at different sites along the nephron- The ability to induce negative balance has made them useful in multiple diseases- Edematous states- Hypertension- Mechanism of action- Three major classes- Loop- NaK2Cl- Up to 25% of filtered sodium excreted- Thiazide- NCC- Up to 3-5% of filtered sodium excr
Chapter Fourteen: Hypovolemic States, part 2
Outline Chapter 14 — Treatment- Treatment - Both oral and IV treatment can be used for volume replacement - The goal of therapy are to restore normovolemia - And to correct associated acid-base and electrolyte disorders - Oral Therapy - Usually can be accomplished with increased water and dietary sodium - May use salt tablets - Gluco
Chapter Fourteen: Hypovolemic States, part 1
OutlineChapter 14- Hypovolemic States- Etiology - True volume depletion occurs when fluid is lost from from the extracellular fluid at a rate exceeding intake - Can come the GI tract - Lungs - Urine - Sequestration in the body in a “third space” that is not in equilibrium with the extracellular fluid. - When losses occur two responses ameliorate them - Our
Chapter Thirteen: Meaning and Application of Urine Chemistries
ReferencesJC mentioned that the diagnostic accuracy of 24 hour urine collection increases with more collections! Metabolic evaluation of patients with recurrent idiopathic calcium nephrolithiasisWe didn't refer to a particular study on sodium intake and the 24 hour urine but this meta-analysis Comparison of 24‐hour urine and 24‐hour diet recall for estimating dietary sodium intake in populations:
Chapter Eleven: Regulation of Acid-Base Balance, part 2
ReferencesWe considered the complexity of the machinery to excrete ammonium in the context of research on dietary protein and how high protein intake may increase glomerular pressure and contribute to progressive renal disease (many refer to this as the “Brenner hypothesis”). Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury
The 2023 NKF Clinical Meeting Live Recording: Diuretic Draft
The Channelers went where no nephrology podcasters have gone before, recording in front of a live audience at the National Kidney Foundation Clinical Meeting in Austin. We had all eight Channelers doing a live podcast.We did a Freely Filtered-inspired draft of the best diuretics.The draft order:Leticia Rolon Anna Gaddy Joel TopfRoger Rodby Josh Waitzman Amy Yau JC Velez And Melanie HoenigReference
A Very Special Episode: Meet the Glaucomfleckens
Chapter Eleven: Regulation of Acid-Base Balance, part 1
ReferencesWe considered the effect of a high protein diet and potential metabolic acidosis on kidney function. This review is of interest by Donald Wesson, a champion for addressing this issue and limiting animal protein: Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney DiseaseHostetter explored the effect of a high protein diet in the remnant kidney model with 1 ¾ nephrect
Chapter Ten: Acid-Base Physiology
References for Chapter 10We did not mention many references in our discussion today but our listeners may enjoy some of the references below. Effects of pH on Potassium: New Explanations for Old Observations - PMC although the focus of this article is on potassium, this elegant review by Aronson and Giebisch reviews intracellular shifts as it relates to pH and K+.Josh swooned for Figure 10-1
Chapter Nine: Regulation of Plasma Osmolality
References for Chapter 9One of the few papers that Rose wrote as a single author explores electrolyte free water clearance. This seminal paper explores the issue in greater detail than the book. A New approach to disturbances in the plasma sodium concentrationWondering about the volume of sweat? Josh taught us that the volume of “transepidermal volume loss” is not affected by humidity https://www.
Chapter Eight: Regulation of The Effective Circulating Volume
References for chapter 8Robert Schrier proposed a unifying hypothesis to explain the sodium retention seen in edematous states like cirrhosis and heart failure, coining the term effective arterial blood volume (EABV). An open access review in JASN 2007 can be found here: https://jasn.asnjournals.org/content/18/7/2028#ref-3 John P PetersASN Annual Award: https://www.asn-online.org/
Chapter Seven: The Total Body Water and The Plasma Sodium Concentration
Chapter 7ReferencesSands JM, Blount MA and Klein JD. Regulation of Renal Urea Transport by Vasopressin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116377/In this invited piece, Sands and colleagues explain that although urea is permeable across membranes, this is slow, thus urea transporters in the kidney, under control of vasopressin, are needed to facilitate transport and create the medullary
Chapter Six: Effects of Hormones on Renal Function, part 2
Chapter 6 part 2. ReferencesJosh touts the PARADIGM-HF Trial Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure | NEJM which found this combination was superior to an ARB alone Joel mentions an early atrial natriuretic peptide trial by Julie Lewis et al. Atrial natriuretic factor in oliguric acute renal failure - American Journal of Kidney Diseases and here’s a metanalysis th
Chapter Six: Effects of Hormones on Renal Function part 1
Chapter 6 part 1In this review of vasopressin, you can find an excellent discussion of basic stimuli and vasopressin receptors: Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems | Physiological ReviewsX-Linked Nephrogenic diabetes insipidus is very rare and there was theory that all patients originated from the same family and traveled to the US on the Hopewell ship JCI -
Chapter Five: Functions of the Distal Nephron
References for Chapter 5--the Distal NephronRoger pointed out the fact that the distal nephron can achieve very low urinary sodium as evidenced by observations in people from the Yanomamo tribe Blood pressure and electrolyte excretion in the Yanomamo Indians, an isolated population in this report, 84% of the participants had urinary sodium < 1mmol/24 hours. Information about the Yanomamo T
Chapter Four: The Loop of Henle and Counter Current Exchange
Show notes with a full set of references are available here: http://www.rosebook.club/episodes/2021/6/22/chapter-fourAlso, please fill out our listener survey: https://forms.gle/DVdcJikKZkzY56mXA
Chapter Three: The Proximal Tubule
Chapter Three: How the proximal tubule is like Elizabeth Warren and other
truths my friends from Boston taught me
Chapter Two: Renal Circulation and Glomerular Filtration Rate, part 2
The exciting conclusion to Chapter Two: Renal Circulation and Glomerular
Filtration Rate
Chapter Two: Renal Circulation and Glomerular Filtration Rate, part 1
Back by popular demand…all two of you…the second chapter of The Clinical
Physiology of Acid Base and Electrolyte Disorders.
Chapter One: Introduction to Renal Function
The Channel Gang discusses the name of their new podcast and then discuss chapter one of The Book.
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