Pseudo-nephrotic Syndrome

Severe Monocytosis (perhaps in CMML) causes marked lysozymuria - which can be confused and read as nephrotic range proteinuria and this is actually pseudo nephrotic syndrome.  This case report below mentions this confounder in measurement of proteinuria. Unclear if this would be an issue today as we have much more sophisticated measuring devices for albumin and total protein.

Ref:
http://www.annals.org/content/121/10/818.1.long
image source: Wikipedia.com

Another Did you Know Video? Some of the facts will shock you!

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TOPIC DISCUSSION: ADH and Pain?

The relationship of pain and SIADH is well documented. Severe pain can lead to inappropriate ADH production.  Why is that? Why does pain cause ADH release? Looking into the literature, not much has been studied regarding this specific question.
A single paper in 1977 from UCLA describes the effect of pain on plasma ADH concentrations. They studied patients with pain after surgery and compared to controls. Age, smoking and pain came out factors associated with increase in ADH levels. It was a nice and small study but showed that pain led to ADH increase.
Stress might not be the case, might be pain directly. Some studies have shown that stress itself without pain did not led to increase ADH.  Pain has two components:- readily localizable specific sensation that is mediated by the spinothalamic tracts and the second is the arousal of the Reticular formation , ventral thalamus and hypothalamus and perhaps ADH connection might be in this latter portion. Stimulation of the brain stem reticular formation has shown to increase ADH in animals.
When asking few academicians: some responses I got was : Flight and Fight state from an evolutionary standpoint perhaps that wants ADH to be elevated in that state and allow for the beneficial effects.
Also, ADH is produced naturally perhaps in wound healing and in these pain flight and fight situations, leads to such a response.
Interesting , not well defined and studied

Ref:
http://www.ncbi.nlm.nih.gov/pubmed/630725
http://www.ncbi.nlm.nih.gov/pubmed/6399311

TOPIC DISCUSSION: What causes Foamy Urine?

Besides albuminuria, proteinuria and infection, what else can cause foamy urine??? ever wondered?
Here is a list of causes other than above
1. Bilirubinemia
2. Pneumaturia
3. Retrograde ejaculation
4. Fast urination, or increased velocity
5. Vesicocolic fistula
6. New onset of prostatitis

Image source: http://www.urinecolors.com/foamy_urine.php

Smoldering vs Active Myeloma

Here's a simple way to differentiate from smoldering or inactive Myeloma from active( borrowed from our Heme/onc doctors)

C alcemia (hyper)
R enal failure
A nemia
B ony mets and pain
I nfections or immunoparesis(is defined as a reduction (below the lower normal limit) in the levels of 1 or 2 immunoglobulin (Ig), with respect to the values of the corresponding uninvolved Ig.)

TOPIC DISCUSSION: Blood Urea Nitrogen ( BUN)

We associated BUN always with renal disease. What about other causes?
Why does BUN rise in GI Bleed? 
Extensive bleeding into the gastrointestinal (GI) tract will also cause an elevated BUN because digested blood is a source of urea. For example, a hemorrhage of one liter of blood into the GI tract may elevate the BUN up to 40mg/ml. Other non renal causes are: Acute myocardial infarction,Stress and excessive protein intake,steroid use or protein catabolism.


A decreased BUN may be seen in: Liver failure,Malnutrition, pregnancy, impaired nutrient absorption and SIADH
Because urea is synthesized by the liver, severe liver failure causes a reduction of urea in the blood. Just as dehydration may cause an elevated BUN, overhydration causes a decreased BUN. And finally water excess in SIADH can lead to decreased BUN.

DID YOU KNOW? Extra renal Podocyte like systems?

Besides the kidney, where else does a well designed filtration barrier exist in our body? This area lacks podocytes but produces a filtrate that is also virtually free of plasma proteins.
Its the choroid plexus. The sieving coefficient of the plexus is similar to that of the renal glomerulus. So do patients leak protein in the CSF in proteinuric diseases? In a small cohort study of diabetic patients that protein concentrations where increased in the CSF with diabetes duration.
Hmm!!


Take a look at these references:
http://www.ncbi.nlm.nih.gov/pubmed/21184239
http://www.ncbi.nlm.nih.gov/pubmed/18628631?dopt=Abstract
Image source: Penn state