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Nephrology beginnings
1. Why the history of nephrology? “To understand a science it is necessary to know its history,” said August Comte (1798–1857), founder of modern sociology. Rooted in sociology, this saying evolved into what is now known as the theory of…
Palliative care in nephrology
Overview of palliative care and role in nephrology care 1. What is palliative care? Palliative care is specialized care that treats the symptoms and burdens associated with serious illness. Palliative care is delivered by an interdisciplinary team that includes physicians,…
Metabolic alkalosis
Introduction and physiology 1. What is metabolic alkalosis? The metabolic alkaloses represent a heterogeneous group of disorders that have in common a high concentration of plasma bicarbonate [HCO 3 − ] and a low concentration of H + in plasma.…
Metabolic acidosis
Metabolic acidosis The “secrets” of metabolic acidosis will be the emphasis of this chapter, given the breadth of this topic. This chapter is parsed into, first, a brief overview of relevant physiology and, second, an algorithmic, clinically relevant approach to…
Disorders of magnesium metabolism
Normal magnesium physiology 1. How is magnesium measured? The molecular weight of magnesium is 24.3 g/mol, with a 2+ valence (Mg2+). The normal serum magnesium level is 0.7 to 0.85 mmol/L, but it is often expressed as equivalents per liter,…
Disorders of phosphorus metabolism
Normal phosphorus physiology 1. What is the difference between phosphate and phosphorus and how are they measured in clinical medicine? Phosphorus is a critical element in physiology. Phosphorus is an essential component of bone (hydroxyapatite), DNA, lipid membranes (phospholipids), signal…
Hypocalcemia and hypercalcemia
1. What is calcium homeostasis? Calcium homeostasis refers to the regulation of the calcium concentration in the extracellular fluid. Normal serum calcium concentration varies between laboratories, but is usually 8.5 to 10.5 mg/dL (2.1 to 2.6 mmol/L) and it represents…
Hypokalemia and hyperkalemia
1. Describe normal potassium balance. Approximately 98% of total body potassium resides inside cells, making it the most abundant cation in the intracellular fluid (ICF). The total body stores approximately 3000 mEq or more (approximately 50 to 70 mEq/kg body…
Dysnatremias
1. What are dysnatremias? The term dysnatremia applies when an aberration in plasma sodium concentration is present. Changes in plasma sodium concentration can result in fluid shifts between the intra- and extracellular compartments of the body. In the healthy state,…