All of you #NephMadness players crying into your coffee about Proteinuria getting beat out by Patient Reported Outcomes need to understand that proteinuria isn’t always bad*.
*I am being sarcastic here, proteinuria is always bad, and the only reason I am writing this post is because of this interesting quirk where it appears to be protective.
Proteinuria protects against amphotericin b induced hypokalemia. In patients on amphotericin, heavy proteinuria, a protein concentration of 3 g/L (3+ on dipstick), is protective against amphotericin b induced hypokalemia.
The study was done on normal formulations (as opposed to liposomal preparations) of amphotericin B.
Amphotericin B is highly protein bound. With standard doses, the normal amphotericin concentration in the urine will be 1-2 micromol/L. With 3+ urine protein, the albuminuria concentration is over 40 micromol/L, and this is apparently enough to bind and neutralize amphotericin’s collecting duct toxicity. Amphotericin’s anti-fungal property comes from its ability to tear open fungi cell membranes. Unfortunately it does a doozy on the membranes of the collecting tubules as well, allowing potassium to flow down its contraction gradient from the cells to the tubular fluid (and out in the urine). Similarly hydrogen flow from the tubular fluid back into the cells causing metabolic acidosis.Β It is an unusual cause of renal potassium loss without increased aldosterone levels.
For you #NephMadness geeks, toad bladder was instrumental to working out the mechanism for amphotericin induced hypokalemia.
But in 2018, AJKD forgot to ban gambling. So call your bookie! Mortgage the house! Cash in the kids’ 509 college plan! I’m going to whisper the winners. These darlings are your chance for a better life!
I finished the hike with Ben, Jen, and Ellen. We finished with headlights. Eleven hours. A rolling hike with a total descent from 15,000 to 11,000 feet with two significant climbs. A fine end to a fine trek through the Himalayas.
During the hike we got to see Everest peak over a ridge of mountains that normally obscures it. Like I said, perfect weather. As we hiked up the left side of the lateral moraine of the Kumbu glacier, it became apparent we were hiking into blind canyon. I knew that Everest climbs started by climbing through the Kumbu ice fall, but it was unclear where that went. Eventually it became apparent that the glacier took a turn to the right and there was a hidden gap in the wall that led up the mountain to camp one. Once that geography became clear my eyes knew where to look for Basecamp and could pick up the prayer flags.
I’m not entirely sure, but I think the wedding dress is from 
Love your kidneys
CJASN and Everest Basecamp
Silva and Jeff had a touching moment where they dedicated the climb to the loved ones they lost and then drank some home-made Raki and poured some out. Before long, English Paul and Bishnu were calling for us to wrap it up and hike back to Gorek Shep.
The Lobuche Helipad
We had some fluffy white clouds chasing us up the mountain all day.
Gorek Shep in all of its glory (with helicopter)
The hot shower? Fake news.
loading the stove with dried yak dung. The tea houses would only have a stove going in the evening. Since we were going to be there during the day, we had to pay them a few hundred rupees to light the stove early.
