From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology
Subject: Re: Question: blood test results
Date: 4 Aug 2005 17:38:21 -0700
Message-ID: <1123202301.808468.167830@g49g2000cwa.googlegroups.com>

Robert wrote:

> > as DR C pointed out...your creatinine is a tad high..but depends upon the
> > limits of the lab used...how much muscle you have etc...


> > creatinine can be a tad higher in muscular men...in fact..acceptable
> > levels are higher in men than women..
>
> That's true although the stated upper limit of normal was 1.2.



COMMENT:
Yes. I used to know a nephrologist who was also a team doc for a local
football team. Did you know that the average creatinine of the average
young football player is 1.4 ?  This was in the 80's, LONG before
creatine supplements.


> There is an inapproprate normal BUN in relation to the creatinine.

COMMENT:
It is indeed. Unless this guy is creatine supplementer.


> If any reduction occurs in single nephron glomerular filtration rate
> resulting in an increased creatinine must result also result in an increased
> BUN. Both are filtered by the kidneys but the BUN is more permeable to the
> tubules and so with conditions that increased renal tubule transit time such
> as low SNGFR or obstruction it will favor an increase of BUN resorption.
> You should always look at the BUN in relation to the creatinine and serial
> measurements are better than one measurement.
> A ratio as low as 6:1 BUN/creatinine is seen in rhabdomyolysis when large
> amounts of creatinine are released by the muscles. Both are abnormal.
> Renal failure in general has ratios of less than 10. With prerenal causes
> having greater than 20 and very high ratios in GI bleed.
> His ratio is about 5 with only the creatinine elevated.
>
> It is an extreme rare occurance to not see an elevated BUN with an elevated
> creatinine. During the early days of the Jaffe reaction there were more of
> these cases I had to talk to doctors about. Ketosis and antibiotics,
> ascorbic acid would all falsely increase the creatinine with a normal BUN. I
> remember one involving a 3.0 creatinine.


COMMENT:

You've left out the most COMMON reason (other than lab error) for a
really low BUN with relatively normal creatinine (even a higher
creatinine due to mild renal insufficiency (as here).  That's a really
low protein diet, and/or starvation. If you don't eat protein, your BUN
goes way down. It's low in vegans.

I'd have the labs repeated before I'd waste any more time.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology
Subject: Re: Question: blood test results
Date: 5 Aug 2005 14:38:50 -0700
Message-ID: <1123277930.618997.172540@g47g2000cwa.googlegroups.com>

Robert wrote:

> > COMMENT:
> >
> > You've left out the most COMMON reason (other than lab error) for a
> > really low BUN with relatively normal creatinine (even a higher
> > creatinine due to mild renal insufficiency (as here).  That's a really
> > low protein diet, and/or starvation. If you don't eat protein, your BUN
> > goes way down. It's low in vegans.
> >
> > I'd have the labs repeated before I'd waste any more time.
> >
> > SBH
> >
>
> That's true but I really wasn't trying to include every possibility. I was
> not under the impression that he was not vegan or starving with no evidence
> of ketosis in his urine or without any urine abnormalities at all.


COMMENT:
As it turns out, he's on a low protein diet. Perhaps for his kidneys.
But says he's had a creatinine of 1.0 before.  My conclusion re Jason
is: "Troll." Hyperanxious, intelligent, needs attention. Some large
chunk of medical bills are spent on such people-- caring for them takes
up FAR more resources than does defensive testing due to malpractice
fears. Systems without centralized medical records sytems (like the US)
just get KILLED by them. The UK saves tons of money by working them up
only ONCE.

Maxim of of Oscar London, MD, self-described World's Greatest Doctor:
"If you won't give your patients Valium, you'd better take some
yourself."  If Freud had had access to Valium and Xanax in Vienna,
modern psychiatry might have been quite different; maybe even
nonexistant as we know it. Since you can erase a lot of neuroses with a
pill-- jap!--- and that can leave you free to concentrate on the major
mental and real physical disorders, if they exist.

> The low
> BUN's that I see are in the elderly in that are not very well nourished.


COMMENT:
Exactly! That's simply the low protein (in somebody with a normal
bilirubin and therefore a good liver). This, and low albumen and low
lymphocytes paints a picture of a borderlin-starving patient, at risk
for dozens of other nutritional problems (since if the elderly are not
getting protein they almost certainly are not getting vitamins,
minerals, and so on-- due to the fact that high-protein/vitamin ratio
foods are easist to chew, so if you've got a low protein diet you
probably haven't got anything). Seeing a repeatably low BUN with a
normal bilirubin means you should start to think like a natuopath for a
while before you get them re-nurished. All kinds of odd problems then
disappear, and you can concentrate on what's left, with standard
medicine. It's a bit like using benzodiazepines as a filter and
diagnostic aid for psych problems and psychosomatic problems.  Do the
cheap stuff first. It's also a wise way to practice geriatics, IMHO.


>I
> usually don't associate it with a normal person on a normal diet.
> Those labs were repeated so we have to ask Jason if he avoids protein meals.


SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology
Subject: Re: Question: blood test results
Date: 8 Aug 2005 20:33:12 -0700
Message-ID: <1123558392.692583.186240@g43g2000cwa.googlegroups.com>

Sharon Hope wrote:
> <Hawki63@sbcglobal.net> wrote in message
> news:zssIe.9895$_%4.8316@newssvr14.news.prodigy.com...
> >
> > "Robert" <Robertitsme@hotmail.com> wrote in message
> > news:aMOdnVqrJL-ERWzfRVn-sA@got.net...
> >>
> >> <Hawki63@sbcglobal.net> wrote in message
> >> news:cu9Ie.1304$fJ1.806@newssvr13.news.prodigy.com...
> >>>
> >>> "Jason" <jason@nospam.com> wrote in message
> >>> news:jason-0308051234120001@pm1-broad-111.snlo.dialup.fix.net...
> >>> >
> <snip>
> >> A ratio as low as 6:1 BUN/creatinine is seen in rhabdomyolysis when large
> >> amounts of creatinine are released by the muscles. Both are abnormal.
> >
> > hmmmm...interesting..but wouldn't Jason be well aware of rhabdo??
> > <snip>
>
>
> Folks, I seem to recall a recent thread or two where Jason asked about
> rhabdo, and he was inundated with posts telling him it was so rare as to be
> impossible, and insulting his intelligence for even asking about it because
> it was so rare.
>
> Now, many of the same folks are taking the possibility more seriously.


COMMENT:

Nobody who knows anything about rhabdomyolysis is. The BUN/creatinine
ratio is irrelevent if the BUN is 7. That's not rhabdomyolysis, end of
story. Next patient?


> Please note that, and acknowledge to yourselves that any "rare" adverse
> effect of statins is only "rare" in a large population.
>
> In any single individual, it is binary:  Present or not Present
>
> Rare is not impossible, so an individual CAN have such a condition -
> obviously some individuals developed a condition for it to be called 'rare.'
>
> Horses, not zebras, SHOULD be the diagnostic approach that first considers
> the known adverse effects of a drug taken by the patient, BEFORE searching
> for other causative factors when confronted with an unusual presentation.


COMMENT:
This is not an "unusual presentation." This is not a presentation at
all. This is some guy on USENET posting one set of labs. Which may or
may not be real, and which haven't been repeated even if they are real.
 This situation demands no searching at all, for horses OR zebras. It's
entertainment.


> Jason was on statins, and experienced muscle damage.

COMMENT:
So he says. He says a lot of things.



>  Statin myopathy is a
> well known statin adverse effect, and the most frequently experienced statin
> adverse effect.  Statin myopathy puts an additional strain on the kidneys
> and liver.  In Jason's case, the kidneys have sustained a prior insult.


COMMENT:
Not proven. Not even good evidence for it.



> Please take this opportunity to apologize to Jason for attacking, abusing,
> ridiculing, and flaming him so when he came to this ng for help, asking if
> rhabdo was possible.


COMMENT:

I'm not apologizing to anybody. Jason took flack for being a squirrel.
With his labs, rhabdo isn't possible. Of course, nobody knows if he's
real or his labs are real.



> Take a moment for a collective acknowledgement of
> shame for the lynch-mob-mentality because of the state of denial that
> approached mass hysteria - total denial that this "rare" statin adverse
> effect could be the problem in his case.

COMMENT:
Total denial is appropriate. Statin rhabdo is not in the differential
for why your creatinine might have risen from 1 to 1.5 if you BUN is
still 7.  Sorry.


> Note, I am not saying he has rhabdo, but I am ashamed of all of the people
> who pontificated their denial of the possiblity, only to learn that the
> anomalous blood test showed it is indeed possible.

COMMENT:

You only have to be ashamed of the people who entertained the
possibility for more than a second, looking at those numbers. But I'm
sure they'll reconsider.


> In a patient population this unprecedentedly huge, the number of individuals
> experiencing even a 'rare' adverse effect is a tremendous number of
> individuals.


COMMENT:

So is the number of strokes and heart attacks prevented.


> Please join me in a moment of silence for all those who had similar concerns
> to those Jason voiced, and stopped reading the ng when they became horrified
> at the treatment he was subjected to for having the temerity to ask.  They,
> the silent ones, may not return to find that this thread paints an entirely
> different picture.


COMMENT:

And then another moment of silence at people taking statins for a very
good reason, who read newsgroup reports by a few people of horrible
side effects, and decided to stop a drug which was keeping them from
having a big stroke or MI. You've probably killed a few people already,
Sharon. Such a calling you have.


> Thanks, Jason, for hanging in there and fighting for your health.

COMMENT:
Thanks, Jason, for illustrating why lab tests shouldn't be bothered
about unless confirmed.

SBH